An Exploratory Study to Identify Problems Related to old age and Adaptive Strategies used by Elderly from a Selected Urban Community in a Metropolitan City of Maharashtra

 

Ms. Sonali S. Sangrulkar

Lecturer, Holy Spirit Institute of Nursing Education, Mumbai

 

ABSTRACT:

Old age can be broadly characterized by time-altered changes in an individual’s biological, psychological and health related capabilities and it’s implication for the consequent changes in the individual role in the society. This immediately implies care for an attentive focus on the elderly and the major concern in old age also talks much about abuse. Old age problem has been identified as a major public health problem. Multiple variables are responsible for the problems of elderly in areas of physical, psychological, social and last but not least abuse. The social problem of abuse of older people exist throughout the country but in general we know very little the fact. In elderly problems are prevailing and is also significant but it goes unrecognized, thereby contributing to the development of further problem. This study reviews the prevalence of problems of elderly, with a specific focus on areas like physical, psychological, social, economical problem and abuse. The findings of the study will provide direction to the health care providers to help the elderly by providing adequate knowledge, constant support and reinforcement, based on their needs and problems.

OBJECTIVES OF THE STUDY:

1.      To identify the existing problems faced by elderly from a selected urban community in a metropolitan city of Maharashtra.

2.      To identify the adaptive strategies used to cope with the problems by elderly from a selected urban community in a metropolitan city of Maharashtra.

3.      To associate selected problems with selected demographic variables of elderly from a selected urban community in a metropolitan city of Maharashtra.

RESEARCH METHDOLOGY:

In this study Conceptual framework based on Roy’s Adaptation Model used. The exploratory descriptive approach was used to illicit data .Non probability purposive sampling technique was adopted for selection of the samples. The sample consisted of one fifty elderly from a selected urban community in a metropolitan city of Maharashtra. Semi structure interview technique was used by the investigator for data collection as the information could be elicited on a personal interaction (face to face contact) with the client. The administration of semi structured questionnaire  took 20-30 minutes for each samples.

MAJOR STUDY FINDINGS:

The collected data was analyzed in terms of the objectives of the study using descriptive and inferential statistics.

Section 1: This section deals with the analysis of data related to the demographic variables. It reveals that 58.0% subjects belonged to the age group 60-69 years. The study reveals that 44.0% were males followed by 56.0% were females.

The subjects who belong to nuclear family were 26.0% whereas 74% belong to joint family. The study also reveals that 71.3% subjects were married. The study also emphasized that 20.7% subjects were illiterate followed by 39.3% of the subjects were educated.

When taken into account the dependency of the elderly major source of income was from husband/wife/Child 65.3%. When spoken about elderly this study also focuses on the major co-morbidities which are Hypertension 47.8%, Diabetic Mellitus 43.3% and Heart disease 13.4%.

Section 2 A: This section deals with the analysis and interpretation of data related with various problems including physical problems, psychological problems, social problems and various adaptive strategies used by the elderly. A total of 12% of the subjects had other major problem like Palpitation and Pneumonia, 14.6% of elderly had constipation, subjects have integumentary problems such as pigmentation (6.7%) and itching (0.7%), back pain was seen in 6.7% of elderly, Psychological problems like depression and hopelessness were seen among the elderly. Out of 150 samples, 15 have inculcated diet modification as an adaptive strategy. Rest was preferred by 5.3% of respondents. Other strategies like yoga and walk is used by 0.7% and 3.3% of elderly respectively. Most drugs used by the subjects are antacid, laxatives (5.3% each) and calcium supplements are used by only 6.7% of elderly.

Section 2 B: This section deals with the analysis and interpretation of data related with various abuse of elderly such as financial abuse, emotional/verbal abuse, physical abuse, sexual abuse and neglect. The majority of the subjects witnessed emotional/verbal abuse i.e., 14.7%.

Section 3: This section deals with the association of abuse and neglect with selected demographic variables of age, gender, marital status, type of family, co-morbidity.

In regard to age the calculated x² values is less than the table value, therefore null hypothesis is accepted.

CONCLUSION: Problems of elderly are a universal significant factor of concern, thereby requiring a comprehensive approach. For the elderly population, communication between the health care team and the elderly can become a key factor in verbalizing the problems and decreasing the intensity of the problem. Major problems of elderly like abuse can be tackled by giving adequate information to the health care providers and also care givers. Health education along with constant support and reinforcement can uplift the morale of the elderly.

