The Pandemic and the Elderly: Navigating Age and the COVID-19 Policies of India

Background

COVID-19 hit India early in the year 2020, and to control the spread of the pandemic, the Government of India announced a nationwide lockdown in the last week of March 2020. Lockdown measures had helped to control the pandemic, and India began unlocking from July 2020. However, election rallies and religious gatherings soon resulted in the rise of cases and India began to grapple with the effects of the second wave of COVID-19. The second wave which began in March 2021 was worse than the first wave owing to a lack of oxygen cylinders, hospital beds and medical drugs (Safi & Dhillon, 2021).

Despite the approval and regulation of two vaccines, India continued to record a huge number of cases daily. Covishield, (manufactured by the Serum Institute of India under licence from Astra Zeneca) and Covaxin (produced by Bharat Biotech) were the two vaccines being administered across India. The first phase of the vaccination drive in India began in January 2021 by vaccinating health and frontline workers. Subsequently, from March 2021, India began vaccinating the elderly (60 years and above) and those (45 years and above) with comorbidities (Sharma, 2021). This strategy of vaccinating the old and those with comorbidities led the youth of India (those in the age group of 30 and above) being infected in the second wave (Lalwani, 2021). The shortage of raw materials, huge population and differential pricing caused a major vaccine shortage in India (Menon, 2021).

Throwing light on the issue of vaccination and the onslaught of the second wave, several media articles discussed the efficacy of government policies and the impact of the second wave on India’s population. However, in most of these media reporting, the central focus was on the youth of India. An in-depth understanding of how the pandemic was being perceived by the elderly of the country, those above 60 years, was missing from both academic comments and media analysis. A close examination of how the pandemic, the lockdown and the vaccination policies impacted the elderly is relevant as in the first wave, older adults with comorbidities suffered a higher mortality risk as compared to the rest of India’s population (Mona, 2021). Though the Government of India started by vaccinating the elderly, a lack of information, fear of side-effects, mobility and lack of familiarity with smartphones and technologies resulted in low vaccination rates among the elderly population of India. Consequently, only 58 per cent of India’s elderly population was initially vaccinated, with Jharkhand and Tamil Nadu ranking last in their vaccination coverage for their older population until December 2021 (Observer Research Foundation, Vaccination Watch, 2021). ¹

Against this backdrop, this article seeks to examine the intersection between aging, a global disaster such as the pandemic, later life ties and religion in India. Specifically, this article relies on qualitative interviews with middle-class older adults and demonstrates how these elderly people are navigating the pandemic in their everyday lives.

The Elderly and the Pandemic

As per the World Health Organization data, during the first wave of the pandemic from April 2020 onwards, more than 95 per cent of COVID-19 deaths across the globe were among older adults (60 and above). Additionally, studies and media reports have also pointed out that the older population was more vulnerable and one of the highest risk groups for COVID-19 (Banerjee, 2020; Cheung et al., 2020; Daoust, 2020). Though the first wave of the pandemic has affected the elderly population, it needs to be noted that eldercare played a crucial role in determining the conditions of the elderly during the pandemic. In most first-world countries, the aging population had already reached its peak. As a result, residential care and institutional care for the elderly and, most importantly, state support were already in place (Roy & Ayalon, 2020).

