how the elderly live in punjab

How the Elderly Live in Punjab

A Field Survey of the Living Conditions and Health Status of

the Elderly of Punjab 2009

University of Gujrat with support from

United Nations Population Fund (UNFPA), Pakistan

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Graphic Design: Ghafar Mohiudin and Mohammad Nadeem (School of Art, Design and Architecture, University of Gujrat)

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How the Elderly Live

in Punjab

A Field Survey of the Living Conditions of the Elderly of Punjab 2009

Core Project Team

Prof Dr Mohammad Nizamuddin (Principal Investigator) Dr Fauzia Maqsood (Co-Principal Investigator)

Javed Sajjad Ahmad (Consultant) Mustafa Nazir Ahmad (Editor)

March 2010

University of Gujrat with support from

United Nations Population Fund (UNFPA), Pakistan

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Acknowledgements The survey was conducted by the University of Gujrat (UOG) with financial support from the United Nations Population Fund (UNFPA), Pakistan Country Office. I would especially like to thank the UNFPA Country Representative in Pakistan, Daniel B Baker, and his assistant, Mohammad Ajmal, for providing this support.

The Bureau of Statistics, Government of the Punjab, provided technical and field support for this venture. In particular, its offices in Lahore and Islamabad extended generous support to facilitate the field operations. Taking this opportunity, I would like to thank the Bureau’s Director-General Shamim Rafique; Deputy Director Sajid Rasul; and Research Officer Arif Bhatti.

The survey used the sampling frame prepared by Armando Raul Levinson, of the U.S. Bureau of the Census, for the Punjab Government’s ‘Multiple Indicator Cluster Survey 2007-08’. I am grateful to him for allowing us to use it. This saved both time and precious resources.

A special note of thanks goes to members of the Technical Advisory Committee, field supervisors, field editors, data entry operators/office editors and interviewers, without whom this task would not have been possible. Besides them, the survey also benefited from the services of Mohammad Nawaz Khan (District Officer, Social Welfare Department, Sialkot) and Nazeer Ahmed (a school teacher in Narowal).

The pivotal guidance provided by Dr Zahoor Ahmed and Mirza Rizwan Sajid of the Department of Statistics, University of Gujrat, deserves a special mention here. They helped the process right from the conception to the development of data-gathering instruments and sampling design, and from carrying out of the field operations to tabulating data.

The survey was carried out in a minimum possible time and within a limited budget. This was made possible only because of the dedication shown by the team of UOG’s Centre for Population, Urban and Environment Studies, headed by Dr Fauzia Maqsood. I am personally indebted to them for this effort. I also want to thank Javed Sajjad Ahmad, an international expert on ageing who worked as consultant on this project and prepared the initial draft of the survey report. We also benefited from the services of Iqbal Alam, former Senior Technical Advisor for Population Surveys and Censuses at the UN Statistical Division. Finally, Mustafa Nazir Ahmad (Director, Modern Languages and Learning Centre, UOG) deserves a special mention for editing this report, as well as supervising its design. Prof Dr Mohammad Nizamuddin Vice Chancellor University of Gujrat

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Foreword Pakistan is in the midst of a demographic revolution. With rising life expectancy and lowering mortality rates, a vast new generation of women and men is moving past midlife. Its numbers will soon swell to unprecedented proportions and a new demographic reality will redefine what it means to grow older in this country.

A global issue, demographic ageing is one of the strategic forces shaping the context of reforms and policies in many countries. The reform of social protection, health care and the labour market, in response to ageing, is a growing public policy concern. However, better health and longer life are both positively important values.

Many social scientists believe that a healthy, educated and long living population represents an opportunity, rather than a threat to the economic and social development. The challenge ahead is to transform population ageing into future economic and social development by enhancing cohesion in our families, communities and societies. Adopting policies that promote social and intergenerational cohesion in an age-friendly society has to be a long-term priority.

The findings of this survey on the elderly (aged 60 and above) of Punjab, conducted by the University of Gujrat (UOG) with financial support from the United Nations Population Fund (UNFPA) Pakistan Country Office and technical support from the Bureau of Statistics, Government of the Punjab, are expected to contribute significantly to the national policy framework around population welfare. A milestone initiative, the survey entailed a study of the physical and mental health status; social conditions and economic needs; and attitudes and beliefs of more than 4,000 respondents in Pakistan’s largest province of province.

Conducted as part of UNFPA’s global agenda, the survey is a major step towards assessing the needs of the elderly in Punjab and igniting a national policy dialogue. UOG has been working with UNFPA on population-related issues since 2008, when it organised a seminar on the needs of the elderly in collaboration with the Ministry of Population Welfare, and Ministry of Social Welfare and Special Education. The current survey is an outcome of that seminar.

The survey is a substantive contribution to the burgeoning body of research being conducted on ageing and related issues in Pakistan. It brings to the wider academic and practitioner community both empirical and theoretical work in order to develop and refine policy and practice. Encouraging both emerging and senior researchers, the survey focuses on issues within social and behavioural gerontology with a direct practical application to the development of policy and practice in this field. Informative and wide-ranging, it will be of particular interest to the academics, policymakers and practitioners who are working on or with the elderly. Daniel B Baker UNFPA Representative in Pakistan

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Executive Summary

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Contents List of Tables Chapter 1 Introduction

1.1 Background 1.2 Selected Studies on Ageing 1.3 Demographic Characteristics of the Elderly 1.4 The Rationale for Ageing Survey 1.5 Why Punjab? 1.6 Objectives of the Survey 1.7 Institutional Framework 1.8 Sampling Design 1.9 Formulation of the Questionnaire 1.10 Selection and Training of Field Teams 1.11 Field Operations 1.12 Data Tabulation and Analysis

Chapter 2 Living Arrangements and Housing Conditions

2.1 Household Characteristics 2.1.1 Living Arrangements 2.1.2 House Ownership and Materials Used 2.1.3 Access to Electricity 2.1.4 Access to Water 2.1.5 Toilet Facilities 2.1.6 Cooking Fuel

2.2 Access to Information and Communication Technologies 2.3 Household Appliances 2.4 Means of Transportation 2.5 Views about Old People’s Homes 2.6 Views about Community Centres

Chapter 3 Demographic and Socioeconomic Status

3.1 Demographic Status 3.2 Place of Growing Up

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3.3 Parents’ Age at and Cause of Death 3.4 Health Expectancy 3.5 Marital Status 3.6 Morbidity 3.7 Education 3.8 Parents’ Education and Occupation 3.9 Attitudes and Beliefs 3.10 Working Status 3.11 Financial Needs

Chapter 4 Perceptions of Health, Illness and Wellbeing

4.1 Current Health Status 4.2 Chronic Illnesses and Disabilities 4.3 Age at the Onset of Illness 4.4 Heart Attack 4.5 Loss of Vision 4.6 Difficulty in Hearing 4.7 Sleep Duration 4.8 Body Pain 4.9 Bladder and Bowel Control 4.10 Health Services 4.11 Health Care Utilisation

4.11.1 Inpatient Utilisation 4.11.2 Outpatient Utilisation

4.12 Mental Health 4.13 Satisfaction with Present Life

Chapter 5 Activities of Daily Living (ADLs)

5.1 Activities of Daily Living 5.2 Involvement in Recreational and Social Activities

5.2.1 Listening to Radio 5.2.2 Reading Newspapers and Magazines 5.2.3 Watching Television 5.2.4 Attending Social Activities 5.2.5 Physical Exercise 5.2.6 Gardening 5.2.7 Hanging Out with Friends and Neighbours

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5.2.8 Watching Movies Outside the House 5.2.9 Engagement in Volunteer Work

Chapter 6 Conclusions and Recommendations

6.1 Demographic and Socioeconomic Characteristics 6.2 Mental Health 6.3 Health Status and Disability 6.4 Health Care Utilisation 6.5 Support Systems for the Elderly 6.6 Views about Old People’s Home and Community Centres 6.7 Recommendations

References Appendices

1 Additional Tables 2 Sampling Design 3 Questionnaire 4 Project Team

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List of Tables 1.1 Estimated Population of the Elderly in Pakistan by Age, 2010-2050 1.2 Distribution of Selected Blocks by Residence and Region 1.3 Response Rate 2.1 Percentage of Respondents by Region, Residence, Number of Rooms in House and Separate

