While parents left behind in India are terrified of COVID-19, their NRI children are impatient in a distant land to return back to them. We are worried about our loved ones staying far away. Recently, NRIs settled in US, UK, France, dealt with the rapid transmission of COVID-19. The nightmare of a rapid influx of positive COVID-19 cases among potential foreign returnees is petrifying and we must be wary for the most vulnerable populations in India.
In India, the number of working-age populations suffering from COVID-19 is substantial because of its large middle-aged populace, yet the elderly are just as likely of getting the infection, resulting in fatality; this is due to weaker immunity systems, presence of comorbidities, and slower recoveries from diseases.
A handful of research supports that 60+ people with pre-existing comorbidities like chronic lung, liver, kidney diseases, hypertension, cardiovascular illnesses, cerebrovascular diseases, diabetes, and those dependent on immunosuppressive drugs have a higher chance of COVID-19 infection than the rest.
According to the Center for Disease Control and Prevention (CDC), 80% of COVID-19 associated deaths are among more than 65 years’ age group, with increased deaths in elderly males. Thereby, it becomes a challenge to fight the disease for India where the number of the elderly population is close to the combined population of UK and Italy.
The Health Ministry opined in April that “8.61% cases are between 0-20 years, 41.88% cases are between 21 to 40 years, 32.82% cases are between 41 to 60 years and 16.69% cases above 60 years“. Simple statistics from the current population structure can establish the vulnerability of the greying population- about 8% of Indian population above 60 years’ accounts 17 % of COVID 19 patients; while about 62% Indians 20-60 years have approximately 73% COVID-19 cases. Hence, the elderly is at no less risk than the middle-aged to this novel disease.
India has a propounding 140 million (UN projection, 2020) 60+ population. Majority of the districts across India have 7-10% percent elderly. While, many districts of Southern states – Maharashtra, Himachal, Uttarakhand, Punjab – have more than a 10% elderly population (Fig1: a). Based on 2011 Census, our map indicates that many districts of Rajasthan Madhya Pradesh, Chhattisgarh, Orissa, Gujarat, Kerala, Andhra Pradesh, and Telangana have a high proportion of 60+ elderly who are disabled (seeing, hearing, speech, movement, mental retardation, and mental illness; Fig1: b). Districts with a higher proportion of elderly, especially disabled elderly, require special focus and regular monitoring in the framework of tackling pandemic.
Elderly Population in India, 2011.
(a) Proportion of 60+ elderly; (b) Proportion of 60+ elderly disable
Impacts on the elderly are layered. World Health Organization (WHO) has identified mental health as an integral part of overall health in correspondence with physiological, behavioral, and psychological wellbeing of older adults. Gerontological studies have established the association of inadequate social wellbeing and poor elderly health.
Proportion of Elderly Living Alone and The Prevalence of Different Diseases Per 1000
| State | Living Alone | Mental Illness | Depressive symptoms | Hypertension | Diabetes | Asthma |
| Assam | 386.90 | 20.80 | 656.20 | 252.80 | 59.00 | 80.10 |
| Karnataka | 343.10 | 117.40 | 592.90 | 237.90 | 141.60 | 72.10 |
| Maharashtra | 341.50 | 5.40 | 557.00 | 179.00 | 90.60 | 110.10 |
| Rajasthan | 378.30 | 6.10 | 452.00 | 142.90 | 42.00 | 78.60 |
| Uttar Pradesh | 316.00 | 28.20 | 552.00 | 133.60 | 28.80 | 100.50 |
| West Bengal | 350.00 | 4.10 | 567.30 | 245.10 | 67.30 | 64.30 |
| India | 341.00 | 26.80 | 554.30 | 181.60 | 65.70 | 89.80 |
Source: Calculated from WHO-SAGE 2007 Data
The long lockdown in India is vital to avoid burdening the healthcare system and to suppress the chain of transmission of infection. It is mandatory to take “extra care” of the elderly because social distancing may lead to depression, anxiety, and mental illness, especially among the elderly who are living alone and/or are disabled. The vulnerability of the elderly with less social support can escalate in instances of accessing medical support, transportation, banking, food access, etc.
Income, medical security, and social support are major challenges during and beyond the lockdown period. Although, the central government has announced some financial-welfare schemes and guidelines/instructions in the light of the COVID-19 crisis, the helplessness of the aged needs special consideration.
During this tough time, it is necessary for the government, stakeholders, social welfare organizations, and communities to stand in solidarity to provide the essential supplies (groceries, vegetables- fruits and medicines) to the elderly at their doorstep. We need to take precautionary steps to avoid infecting the older adults by sanitizing and frequently cleaning their belongings like, clothes, spectacles, canes, walkers, beds, toilets, chappals, etc. and encouraging them to get engaged in possible physical activities/works within the home.
In order to bolster our elderly loved ones, we need to assist them through social and mental connectivity. The void of connectedness can be minimized through phone, online calls, messages, or encouraging them to interact with friends/neighbors keeping a safe distance. We all should stay connected with the aged while staying away to keep the world positive.
Subhojit Shaw is a doctoral fellow at the International Institute for Population Sciences in Mumbai, India (IIPS, Mumbai). His academic quest revolves around population aging, child health, and environmental health.
Aparajita Chattopadhyay with her two decades of teaching and research experience, has contributed well in the fields of public health, gender issues, aging, environment-development, and nutrition. She is a faculty of the International Institute for Population Sciences.
All views expressed are personal.