Deteriorating health, malnutrition, lack of shelter, fear, depression, senility, isolation, boredom, non-productivity, and financial incapacity are

the most common problems that senior citizens all over the world face today. These problems can be grouped into two categories that relate to the physical and mental health and the financial capacity of the senior citizen. 1. Physical and mental health Stability of physical and mental health is a key concern that senior citizens have to contend with as they go through their twilight years. The human body is a system that wears out with long and repetitive use; and quite easily, with neglect and abuse. Aging is a life-cycle stage where the human capacity to think, act, relate, and learn starts to falter and deteriorate. Aging breeds illnesses such as loss of memory, immobility, organ failure, and poor vision. These are critical dysfunctions that could sideline a senior citizen to a lonely and miserable life. While a clean and discreet lifestyle in his or her prime could reduce the susceptibility of a senior citizen to dreaded post-retirement illnesses, the onset of any dysfunction is one unpredictable happening even if the person might have had robust financial health. The frailty of the human body grows with the aging process regardless of who the person is, a sure-to-come event magnifying the primacy of physical and mental health stability as a fundamental problem of senior citizens. 2. Financial capacity Possessing sustainable financial capacity before, during, and after the inception of a senior status is both a basic problem and an elusive dream for most people. This financial dilemma is common among senior citizens who are usually relegated to an abject position of economic inactivity. Lack or absence of financial capacity creates a stressful life and invites the entry of problems other than physical and mental health issues. For instance, domestic problems in an extended family system can aggravate the problem of a financially-destitute senior citizen. Should any of the children be wallowing in a similar state of poverty, the senior citizen becomes physically and mentally loaded up with intense and continuing pressure out of being totally helpless to come to the financial rescue a grieving son or daughter. While it may not be the panacea to aging-related problems, the value of money cannot be overstated in the post-retirement period. A financially-handicapped senior citizen, afflicted with some degenerative or serious

illness, is practically on the road to an early death. A financially secure senior citizen with the same illness, however, may have a longer life to live because money can give quick and convenient access to life-giving remedies. Even with state-of-mind dysfunctions like severe depression, boredom, nervous breakdown, and self-pity, financial capacity can buy options to rejuvenate and refresh a financially-capable senior citizen, through travels, elderly recreation, social renewal, and continuing education. A poor senior citizen in the same state of mental degradation cannot afford to do the same; and more so, be back into the mainstream of society. As can be discerned from the preceding discussions, the severity and importance of both health and financial problems is a function of the milestones the senior citizen had set up preparatory to facing the challenge of post-retirement. These milestones are: 1) Quality: what lifestyle had been lived in the past 2) Quantity: what endowments and financial fortune had been built 3) Relationships: what community of people the senior citizen had moved about and is attached with. What is then the most important problem that senior citizens face today? Is it health (physical and mental) or financial capacity? From a practical and realistic standpoint, I consider the inseparable tandem of health and financial capacity as the most important problem that senior citizens have to prepare and plan for. I use the phrase "prepare and plan for" because health and financial capacity becomes a problem only if the senior citizen had, in the past, been unmindful or neglectful of its future importance. A healthful life is like a running well-oiled machine, with its vital parts continuously maintained so that it can perform normally, or at peak productivity, beyond its anticipated useful life. The onset of sudden serious health problems can be substantially mitigated, if not totally avoided. This holds true if the senior citizen, at the time of his or her prime, had led a clean, discreet, active, family-based, helpful, and interconnected life, a discipline that builds premium on fitness, integrity, peace, humility, fulfillment, and friendship. Financial hardships can be avoided if the senior citizen, during his or her period of economic activity and utility, had deliberately exercised foresight, focus, continuous learning, perseverance, and simplicity, a discipline that consistently upholds the importance of modest needs, savings, productivity,

