Aging and Health in India: A Longitudinal Study and an Experimental Platform
Location: Tamil Nadu (districts of Chennai, Dharmapuri, Kanyakumari, Tiruchirappalli, Tiruvannamalai)
Sample: ~ 5,000 elderly individuals
Timeline: April - December 2020
J-PAL Initiatives providing funding: N/A
Target group: Individuals above 55 years of age (who are already part of the longer-term longitudinal panel sample)
Outcome of interest: Health knowledge and awareness; Food security and nutrition; Mental health & well-being
Covid-19 dimensions: Economic shocks on individuals, households, and small and medium enterprises (SMEs); Knowledge, attitudes, practices & beliefs; Access to government relief measures; Covid-19 symptoms; Mental health & well-being; Food security
Mode of data collection: Computer-assisted Telephone Interviewing (CATI) / phone surveys
Nature of activities: Data collection (surveys)
Research paper(s): N/A
Given the particular vulnerability of elderly populations in the pandemic, due to both heightened health risks and lockdown-induced isolation, an initiative to collect Covid-19 related data grew within the Tamil Nadu Aging Panel Survey being conducted under the institutional partnership between J-PAL South Asia and the Government of Tamil Nadu to study the long-term well-being of elderly individuals.
Surveys were undertaken with an aim to generate immediate and actionable insights for the government in aid of this population and to shed light on how social protection programs like old age pensions can potentially mitigate the effects of large negative shocks and crises on vulnerable populations.
Two rounds of data collection have been completed: one in early April 2020 and another at the end of July 2020 with a focus on understanding the implications of Covid-19 and the imposed lockdown on the elderly (specifically for their access to food, financial status, and physical and mental health). The surveys also examined the role of non-contributory pensions in improving elderly well-being in the pandemic. The project plans to conduct a third round of data collection in November 2020 to understand changes in the lifestyle of the elderly upon the lifting of lockdown measures along with other aspects that affect their well-being.
The Government of Tamil Nadu launched two schemes for ration card-holders in the state:
Free rations from April to July, doubling the rice entitlement;
A cash transfer of Rs.1000 (about USD 14) per ration card for April and May
The schemes reached most, although not all intended recipients.
Food security and nutrition: At the start of the lockdown in March 2020, the elderly faced sizeable health and food-security challenges: nearly 50 percent of respondents reported not having enough resources for food in the next week (Figure 2).
In subsequent survey rounds, it was found that the number of elderly unable to buy medicine or see a doctor since April had fallen. Food insecurity, however, had risen and was high particularly among the elderly living alone (Figure 3).
Health knowledge and awareness: During the April phone surveys, 1.4 percent of the elderly reported having Covid-19 symptoms. Of the elderly reporting symptoms, nearly 80 percent did nothing or self-medicated. No respondent reported calling the government helpline in April; only 0.1 percent reported having called the government helpline in July (Figure 4).
Awareness of Covid-19 spread, symptoms, and precautions was moderate in April. In July, awareness had grown among the elderly living alone, presumably as information percolates through networks (Figure 5).
Mental health and well-being:
Social connection: At the beginning of the lockdown, social interaction was low for the elderly, both in-person and remote. In April, the elderly who were living alone were less likely to have regular phone calls (Figure 6). By July, both regular in-person visits and calls had picked up moderately for the elderly living alone and elderly living with others (Figure 7).
Loneliness and depression: In April, the elderly living alone were about twice as likely to indicate feelings of loneliness and depression than those living with others in their households (Figure 8). These indicators reflect lower loneliness and depression than those at the baseline survey. This may be due to the nature of the Covid-19 survey (shorter and via the phone), which is less conducive to building a rapport between surveyors and respondents.
As the lockdown progressed, all elderly (those living alone and those living with others) became far more likely to express feelings of loneliness and depression. This was especially true for the elderly living alone, 32 percent of whom reported often feeling lonely when asked in July (Figure 9).
For more information on the larger panel study, surveys, and other indicators studied, please refer to the resources in the section below.