The population of the aged in India and other countries across the world is on an increase. There is a significant increase in life expectancy of both men and women due to medical advancement and a higher standard of living. This increased longevity implies a greater demand for support systems and services. Worldwide evidence shows that aged women outnumber aged men. It is estimated that by 2050, half the world's aged population will be living in China and India.

Traditionally, Indians respect the elderly. It is a socially accepted norm to seek their guidance, as they are considered to possess experience, wisdom, knowledge, kindness, love and affection. The scriptures advocate respect for the elderly. The order of reverence in India is mother, father, guru and only then god. The aged are considered the head of the family and their decisions are respected. It is incumbent upon the children to obey them and look after their needs. The aged are considered a reservoir of knowledge, experience and wisdom. Interestingly, both in 1987 and in 2003, when I wanted to study the aged, I met with resistance from my seniors, as it was felt that our society did not have problem with the aged.

Joint family system is the most salient institution for support and care for the elderly. It can be described as 2-3 generations related through blood, living together under one roof and eating out of one kitchen. Here, the aged patriarch is the head of the family and resources are pooled. Unfortunately, urbanization, industrialization, globalization, technology advancement, female employment, etc., have changed the family structure, resulting in the breakup of the joint family system. This breakup has deprived the elderly of a social support system for their care needs. During my study, many aged talked about the restrictions they faced in their life due to joint family living and envied the life enjoyed by the younger generation today. Many aged complained that the fabric of joint family was now disintegrating and it existed merely in name.

Aging process is particularly harsh on women. Biologically, women live longer than men. As women marry men elder to them, it results in a large population of elderly widows. These elderly widows may see a decade or more of life without their husbands. Their economic status is lower than that of married women and the worst of the aged are the poor widows. Widows are abandoned by their families in places of pilgrimage, such as Banaras and Vrindavan, thereby forcing them to live a defenseless and destitute life, begging for alms. Data available shows that aged women own a very small percentage of property and have minimal life insurance. Many of the aged widows studied by me talked about loss of respect in the family, loss of decision making, loss of finance and an emptiness in their life.

As the elderly age, their needs for care and support increase. To begin with, the elderly need help with household work, cooking, banking, transport, etc. Then,they need help for also meeting their personal hygiene needs; this may further worsen when the aged becomes bed ridden. Aged in the 75-85 years age group show an increased requirement of care and support needs, and aged above 85 years need constant care. It is imperative to understand that caretakers of the aged also work with limited resources and face many challenging problems. The need for caretakers is growing and trained caretakers are hard to find. The family is the preferred source of caregiving and support, with female family members, such as wife, daughter, daughter-in-law and granddaughter, playing a major role. But with more and more females opting for working, paid caretakers are required to fill their places. Paid caretakers include trained nurses, paramedical staff, untrained staff and domestic help.

Majority of the aged faces psychological problems, such as depression, loneliness, anxiety, issues with self worth, uselessness and isolation. A very small percentage of them get treatment for their problems, as caretakers are often unaware of psychological problems, viewing them as part of old age;the aged also refuse such treatment. In some cases, weakening of interpersonal relations in the family may be a cause of the psychological problems. I have found that the loss of loved ones can be a trigger for depression and for many, this loss becomes a mourning for life. Many a time I found anti-depressants and anti-anxiety drugs being prescribed by the aged's GP without the aged's knowledge.

Today, due to increased longevity and improvement in the standard of living,families have 4-5 generations living and their ways are changing. The intergenerational relationship of the aged with the younger generation is seeing a lot of conflict. The individualistic approach of the younger generation revolts against the older authority, which feels that it can control the behavioral decision of the youngsters. Very often,control issue and adjustment are the reasons for conflict within a family.Further, the economic dependence of the aged on their children only serves to make matters worse. As time passes, this dependency grows and now also includes limited mobility and taking care of even the trivial needs of the aged. The seeds of elderly neglect due to omission or commission are already sown. An attitude of becoming a martyr is also seen in the elderly, which promotes trouble with the young. As the role of decision-making is taken away from the elderly, their feeling of worthlessness increases.

The concept of institutionalization of the aged has been borrowed from the West, where values and norms are very different from ours. The break-up of the traditional support systems in India has made institutionalisation a harsh reality. Today, there are individuals who cannot live by themselves, many are abandoned, and then there are others who are choosing to go to old-age homes. Traditionally, old-age homes were run by voluntary and religious organisations, and were mainly in the urban areas. In recent years, urban aged residential societies and communities are popping up due to commercial interests. There are no rules and regulations governing old-age homes, something I had recommended way back in 1988. As I have met and talked to many residents of old-age homes, it is apparent that the reasons to choose old-age homes are varied, and while some are happy and content there, others hate living there. A new trend of the aged jumping from one old-age home to another has been observed.