 

 

 

INTRODUCTION:

“All my life I’ve been taught how to die, but no one ever taught me how to grow old”

                                                                Billy Graham

The average length of human life has increased over the centuries as living conditions has improved and childhood mortality has fallen. The maximum lifespan of our species is determined largely by our genes and will be the same as it ever was. The only debate is whether and how this optimal genetic potential can be realized. The care of the elderly is drawing more and more attention of the government and the public. It is already a major social and health problem in affluent countries. Like pediatrics, it deals with an age group which has high mortality and morbidity.¹

 

Unfortunately, old age has now become a prevalent social problem in our society. It is strange that no one wants to grow grey but wants to live long and stay younger. Old age is observed as an ineluctable, undesirable and problem-ridden stage of life that we all are compelled to live, marking time until our final exit from life itself.²

 

 

Old age can be broadly characterized by time-altered changes in an elderly individual’s biological, psychological and health related capabilities and it’s implication for the consequent changes in the individual role in the society. This immediately implies care for an attentive focus on the elderly and the major concern in old age also talks much about abuse. Elder Abuse it often referred to as the ‘hidden crime’ that seniors are reluctant to speak about. When elder abuse occurs many older adults have the capacity and ability to communicate their concerns but, for a variety of reasons such as shame, embarrassment, and fear they are reluctant to talk to anyone.³

 

We have reached an important landmark crossroads, the closing of one millennium and the beginning of another. Yet what is overwhelming is what the future stores for the world in this new era as it undergoes a demographic revolution. The older persons have been the witness to these changes; they must also be its beneficiaries.⁴

 

In the next 50 years, the number of older persons will nearly quadruple, growing from about 600 million to almost 2 billion senior citizens. As number of elderly increases, their problems also would increase and contribute to a total health care burden. In spite of various welfare measures, by government, problems of elderly in particular abuse is still at its peak. This necessitates the need to validate most prevalent problems of elderly and adaptive measure adopted by them.

 

NEED FOR THE STUDY:

International day for older persons 2013 theme is “The future we want: what older persons are saying”. ⁴“The 21^st century is seeing an unprecedented global demographic transition, with population ageing at its heart”. According to a UN-backed study on the well-being of the elderly in a rapidly ageing world. Global Age Watch Index 2013- the first of its kind released the rankings based on the data from WHO, in which India stands a dismal 73^rd in the list of 91 countries.⁵

 

A major public policy concern in the long-term care field is the potential burden an aging society will place on the care-giving system and public finances. The “2030 problem” involves the challenge of assuring that sufficient resources and an effective service system are available in thirty years, when the elderly population is twice what it is today. Much of this growth will be prompted by the aging of the Baby Boomers, who in 2030 will be aged 66 to 84 the “young old” and will number 61 million people. In addition to the Baby Boomers, those born prior to 1946 the “oldest old” will number 9 million people in 2030.⁶

 

According to a study conducted by A Leena et al, (2008) in Orissa out of 88  elderly persons who attended the preventive elderly clinic (80%) were males. Majority i.e., 78% persons were literate, 65% were pension holders, 48% persons were doing regular exercise. Majority i.e., 52% elderly were vegetarians. Around 36% persons had history of substance abuse. Nearly half of the study population was hypertensive (51%) and overweight (BMI> 25 kg/m²). Thirty six percent of elderly had Diabetes mellitus, other significant morbidities recorded were Gastro-intestinal disorder (30%), Neuropathies (17%), Dental and Or pharyngeal problems (17%), Visual problems (11%) Impaired Hearing (11%) followed by respiratory and skin problems (10-20%). Majority i.e., 64% of overweight patients had hypertension and 30% of them suffered with osteoarthritis.⁷

 

A study conducted on crimes on elderly by Anindya J. Mishra and Avanish Bhai patel (2013) reveals that the cases of crimes against the elderly are rising fast across India. Today, they are victims of grievous hurt, murder, and abuse and isolated by neighbors, family members and domestic servants. These cases have certainly affected the way of life and sense of well-being of the elderly to a large extent in the family as well as in the society. This paper examines the factors causing fear of crime among the elderly and explores the different types of crime. This study is based on secondary data collected from newspapers. These news items pertaining to crimes against the elderly have been systematically collected and their content has been analyzed. The newspaper reports were collected for a period of six months starting from 1st April 2012 till 30th September 2012.. The findings show that there are various factors such as residential location, previous victimization experience, vulnerability, defensibility and incivility that cause fear of crime in the minds of the elders in India. The break-up of 170 cases of crime around 45% were murder cases. Crimes have been reported against the elderly men as compared to 65 (38.24%) as compared to women. While around (14.71%) incidents belong to 66-70 year age group, we find that a total of (52.35%) incidents of crimes have been reported against the elderly within the house, (22.35%) incidents of crime have been committed by family members and relatives.¹⁴From the results it is apparent that there is a substantial rise in crime against the elderly. Such crimes are bound to inject fear among the elderly affecting their physical and mental well-being.⁸