competence, and delivering superior value to people and organizations. The idea here is to build a sustainable wealth of lifetime resources to address the financial requirements of the person across the twilight zone. On my mother's side, my grandma died at the age of 95 years old while my grandpa passed away at 92. With no known serious illness at the time of their death, we were all of the opinion that they died by reason of old age. How did they manage to both live a long life? With regard to their having a healthful life, both my grandma and my grandpa were vegetarians. They religiously observed full eight-hour night sleep and two-hour afternoon nap everyday. They were both active. With my grandma coming from a political family, she was all over the community interacting with people during her free time. My grandpa, who was a full-blooded Christian, was quite busy each day evangelizing on the bible with different kinds of people. As we had initially lived at my grandparents' home, I could clearly recall that there was no day that they did not have visitors, at least two to three batches of people with different stories and problems to tell and request advice for. In short, they were always interconnected with people. It was a home full of excitement, sharing, and guidance, an abode that I think was the spring of long life for my grandparents. As to how my grandparents sustained a fairly comfortable life, even if both of them were economically inactive, was to me a story of disciplined survival worth emulating and modeling upon. The household just lived on the small pension of my grandpa plus some assistance from an uncle who was gainfully employed. But my grandma, who closely tracked and managed the finances, had the regimen and capacity to prioritize and stretch the budget in a manner that, on a monthly basis, the basic needs were sufficiently addressed and some residual money were tightly saved. Though my grandma was a stickler of kindness and generosity to people, I never witnessed any moment that they were in the run for some emergency money. Neither had they borrowed anything from any relatives or friends. To my estimation, they had a retirement fund chest that remained intact until the hour of their death. And how did this happen? I think it was a providential blessing. Incremental assistance money, though in reasonably small amounts, regularly flowed in from people who had been helped by my grandparents, not financially, but on the resolution of their domestic and career problems. Whenever I go on a recollection mode about my childhood and adolescent days, I am elated for being a grandson to my grandparents. Such recollection always reinforces in me the nonerasable thought that the abstract endowments of wisdom, compassion, kindness, humility,

and transparency not only build a reputation of respectability and a life of longevity; but also, over time, they give finite financial returns that can bridge people to a fulfilling postretirement life as a senior citizen. With all the exciting, fun-filled, and encouraging lessons from my grandparents, I have no apprehension facing the life of a senior citizen. It is all how you live and love your life in the service of your family, of the people around you, and of humanity in general.

Reflections on the Management of the Aged in India P. K. Misra

Humans are one. They belong to a single species. They have a long history. Even in prehistoric times there were migrations, near and distant, all over the world. Seas, rivers, lakes, mountains, deserts and forests have not been able to deter human beings moving from one place to another. Come to think of it, migrations of people like the Jarawa (a classic food-gathering and hunting Negrito group) to another island in Car Nicobar or of the Toda to the Nilgiris, or of the Ladakhi to the Ladakh region, speak about the immense capacities of human beings. Some such movements might have been prompted by compelling natural, social or economic circumstances, but many were not. Being mobile at one stage and sedentary at another is a part of human nature. It appears that human beings are restless in either state (Misra 1986). They are curious about themselves, about the things around and beyond them, and are ever eager to impose order on them. Apart from the immense capacity to endeavour, to learn, to innovate and to adapt to any ecological condition, they add to their cultural baggage by borrowing. Any attempt to characterise people in terms of indigenous and non-indigenous amounts to taking a very short perspective of history. Such categories, if anything, are basically political. Dynamics of culture If culture is the way society formulates and deals with the basic problems of human existence (Heesterman 1972:97), people living in different environments are likely to develop different cultures. But the very fact that human beings have been restless and have been migrating should indicate that they have not been satisfied with either the way they had formulated the problem of existence or the way they dealt with it. Whatever may have been the reason, as a result of their migrations and through various means of communication people have been exposed to different cultures. Thus cultures have grown through a process of borrowing, retaining and inventing. The process is extremely complex, because even a thing like borrowing is not simple. The borrowed item goes through cultural processing and is only then adopted. The process is further complicated by the fact that human beings attach meaning to cultural items and meanings may be multiple depending upon the context. Culture is also not a loose assemblage of discrete items; there is some degree of integration in them. One can argue that perfect integration is never achieved, and if that should happen a culture would never change. But cultures do change, some change very rapidly and others slowly. It is possible to argue that change is to seek better integration in the culture. To achieve that, there has to be a scheme. This scheme has to be experimental, otherwise there would not be any necessity for borrowing or inventing. In a culture, what is seen is just like the tip of an iceberg, a lot in terms of ideas, values and morals remain submerged but directs actions. All cultural practices, beliefs, ideas, morals, values and the attempts to integrate them would be senseless if the culture does not have goals perceived and defined by it. There can be a debate about the goals, but to claim its non-existence would mean that each aspect of culture has its own autonomous and ad hoc existence. If that be so, all discourse about culture would be meaningless. While working among the East Indian population in Trinidad, I noted that the Indians there have a