In comparison to the West, India, which mostly depends upon family support (Gangopadhyay, 2020; Lamb, 2014) to provide later life care, was unprepared to deal with multiple challenges that were thrown at the elderly during the pandemic. Additionally, a recent report by Ipsos Research for HelpAge India highlighted how the elderly in India were battling isolation, loneliness and abuse constantly during the pandemic. Based on research conducted in six cities with 3,500 elderly people, this report highlighted how the old are facing neglect and abuse at the hands of their caregivers or are feeling lonely and trapped in their homes (Sofi, 2020). Another survey conducted by a non-governmental organisation (NGO), Agewell Foundation found that cases of fear and uncertainty increased among the senior citizens of the country during the second wave of the pandemic. Based on interactions with 5,000 elderly people, this survey indicated that 82.4 per cent of them complained of health anxiety due to an increase in cases of coronavirus and the casualties owing to COVID-19. Additionally, 70 per cent of the elderly indicated that they had experienced sleeplessness, insomnia or nightmares due to the poor quality of sleep (The Wire, 2021). Despite these issues faced by the elderly, a detailed understanding of how the elderly coped with the first phase of the pandemic or the lockdown was missing in the academic debate of India. Addressing this gap, this study aims to understand how the pandemic and the nationwide lockdown were perceived and experienced by the senior population of India. Additionally, this study has also examined how the elderly navigated multiple challenges and emerged independent during the pandemic. In the process, this piece also throws light on important policy initiatives that need to be taken to prepare older population for future pandemics.

Studies on Aging and the Elderly in India

Generally, one can say that India’s older population has garnered significant academic attention and a large number of studies have examined elder abuse, emotional and loneliness issues, living and financial arrangements and health status (Dey et al., 2012; Rajan & Mishra, 2020; Shankardass & Rajan, 2018; Siva Raju, 2002). Using large data sets such as the Census of India, Migration Data and the National Family Health Surveys, these studies have urged for immediate policy formulation to improve the well-being of older adults in India. On the other hand, another set of studies has interrogated questions around the subjective and cultural experiences of aging, intergenerational relationships and caregiving arrangements in India (Gangopadhyay, 2021; Lamb, 2009, 2014; Samanta, 2018; van Willigen & Chadha, 1999). In particular, these studies have highlighted how religion plays a key role in determining the aging processes in India. For instance, Lamb (2002, 2017), in her research in Kolkata, found that the elderly practice detachment and loosening of ties by depending upon religion. Other studies have also indicated that to accept disability and bodily changes associated with aging, the elderly often relied on religion (Gangopadhyay & Samanta, 2017; van Willigen & Chadha, 1999). In addition to illustrating the significance of religion among the elderly, studies have also indicated how the urban elderly are gradually shifting their emotional dependence from their adult children and family members to focus and develop their own selves (Gangopadhyay et al., 2020; Samanta, 2021; Visaria & Dommaraju, 2019). The present study draws from these studies, which have examined aging as a cultural process, and discusses the impact of the pandemic, the lockdown and the vaccine policy on the elderly in urban India.

Studies on the Pandemic and the Elderly: A Global Perspective

Though the pandemic has led to a huge expansion of all forms of research, only a handful of studies have examined the intersections between the elderly and the pandemic. For instance, Lamb (2020), in her study on older Americans, highlights how her respondents coped with the pandemic through optimism, humour and resilience. Contradicting the image of the vulnerable, isolated and dying elderly during the pandemic, Lamb argues that older Americans were also experiencing vibrant social connections, agency and pleasure during the lockdown. Highlighting the situation of the elderly with comorbidities in South Africa, Manderson and Levine (2020) in their study illustrate that the pandemic amplified already existing structural vulnerabilities in the care arrangement systems for the frail and aged in South Africa. Findings from their study indicated that while the pandemic heightened social isolation for the elderly in the wealthier households, it increased levels of dependency and vulnerability in poorer households. In another study, Clotworthy and Westendorp (2020) critiqued the isolation of older adults in Denmark as part of the lockdown policies of the Danish government to control the pandemic. In particular, 1 and Westendorp (2020) pointed out that older adults with chronic illnesses and aged 65+ were characterised as a high-risk group and were placed with more restrictions and mobility curbs to protect them from the pandemic. Despite these groups of older adults using masks and different means of sanitisation, the government continued to isolate these groups Finally, Suzuki (2020), in her study, suggests that the development of age-friendly communities helped the elderly of Japan to have more interactions and social connections during the lockdown. These age-friendly communities, built under the WHO Cities project to aid eldercare living, are equipped with help for daily activities such as eating and bathing as well as recreation and exercise. Such assistance was provided either as day services or by a healthcare worker at home. These communities, which had been developed under Japan’s long-term care insurance system for older adults wanting to live in their own homes rather than move to a senior-care facility, proved to be immensely helpful during the pandemic.