 

During various field postings, investigator came across elderly population experiencing various health related problems and psychosocial issues. Investigator also realized that abuse often verbal is yet another unexplored area in a given community. It was also noticed that there are many avenues such as mahila mandal, open grounds and parks available for socialization and excursions of elderly. But very limited portions of elderly actually resort to all these facilities. All above facts intrigued the investigator to take up project wherein she can assess various problems of elderly in particular abuse and neglect and various adaptive strategies adopted by them.  This venture would highlight unexplored and vital aspects of geriatric health and inturn contribute towards development and refinement of facilities for respective group.

 

PROBLEM STATEMENT:

An exploratory study to identify problems related to old age and adaptive strategies used by elderly from a selected urban community in a metropolitan city of Maharashtra.

 

OBJECTIVES OF THE STUDY:

1.      To identify the existing problems faced by elderly from a selected urban community in a metropolitan city of Maharashtra.

2.      To identify the adaptive strategies used to cope up with the problems by elderly from a selected urban community in a metropolitan city of Maharashtra.

3.      To associate abuse and neglect with selected demographic variables of elderly form a selected urban community in a metropolitan city of Maharashtra.

OPERATIONAL DIFINITION:

1.      Problems:

According to Oxford Advanced Learning Dictionary, problem is a matter or situation regarded as unwelcome or harmful and needing to be dealt with and overcome.⁹ According to the study, problem is defined as the difficulties faced by the elderly in areas such as physical, psychological, social, economic and abuse.

 

2.      Elderly:

According to WHO- The chronological age of 60 years is a universally accepted definition of ‘elderly’ or older person. According to this study, individual who is of 60 years of age and above from selected urban community.

 

3.      Adaptive Strategies:

According to oxford dictionary, adaptive strategies are the actions taken by individuals or groups in response to an environmental or a social challenge. According to this study, adaptive strategies are the various measures that the elderly population inculcates to overcome their problems related to their old age.

 

4.      Selected variable:

According to Oxford Advanced Learning Dictionary, ¹⁰

Selected is defined as, choosing the most suitable.

Variable are defined as, a quantity that is assuming of any set of fixed values. According to this study, selected variables refer to age, gender, marital status, source of income, type of family.

 

HYPOTHESIS:

H₀- There is a significant difference with regard to abuse and neglect within selected demographic variables.

H₁- There is a significant difference with regard to abuse and neglect within selected demographic variables.

 

ASSUMPTIONS:

·        Elderly may have various physical, psychological, social, economical problems.

·        Elderly may be using adaptive strategies to combat the problems.

 

DELIMITATION:

·        This study is limited only to the elderly from a selected urban community in a metropolitan city of Maharashtra.

 

RESEARCH METHODOLOGY:

·        RESEARCH APPROACH:

Exploratory descriptive approach adopted by the investigator for the accomplishment of the present study.

 

·        RESEARCH DESIGN:

The investigator has adopted survey as a research design.

·        RESEARCH VARIABLES:

Problems in elderly:

Difficulties faced by the elderly in areas such as physical, psychological, social, economic along with abuse and neglect.

 

Adaptive strategies used by elderly:

adaptive strategies are the various measures that the elderly population inculcates to overcome their problems related to their old age.

 

Selected variables:

Refers to age, gender, marital status, source of income, type of family.

 

·        SETTING OF THE RESEARCH:

The present study was conducted in urban community which comprise of approximately two lakhs population.

 

·        POPULATION:

In this study, target population comprises of all elderly people above 60 years of age and accessible population includes all elderly people above 60 years of age fulfilling the inclusion and exclusion criteria and residing in a selected metropolitan city of Maharashtra.

 

·Sample:

The sample in this study includes elderly people aged 60 years and above

 

·SAMPLE SIZE:

In the present study, the sample size comprised of 150 elderly people aged 60 years and above.

 

·SAMPLING TECHNIQUE:

The sample for the present study was drawn by non-probability purposive sampling technique.