separate identity of their own. The Indians there were an uprooted population they were taken there as indentured labourers, separated from their people and villages. They were a subordinate people, coming as they did from a colonised country to another colonised country, and they had no voice. Their cultures, languages and religions were stigmatised. Those among them who changed their religion were the favoured lot. In spite of all these odds, they were able to reconstruct a culture of their own and establish their identity. This culture is certainly different from what they brought with them but very distinct from what the local culture is. Analysing these developments, I had written, in order to do what a culture does, it may adopt several strategies. It may allow individuals and some groups within to play intervening roles of bridge or buffer between the dominant groups in a multi-ethnic situation. Then there may be some issues which may cut across the individuals and groups. Such groups, individuals and issues to some extent are responsible for the large systems to function and at the same time allow the specific cultures to play the roles they have defined for themselves (Misra 1994:11). Culture, in the long run, seems to be indestructible unless by some catastrophe. It has the capacity to regenerate itself around some ideas, some symbols, some institutions and activities. In the case of the Trinidad Indians I have shown that their population size, acquiring land, forming uni-ethnic villages, political actions to protect their interests, formation of the Indian association, struggling to get some of their rituals recognised, collecting contributions for the Bengal relief fund, arrival of Indian films and music, visitors from India, attempts at reviving rituals, performance of community worship, building temples and mosques, building networks through pandits and tharia-lota, were used to form a community of their own (ibid). Whatever they have constructed has to cope with external pressures and inner conflicts. It is not that culture resolves all conflicts. In fact, culture may regenerate itself, weaving its way through conflicts. In Trinidad, for example, the Indians have constructed a kind of duality of inner and outer lives to cope with the apparently contradictory Indian and Western values (Misra 1994:4). A couple of decades ago Singer, in his study of the Indian joint family in modern industry, made a similar observation: Structural change and structural persistence are not mutually exclusive phenomena, they both are occurring simultaneously (1968:438). In a detailed study of nineteen outstanding industrial families he found that there was a clear-cut separation of work and residence. The home becomes the sphere of religion and traditional values, while office and factory become the sphere of business and modern values. He calls this separation compartmentalisation. Compartmentalisation is an adaptive process which permits the incorporation of innovative patterns of thought and behaviour associated with modern industry without too direct a collision with traditional modes of thought and behaviour (ibid., p.439). A study of development programmes initiated by the Government of India among five tribal groups in south India indicated that the response of each group was different (Misra 1982). In another study it was noted that of the two tribes inhabiting the same ecological region, one tribe totally rejected most of the development programmes while the other accepted them with some enthusiasm (Misra 1970). It was found that acceptance and rejection of specific development programmes were correlated to the social structure and values of the respective tribes. This was significant because both the groups were very poor and barely managed their existence by food gathering, some agriculture and extraction of minor forest products. Yet both the groups were very concerned about their cultures and retaining their respective identities. Even in a situation where there were enormous existential difficulties, Thorbek, in her study of a slum in Sri Lanka, found that the slum dwellers there were more concerned with their relations with spouses, children, mothers, relatives, neighbours, performance of rituals and what was right and wrong, than with money alone, in short with their culture and values (1994). Cultural variety

Elsewhere too, particularly in the emergence of ethnic conflict all over the world, it has been noted that cultures cannot be changed or preserved at will. The indirect evidence of the existence of the immense varieties of cultures all over the world in spite of powerful forces unleashed by modernisation supports the above hypothesis. Culture has its own internal dynamics. Each culture, in a way, is unique. In the process of its growth it develops its own emphasis. These emphases make each culture appear different. They allow people to feel good and satisfied. Thinking of the varieties of culture and their interrelations, the image that comes to mind is that of an unspoiled tropical forest where there are immense trees, plants and creepers, growing in and out of each other, together providing shelter and nourishment to innumerable varieties of creatures. The whole is a system but each element in it has its own identity and function. For obvious reasons this imagery cannot be pushed too far in understanding human societies, yet keeping it in view I would like to make the following points. The individual culture is part of a larger system. The relevance and meaning of the individual culture can be appreciated and fully understood only in the context of the larger system. Deviation from this perspective leads to distortion in understanding, though it is true that big and strong societies have grown at the expense of small and weak ones. It is difficult to conceive of a world which has a uniform culture. None can deny that despite pressures even the small and weak have been able to maintain their cultural identities. By this I do not mean that they have remained static. Far from it, they too have been adapting and changing, and also influencing the larger system through a complex process of inter-culturation. The very fact that cultural variety has existed both in time and space shows that there are innumerable ways to formulate and deal with the problem of human existence. The larger system, if it is a system, has to be connected with its constituent parts howsoever remote and thin these connections may be. This way the distinctions between endogenous and exogenous models of development, tradition and modernity, become dim. It is true that cultures cannot be kept isolated. It was not possible in the past and is much less possible now in the wake of the communications revolution. Culture and development This is the era of development. The world has been divided into developed and developing. The developing are exhorted to hasten and catch up with the developed. All kinds of packages have been created so that the developing world is able to meet at least the basic needs of its people. Meanwhile, in spite of all pious thoughts and plans, the gap between developed and developing within and between states has widened. This has increased anxiety the world over, particularly on account of the realisation that the world is an integrated system. The problems of one region, whether they are ecological, social, economic or political, are bound to affect the other regions too. There is yet another realisation, that development without intense humanism is selfdestructive it is the Hiroshima path. The situation now is far more dangerous than it was fifty years ago. Several countries have developed perilous capacities. Now the crucial question is whether it is possible to break or change the direction of development. One of the ways that has been suggested is to bring the required thrust of humanism into the development process. In this volume Kasai writes that tradition should continue to guide individuals and societies in their search for a just order and society, and development should supply more effective means for their search. But in Japan, he writes, tradition was exploited for just the opposite ends. There is enough evidence from all over the world that culture has been used for economic development and hegemonic tendencies. Even Kasai, after expounding the profoundest thoughts of Japanese tradition, ends by saying that the events of the past are the reminders of the violence of the development. Why does this happen? It is seen that in practice development means material advancement. All the great thoughts about developing the finer aspects of human beings do not get translated into