A summary of these studies indicates that different scholars around the globe have analysed the impact of their government’s lockdown policies on the elderly population of their country. Following such studies and drawing from the already existing scholarship on social gerontology in India, this study intends to understand how the pandemic policies of the Indian government affected the middle-class elderly population of urban India.

Research Objectives

As indicated, the current study draws from the existing gerontological scholarship on India as well as from global studies examining the intersections between aging and the pandemic. The main research objectives of this study are to examine how older adults of urban India navigated their fear and agency during the first phase of the pandemic and the lockdown; to investigate the impact of the pandemic on the family ties and intergenerational relationships among this cohort of older adults in India; and, finally, to discuss the Government of India’s lockdown and vaccine policies and their impact on the elderly population of urban India.

Methodology and Study Site

This study used a qualitative approach and conducted field research to fulfil its research objectives. Since this study intended to reflect on detailed narratives of the elderly, a qualitative approach and field research seemed to be the best suited approach. Owing to various lockdowns, the data for this study was collected through telephonic interviews. A total of 15 older respondents were interviewed. The author relied on snowball and convenience sampling methods to recruit participants for this study. The interviews were conducted in the city of Kolkata, as the author had personal contacts in this city and could approach older adults who would be willing to talk. The author is familiar and fluent with the mother tongue of this city, and this was an additional advantage to build rapport and hold enriching conversations with the respondents. The age range of the older adults was from 60 years to 80 years. The background information of the older respondents is indicated in Table 1 .

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Table 1.

Socio-Demographic Information

Feature	Sample (n = 15) Characteristic
Caste	Brahmins (7 older adults); Kshatriyas (5 older adults); Vaishyas (3 older adults)
Average monthly income	₹50,000
Religion	Hindu
Source of income	Individual savings and monthly pensions
Living arrangement	Living alone (3 older men and 5 older women); couples (7)
Number of children	All the older adults had two adult children living in different parts of the world
Average numbers of years staying without their adult children or any form of care-giving support	Three years
Ownership of property	All respondents owned their own house or apartment

Source: The author.

Based on several media reports on the issues faced by elderly population, the present study used the deductive method to construct a semi-structured questionnaire to interview the older respondents. The questionnaire was divided into four parts—background information; daily routine and the pandemic; everyday practices, the pandemic and the lockdown; and lastly, policy issues.

The Pandemic, the Lockdown and Religion

Findings from the study revealed that the pandemic had created a great sense of fear among older adults. Most older respondents were worried that the pandemic would lead to complete chaos. None of the older adults had ever witnessed a global disaster such as COVID-19 or had experienced a lockdown. In addition to the pandemic, the lockdown added to the woes of the elderly. As indicated, none of the older respondents lived with their adult children and the lockdown coerced them to risk their lives to make provisions for themselves.

Based on these quotes, it can be suggested that the older respondents faced multiple challenges in managing their daily lives during the pandemic. In particular, the lockdown added significant stress to their regular lifestyles and took a toll on their physical and mental health. Despite various forms of stress, religion played a key role in maintaining some resilience among the elderly during the pandemic. Several of the older respondents mentioned that their faith in God helped them maintain their inner peace and strength. For instance, as one older male respondent, aged 66 indicated, ‘Although the pandemic is creating mayhem across the globe and a lot of people are losing their lives, I still believe that God is protecting us. We have wronged Mother Nature and so we are being punished. But finally, God will take care of us. We will survive this pandemic’. Through their narratives, the older adults also stressed how they now performed their daily rituals more dedicatedly and also prayed more regularly to reaffirm their religious beliefs and to regain their inner strength and peace.