 

·        DESCRIPTION OF TOOL:

Tool prepared by the present study is a semi-structured questionnaire divided into two sections-

 

Section 1:

Demographic Profile like age, gender, type of family, marital status, educational status, source of income, co-morbidity

 

Section 2

Section 2 A: This section deals with various problems including physical problems, psychological problems, and social problems and various adaptive strategies used by the elderly.

Section 2 B: This section deals with various abuse of elderly such as financial abuse,

 

 

DATA COLLECTION:

Data collection process commenced from 24^th October to 14^th December. The investigator approached the respective ward officer for receiving the permission to conduct the research study. The time schedule was prepared to complete the data collection process within the stipulated time frame. The investigator first approached the houses of elderly residents in the selected urban community. Then investigator gave a brief idea about the research study to the elderly and their family members. The elderly residents who met the inclusion criteria were selected for the study. The investigator obtained the written informed consent from the subjects. A corner of house was selected to collect data in order to ensure privacy and confidentiality.

 

Investigator ensured conducive physical environment in terms of adequate ventilation and light. Initially investigator began with informal interactions to build an interpersonal relationship. This strategy has helped subjects to open up with their problems specifically abuse if present. It took nearly 20-30 minutes for each subject for completion of interview. In case of any abuse if they are facing and wanted to share than it would take nearly 45-50 minutes for completion of an interview. All findings were recorded simultaneously. Investigator ensured that entire questionnaire is administered without any inadvertent omissions. Investigator also took this opportunity to recommend measures for their existing problems as well as delivered incidental health education on various aspects. At the end of the interview the investigator whole heartedly thanked the subjects as well as their relatives for participation and cooperation.

 

PLAN FOR DATA ANALYSIS:

The collected data is analyzed in terms of the objectives of study using descriptive and inferential statistics:

·        Analysis of demographic data is analyzed using frequency and percentage.

·        Existing problems faced by elderly from a selected urban community is analyzed using frequency and percentage.

·        Various adaptive strategies used to cope up with the problems by elderly from a selected urban community are analyzed using frequency percentage.

·        Association of abuse and neglect with selected demographic variables of elderly is analyzed using Chi square test. emotional/verbal abuse, physical abuse, sexual abuse and neglect.

 

Analysis of Demographic Variable:

In this sections analysis of demographic variables revels that 58.0% subjects belonged to the age group 60-69 years. The study reveals that 44.0% were males followed by 56.0% were females. The subjects who belong to nuclear family were 26.0% whereas 74% belong to joint family. The study also reveals that 71.3% subjects were married. The study also emphasized that 20.7% subjects were illiterate followed by 39.3% of the subjects had done their education till primary standard then 37.3% had done their secondary education. When taken into account the dependency of the elderly major source of income was from husband/wife/Child 65.3%, followed by 25.3% have source of income as pension and remaining 9.3% have source from other family member or other sources.

 

 

TABLE 1: Distribution of Subjects According to Co-morbidities                                                                                                               N=150

 

Table 1 shows distribution according to co-morbidities. The major co-morbidities are Hypertension (20.6%), Diabetic Mellitus (17.3%) and Heart disease (4.6%) and other co morbidities such as Asthma, Arthritis, Cancer of Prostrate, Breast Cancer, Cataract, COPD and ARF with prevalence ranging from 3% to 0.5%.Whereas nearly 48% of elderly did not have any co-morbidities.

 

TABLE 2: Distribution of Subjects In Relation to Abuse (Overall) Experienced                                                                         N=150

 

 

Table 2 reveals that a total of 32 subjects reported of being abused. The majority of the subjects witnessed emotional/verbal abuse i.e., 14.7% whereas no body reported physical and sexual abuse. Shubha Soneja presented a report on abuse in elderly in collaboration with WHO and Help Age India. Sample was taken from urban society residing in Delhi. The study revealed that the middle income group listed “economic” problems on priority. The other problems listed were lack of facilities for utilization of leisure time and a general feeling of loneliness “talking to walls”. The problem here did not seem to be lack of money but lack of time by the “others” for the older persons. Second to economic problem was “lack of emotional support” from family Members.¹¹

TABLE 3: Association of Abuse with Age, Gender, Type of Family, Marital Status and Comorbidity                                                     N = 150