reality. They remain in the books. Even if it was intended, no one would know how to go about it. Therefore a peculiar situation prevails: while human beings can boast of tremendous material development, the same cannot be said about their own quality. They remain the same while they are expected to help in establishing a just order. For the same reason the matter of establishing a just order cannot be left to culture or tradition, as the context has considerably changed. Both traditional thought and modern experience will have to be focused on human development. Human heritage Right from the time human beings became cultural beings, they have been exploring the external universe and making internal arrangements of living. Over time such discoveries and arrangements have become part of the human heritage. It will be futile to argue whether fire or the innumerable varieties of food that we consume, or the various tools that we use, or the idea of counting, or the families in which we live, were found in east, west, north or south. What was found suitable was adopted with appropriate modifications by different cultures. In the same way modern discoveries are becoming part of the cultures of big and small countries. While such developments have apparently made life easier, they have thrown up many new, serious and urgent challenges before mankind, such as the phenomenal rise of human population, environmental pollution, demographic transition, etc. In this paper I intend to focus on the problems caused by demographic transition, resulting in the rise of the population of the aged. I argue that the management of the aged raises the issue of human development. Demographic transition A significant change has been taking place in the demographic structure of various countries. Their populations have been ageing. It is a dynamic phenomenon. It means more rapid increase of the proportion of old people as compared to other age segments. Till recently it was thought to be a problem of the developed countries, but now it is becoming a problem of the developing countries also. In 1985, there had been 427 million elderly persons (aged 60 and above) accounting for 8.8 per cent of world population. In relative terms, demographic aging was most advanced in the more developed countries where the elderly accounted for 16 per cent of total population as opposed to 7 per cent in the less developed countries (UN 1988:3). An international symposium on population structure and development recognised that population ageing was taking place in the context of a rapidly increasing total world population. Growing from an estimated 2.5 billion in 1950, it had reached 4.8 billion in 1985 and was projected to reach 8.2 billion in 2025 (ibid., p.3). In India, the ageing process of the population is yet to set in full swing since fertility has not come down significantly; but that is no relief as in absolute terms there were more than 43 million people above the age of 60 in 1981 (Guha Roy 1987:61). The percentage of persons in the age group of 60+ in 1961 was 4.57, in 1981 it was 5.14, and in 2001 it is likely to be 7.11 (Chowdhary 1992:30). That is, the population of the aged in the country is already large and is going to be larger still, which is a consequence of development. What problems and issues does this demographic change bring forth? Problems and issues The rise in the number of those who are non-productive and who do not generate any hope immediately raises an economic problem. It is also a social problem: Who is going to provide support to them and how? Apart from food and shelter, the old need care and medicines. They also crave love and tender care. They would like to interact, be heard, be visible, and would like a bit of space of their own and have a constructive and creative role to play in society. Among the old, the problems of old women, single, divorced and widowed, are different from those of old men. In a column in a newspaper an elderly male wrote:

I am 65 years old and I lost my wife about two years ago. But for the feeling of loneliness which has me in its grip every once in a while, I am happily placed in life. My children are happily married and settled. They look after me well but have their limitations. I am beginning to feel that it will become difficult to cope with life without a partner. Much of lifes charm has indeed vanished ever since the death of my wife. I feel like I have everything and yet nothing. I agree with Mr K., who felt that widowers and widows could lead a happier life if they have companions to avoid loneliness. And especially at a senior age, the need for a partner to share life with intensifies greatly. In todays social context, however, elderly widows and widowers have little choice but to suffer silently (Times of India, 30 March 1995). In the same paper another old person wrote, I am a single senior citizen and I feel there are many facets to the problems of single elderly people in our society. It concerns widowers, widows as well as bachelors and single women in advanced age groups. Harking back to past traditions and past family systems cannot be solutions. Apart from the problems of the reasonably healthy elderly, the problems of the disabled and senile are of a very special kind. Ageing marginalised There are not many studies focusing on these problems. A quick glance at the available literature indicates that Indian society does not even realise that a serious human, social and economic problem is at hand which needs immediate specialised attention. The Western response to the problem has been liberating the old from various kinds of filial responsibilities, making them economically as viable as possible and handing over the problems of health and care to specialised institutions. In the United States of America, apart from schemes of pension, insurance and retirement benefits, the health care of the aged is linked with the social security system. Mobile home service for the aged has been devised in order to lessen the pressure on institutions and costly nursing homes. How exactly these institutions work and what problems the old people under these schemes face are a different matter. However, it is clear that while these institutions can meet the material needs of the aged, they cannot do much when it comes to love, warmth, and the desire to be heard and to be visible. The Indian situation In India the situation is far more complex. An overwhelming number of people live in rural areas but migration from rural to urban areas is substantial, which creates problems for the ageing at both ends. If children go to urban areas leaving behind the aged in the rural areas, that creates one set of problems, and if the old are taken along, it creates another set of problems. The growth of the urban population and urban centres have been haphazard, and there are acute shortages of housing and other facilities. The health care system is woefully inadequate and there is hardly any specialised agency focusing on the old. There are no programmes available to train people taking care of the aged. In other words, the entire responsibility of taking care of the old continues to be with the traditional institution of the family. Biswass study of 13 villages in Giridih district of Bihar conducted at two points in time shows that an overwhelming number of the aged lived with their sons 90.32 per cent in 1960 and 88.36 per cent in 1982. There were very few who decided to live with their daughters. Biswas writes, In substance, therefore, sons were the first choice for old age care, and they were often referred to as old age insurance for which property was transferred to [them] as premium (1987:46). In the same study it is pointed out that 14.29 per cent old men and 57.78 per cent old women were dissatisfied with the care and service they got. Of those in ill health, a third of the men and more than half the women felt that they were not properly cared for (ibid., p.53). As regards the interpersonal relations of the ageing with the other members of their families, the study found that

a majority of them were bound by bonds of reciprocal respect and love, irrespective of complaints about accommodation, food and care. Dissatisfaction was greater among those who were fully dependent on their supporters. It grew keener and more bitter with age. Ageing women as a rule were neglected (ibid., p.57). The study highlights that in the rural areas the families of male children provide care and support to the aged. They are bound by traditional norms of respect and love. But now they are getting increasingly marginalised. Ageing in urban areas In urban areas the problems get further accentuated. Community support is weak and the kin network is diffused over a large area and relatively ineffective. The entire responsibility of support and care of the ageing falls on the male children with whom the ageing live. The composition of the family in urban areas is becoming nuclear and smaller, as a result of which there are fewer people available in the house to provide care and comfort to the ageing. Those who are available are torn apart by the stresses of urban living. Women too in the urban areas are now working outside the family. They have fixed schedules of work and have other pressures on them. Children are loaded with their studies, competitive examinations and concerns for making their careers. The authority that the ageing exercised on their children in the past as a result of greater experience has almost vanished, and the aged are now told, You dont know. There are several reasons for this admonishment. First, the children of the ageing are not in the same profession. Second, the quantum of information which their children claim to have makes the ageing look almost primitive. Third, the whole techno-economic situation has now completely changed, which leaves the ageing bewildered and redundant. When paucity of accommodation, high cost of living, general stress and tensions at all levels are added to these, the problems of the aged are extremely serious. Discussion The ageing pose a serious human problem. Since they are considered non-productive and as they also do not generate any hope, it is all the more necessary that serious attention be paid to them. They raise moral questions and direct our attention towards transcendental values. In the past, ageing was not a serious issue and societies did not give it priority. They dealt with it as a natural phenomenon. Family members were responsible for the care and management of the old. But now the situation is different. The size of the people in the ageing category is already bulging and it is growing very fast. The problems posed by ageing are by no means accidental and isolated. They have grown as a result of the development process itself. The entire emphasis of development is on individual success, career promotion, entrepreneurship, investment, capital building and profit. In such a scheme of things, there is hardly any scope for thoughts about human development. At family, community and government levels the problems of the ageing get no or very low priority. It is taken for granted that the problem will get solved on its own or that it is a problem of individual families, with communities and governments having nothing to do with it. The family, where the ageing are supposed to get care and comfort, is on the rocks and in any case shrinking. The members of the family are spread around in pursuit of their careers. The old, on their part, are not getting detached either. They think that they are going to live for ever and that in any case this is not the time to quit. The ideas of vanaprastha and samnyasa are too remote and idealistic. They are bored looking after grandchildren, listening to religious discourses and devotional music, making rounds of holy places or just sitting before the small screen. They seek companionship, appropriate creative and constructive roles.