Later Life Ties, Self-Reliance and the Pandemic

One of the main decisions of the nationwide lockdown was the halt of all forms of domestic and international travel via flights. As a result, all older adults understood that it would be very difficult for them to meet their adult children or rely on any form of physical help from their adult children anytime soon. The problem of being alone during the lockdown was more critical as opposed to being with their older partners; however, both categories of older adults expressed their anguish and anxieties of coping with the lockdown without any form of physical and mental support from their adult children or domestic help. Though all the older respondents were in regular touch with their adult children over the phone, they had to deal with their daily situations on their own. In particular, these older respondents illustrated how this lack of support helped them become self-sufficient during the lockdown. The narrative below highlights how these older adults tackled their lockdown issues:

My neighbours helped me a little, but gradually I had to start relying on dry food items, such as chips and biscuits. Later at this stage, I learned cooking from YouTube. I ordered essentials online and did my own cooking. My children called me every day, but I understood the meaning of being alone. One core thing this lockdown taught me was to not depend on anyone. One should learn to live alone and remain independent forever. (Older male respondent, aged 63)

Older couples also faced similar hardships and they outlined how they overcame their challenges as well. As highlighted by an older female respondent, aged 69, living with her partner,

One of the biggest consequences of the lockdown was that all forms of domestic help stopped coming to work. As a result, both my husband and I had to perform all the household chores. Though my husband has never washed any utensils or cleaned the house, he helped me a lot during the lockdown. We also started planning together and gradually started dividing the household responsibilities. We would often call our children and share our problems, but mostly we learned to solve our own problems.

In addition, two older adults who were supposed to travel for the birth of their first grandchild had to reschedule their travel owing to travel restrictions. Other older adults also had planned several trips and all of those had to be postponed indefinitely because of the pandemic. This caused a huge sense of isolation and the constant feeling of being at home often resulted in tremendous emotional strain among the older adults. Comparing their fate with their own parents, all the older respondents indicated that looking after their older parents was their priority. Though none of the older respondents blamed their adult children, they lamented over the geographical distance between them. Despite these setbacks, the older adults sounded positive when they explained how they had learned to become self-contained during the lockdown. In particular, all the older respondents highlighted and stressed how the pandemic had made them independent and taught them various survival skills. Despite various constraints with regard to the use of technology or household skills, all the older adults adapted to this change and channelised their daily lives accordingly.

Policies for the Elderly and the Pandemic

Demographically, India has been recognised as a young country. Policies for the elderly are generally lacking in the overall policymaking of India, and the pandemic only compounded the already existing problems of the elderly in the country. Most older adults cited the exemplary model of the Kerala state government and suggested that their governments should follow the Kerala model to improve the conditions and well-being of the elderly during the pandemic.

All the older adults were extremely dissatisfied with the policies for the elderly and expressed that, in spite of the pandemic, they were sure that the government would still overlook the needs of its elderly population. In addition to Kerala, NGOs in other states such as West Bengal (Datta, 2021) and Delhi ( Hindustan Times, 2020 ), had also provided volunteer support to their elderly population. Nine of the older respondents interviewed in the present study had used the services of these volunteers. Giving credit to these NGOs, the older respondents had indicated how their state government had failed to do much for their elderly population.

Discussion

The results of this study indicated that the nationwide lockdown announced to control the first phase of the pandemic was quite hard on the elderly population of urban India. Despite their many physical hardships, the findings revealed that older adults were resilient, patient and satisfied their own daily needs. Additionally, the study also found that religion played a key role in sustaining the mental strength of the older participants. Before the pandemic, studies have noted how older adults depended upon religion to accept death and later life disability (Gangopadhyay, 2021; Gangopadhyay & Samanta, 2017; Lamb, 2002, 2017; van Willigen & Chadha, 1999). Similar to these studies, the responses of the older adults of this study demonstrated how religion helped them to remain patient and calm during this global crisis. Based on the findings, it may be suggested that despite their daily woes, these older adults remained hopeful that they could cope with the pandemic through their religious beliefs. Religion was an integral factor that enabled older adults to cope with their fear and preserve their agency during these difficult times. Additionally, in line with Lamb’s study (2020) on older Americans during the pandemic, this study also found that instead of being vulnerable and fragile, these older adults were resilient and held onto faith amidst a global disaster.

