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noteworthy. Of the 7.5% of the population who are elderly, two-thirds live in villages and nearly half are of poor socioeconomic status (SES) (Lena et al., 2009). Half of the Indian elderly are dependents, often due to widowhood, divorce, or separation, and a majority of the elderly are women (70%) (Rajan, 2001). Of the minority (2.4%) of the elderly living alone, more are women (3.49%) than men (1.42%) (Rajan and Kumar, 2003). Thus, the majority of elderly reside in rural areas, belong to low SES, and are dependent upon their families.

While the southern states (Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu) may be considered the biggest drivers of aging in India, other Indian states (notably Haryana, Himachal Pradesh, Maharashtra, Orissa, and Punjab) are also experiencing an elderly population boom, largely in rural areas (Alam and Karan, 2010). Large-scale studies of the health behaviors of this growing elderly Indian population are scarce. However, information gathered from numerous surveys and regional and local studies point to the high prevalence of several risky behaviors, such as tobacco and alcohol use (Goswami et al., 2005; Gupta et al., 2005; Mutharayappa and Bhat, 2008), and physical inactivity (Rastogi et al., 2004; Vaz and Bharathi, 2004). With these stressors, predictably, aggregate data comparing the 52nd (1995-1996) and 60th Rounds (2004) of the National Sample Survey (NSS) suggest a general increase in the reports of ailments and utilization of healthcare services among the elderly (Alam and Karan, 2010; Rao, 2006). Access to services, however, is uneven across the country.

An analysis of morbidity patterns by age clearly indicates that the elderly experience a greater burden of ailments (which the National Sample Survey Organisation defines as illness, sickness, injury, and poisoning) compared to other age groups (see National Sample Survey Organisation, 2006, Fig. 1), across genders and residential locations. The elderly most frequently suffer from cardiovascular illness, circulatory diseases, and cancers, while the non-elderly face a higher risk of mortality from infectious and parasitic diseases (Alam, 2000; Kosuke and Samir, 2004; Shrestha, 2000). In developed countries advancing through demographic transition, there have been emerging epidemics of chronic non-communicable diseases (NCDs), most of which are lifestyle-based diseases and disabilities (Gruenberg, 1977; Waite, 2004). In contrast, India’s accelerated demographic transition has not been accompanied by a corresponding epidemiological transition from communicable diseases to NCDs (Agarwal and Arokiasamy, 2010). As indicated in Figure 15-1, the Indian elderly are more likely to suffer from chronic than acute illness. There is a rise in NCDs, particularly cardiovascular, metabolic, and degenerative disorders, as well as communicable diseases (Ingle and Nath, 2008). While cardiovascular disease is the leading cause of death among the elderly



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