Modern societies are following an ostrich-like policy in this regard. The Western solution to the problem has been old age homes, pensions, social security and health care. No doubt these are important steps, but these programmes are caught up in the conceptual groove that the old have lived their lives and at best they need some material comforts. In any case the old are marginal, backyard people and come in the category of waste. This attitude is exactly what development has to avoid. Development that does not develop the sensitivities and quality of human beings is a potential monster, a Hiroshima. The management and care of the old illustrates this point very well. A concern for non-productive people, sparing a thought for those who have been consigned as waste, would resolve most doubts about development. Development in the last analysis should mean enhancing the capacity of people to establish a just society. In India even systematic thinking as to what should be the policy towards the ageing has not begun. At this stage in history the country is caught up in the whirlpool of market forces and resultant consumerism. Consumerism thrives on waste and decay. Consumer as well as producer know very well that this kind of development is not sustainable. A shift from consumption to conservation, from individual to community, is bound to take place, which will be in keeping with the Indian ethos. It is possible to be modern with the emphasis on conservation and focus on the community. This point gets very well illustrated in the management of the ageing. Taking care of the aged means highlighting the importance of conservation and humanitarianism. It will also strengthen the community, for the aged can be best taken care of within the fold of the family, bound by filial rights, duties and obligations. There is no institution that can replace the family but there is room to build into it the ideas of equality, justice and freedom. All this will not happen automatically. The focus has to be human development. That will provide new strength to the family and further support from the community. The old and infirm may find loving care. As far as the ageing of the disabled and senile is concerned, apart from giving them specialised attention through nursing homes and mobile health units, family members will have to be trained in their care. It is to be borne in mind that care cannot be given by mere emotions and a sense of obligation. There has to be proper understanding of the problem and of the remedial measures which can be provided by modern knowledge of health and medicine. Thus a combination of modern knowledge and intense feeling for those who are non-productive can provide physical and emotional comfort to the old. References Biswas, S.K. 1987, Dependency and Family Care of the Aged. In S.K. Biswas, ed., Aging in Contemporary India. Calcutta: The Indian Anthropological Society Chowdhary, D. Paul, 1992, Aging and the Aged. New Delhi: Inter-India Publications Guha Roy, S, 1987, Demography of Aging: Indian Experience. In S.K. Biswas, ed., Aging in Contemporary India. Calcutta: The Indian Anthropological Society Heesterman, J.C., 1972, India and the Inner Conflict of Tradition. In S.N. Eisenstadt, PostTraditional Societies. New York: W. W. Norton & Co. Misra, P. K., 1970, Economic Development among the Jenu Kuruba. Man in India, Vol.50, No.1 , 1982, Differential Response to Change: A Case Study of Economy, Society and Change among Five Tribal Groups in Southern Zone. In K.S. Singh, ed., Economies of the Tribes and Their Transformation. New Delhi: Concept Publishing Company

, Mobility Sedentary Opposition: A Case Study among the Nomadic Gadulia Lohars. In Joseph Berland and Hatt T. Salo, eds Peripatetic Peoples. Special Issue of Nomadic Peoples, Nos. 21 and 22 , 1994a, Cultural Design in Identity Formation in Trinidad. Unpublished , 1994b, Reflections on Inner-Outer Duality in Gender Relations among the East Indians in Trinidad. Unpublished Singer, Milton, 1968, The Indian Joint Family in Modern Industry". In Milton Singer and Bernard S. Cohn, eds., Structure and Change in Indian Society. New York: Wenner-Gren Foundation for Anthropological Research Thorbek, Susanne, 1994, Gender and Slum Culture in Urban Asia. New Delhi: Vistaar Publications United Nations, 1988, Economic and Social Implications of Population Aging. New York: United Nations