Room for the Elderly 2.2 Percentage of Respondents by Region, Residence, House Ownership and Materials Used 2.3 Percentage of Respondents by Region, Residence and Access to Electricity 2.4 Percentage of Respondents by Region, Residence and Main Source of Drinking Water 2.5 Percentage of Respondents by Region, Residence and Availability of Water 2.6 Percentage of Respondents by Region, Residence and Use of Treated Water 2.7 Percentage of Respondents by Region, Residence and Type of Toilet Facility 2.8 Percentage of Respondents by Region, Residence and Type of Fuel Used 2.9 Percentage of Respondents by Region, Residence and Access to ICTs 2.10 Percentage of Respondents by Region, Residence and Possession of Household Appliances 2.11 Percentage of Respondents by Region, Residence and Ownership of Transport 2.12 Percentage of Respondents by Region, Residence, Gender and Support for Old People’s Homes 2.13 Percentage of Respondents by Region, Residence, Gender and Reason for Supporting Old

People’s Homes 2.14 Percentage of Respondents by Region, Residence, Gender and Reason for Not Supporting Old

People’s Homes 2.15 Percentage of Respondents by Region, Residence, Gender and Desire to Live in Old People’s

Homes 2.16 Percentage of Respondents by Region, Residence, Gender and Desire to Live in Old People’s

Homes Right Now 2.17 Percentage of Respondents by Region, Residence, Gender and Desire to Visit Community Centre

Right Now 3.1 Percentage and Number of Respondents by Residence, Gender and Region 3.2 Percentage of Respondents by Gender and Age Group 3.3 Percentage of Respondents by Region, Residence, Gender and Age Group 3.4 Percentage of Respondents by Region, Residence, Gender and Place of Growing Up 3.5 Percentage of Respondents by Region, Residence, Gender and Place of Growing Up of Spouse 3.6 Percentage of Respondents by Region, Residence, Gender and Illness of Father before Death 3.7 Percentage of Respondents by Region, Residence, Gender and Illness of Mother before Death 3.8 Percentage of Respondents by Region, Residence, Gender and Marital Status 3.9 Percentage of Respondents by Region, Residence, Gender and Illness Period before Death of

Spouse 3.10 Percentage of Respondents by Region, Residence, Gender and Education 3.11 Percentage of Respondents by Region, Residence, Gender and Education of Spouse 3.12 Percentage of Respondents by Region, Residence, Gender and Beliefs regarding Rights and

Responsibilities of Children 3.13 Percentage of Respondents by Region, Residence, Gender and Perception of Gender Roles 3.14 Percentage of Respondents by Region, Residence, Gender and Best Living Arrangement for Older

Couples

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3.15 Percentage of Respondents by Region, Residence, Gender and Best Living Arrangement for Unmarried Older Persons

3.16 Percentage of Respondents by Region, Residence, Gender and Current Working Status 3.17 Percentage of Respondents by Region, Residence, Gender and Reason Why Stopped Working 3.18 Percentage of Respondents by Region, Residence, Gender and Age When Stopped Working 3.19 Percentage of Respondents by Region, Residence, Gender and Current Occupation 3.20 Percentage of Respondents by Region, Residence, Gender and Working after Retirement 3.21 Percentage of Respondents by Region, Residence, Gender and Longest Occupation 3.22 Percentage of Respondents by Region, Residence, Gender and Age When Started Working 3.23 Percentage of Respondents by Region, Residence, Gender and Independent Source of Income 3.24 Percentage of Respondents by Region, Residence, Gender and Who Most Likely to Help

Financially 3.25 Percentage of Respondents by Region, Residence, Gender and Monthly Financial Need 3.26 Percentage of Respondents by Region, Residence, Gender and Money to Pay for Public Transport 3.27 Percentage of Respondents by Region, Residence, Gender and Does Family Take for Outings 3.28 Percentage of Respondents by Region, Residence, Gender and How Often Change Clothes 3.29 Percentage of Respondents by Region, Residence, Gender, and Use of Fan and Heater 4.1 Percentage of Respondents by Region, Residence, Gender and Current Health Status 4.2 Percentage of Respondents by Region, Residence, Gender and Illness 4.3 Percentage of Respondents by Region, Residence, Gender and Illness of Spouse 4.4 Percentage of Respondents by Region, Residence, Gender and Taking Medicines for Illness 4.5 Percentage of Respondents by Region, Residence, Gender and Spouse Taking Medicines for

Illness 4.6 Percentage of Respondents by Region, Residence, Gender and Age at Heart Attack 4.7 Percentage of Respondents by Region, Residence, Gender and Taking Medicines after Heart

Attack 4.8 Percentage of Respondents by Region, Residence, Gender and Vision 4.9 Percentage of Respondents by Region, Residence, Gender and Wearing of Glasses 4.10 Percentage of Respondents by Region, Residence, Gender and Vision with Glasses 4.11 Percentage of Respondents by Region, Residence, Gender and Difficulty in Hearing in Both Ears 4.12 Percentage of Respondents by Region, Residence, Gender and Use of Hearing Aids 4.13 Percentage of Respondents by Region, Residence, Gender and Body Pain during Last Month 4.14 Percentage of Respondents by Region, Residence, Gender and Bladder and Bowel Control 4.15 Percentage of Respondents by Region, Residence, Gender and Difficulty in Bladder and/or Bowel

Control 4.16 Percentage of Respondents by Region, Residence, Gender and Caregivers 4.17 Percentage of Respondents by Region, Residence, Gender and Overnight Stay at Hospital during

Last Year 4.18 Percentage of Respondents by Region, Residence, Gender and Number of Times Overnight Stay

at Hospital during Last Year 4.19 Percentage of Respondents by Region, Residence, Gender and Type of Medical Facility

(Inpatients) 4.20 Percentage of Respondents by Region, Residence, Gender and Reason for Hospitalisation 4.21 Percentage of Respondents by Region, Residence, Gender and Who Paid for Hospitalisation 4.22 Percentage of Respondents by Region, Residence, Gender and Medical Care without Overnight

Stay

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4.23 Percentage of Respondents by Region, Residence, Gender and Type of Medical Facility (Outpatients)

4.24 Percentage of Respondents by Region, Residence, Gender and Type of Health Practitioner 4.25 Percentage of Respondents by Region, Residence, Gender and Not Visiting a Health Practitioner 4.26 Percentage of Respondents by Region, Residence, Gender and Reason for Not Visiting a Health

Practitioner 4.27 Percentage of Respondents from Northern Punjab by Residence, Gender and Feelings 4.28 Percentage of Respondents from Central Punjab by Residence, Gender and Feelings 4.29 Percentage of Respondents from Southern Punjab by Residence, Gender and Feelings 4.30 Percentage of Respondents by Region, Residence, Gender and Satisfaction with Present Life 5.1 Percentage of Respondents by Gender and Difficulty in Performing ADLs 5.2 Percentage of Respondents by Region, Residence, Gender and Status of ADLs 5.3 Percentage of Respondents by Region, Residence, Gender and Need for Assistance in Performing

ADLs 5.4 Percentage of Respondents by Difficulty in Performing ADLs and Age 5.5 Percentage of Respondents by Region, Residence, Gender and Listening to Radio 5.6 Percentage of Respondents by Region, Residence, Gender, and Reading of Newspaper and

Magazines 5.7 Percentage of Respondents by Region, Residence, Gender and Watching Television 5.8 Percentage of Respondents by Region, Residence, Gender and with whom Watch Television 5.9 Percentage of Respondents by Region, Residence, Gender and Duration of Watching Television 5.10 Percentage of Respondents by Region, Residence, Gender and Attending Social Activities 5.11 Percentage of Respondents by Region, Residence, Gender and Doing Physical Exercise 5.12 Percentage of Respondents by Region, Residence, Gender and Gardening 5.13 Percentage of Respondents by Region, Residence, Gender and Hanging Out with Friends and

Neighbours 5.14 Percentage of Respondents by Region, Residence, Gender and Watching Movies Outside the

House 5.15 Percentage of Respondents by Region, Residence, Gender and Engaging in Volunteer Work Appendix 1 1 Percentage of Respondents by Region, Residence, Gender and Father’s Age at Death 2 Percentage of Respondents by Region, Residence, Gender and Mother’s Age at Death 3 Percentage of Respondents by Region, Residence, Gender and Cause of Father’s Death 4 Percentage of Respondents by Region, Residence, Gender and Cause of Mother’s Death 5 Percentage of Respondents by Region, Residence, Gender and Father’s Education 6 Percentage of Respondents by Region, Residence, Gender and Mother’s Education 7 Percentage of Respondents by Region, Residence, Gender and Father’s Occupation 8 Percentage of Respondents by Region, Residence, Gender and Mother’s Occupation 9 Percentage of Respondents by Region, Residence, Gender and Best Living Arrangement for a

Widow 10 Percentage of Respondents by Region, Residence, Gender and Best Living Arrangement for a