In India, it is somehow expected of the aged to participate in religious activities. All major religions encourage them to take part in religious activities, such as prayers, meditation, singing bhajans or going to places of worship. Many a time religion can give the aged meaning to life, spiritual upliftment, lend support, help occupy their time, and play a role in social activities. Religious practices can take various forms – going to places of worship, reading religious books, listening to bhajans and kirtans, meditating and other forms of worship. Some aged make their daily routine in sync with their religious duties. Yet others have been seen to join cults and have their personal gurus and satsang practices. I have observed that a strong base in religion keeps the elderly happier and grounded. A number of the elderly watch lot of religious programmes on television and play CDs and cassettes of bhajans, kirtans and kathas. I have also observed that sometimes the aged also use their religious beliefs to control their families and also that conflicting beliefs of family members may cause a lot of grief to them.

The environment of both residence and neighbourhood plays a great role in the life of the aged. The facilities in the residence and neighbourhood can affect their physical health and emotional well-being. Well-constructed houses with good lighting and ventilation in safe neighbourhoods, with access to parks, markets, places of worship, chemists, hospital and transportation would be the ideal situation. My study found that residences of most of the aged had problems with flooring, stairs, bathrooms, adequate living area, lighting, access to sunlight, uninterrupted water and electricity supply. Many aged suffer from empty-nest syndrome, while for some, their bedroom became their world, where they spent the whole day, ate, watched television and slept. Often, their rooms were cluttered and dirty, with many old objects belonging to their past.

With increasing age, the care and support needs of the aged also increase, with maximum need for care in the 75-plus age group. Illness and hospitalisation of any kind increase care and support needs. The caretakers of the aged are primary caretakers and secondary caretakers. Primary caretakers are spouse, sons, daughters-in-law and, in some cases, hired help, such as an ayah or nurse.Of these, it has been seen that the spouse is the major caretaker for the aged. There is also the feminization of caregivers, be it the wife, sister, daughter-in-law, daughter or maid. Caretaking ability is limited by distance, money, spare time, good health, attitude and nature of a caretaker. The challenges faced by caretakers are enormous and there is no or very little government help. The need for trained caretakers for the aged is increasing. I have found that caregiving is always better when motivated by love and affection.

In today's world, technology plays an important role, from communication to information gathering to medical health. The young adopt new technology easily, but the aged are often reluctant. Often, they have to be forced, pushed to use mobile phones, learn basic computer skills,etc. I have found that those aged who adopt new technology are often happier, busier and more aware, compared with those who don't. Aged who have children or grandchildren living away from them, benefit hugely by using their computers, iPads or mobile phones. Chatting with relatives using Whatsapp, Skype, etc. helps the aged keep loneliness in check. Games, such as Candy Crush and Solitaire, on computers or mobile phones are good pastime. Some aged increase their knowledge by using the Internet.

Man is a social animal and thrives on human contact. The aged are no exception and need to interact with other people. I have found that very often that as they age, their social circle decreases due to various reasons, such as limited mobility, hearing problems, loss of interest in daily happenings, death of peers and limited finances. On a daily basis, many of the aged may not have spoken to anyone other than their daily help and the hawkers that come to their residence. Studies have found that those aged who are able to maintain strong relationships with spouse, family and friends, lead a happier and healthier old age. It is very important to maintain old friendships and social groups along with also creating new groups closer to home. Social isolation is a significant factor in poor aging.

Retirement is a hard fact in the life of the aged, especially males. Studies show that the post-retirement period increases the probability of depression in the aged. Loss of job, coupled with financial crunch, and not having a daily routine anymore can become very taxing to the aged. The Indian pension system has been found to be inadequate and unsustainable. There is no pension for the poor, self-employed and homemakers, and less than six percent of the working population is covered by private pension plans. Today, the reality is the aged cannot depend on their children or the government in their sunset years. Many take up part-time jobs to earn money. I have found that aged with their own businesses and shops do not retire; I have known aged in their nineties, who still go to their businesses and shops, be it only for an hour or two. Even lawyers and doctors do not retire – they only reduce their working hours as they age.