Electrical Activity of the Brain

The Origin of the Alpha Rhythm. Olof Lippold. (Pp. 267; 6.) Churchill Livingstone. 1973. This author writes from the department of physiology, University College, London: this I would consider to be a guarantee of excellent experimental work and unbiased investigations. It is a pity, therefore, for anybody interested in the study of the electrical activity of the braih to find that relevant literature and sound experiments of the past have been disregarded just for the sake of saying that the alpha rhythm is the electrical concomitant of tremor in the extra-ocular muscles. The pioneer work of Hans Berger, Lord Adrian, Grey Walter, Lindsley, and many others is unfairly attacked. Throughout the book there is an extraordinary lack of respect for so many careful observations, made not only by other physiologists, but also by reliable workers who have established the clinicopathological correlations of electroencephalography. Dr. Lippold neglects the well established observations that localized brain lesions, such as an abscess, a haemorrhage, a vascular occlusion, or a tumour, may alter the electrical activity of the brain recordable through the scalp. Moreover, not only the alpha rhythm but also important and well documented normal cerebral phenomena. such as the contingent negative variation, are considered as due to eye movement artefact in spite of careful exclusion of such interpretation by reputable workers. On page

226, Dr. Lippold mentions "the mechanisms underlying the generation of epileptic spike and wave phenomena" and says "perhaps one or the other is due to a fit involving the eye muscles." In his enthusiasm, Lippold forgets that the term epileptic may be applied to a subject suffering from seizures and not to an electrical phenomenon recorded from the brain (let alone the eye muscles!). This sequence of ideas is fairly typical of the confusion between fact and fantasy in this book. The careful studies of Chapman and his co-workers in 1971 demonstrated that a normal alpha rhythm could be recorded from both cerebral hemispheres from a patient who had lost both eyes and from two subjects who had complete exenteration of one eye, including removal of the eyeball, extra-ocular muscle, and periosteum. Lippold explains that what was recorded in these cases was "a wave form resembling alpha rhythm" and that "this does not mean that the origin of the alpha waves is not in the orbit." Even the anatomy is stretched in an attemnpt to demonstrate that the apex of the orbit is "nearly at the centre of the skull," or that "the site of stimulation used by Moruzzi and Magoun (1949) to produce their classical alerting response and desynchronization would seem to be suspiciously near the ocular motor nuclei." Lippold considers that the real importance of his work is towards the "prevention of wasted scientific effort." In this well printed book the conscientious student has an expensive opportunity of verifying from the many references quoted how other people's work has been interpreted.
G. PAMPIGLIONE

Essentials of Cannulation
Surgical Aspects of Haemodialysis. P. R. F. Bell, F.R.C.S., and K. C. Cainan, F.R.C.S. (Pp. 130; 4 50.) Churchill Livingstone. 1974. Access to the circulation is a sine qua non of haemodialysis. When peripheral blood vessels are healthy and inviolate this is usually easy to achieve, but as there are frequent exceptions to this ideal some ingenuity may be needed-particularly when long-term dialysis is required. Experienced members of haemodialysis and kidney transplantation units will no doubt know a great deal about such relevant vascular problems and how best to overcome

them, so that this well written and well produced volume, which contains a great deal of practical information, is not likely to have much to offer them. However, less experienced people should find the book invaluable, because it covers virtually every aspect of the subject and even includes a detailed list of instruments and equipment that may be required and the names and addresses of the suppliers. The diagrams are clear and the text, though repetitive at times, is easy to follow, except when the prone position is advocated for access to the femoral vein. A little more emphasis might have been given to the value of papaverine applied locally for overcoming vascular spasm and something might have been said about the place of denatured bovine arterial grafts and the Sparks mandril. The authors leave little doubt that they have had a considerable amount of personal experience in their subject and that they are familiar with the relevant literature which has been available for more than a decade, the references to which are to be found at the ends of all but one of the 12 chapters in the book.
RALPH SHACKMAN

Senior Citizens and their Problems

Social and Medical Problems of the Elderly. 3rd edn. Kenneth Hazell, F.R.C.P.E. (Pp. 312; $15-95.) Charles C. Thomas. 1973. Of the medical and social problems confronting our society, that of elderly people is the most intractable. A wide range of social services is geared to their needs and most medical services are heavily committed to their care. The problem, if not insurmountable, remains largely unresolved, and is likely to increase rather than diminish. Often the services are not well co-ordinated and in some areas the needs are much greater than others. Under the N.H.S. most general practitioners are excluded from hopital practice and practically all hospital doctors from the medical care of patients in their homes. It is with this background that the need for special geriatric units has becoe essential in Britain. Social and Medical Problems of the
Elderly is an apt title for this book. It sets out to interest a wide variety of people, but especially doctors, in the needs of the elderly. It is based mainly on Dr. Hazell's experience as a consultant geriatrician with a short section by Dr. K. L. G. Nobbs on