The other important finding of this study was that the pandemic also forced the older respondents to become independent and self-sufficient. Since the lockdown had barred international and domestic travel, none of the adult children could physically help their parents. Though familial ties and intergenerational support continued as emotional sustenance, older adults had to rely on themselves for their physical and biological requirements. Studies have noted how irrespective of the pandemic, the urban elderly were gradually shifting their emotional dependence from their adult children to their own selves (Gangopadhyay, 2020; Samanta, 2019; Visaria & Dommaraju, 2019). Though the findings of the study suggested that the adult children continued to provide mental support virtually, older adults navigated the pandemic and the lockdown on their own and in the process became much more autonomous.

The findings reflected on the major lockdown policies of the Government of India and the impact of these policies on the elderly population of the country. With the imposition of a complete lockdown and without making any form of provisions for the elderly, the Government of India deepened the existing inequalities for the elderly population of the country. The narratives of the older adults indicated that they were unhappy with the state government of West Bengal which had failed to provide for their daily needs. Similar to the studies conducted by Manderson and Levine (2020) and Clotworthy and Westendorp (2020) in South Africa and Denmark, the policies of the Government of India further isolated and created more challenges for the elderly population in urban India.

Conclusion: A Policy Perspective

Recent media reports indicated that several of the elderly made calls to various helpline numbers to seek counselling related to abuse and property disputes during the pandemic (Dasgupta, 2021; Deepika, 2020). Data from Elderline, the helpline set up by the Ministry of Social Justice and Empowerment, revealed that calls from elders increased from 475 calls to 20,000 calls from 17 May to 3 June 2020. This helpline provided information on old age homes, caregiver services and activity centres. Additionally, Elderline also intervened for abandoned or abused elders and provided legal guidance and counselling as and when required. It also acted as an emotional support system by providing counselling services (Dasgupta, 2021). Though this helpline provided some amount of emotional and legal help to the elderly population during the lockdown and the pandemic, the medical and physical needs of the elderly were overlooked by the Government of India.

According to the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, later life caregiving arrangements are expected to be provided by biological children and grandchildren. Recently, this Act was amended and the Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019 introduced in the Lok Sabha in December 2019 has expanded the notion of the family and included daughters-in-law and sons-in-law as well as adopted and stepchildren as family members, all of whom need to provide for their elderly parents. By expanding the concept of the family, the government has only shifted its own responsibility to the family (Gangopadhyay, 2019). The pandemic has thus highlighted some of the major issues of the elderly and the steps that the Government of India needs to take to address the issues of its aging population.

Based on the findings of this study, in this concluding section, the article will attempt to offer some policy solutions to improve the overall well-being of the elderly population. This article demonstrated how older adults in urban Kolkata navigated the pandemic and the lockdown. In particular, this study demonstrated that religion is an integral component in the lives of the elderly population. In particular, elderly respondents relied on religion to cope with their fear and to develop some mental strength during the lockdown. Additionally, this study also illustrated that irrespective of their age, the elderly could shift their dependency from their adult children and paid caregivers to their own selves. In particular, this article showed that living on their own, away from close kin ties, these older adults became self-sufficient and learned several skills to adapt to this new global crisis.