Widower 11 Percentage of Respondents by Region, Residence, Gender and Health Comparison with People of

Same Age 12 Percentage of Respondents by Region, Residence, Gender and Health Comparison with Last Year

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13 Percentage of Respondents by Region, Residence, Gender and Health Status while Growing Up 14 Percentage of Respondents by Region, Residence, Gender and Starting Age of Chronic Diseases 15 Percentage of Respondents by Region, Residence, Gender and Starting Age of Heart Diseases 16 Percentage of Respondents by Region, Residence, Gender and Starting Age of Joint Pains 17 Percentage of Respondents by Region, Residence, Gender and Starting Age of Fractures 18 Percentage of Respondents by Region, Residence, Gender and Sleep Duration 19 Percentage of Respondents by Region, Residence, Gender and Sleep Satisfaction 20 Percentage of Respondents by Region, Residence, Gender and Naps 21 Percentage of Respondents by Region, Residence, Gender and Duration of Naps 22 Percentage of Respondents by Region, Residence, Gender and Body Pain Effect on Activities of

Daily Living 23 Percentage of Respondents by Region, Residence, Gender and Pain in Body Parts 24 Percentage of Respondents by Region, Residence, Gender and Attitude of Family, Relatives and

Friends 25 Percentage of Respondents by Region, Residence, Gender and with whom Listen to Radio 26 Percentage of Respondents by Region, Residence, Gender and with whom Read Newspapers and

Magazines 27 Percentage of Respondents by Region, Residence, Gender and with whom Attend Social

Activities 28 Percentage of Respondents by Region, Residence, Gender and with whom Do Physical Exercise Appendix 2 1 Regional Distribution of Punjab 2 Selected Districts of Each Region (in Bold) 3 Selected Tehsils of Each District (in Bold) 4 Selected Urban Blocks 5 Selected Rural Blocks 6 Identification of Urban Blocks 7 Identification of Rural Blocks 8 Selection and Identification of Urban Blocks of Lahore and Multan 9 Selection and Identification of Urban Blocks of Muzaffargarh and Chakwal 10 Selection and Identification of Rural Blocks of Muzaffargarh and Chakwal

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Chapter 1 Introduction ‘Ageing’ is “the accumulation of changes in an organism or object over time.” In the case of humans, it refers to “a multidimensional process of physical, psychological and social change.” In real life, some aspects of ageing grow and expand over time, while others decline. In short, ageing reflects the biological, physical and social changes that occur in human beings.

There is no universal agreement on the age at which a person should be classified as the elderly. In developing countries such as Pakistan, people aged 60 and above are considered as the elderly. In developed countries, however, people aged 65 and above are considered as the elderly. Moreover, in the developed world, the elderly are further classified into the ‘young old’ (aged between 65 and 74), the ‘middle old’ (aged between 75 and 84) and the ‘oldest old’ (aged 85 and above).

‘Population ageing’, on the other hand, is the increase in the number and proportion of the elderly in a society. Caused mostly by longer life expectancy, low fertility and migration of the youth, population ageing has a significant socioeconomic cost. Providing comprehensive health care facilities and social security to, and making congenial living arrangements for, the elderly are some of the major challenges for both policymakers and society in this regard.

When social environment improves in a country, mostly due to better sanitation, hygiene, nutrition and education, as well as healthy physical activity, people tend to live longer. Those people who maintain a healthy lifestyle during younger years are more likely to enjoy a healthy transition to old age, free of chronic diseases and other ailments commonly associated with ageing. Moreover, such older persons are likely to remain productive in age 60 and above, putting less burden on the society, compared with those who enter old age in frail health with chronic diseases such as diabetes, cardiovascular ailments, arthritis, etc.

The governments of developed countries recognise the special needs of the elderly and allocate adequate resources to improve the living conditions of older persons. Besides, these countries have effective policies and plans for those who are already old, as well as for those who will be entering old age. Compared with this, the situation of the elderly in developing countries is very different: the governments, failing to fully recognise the special needs of older persons, do not allocate sufficient physical and financial resources for their care. The official response to the issues of the elderly generally varies in direct relation to a country’s level of development and the societal recognition of the special needs of older persons. 1.1 Background The concern for the elderly emerged strongly in the First World Assembly on Ageing (Vienna, July-August 1982), when – as part of the United Nations International Plan of Action on Ageing – ‘Principles for Older Persons and Targets on Ageing for 2001’ were adopted. The issue of ageing was further highlighted by the UN General Assembly

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http://en.wikipedia.org/wiki/Time

Resolution 46/91, which more explicitly recognised its importance in less developed regions.

The Programme of Action of the 1994 International Conference on Population and Development (ICPD) provided further impetus for addressing the issue of ageing. It recommended that: 1) Governments should develop social security systems that ensure greater intergenerational and intra-generational equity and solidarity, and that provide support to the elderly through the encouragement of multigenerational families and the provision of long-term support and services; 2) Governments should seek to enhance the self-reliance of the elderly to facilitate their continued participation in society; and 3) Governments, in collaboration with non-governmental organisations and the private sector, should strengthen formal and informal support systems and safety nets for the elderly and eliminate all forms of violence and discrimination against them.

Since then, considerable progress has been made through a number of initiatives aimed at identifying the needs of the elderly. These include the recommendations of the ICPD+5 Technical Meeting on Population Ageing (Brussels, October 1998) and the proposals for key actions for further implementation of the Programme of Action of the ICPD in the Report of the Secretary-General for the 21st Special Session of the UN General Assembly (New York, July 1999).

The Second World Assembly on Ageing (Madrid, April 2002) built upon the concept of creating societies ‘for all ages’. The Plan of Action adopted by the Assembly made several far-reaching recommendations to the member states, and called upon them for changes in attitudes and adjustments in national and international policies, as well as in community, corporate and other organisational practices. 1.2 Selected Studies on Ageing Most research on the situation of the elderly in Pakistan is limited in scope; several attempts have been made to study their quality of life, but none of them is representative of the whole nation. Some of the major surveys and studies on the situation of the elderly in Pakistan have been reviewed in the following: Afzal (1994) did a case study on the consequences of ageing in Pakistan and found that 70 percent of the elderly helped their families generate income without receiving any cash compensation. The study concluded that the majority of the elderly in Pakistan had to work in order to survive.

Dar (1996) studied the status of 100 older persons in an urban community (Allama lqbal Town) of Lahore. The study found that only 34 percent of the male respondents and 27 percent of the female respondents had adequate income. Importantly, over 55 percent of the male respondents and 90 percent of the female respondents reported a lowering of economic status because of old age. The study also found that 33 percent of the male respondents and 67 percent of the female respondents often felt lonely.

Afzal (1999a) did a qualitative study on the elderly, which found that the majority of older men in Pakistan wanted to continue working for income. These people felt that they were losing status in the society and family, and identified insufficient income as a major

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problem for them. The study, therefore, recommended financial assistance, preferably in the form of a social security system, for the elderly.

In another study, Afzal (1999b) found that family was an important source of support for the elderly in Pakistan, but the socioeconomic transformation of the society was affecting family structures in a way that limited their capacity to care for the elderly. The study noted that the majority of the elderly had some chronic disease. It also found that most of the caregivers of the rural elderly were themselves middle-aged or old, while those of the urban elderly were relatively younger.

Clark (1999) conducted a field study on local Zakat committees and estimated that about 400,000 older persons in Pakistan were eligible to receive modest financial help under the National Zakat and Ushr system. The findings suggested that there might be one million or more poor older persons in Pakistan with no earnings at all and that the majority of the elderly were supported by their families, particularly by their sons. The findings also showed that most of the elderly did not rate their health as excellent and a significant number of them rated their diets as inadequate. Moreover, some of the elderly reported that they had lost respect in the family after growing old. The findings also indicated that some of the elderly suffered from loneliness.

The National Council of Social Welfare, Ministry of Women Development, Social Welfare and Special Education, Government of Pakistan (2000) conducted a field survey of 1,000 older persons in Islamabad and another 100 in Lahore to ascertain their situation. The survey findings revealed that 57 percent of the male respondents in urban areas and 80 percent in rural areas had an income of Rs1,000 or less per month. Moreover, 77 percent of the female respondents had no cash income. The findings also revealed that while about two-thirds of the male respondents were not economically dependent on anyone, almost all the female respondents were economically dependent on others. A high proportion of the elderly of both sexes felt that cash income ensured respect in the family. They also suggested that the government should assist the elderly with low incomes by arranging jobs for and providing medical facilities to them. The survey concluded that income and occupation largely influenced the independence of the elderly in Pakistan.