mental illness, a chapter by Mrs. W. A. Hurr on nursing care, and a most useful contribution by Professor Ferguson Anderson on preventive medicine. To enable the lay public to understand the close link between social conditions and illness in the elderly, the medical sections are written in simple, non-technical language. The social services are dealt with succinctly. This book provides a sense of the frustration, and to a lesser extent the satisfaction, of trying to help the elderly sick. The frustration is understandable. Often hospital facilities are inadequate, and too frequently the underlying realization exists that to return patients from hospital to comunity care means sending them to dilapidated homes, inadequate heating, and insufficient home help. More hopeful is the section dealing with preventive medicine. Here the emphasis is on routine medical check-ups for the old, pre-retirement training, family responsibility, and the development of positive attitudes to life with the use of graded exercises for improving health. Of least general interest is the large section dealing with the management and equipment of a geriatric unit. A book that seeks to satisfy a wide medical and lay public, as this one does, is likely to provide insufficient data for the medical reader. The sections dealing with the special medical problems of the elderly are too brief for the average doctor, but this shortoming is balanced by the underlying philosophy and broad perspective which makes this book worth reading.
W. DEWI REES

The dream of the people all over the world to live long is now becoming a reality due to the advancement in socio economic development and sciences, particularly medical sciences. It is estimated that there are 416 million old people (aged 60 years and above) around the globe and by 2020 world's 11.9% of population will be above 60 years. In India also the trend is same, 7.5% of the total population is above 60 years and the life expectancy is increasing gradually. Healthy ageing is not only related to the advances in medical technology but also related to the interaction of a wide range of social factors such as maintaining and enhancing physical and cognitive functions being fully involved in the society, leading a stimulating and productive life, living in a stable social environment and having meaningful personal relationships.

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of Interest

An old age problem. 'Growing grey gracefully' Need of specialty nursing care for senior citizens 'I thought I knew the problems facing senior citizens but I was just Issues and Problems of the Elderly in Pakistan, The

The diminishing joint family system in India and the various other social factors created a boom in emergence of old age homes, especially in cities. Various surveys done in India and abroad have confirmed that most of the elderly people consider home as a place where they can derive greatest emotional satisfaction. Elder abuse is one of the subjects of frequent discussion these days, whether it is institution based or community based. Elder abuse is not merely physical instead there are mainly five categories- physical, emotional, financial, neglect and sexual. The care givers ie, along with whom the elderly is staying in the home is indirectly or directly responsible for the abuse of elders in their home. Population ageing creates a new problem ie., a growing breed of care givers who are themselves in need of care. Hence, this author felt that it is vital to assess the existing knowledge and reinforce the same to improve the quality of life of the elderly. STATEMENT OF THE
The Chi - Square test showed there was no association for any of the demographic variable with level of knowledge during post test. The null hypothesis was accepted at this point. This further supports that the structured teaching was effective for all the care givers irrespective of the educational level and occupation. The implications were identified as to develop more health education programmes in the community as well as mass media for the family caregivers of the elderly to make the care more effective, re duce the stress of caregivers and to change the trend of industrialization. WHO's recommendations also agree to this, as family care is the most acceptable one for the senior citizens.

MoreArticles of Interest

An old age problem. 'Growing grey gracefully' Need of specialty nursing care for senior citizens 'I thought I knew the problems facing senior citizens but I was just Issues and Problems of the Elderly in Pakistan, The

BIBLIOGRAPHY BOOKS 1. Bhatia, Medical and health problems in Elderly, New Delhi, National Institute of primary health care, October 1993. 2. Niacholas conie et al, Lecture notes on Geriatrics, 4th edition, London. Blackwell scientific publications, 1993.

3. Robert, A Karen, The Elderly caregiver, New Delhi, SAGE Publications, 1993. JOURNALS: 1. A Asharf and V. Jayachandran, `Generation gap - A threat to family care of Kerala's Elderly, some evidence from National Family Health survey', International congress on aging, Trivandrum: 1996. 2. Dr. Balaraja Nikku. ' Old age, negotiating the inevitable', Health Action 9 (12), Dec 1996. 3. Bennet Gari G. and Ogg Jim, `Detection of abuse of older people', Nursing Times, 90 (37) September 14 1994. 4. Jamuna. D. `Stress dimensions among caregivers of the elderly' Indian Journal of Medical Research, 106 October 1997. Author: Lecturer, Community Health Nursing Department, Omayal Achi College of Nursing [at the time of writing this article] Copyright Trained Nurses' Association of India Oct 2002 Provided by ProQuest Information and Learning Company. All rights Reserved

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