Demographic variables		Type of Abuses			Df	X² cal	X² tab	Significance
		Physical	Emotional	None
Age	>80 yrs	1	7	21	4	8.051	9.49	0.000
	60-69 yrs	0	9	78
	70-79 yrs	0	6	28
Gender	Female	0	14	70	2	1.833	5.99	0.000
	Male	1	8	57
Type of family	Joint	1	19	91	2	2.463	5.99	0.000
	Nuclear	0	3	36
Marital status	Divorced	0	1	3	6	9.416	12.59	0.000*
	Married	1	10	96
	Unmarried	0	0	1
	Widow	0	11	27
Source of Income	Husband/ wife/ children	1	18	79	6	5.493	12.59	0.000*
	Other family member	0	1	2
	Other sources	0	1	10
	Pension	0	2	36

By chi-square test  ; P=0005 ; * Not significant

 

 

Data presented in table 22 reveals that chi-square value which is calculated to find the association of abuse with age, gender, type of family, marital status, co-morbidity.

·        AGE: Based on the ‘x² test of association done for data, the table x² value for age is 9.49. The calculated value is 8.05. The calculated x² values is less than the table value, therefore null hypothesis is accepted. This concludes that abuse is seen equally in all age group.

·        GENDER: Based on the ‘x² test of association done for data, the table x² value for gender is 5.99. The calculated value is 1.83. The calculated x² values is less than the table value, therefore null hypothesis is accepted. Abuse does not vary significantly in males and females.

·        TYPE OF FAMILY: Based on the ‘x² test of association done for data, the table x² value for type of family is 5.99. The calculated value is 2.46. The calculated x² values is less than the table value, therefore null hypothesis is accepted. This concludes that abuse does not vary according to types of family.

·        MARITAL STATUS: Based on the ‘x² test of association done for data, the table x² value for marital status is 12.59. The calculated value is 9.41. The calculated x² values is less than the table value, so null hypothesis is accepted ruling out possibility of association. The reason may be presence of skewed subject distribution with maximum samples in marital status.

·        SOURCE OF INCOME: Based on the ‘x² test of association done for data, the table x² value for source of income is 12.59. The calculated value is 5.49. The calculated x² values is less than the table value, so null hypothesis is accepted. Thus it means abuse is seen equally irrespective of source of income.

 

 

TABLE 4: Association of Neglect with Age, Gender, Type of Family, Marital Status and Comorbidity                                                   N = 150

Association of demographic variable with neglect		Type of neglect			df	X² cal	X² tab	Significance
		No help	Alone	None
Age	>80 yrs	0	1	28	4	3.033	9.49	0.000
	60-69 yrs	6	2	79
	70-79 yrs	2	2	30
Gender	Female	4	3	77	2	0.152	5.99	0.000
	Male	4	2	60
Type of family	Joint	3	5	103	2	5.396	5.99	0.000
	Nuclear	5	0	34
Marital status	Divorced	0	0	4	6	2.411	12.59	0.000
	Married	6	5	96
	Unmarried	0	0	1
	Widow	2	0	36
Source of Income	Husband/ wife/ children	6	4	88	6	3.585	12.59	0.000
	Other family member	0	0	3
	Other sources	0	1	10
	Pension	2	0	36

By chi square test ; P=0.005; * Not significant

 

·        Data presented in table 23 reveals chi-square value which is calculated to find, association of abuse with age, gender, type of family, marital status, co-morbidity.

·        AGE: Based on the ‘x² test of association done for data, the table x² value for age is 9.49. The calculated value is 3.033. The calculated x² values is less than the table value, therefore null hypothesis is accepted. This concludes that neglect does not vary significantly according to the age groups divisions in elderly.

·        GENDER: Based on the ‘x² test of association done for data, the table x² value for gender is 5.99. The calculated value is 0.152. The calculated x² values is less than the table value, therefore null hypothesis is accepted. This contributes to the fact that neglect is seen in both genders almost equally.

·        TYPE OF FAMILY: Based on the ‘x² test of association done for data, the table x² value for type of family is 5.99. The calculated value is 5.396. The calculated x² values is less than the table value, therefore null hypothesis is accepted. This concludes that neglect does not vary according to types of family.

·        MARITAL STATUS: Based on the ‘x² test of association done for data, the table x² value for marital status is 12.59. The calculated value is 2.411. The calculated x² values is less than the table value, so null hypothesis is accepted ruling out possibility of association.

·        SOURCE OF INCOME: Based on the ‘x² test of association done for data, the table x² value for source of income is 12.59. The calculated value is 3.585. The calculated x² values is less than the table value, so therefore it states that neglect can be seen equally irrespective of source of income.