Clark et al (2002) conducted a research study on traditional assumptions about family support for the elderly on six sites in Punjab. The study found that the majority of the elderly (62% women and 58% men) were in their 60s. A significant number of the elderly lived with their married sons, while a few with their unmarried daughters. The findings also confirmed that most of the elderly were engaged in unpaid labour and that the elderly women were rarely involved in decision-making. Moreover, the elderly generally received financial help from their children, but in some cases they also lived fully or partially by drawing upon their savings.

Furthermore, the elderly were usually taken care of by their children or other relatives, especially when they were ill or incapacitated. The study concluded that unless an older person retained the ability to earn for himself or herself, or had income-producing property, or had a child who would provide support, old age in Pakistan implied bleak prospects.

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Nizamuddin and Ahmad (2002) emphasised the need to study the growing ageing population in Pakistan. He made several recommendations towards formulating a national policy on the elderly and ageing population. However, he pointed out that Pakistan was still not prepared to formulate a policy to cater to the needs of growing number of older persons.

Ali and Kiani (2003) conducted a nationwide study on ageing and poverty in Pakistan to assess the wellbeing of the elderly in terms of their quality of life, using indicators such as living arrangements, gender, place of residence and poverty. The findings showed that per capita food and non-food consumption was the major determinant of the quality of life of the elderly. In addition, type of residence and gender contributed significantly to their quality of life. The study also looked into the health status of the elderly and found that they frequently required medical care.

The Pakistan Medical Research Council (2003) conducted a nationwide study involving 2,899 respondents on the health and living conditions of the elderly in Pakistan. The study findings confirmed several observations made by earlier studies: the elderly women lived in poorer conditions than their male counterparts; the rural elderly were less likely to seek medical care than the urban elderly, who had poorer health and higher level of cardiovascular problems; more than one-third of the elderly had to continue working after reaching 60; a very few of the elderly (28% men and 8% women) received pension; the vast majority of the elderly lived with their families and only 6 percent lived alone; the elderly living in nuclear families were worse off than those living in joint family system; more than two-thirds of the elderly were supported by married sons; less than one-half of the elderly felt that they were involved in family decision-making; major health problems of the elderly included chronic illnesses such as cardiovascular problems, diabetes, joint pains and respiratory diseases; vision impairment and joint pains were the main causes of disability among the elderly; and the rural elderly had lesser access to health care facilities than the urban elderly.

Hafeez (2004) conducted a study based on 195 elderly men and women from three urban communities of Lahore. The study findings showed that the quality of life had several dimensions for the urban elderly in Pakistan. The study revealed that the elderly were generally happy with their arrangements of co-residence with one or more of their adult offspring. The findings also showed that only a negligible proportion of the elderly had excellent health and that more than one-fourth of them had poor health.

The Government of Pakistan established a high-level National Senior Citizens Task Force in 2002 to identify the socioeconomic and health needs of the elderly, and to draft a comprehensive policy in line with its international commitments. The government also made provisions to exempt the elderly from standing up in queues and paying tax on recreational activities, to give them free access to public libraries, and to appoint focal points for them at public hospitals. In addition, the government set up a few old people’s homes in major cities of the country.

In 2004, the government introduced a draft bill in the National Assembly for the establishment of a National Senior Citizens Council aimed at assisting the elderly in their pursuit of a healthy, productive and meaningful life. The bill, which has been modified considerably since its introduction, is still under active consideration.

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More recently, in February 2008, a national seminar on the theme of ‘Addressing the Unmet Needs of the Elderly in Pakistan’ was organised in Islamabad by the Ministry of Social Welfare and Special Education and the Ministry of Population Welfare, in collaboration with the University of Gujrat, to galvanise support for the enactment of the pending bill on the elderly. 1.3 Demographic Characteristics of the Elderly The population of Pakistan is rapidly increasing and, according to the UN, it is currently estimated to be 185 million. The population of the elderly is also increasing, both in numbers and as a percentage of the total population. The population census of 1981 counted 5.7 million people aged 60 and above. The number of the elderly increased to 7.2 million by the time of the next census in 1998 (an increase of 26% in 17 years). According to UN estimates, there are currently 11.5 million (of the total population of 185 million) people aged 60 and above in Pakistan, of whom 1.1 million are aged 80 and above. These numbers are likely to reach 16 million (of the total population of 226 million) by 2020 and 50 million (of the total population of 335 million) by 2050 (Table 1.1). Table 1.1 Estimated Population of the Elderly in Pakistan by Age,

2010-2050 Age 2010 2020 2050 60 Years and Above 11,458,000 16,087,000 49,802,000 65 Years and Above 7,548,000 10,509,000 33,507,000 80 Years and Above 1,079,000 1,597,000 6,155,000 TOTAL 184,753,000 226,187,000 335,195,000 Source: UNDESA 2009 The elderly currently constitute almost six percent of Pakistan’s total population. With the ongoing demographic transition, their percentage will increase to 16 percent of the country’s total population by 2050. The old age support ratio (number of people aged between 15 and 64 divided by number of people aged 65 and above), which is currently estimated to be 15, is likely to come down to 7 by 2050.

These numbers speak for themselves. When translated into the cost of caring for the elderly, providing them with adequate housing, health care, financial assistance and social support, the numbers will be mindboggling. The ageing population brings with it issues that have no precedence, especially in countries such as Pakistan where an overwhelming proportion of the population lacks access to basic services.

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1.4 The Rationale for Ageing Survey Lukewarm support of the government to the issues of the elderly arises largely from a poor understanding of the underlying dynamics of the special needs of older persons, mainly due to non-availability of reliable information on their living and health conditions, and inadequate recognition of their contribution to economic and social development of the country. In turn, this neglect results in growing exclusion and isolation of the elderly from the mainstream Pakistani society. Besides, the family and societal value structure and norms are changing, and the elderly are not getting the type of support provided by the families earlier. To fully appreciate the changing dynamics, a critical look at the underlying causes is necessary. The present survey and similar activities are important to fully understand and appreciate the issue, so that the government and civil society could design appropriate programmes, policies and interventions for the elderly. Moreover, population ageing is poised to become a formidable public policy issue in Pakistan, as the rapidly changing age structure presents a major resource crisis.

Furthermore, the significance of research on ageing issues in Pakistan can best be viewed in the context of gradual breaking down of traditional family structures, increasing life expectancy, declining birth rates, increasing internal and external migration by the youth, and increasing poverty throughout the country. These factors affect the elderly more than others segments of the population. Moreover, there is an increasing evidence to suggest that a large number of the elderly may be living alone. Instances of their neglect and abuse, as well as of violence against them, are no more anecdotal. Though most children still care for their elders, a large number of the elderly are living in distress, and need protection, care and comfortable living.

Like in most of the developing countries, the problems of the elderly are seldom acknowledged in Pakistan. This is mainly due to indifference of Pakistan’s civil society and government, insufficient interest by international development agencies in the subject, and absence of platforms for the elderly to articulate their needs and demands. Advocacy for the elderly is limited to occasional write-ups and news items on the issue and efforts by a handful of NGOs. Moreover, actual circumstances of the older persons’ lives are rarely studied.

Coping with the increasing number of the elderly in the midst of widespread poverty and inadequate health care systems requires innovative planning and substantive policy reforms on an urgent basis. However, the needs seem to far exceed the existing resources and national capacities. Despite the growing size of the elderly population, ageing remains largely invisible in public policies and programmes. On the other hand, issues such as unemployment, illiteracy, child labour and poverty are perceived as more pressing and receive attention and resources. 1.5 Why Punjab? The major reason for conducting this survey in Punjab was that it is Pakistan’s largest province in terms of population and it could thus provide a solid basis for a potential nationwide survey. However, this does not necessarily imply that the situation of the

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elderly is similar in all parts of the country. In fact, it is more likely that the elderly in Balochistan, Gilgit-Baltistan, the NWFP and Sindh have greater needs than their counterparts in Punjab, mainly because of the spatial distribution of the population and difficult terrain, which makes medical and health care facilities inaccessible for many. Punjab was also selected in the hope that the support of the government and international development agencies could be garnered for a nationwide study. Yet another reason for selecting Punjab was its geographical proximity to the University of Gujrat. 1.6 Objectives of the Survey The main objectives of the survey were to assess the physical and mental health and financial conditions of the elderly based on sex, marital status, living arrangements, dependency relationships and activities of daily living (ADLs); develop database for building national capacity to undertake research of the rapidly changing population age structure and its implications; develop advocacy strategies leading to policy action for the aged; and elicit international support and technical assistance on the issue. 1.7 Institutional Framework The survey was conducted by the University of Gujrat in collaboration with the United Nations Population Fund (UNFPA) and the Bureau of Statistics, Government of the Punjab. UNFPA provided the required financial assistance, while the Bureau of Statistics, Government of the Punjab, extended technical and field support for the project. 1.8 Sampling Design To save time and resources, the sampling frame developed by the Bureau of Statistics, Government of the Punjab, for the ‘Multiple Indicator Cluster Survey 2007-08’ was used (see Appendix 2 for details about this survey’s sampling design). Details of rural and urban blocks of all the selected tehsils (sub-districts) are available in this frame. Within a tehsil, cities or towns have been divided into enumeration blocks (EBs) consisting of on average 200-250 households, while villages have been divided into rural blocks consisting of on average 250-300 households.