Finally, this study indicated the role of NGO volunteers in fulfilling the needs of the elderly population in urban India. Drawing from these findings, this study suggests that the Government of India should tie-up with different NGOs which address elderly issues in India to meet the later life requirements of the country’s elderly population. Specifically, these NGOs could conduct training workshops for the elderly and train them to use different forms of technological gadgets and online services to enhance their self-sufficiency skills. The NGO volunteers could also read religious scriptures or play audio-recordings of different religious preachings to the disabled and bedridden elderly to enable them to gain strength and peace of mind. As discussed by Suzuki (2020), in her study on age-friendly communities in Japan, the Government of India could also start such initiatives for its elderly population. Similar to Japan, the Government of India could tie up with the World Health Organization and create age-friendly communities in states with a high elderly population. These communities could be equipped with health facilities, volunteer services, daily groceries, recreational centres and basic transport support to help improve the quality of life of the older population in India. However, to implement all these policies, the Government of India first needs to recognise the growing elderly population of the country. Only by doing so will the Government of India be able to address the needs of the older adults of the country.

In addition to reflecting on the experiences of the elderly during the first phase of the pandemic and offering policy perspectives, this article also discusses some new challenges faced by the elderly during the second phase of the pandemic. For instance, the vaccination policies also created further challenges for the older population of the country. Hence, in closing, this article has attempted to throw some light on other major issues that have been plaguing the aging population of the country.

In the month of March 2021, when India began vaccinating its elderly, it did not provide any home vaccination. The elderly were expected to register on the CoWIN portal and walk to their nearest hospital or clinic and take the vaccine. This strategy led to the exclusion of several elderly who were disabled and bedridden (Dhupkar, 2021; Shankar, 2021). Additionally, several authorities running old age homes and longterm care facilities for the elderly also found it hard to vaccinate their elderly as the government had not issued any guidelines for vaccination camps on their premises. A letter written by the trustees of Nightingales Medical Trust, an NGO, requested that the government prioritise vaccinating older residents in longterm care facilities as several of their residents suffered from dementia and it would be impossible to get them vaccinated at hospitals (Yasmeen, 2021). It was only in May 2021 that the government allowed for in-house vaccinations for the elderly (Mordani, 2021). With regard to the old age homes, while the central government made provisions for vaccinations in the registered homes, the unregistered ones are yet to conduct their vaccination drives. In particular, the older residents in the unregistered homes are frustrated and continue to live with uncertainty (Mili, 2021). Additionally, many older adults struggled to register in the CoWIN portal owing to various technological challenges at their end.

Apart from these issues, many elderly people also lost their only earning member as the first and the second phase of the vaccination drive did not vaccinate those in the age group 18 to 45. As a result, a large section of India’s working population was infected and many were the only breadwinners of their families (Mantri, 2021). Additionally, many children who have been orphaned and have lost both their parents have been left under the care of their aging grandparents (Pandey & Clarance, 2021). This is a huge risk, as they might lose their grandparents as well and be left with no kin at all. The older population mostly stay in their houses and do not have to go out looking for work. Hence, vaccinating them in the second phase on a priority basis emerged as a major issue as the majority of India’s working population succumbed to the pandemic. As a result, many older adults have become completely dependent on the state or have to start looking for employment again to survive their final days.

Summarising the policies and the findings of the study, it might be suggested that the older adults in India encountered a number of problems during the pandemic as well as during the vaccination drive. Given the current situation, it may be suggested that the pandemic might continue to haunt us for some more time and the government needs to take corrective measures to prepare for future pandemics. However, the elderly people need to be taken into consideration and special committees need to be set up that will focus on drafting policies for the elderly of the country. India needs to understand that its older population is increasing and that designing effective policies is the only way to tackle their physical and emotional needs. The older respondents of this article were privileged and had monetary resources to be able to fulfil their needs. Additionally, as indicated, none of the older respondents was disabled. With the dismantling of the joint family system, the government needs to shoulder more responsibility and shift later life caregiving from the domain of the family. Additionally, childless elderly people also need to be factored in as they often rely on neighbours for their later life care. For efficient policymaking, further studies need to be conducted to be able to improve the overall well-being of the elderly of the country.