 

IMPLICATION OF THE STUDY:

This research was conducted to identify problems related to old age and adaptive strategies used by elderly from a selected urban community in a metropolitan city of Maharashtra. The implications of the study can be discussed under four broad categories.

·        Community nursing

·        Nursing practice

·        Nursing education

·        Nursing research

·        Nursing administration

 

Community Health Nursing:

This study will help the nurses and the other health care professionals to provide information on old age problems. Awareness among the elderly population should be created for regular medical check-ups to ensure prevention and early detection of the chronic diseases through community outreach services.

 

 

Nursing Practice:

Nurses come in contact with people in different stages of life. Proportion of elderly population either visiting health care facilities or in community is significant. Also geriatric problems are different from the others. Findings of the study would help the community health nurse to gain insight into most prevalent and actual problems of elderly. This study would also audit accessibility and availability of welfare measures and various adaptive strategies meant for elderly. 

 

Nursing Education:

Geriatric nursing is an upcoming specialty and occupies significant weight age in both graduate and postgraduate nursing education. Findings of the study would help to expand body of knowledge in geriatric nursing. Also, it would facilitate awareness about issues and problems of elderly in nursing students.

 

Nursing Administration:

Findings of this study would help to improve component of in-service education program related to care of elderly. It would also help to develop and refine welfare measures for elderly in hospital as well as community.

 

Nursing Research:

Nursing research is an essential aspect of every profession, to as in nursing. Another research has been added to the nursing literature. There is a need for extensive nursing research in the area of Geriatric Nursing in community set up. Findings of above study would serve as a baseline data for conducting experimental and evaluator research in respective areas.

 

LIMITATIONS OF THE STUDY:

·        The study was conducted on a smaller sample size.

·        The study could not involve all the systemic physical problems of the elderly.

·        In the study, no tool for formal diagnosis of any problem was used on the elderly.

 

RECOMMENDATION FOR FURTHER STUDIES:

·        A similar study can be conducted to find comparison between problems of elderly in rural area and urban area.

·        An exploratory study can be conducted to identify the causes contributing towards common problems of elderly.

·        A similar study may be replicated on large subjects to generalize the study findings.

·        A similar study can be conducted by focusing on a particular geriatric problem.

·        A descriptive study can be conducted on the quality of life of the elderly.

·        A study can be conducted to assess the attitude of care givers while providing care to the elderly.

·        A study can be conducted to assess the knowledge level of elderly about the provision of services in the community.

·        A similar study can be conducted for different population like widows/widowers.

 

REFERENCES:

1.       MC Gupta, BK Mahajan. Textbook of preventive and social medicine. New Delhi: Jaypee Publications Ltd; 3^rd edition, 2003.

2.       Perceiving Old Age. [Internet]. Available from http://www.sqidoo.com/old-age-problems.

3.       Elder Abuse Assessment Tool Kit Breaking the Silence: Giving a Voice Back to Seniors; may 20124p. Available fromURL:http://www.durhamelderabusenetwork.ca/CommunicationToolKitInstructions.pdf region of Durham.

4.       Altius Directory. International day for older persons. Available from URL: http://www.altiusdirectory.com/Society/international-day-older-persons.php

5.       India no country for older men: UN report. NDTV. 2013 Oct 02.

6.       Health Serv Res. 2002 August; 37(4): 849–884. doi:  10.1034/j.1600-0560.2002.56.x PMCID: PMC1464018 The 2030 Problem: Caring for Aging Baby Boomers James R Knickman and Emily K Snell Available from URL: G:\research\used rol\The 2030 Problem  Caring for Aging Baby Boomers.htm

7.       A Lena, K Ashok, AKamath. Health and Social Problems of the Elderly: A Cross-Sectional Study in Udupi Taluk, Karnataka Indian J Community Med. 2009 April; 34(2): 131–134.

8.       Anindya J. Mishra, Avanish Bhai Patel Crimes against the Elderly in India: A Content Analysis on Factors causing Fear of Crime. IJCJS . ISSN: 0973-5089 January – June 2013. Vol. 8 (1): 13–23

9.       Oxford English dictionary. 10^th edition. Oxford university press; US: 2002.

10.     A.S. Horny. Oxford Advanced Learner’s Dictionary of current English. 6^th edition. Oxford University Press.2000.

11.     Shubha Soneja. Elder abuse in India. Country Report For World Health Organization. Help Age India.

 

 

Received on 10.06.2015           Modified on 26.06.2015

Accepted on 11.07.2015     © A&V Publication all right reserved