The living conditions of the elderly in Punjab are heterogeneous, so the province was divided into three regions: Central, Northern and Southern (Appendix 2, Table 1). A four-stage cluster sampling design was used. At the first stage, about one-third of the districts from each of the three regions (10 in all: two from Northern Punjab, five from Central Punjab and three from Southern Punjab) were selected with probability proportional to size (PPS) of their population (Appendix 2, Table 2). At the second stage, about one-half of the tehsils from each selected district were selected with PPS of their population (Appendix 2, Table 3). At the third stage, urban and rural blocks were selected from each of the selected tehsils (Appendix 2, Tables 4 and 5). In case of 20 urban blocks or more, two were identified with PPS of their population; while in case of less than 20 urban blocks, only one was identified with PPS of its population (Appendix 2, Table 6). For

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rural areas, almost five percent blocks were identified with PPS of their population (Appendix 2, Table 7).

As a last minute decision, it was decided that the survey would also be conducted in the urban areas of two additional districts: Lahore and Multan (Appendix 2, Table 8). Moreover, on special request of UNFPA, both urban and rural areas of Muzaffargrah and Chakwal districts were included in the sampling design (Appendix 2, Tables 9 and 10). This increased the number of districts in which this survey was conducted to 14. The selection criteria for blocks of the four additional districts were the same as discussed above. In all, 116 blocks were selected, of which 42 were urban and 74 were rural (Table 1.2). Table 1.2 Distribution of Selected Blocks by Residence and Region

Region Urban Rural Total Northern Punjab 9 15 24 Central Punjab 19 37 56 Southern Punjab 14 22 36

TOTAL 42 74 116 For each selected block, a sampling frame for eligible households was prepared. At the fourth and final stage, 40 eligible households (having at least one member aged 60 and above) for all selected urban and rural blocks were selected randomly. This way, the total sample size came to 4,640.

It was decided before the field survey that one cluster would be covered in one day; and if the interviewer failed to find the respondent from any selected household, then he/she would consider the immediate next eligible household. Due to such limitations and some other reasons, some non responses were also recorded (Table 1.3). Of the 4,640 selected households, 4,476 (96.47%) were successfully interviewed. Of these, 285 respondents (6.38%) were found to be aged less than 60. This group was excluded from the final analysis, thus the final sample size came to 4,191. Table 1.3 Response Rate Status of Response Number of Households Percent Completed 4,476 96.47 Partially Completed 39 0.84 Refused 28 0.60 Not at Home 55 1.19 House not Located 33 0.71 Others 9 0.19

TOTAL 4,640 100.00

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1.9 Formulation of the Questionnaire The Technical Advisory Committee (Appendix 4) formed to supervise the survey discussed and reviewed various types of questionnaires. In particular, the questionnaires developed by the World Health Organization (WHO) and the Population Institute, University of Philippines, were considered. After reviewing these questionnaires, the Committee decided to adopt international protocols, thus the questionnaire for the survey is based on internationally agreed set of questions. However, the questions were slightly modified to make them in line with the local realities. Initially, two questionnaires were drafted. One questionnaire was designed to collect data on general characteristics of the household and co-residential arrangements for the elderly. The other questionnaire was aimed at collecting individual information about the physical and mental health and activities of daily living (ADLs) of the elderly.

The questionnaires for the survey were first pretested on 45 respondents in the adjoining areas of Gujrat district. Based on the results of pretesting, some changes were made to the main individual questionnaire. For example, Section B on information about children and grandchildren of the respondents was excluded. Section C on the health status of the respondents was modified. Section D was divided in two parts: Physical Ability and Disability, and Activities of Daily Living. Moreover, in this section, questions regarding the spouse of the respondent were included and culturally sensitive questions were excluded. Section H about information on income and assets of the respondents was excluded because, during pretesting, it was observed that the respondents were reluctant to answer such questions. A new section I was included in the main individual questionnaire to assess the financial needs of the respondents. Importantly, the household questionnaire was added to the main individual questionnaire as Section J (see Appendix 3 for the survey questionnaire.). During pretesting, the respondents were initially reluctant to answer questions about housing facilities. However, once a rapport was built between the interviewer and the respondent, it became easier to extract such information.

A community questionnaire was also administered in all the selected clusters. The related data has not yet been processed, but it will be used for elaborate analysis in the future. Moreover, a manual was developed to facilitate the interviewers in completing the questionnaire. The Manual was also modified on the basis of the results of the questionnaires’ pretesting. 1.10 Selection and Training of Field Teams Four teams of seven members each were constituted for the field work (Appendix 4). The team members were selected from UOG as well as the Bureau of Statistics, Government of the Punjab. Each team consisted of five interviewers, one field editor and one field supervisor. The interviewers were responsible for collecting the data and completing the questionnaire. The field editors were responsible for editing the completed questionnaires before sending them to the project headquarters at UOG’s Centre for Population, Urban and Environment Studies for office editing and data entry (see Appendix 4 for list of data entry operators/office editors). The field supervisors were responsible for identifying the households and the respondents.

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After finalisation of the questionnaire, selection of the field teams and identification of the sample areas, a five-day extensive training workshop was conducted for the field staff. This training used a mixed method approach involving both theoretical and practical aspects. On the first and second day, the participants were given an orientation on how to fill different sections of the questionnaire. On the third day, mock interviews were conducted within the classroom. The interviewers completed the questionnaires and the field editors checked on the spot that they had been duly completed. Moreover, as part of the training, all team members were sent to the field to collect data from both rural and urban respondents. 1.11 Field Operations As mentioned above, four field teams (two for Central Punjab and one each for Northern and Southern Punjab) were involved in data collection. These teams covered both urban and rural sample areas. They also sought help of local chowkidars and senior community members in the field operations. To ensure quality data collection, the core project team (Appendix 4), including the Project Director and Deputy Project Director, monitored field operations through regular visits, meetings with team members and experience sharing. In addition, the Director General and Deputy Director of the Bureau of Statistics, Government of the Punjab, also made supervisory visits to the field.

Although the respondents generally cooperated with the field interviewers, especially in rural areas, at times it was difficult to extract information from them, so much so that many of the potential respondents simply refused to participate in the survey. A great deal of effort had to be made to assuage their fears and make them cooperate. In some cases, mostly in urban areas, the people would not even open the door.

The household lists provided at the beginning of the survey had to be updated during the process, putting an additional burden on the field teams. Many of the potential respondents had passed away and they had to be substituted by the immediate next eligible household. In three cases, the potential respondents had died just a few days before the interviewer reached their place.

The field teams contacted local nazims or naib nazims in each cluster, to get a local escort to help identify the sample households. However, in many instances, they failed in securing this cooperation. Another major problem encountered by the field teams was unavailability of the respondents for various reasons, including being away from home for work in the fields.

The interviewers also faced hostility when they sought the respondents’ opinion about old people’s homes. Many of the respondents thought that the field teams were there to sell a new idea, which they considered alien and un-Islamic. In an extreme case, a field team was physically intimidated and the situation was pacified only after the supervisor intervened.

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1.12 Data Tabulation and Analysis Unique ID codes were developed for error-free data entry. These compound ID codes consisted of codes for each region, district, tehsil, rural/urban block and respondent. They helped in locating, identifying and rechecking particular completed questionnaires and omitting the errors once the entry had been made. After the first week of field survey, the field teams started sending completed questionnaires for office editing and data entry to the project headquarters. Subsequently, data files were created using the SPSS package. The data entry process was completed by June-August 2009. Next, analytical data files were created and the data was analysed using them. The statistical analysis was completed by October 2009 and the preliminary draft of the survey analysis was finalised by December 2009. Moreover, two meetings of the Technical Advisory Committee were held to review the analysis and finalise the survey report.

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Chapter 2 Living Arrangements and Housing Conditions

Living arrangements of the elderly is one of the major issues in gerontological research. Modernisation theorists argue that the status and wellbeing of the elderly is closely linked with their living arrangements. Extensive research has been conducted on this issue in the developed world, but little attention has been paid to it in the developing world. This is mainly because in developing countries the responsibility to support and take care of the elderly rests largely with the family, primarily with the children. 2.1 Household Characteristics The survey collected information about various facilities in the household – such as access to electricity, type of electronic gadgets and agricultural tools, main source of drinking water, type of toilet facilities, etc – as well as tenancy arrangements and type of materials used to construct the house. In addition, views of the respondents were sought about the usefulness of and need for old homes and community centres .The finding have been summarised in the following: 2.1.1 Living Arrangements Housing is a key component of living arrangements. The survey investigated various aspects of housing available to the respondents. A number of questions, ranging from the number of rooms in the house they lived in to whether they had a separate room for themselves, were asked from the respondents to ascertain the quality of housing available to them.

The survey made evident that more than one-half (51%) of the respondents had a separate room for themselves (Table 2.1). Over 90 percent of the respondents reported living in a house with more than one room, but that does not mean much given Pakistan’s average household size of 7.2. Thirty percent of the respondents reported living in a house with two rooms, 27 percent in a house with three rooms and 34 percent in a house with more than three rooms. Only 4 percent of the respondents said that they lived in a house with seven or more rooms.

Most of the elderly lose the ability to perform one or more activities of daily living and what becomes more important than the housing facility is the kind of care they get. Therefore, the fact that 51 percent of the respondents had a separate room for themselves did not necessarily imply needful living arrangement. On the one hand, availability of a separate room indicates greater independence and socioeconomic status; while, on the other, it might also be inferred that they do not have a caregiver right there when they need one.

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Table 2.1 Percentage of Respondents by Region, Residence, Number of Rooms in House and Separate Room for the Elderly

Number of Rooms in House Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural 1 2.6 8.3 7.3 9.1 7.9 14.5 6.5 10.5 9.1 2 21.3 24.6 30.3 33.1 34.7 28.7 29.7 30.2 30.0 3 27.8 26.2 26.1 29.8 24.0 24.3 25.8 27.5 27.0 4 26.5 21.3 19.4 16.8 16.2 17.7 20.0 17.9 18.6 5 10.1 8.3 8.4 6.0 8.1 6.5 8.7 6.6 7.3 6 4.9 6.5 4.1 3.2 4.3 3.2 4.3 3.8 4.0 7 or More 6.9 5.0 4.3 2.0 4.8 5.2 5.0 3.5 4.0 Separate Room for the Elderly 63.1 53.9 57.8 45.0 42.1 53.5 54.4 49.1 51.0 TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191

2.1.2 House Ownership and Materials Used The survey findings revealed that 94 percent of the respondents lived in a house owned by them or by their family (95% in the rural and 92% in the urban areas). According to the 1998 population census, only 83 percent of the households in Punjab were owned. The sudden jump in ownership patterns is questionable in the light of socioeconomic conditions prevailing in the province and may be attributed to the small sample size. Southern Punjab was the only region where more urban (94%) than rural respondents (92%) lived in a house owned by them or by their family (Table 2.2). The rural areas of Northern Punjab had the highest percentage (96%) of respondents who lived in a house owned by them or by their family. Interestingly, the lowest percentage (85%) of respondents who lived in a house owned by them or by their family was recorded from the urban areas of Northern Punjab.

The respondents were also asked about the kind of materials used in the construction of their house. The survey showed that 80 percent of the respondents lived in concrete houses. In Central and Southern Punjab, more urban respondents (95% and 86%, respectively) reported living in concrete houses than their rural counterparts (83% and 64%, respectively). Surprisingly, however, in Northern Punjab the percentage of urban respondents (71%) living in concrete houses was lower than that of the rural respondents (74%). Almost one-half of the respondents reported having cement/marble floors in their house. However, the percentage of urban respondents (76%) who had cement/ marble floor in their houses was much higher than the rural respondents (36%). This disparity was most obvious in Southern Punjab, where 53 percent of the urban respondents reported having cement/marble floor in their houses, compared with only 15 percent of the rural respondents.

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Table 2.2 Percentage of Respondents by Region, Residence, House Ownership and Materials Used

House Ownership and Materials Used

Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural

Ownership 85.0 96.4 92.9 96.3 94.3 91.5 91.7 94.9 93.8

Outer Wall Material

Concrete 71.2 73.6 94.8 83.3 86.3 63.5 87.5 75.8 79.9 Others 28.8 26.4 5.2 16.7 13.7 36.5 12.5 24.2 20.1

Floor Material

Earth/Sand 3.0 38.0 13.7 54.6 22.4 72.7 14.0 56.7 41.8 Cement/Marble 90.2 55.0 82.7 40.4 52.7 15.3 75.6 35.9 49.7 Others 6.9 7.0 3.5 5.1 24.9 12.0 10.4 7.4 8.5

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.1.3 Access to Electricity The availability of electricity in Punjab is nearly universal: 96 percent of the respondents reported that they had access to the facility (Table 2.3). The only exception was the rural Southern Punjab, from where 12 percent of the respondents said that they did not have access to electricity. Table 2.3 Percentage of Respondents by Region, Residence and

Access to Electricity Access to Electricity Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural Yes 100.0 97.5 98.5 98.4 97.9 87.7 98.6 95.1 96.3 No 0.0 2.5 1.5 1.6 2.1 12.3 1.4 4.9 3.7

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.1.4 Access to Water The survey showed that tube-well or borehole was the main source of drinking water for 35 percent of the respondents (Table 2.4), followed by piped water into house (28%) and hand pump (26%). However, huge variations existed between the urban areas of Central and Southern Punjab. While the majority (53%) of the respondents in the urban Central Punjab had access to piped water supply, more than two-thirds (68%) of the respondents in the urban Southern Punjab relied on tube-well or borehole for drinking water. Understandably, hand pump was the main source of drinking water for the majority (55%) of the respondents in the rural Southern Punjab. Interestingly, according to the survey findings, more rural (87%) than urban (66%) respondents reported that water was always available to them (Table 2.5). In Central Punjab, this difference was the highest: as opposed to 85 percent of the rural respondents, only 53 percent of the urban respondents reported that water was always available to them.

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Table 2.4 Percentage of Respondents by Region, Residence and Main

Source of Drinking Water Main Source of Drinking Water


Piped into House 32.0 29.3 53.2 32.6 11.7 2.4 36.9 23.3 28.0 Piped to Yard/Plot 13.4 14.5 6.2 2.2 2.1 0.6 6.6 4.0 4.9 Tube-Well/Borehole 39.8 34.2 21.8 28.9 67.9 38.1 38.8 32.5 34.7 Hand Pump 6.9 16.0 5.2 32.3 15.3 55.4 8.4 35.9 26.3 Others 7.9 5.9 13.6 4.1 2.9 3.4 9.3 4.3 6.0

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 Table 2.5 Percentage of Respondents by Region, Residence and

Availability of Water Availability of Water Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural Always 59.8 78.4 52.9 84.7 93.1 96.0 65.9 86.8 79.5 Several Hours Per Day 40.2 21.6 47.1 15.3 6.9 4.0 34.1 13.2 20.5

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 The survey found that the vast majority (93%) of the respondents used untreated water (Table 2.6). Overall, the use of treated water was more prevalent in the urban areas than the rural areas, from where only a fraction (2%) of the respondents said that they used treated water. Moreover, there was considerable variation in the use of treated water in the urban areas of Northern, Central and Southern Punjab. Table 2.6 Percentage of Respondents by Region, Residence and Use of

Treated Water Use of Treated Water


Yes 29.8 4.2 16.7 2.1 7.9 0.7 16.9 2.1 7.2 No 70.2 95.8 83.3 97.9 92.1 99.3 83.1 97.9 92.8

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.1.5 Toilet Facilities According to the survey findings, the majority (75%) of the respondents in the urban areas used flush toilets (Table 2.7). However, in the rural areas, only 37 percent of the

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respondents had this facility; and they either used dry toilets (33%) or went outside (30%). The situation was the worst in the rural parts of Southern Punjab, where 48 percent of the respondents said that they had to go outside because of the absence of any type of toilet facility in their house. Compared with this, 95 percent of the respondents used flush toilet in the urban areas of Northern Punjab. Table 2.7 Percentage of Respondents by Region, Residence and Type

of Toilet Facility Type of Toilet Facility Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural Flush 94.5 54.9 68.5 32.9 72.7 31.3 75.2 36.5 50.0 Dry 4.9 16.2 29.5 46.4 15.8 20.5 20.4 33.3 28.8 Outside 0.6 29.0 1.9 20.7 11.5 48.3 4.4 30.2 21.2

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.1.6 Cooking Fuel The survey showed that 29 percent of the respondents had natural gas connections and almost twice as many still used wood for cooking (Table 2.8). However, the situation with regard to natural gas connections was not the same in the urban and rural areas: while 71 percent of the urban respondents reported that they had natural gas connections, only 7 percent of the rural respondents enjoyed this facility. The situation was the worst in the rural areas of Southern Punjab, where very few households had natural gas connections. Table 2.8 Percentage of Respondents by Region, Residence and Type

of Fuel Used Type of Fuel Used Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural Natural Gas 65.0 16.0 81.1 7.8 58.1 0.1 71.1 7.1 29.4 Gas Cylinder 15.0 6.3 1.8 5.1 4.3 0.5 5.3 4.0 4.5 Wood 17.7 74.4 13.9 80.5 36.3 75.7 21.1 78.0 58.2 Dung 2.0 2.0 2.9 6.5 0.9 23.5 2.1 10.6 7.6 Others 0.6 1.4 0.4 0.1 0.2 0.1 0.4 0.4 0.4

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.2 Access to Information and Communication Technologies The survey also studied the respondents’ access to information and communication technologies (ICTs). The vast majority (74%) of the respondents had at least one cellular phone in their house (Table 2.9). In the urban areas, 83 percent of the respondents

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reported having at least one cellular phone in their house; while in the rural areas, 69 percent of the respondents replied in the affirmative to this question. In comparison, only 15 percent of the respondents (26% in the urban and 9% in the rural areas) had a landline in their house.

The survey also showed that almost two-thirds (66%) of the respondents (82% in the urban and 58% of the rural areas) had at least one television set in their house. The numbers, however, took a steep drop when it came to having a radio in the house. The data indicated a very interesting, though unsurprising, shift in terms of reliance on television vis-à-vis the more traditional radio as the primary source of information and entertainment: only 25 percent of the respondents said they had a radio set in the house.

The survey revealed that only 11 percent of the respondents had a CD/DVD player in their house. More urban respondents (17%) had a CD/DVD player in their house than their rural counterparts (7%). An almost similar percentage (10%) of the respondents had a personal computer in their house. Computers also remained more of an urban luxury: 21 percent of the urban respondents, against only 5 percent of the rural respondents, had a computer in their house.

As expected, the urban areas of Northern Punjab fared the best on both these counts: 26 percent and 33 percent of the respondents from these areas reported having a CD/DVD player and a computer, respectively, in their house. In comparison, only 3 percent and 2 percent of the respondents from the rural areas of Southern Punjab reported having a CD/DVD player and a computer, respectively, in their house. Table 2.9 Percentage of Respondents by Region, Residence and

Access to ICTs Access to ICTs Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural Landline 50.0 19.1 24.2 9.1 12.7 2.9 26.3 9.2 15.2 Cellular Phone 87.6 75.4 86.5 76.7 74.6 49.6 83.3 68.6 73.8 Television 93.5 70.7 84.9 66.3 66.7 33.8 81.5 57.8 66.0 Radio 32.4 30.7 18.6 26.8 28.5 18.9 24.3 25.3 24.9 CD/DVD Player 25.8 11.2 17.8 7.9 8.1 3.4 16.7 7.2 10.5 Computer 33.3 8.3 20.1 4.9 13.6 1.9 21.0 4.6 10.4

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.3 Household Appliances Among household appliances, the survey studied the ownership of washing machines and refrigerators/freezers (Table 2.10). The data showed that 74 percent of the urban respondents had a washing machine in their house, compared with only 37 percent of the rural respondents. The same trend was witnessed when the respondents were asked whether they had a refrigerator/freezer in their house: 63 percent of the urban and 38

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percent of the rural respondents replied in the affirmative to this question. While these household possessions are an indicator of the socioeconomic status of the family, they also have a bearing on the level of comfort enjoyed by the elderly, especially women. Table 2.10 Percentage of Respondents by Region, Residence and

Possession of Household Appliances Possession of Household Appliances


Washing Machine 89.6 55.7 75.3 41.3 58.8 18.3 73.6 37.3 49.9 Refrigerator/Freezer 86.0 57.9 64.6 41.8 41.4 16.7 62.5 37.6 46.2

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191 2.4 Means of Transportation The ownership of various means of transportation was yet another measure of socioeconomic wellbeing studied by the survey (Table 2.11). The questionnaire included the most common types of transportation, such as car/jeep/van, motorcycle and bicycle. However, because the majority of the respondents were from the rural areas, the survey also collected information about the ownership of tractors.

According to the survey, only 6 percent (10% in the urban and 4% in the rural areas) of the respondents said that their family owned a car, jeep or van, most of them in the urban areas. The rural areas of Southern Punjab, where only 2 percent of the respondents had a car, jeep or van, fared the worst on this count; while the urban areas of Northern Punjab, where 21 percent of the respondents had a car, jeep or van, fared the best the on this count. The ownership of motorcycle by the family was more common and 28 percent of the respondents in the affirmative to this question.

However, bicycle was by far the most common type of transport and 46 percent of the respondents reported that they had one in their house. Tractor was reported as a means of transportation by 6 percent of the rural respondents. Table 2.11 Percentage of Respondents by Region, Residence and

Ownership of Transport Ownership of Transport


Car/Jeep/Van 20.6 8.2 8.9 3.2 4.8 1.6 10.2 3.7 6.0 Motorcycle 37.6 25.4 37.0 25.3 28.7 23.1 34.8 24.7 28.2 Bicycle 33.0 27.2 46.1 53.3 42.8 51.2 42.4 47.8 46.0 Tractor 0.6 5.5 0.7 5.2 0.2 6.6 0.5 5.6 3.9

TOTAL 306 508 735 1,437 418 787 1,459 2,732 4,191

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2.5 Views about Old People’s Homes The survey also solicited views of the respondents about old people’s homes. The objective was to ascertain whether they liked the idea and if such a facility was available to them, would they avail it. The respondents were first explained that an old people’s home was a place where the elderly could live together away from their families (Table 2.12). The data suggested that the vast majority (77%) of the respondents supported the idea of old people’s homes and agreed that there should be such a facility.

Interestingly, more than one-fourth (28%) of the rural female respondents were against old people’s homes. However, there were huge differences in the perceptions of even rural female respondents in this regard: compared with only 13 percent of the rural female respondents from Southern Punjab, 37 percent of the rural female respondents from Central Punjab opposed the idea of old people’s homes. Table 2.12 Percentage of Respondents by Region, Residence, Gender

and Support for Old People’s Homes

Support Old People’s Homes

Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural

M F M F M F M F M F M F M F M F

Yes 76.9 71.9 84.1 77.3 82.4 86.6 70.5 63.0 79.9 75.3 87.2 87.4 80.5 80.4 77.9 72.5 77.1

No 23.1 28.1 15.9 22.7 17.6 13.4 29.5 37.0 20.1 24.7 12.8 12.6 19.5 19.6 22.1 27.5 22.9

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

Those respondents who favoured old people’s homes were further asked about the reason for supporting the idea. The majority (69%) of the respondents said that old people’s homes were good for lonely older persons (Table 2.13). Especially in Southern Punjab, more than 80 percent of the respondents, irrespective of place of residence and gender, supported old people’s homes for this reason.

The provision of good health care to the elderly was cited as the reason for favouring old people’s homes by 16 percent of the respondents. The idea was also supported by 9 percent of the respondents because they felt that old people’s homes would relieve the family of taking care of the elderly. Finally, 5 percent of the respondents favoured old people’s homes because they felt that they could provide a good social circle to the elderly.

Similarly, the respondents who did not favour old people’s homes were further asked about the reason for not supporting the idea. According to the survey, the majority (56%) of respondents were against the idea because they felt that it was the responsibility of the family to take care of the elderly (Table 2.14).

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Table 2.13 Percentage of Respondents by Region, Residence, Gender and Reason for Supporting Old People’s Homes

Reason for Supporting Old People’s Homes

Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Relieve Family of Taking Care 14.6 7.6 14.2 8.6 9.8 9.8 14.7 11.2 3.4 3.4 2.3 1.8 8.9 7.8 10.5 7.5 8.8

Good Health Care 6.5 9.5 16.0 18.7 19.7 15.8 25.5 19.9 8.4 8.9 13.0 11.1 13.7 12.9 19.5 16.7 16.4 Good Social Circle 3.3 3.8 6.6 2.0 10.8 7.6 6.2 3.9 2.8 1.4 2.3 1.2 6.9 5.3 5.0 2.6 4.7 Good for Lonely Older Persons 74.8 78.1 62.3 70.7 58.7 65.8 53.2 64.6 83.2 84.2 81.9 84.4 69.2 72.8 64.5 72.5 69.3

Others 0.8 1.0 0.9 0.0 1.0 0.9 0.4 0.4 2.2 2.1 0.6 1.5 1.3 1.2 0.6 0.7 0.9

TOTAL 123 105 212 198 305 316 502 457 179 146 353 334 607 567 1,067 989 3,230 Table 2.14 Percentage of Respondents by Region, Residence, Gender

and Reason for Not Supporting Old People’s Homes

Reason for Not Supporting Old People’s Homes


Family Should Take Care of the Elderly 70.3 61.0 47.5 60.3 52.3 59.2 57.6 60.8 31.1 39.6 55.8 47.9 50.3 52.9 56.0 59.1 55.9

The Elderly will Miss their Families 18.9 24.4 37.5 29.3 16.9 16.3 21.0 20.9 22.2 16.7 17.3 18.8 19.0 18.8 22.5 21.9 21.2

The Elderly Cannot Live with Strangers 2.7 4.9 10.0 5.2 7.7 0.0 13.3 6.0 0.0 0.0 3.8 0.0 4.1 1.4 11.3 5.1 6.3

Shameful for Family 5.4 9.8 5.0 5.2 20.0 14.3 8.1 10.1 40.0 27.1 21.2 12.5 22.4 17.4 9.9 9.6 12.8

Others 2.7 0.0 0.0 0.0 3.1 10.2 0.0 2.2 6.7 16.7 1.9 20.8 4.1 9.4 0.3 4.3 3.7

TOTAL 37 41 40 58 65 49 210 268 45 48 52 48 147 138 302 374 961

Especially in the urban Northern Punjab, 70 percent of the male and 61 percent of the female respondents did not favour old people’s homes on these grounds. In comparison, only 31 percent of the male and 40 percent of the female respondents in the urban Southern Punjab opposed the idea because of this reason. In the urban South Punjab, 40 percent of the male and 27 percent of the female respondents said that it would be shameful for their families if the elderly lived in an old people’s home.

Furthermore, all the respondents were asked that if there was an old people’s home near their current residence, would they ever want to live there. Responding to this question, more than one-half (59%) of the respondents replied in the negative (Table 2.15). The survey showed that more male than female respondents wanted to live in an old people’s

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home: 40 percent of the male respondents, against 34 percent of the female respondents, in the urban areas; and 47 percent of the male respondents, against 36 percent of the female respondents, in the rural areas. Interestingly, the majority of the male respondents from the rural Southern Punjab said that they wanted to live in an old people’s home. Table 2.15 Percentage of Respondents by Region, Residence, Gender

and Desire to Live in Old People’s Homes

Desire to Live in Old People’s Homes


Yes 24.4 32.2 44.0 35.2 46.8 37.0 46.8 33.5 38.8 28.4 50.1 41.1 39.7 33.6 47.3 36.0 39.9

No 68.1 64.4 53.6 64.1 51.1 62.7 52.4 65.7 59.8 70.6 49.6 58.1 57.3 65.2 51.8 63.2 58.8

Do Not Know 7.5 3.4 2.4 0.8 2.2 0.3 0.8 0.8 1.3 1.0 0.2 0.8 3.1 1.1 0.9 0.8 1.3

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

The respondents were further asked if they wanted to go to an old people’s home right now. Responding to this question, more than two-thirds (69%) of the respondents replied in the negative (Table 2.16). This shows that they were opposed to the idea because it sounded foreign in our cultural context. The survey showed that, again, more male than female respondents wanted to go to an old people’s home right now: 29 percent of the male respondents, against 25 percent of the female respondents, in the urban areas; and 38 percent of the male respondents, against 26 percent of the female respondents, in the rural areas. Table 2.16 Percentage of Respondents by Region, Residence, Gender

and Desire to Live in Old People’s Homes Right Now

Desire to Live in Old People’s Homes Right Now


Yes 11.9 16.4 31.7 22.3 34.3 28.8 39.2 26.1 30.8 22.7 38.8 29.8 28.5 24.5 37.7 26.4 30.2

No 85.6 81.5 67.5 77.7 64.1 70.7 60.1 73.4 68.8 76.3 61.0 69.6 70.0 74.5 61.7 73.1 69.1

Do Not Know 2.5 2.1 0.8 0.0 1.6 0.5 0.7 0.6 0.4 1.0 0.2 0.5 1.5 1.0 0.6 0.4 0.8

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

2.6 Views about Community Centres The survey also solicited views of the respondents about community centres (Table 2.17). The objective was to ascertain whether they liked the idea and if such a facility was available to them, would they avail it. The respondents were first explained that a

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community centre was a place where the elderly could engage in various kinds of activities, such as meeting people of their age, getting checked up by a nurse, gardening, watching television, reading newspapers and magazines, etc. Table 2.17 Percentage of Respondents by Region, Residence, Gender

and Desire to Visit Community Centre Right Now

Desire to Visit Community Centre Right Now


Yes 49.4 40.4 61.9 42.6 74.9 65.5 76.5 54.2 48.2 29.9 56.0 45.8 61.6 50.5 67.8 49.7 57.9

No 50.7 59.6 37.3 57.0 24.6 33.7 23.3 45.5 50.0 68.0 43.5 54.2 37.7 48.5 31.9 50.1 41.6

Do Not Know 0.0 0.0 0.8 0.4 0.5 0.8 0.1 0.3 1.7 2.0 0.5 0.0 0.8 1.0 0.3 0.2 0.5

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

Although there are no such community centres for the elderly in Pakistan, the respondents were asked whether they wanted to visit a community centre right now. The data suggested that more than one-half (58%) of the respondents replied in the affirmative to this question. More male than female respondents said that they wanted to visit a community centre right now: 62 percent of the male respondents, against 51 percent of the female respondents, in the urban areas; and 68 percent of the male respondents, against 50 percent of the female respondents, in the rural areas.

Interestingly, the respondents were most receptive to the idea of community centres in Central Punjab, where 75 percent of the male and 66 percent of the female respondents in the urban areas and 77 percent of the male and 54 percent of the female respondents showed keen interest in visiting a community centre right now.

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Chapter 3 Demographic and Socioeconomic Status The demographic and social characteristics of the respondents have been summarised in this chapter. The survey collected information about the respondents’ age, place of growing up, occupation, age when started working and reason for stopping work; as well as their attitudes and beliefs regarding gender roles, rights and responsibilities of children, and best living arrangement for unmarried older persons.

In addition, the survey gathered data about the education, working status and place of growing up of the respondents’ spouses. However, the profile of the respondents’ spouses has not been included in this analysis. The purpose of collecting this information was to have a complete profile of the elderly and to assess whether socio-demographic characteristics influence their attitudes, perceptions and health status. For instance, the respondents’ education and working status may influence their perceptions and attitudes, as well as their tasks and activities. 3.1 Demographic Status Of the respondents, 19 percent were from Northern Punjab, 52 percent from Central Punjab and 29 percent from Southern Punjab (Table 3.1). Of these, almost two-thirds (65%) were from the rural areas and the remaining 35 percent from the urban areas. The current division of Punjab’s population is more or less along similar lines, with big cities like Lahore, Faisalabad and Gujranwala falling in Central Punjab. Similarly, the urban and rural population of the province is also divided along the pattern reflected in the survey.

Furthermore, in line with the current distribution of Punjab’s population, 18 percent of the respondents were urban men (4% from Northern Punjab, 9% from Central Punjab and 5% from Southern Punjab) and 33 percent were rural men (6% from Northern Punjab, 17% from Central Punjab and 10% from Southern Punjab); while 17 percent were urban women (4% from Northern Punjab, 9% from Central Punjab and 5% from Southern Punjab) and 33 percent were rural women (6% from Northern Punjab, 17% from Central Punjab and 9% from Southern Punjab). Table 3.1 Percentage and Number of Respondents by Residence,

Gender and Region Region Urban Rural Total

M F M F Northern Punjab 3.8 (160) 3.5 (146) 6.0 (252) 6.1 (256) 19.4 (814) Central Punjab 8.8 (370) 8.7 (365) 17.0 (712) 17.3 (725) 51.8 (2,172) Southern Punjab 5.3 (224) 4.6 (194) 9.7 (405) 9.1 (382) 28.8 (1.205)

TOTAL 34.8 (1,459) 65.2 (2,732) 100 (4,191)

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Surprisingly, in stark contrast to global and regional trends, the female respondents outnumbered the male respondents in only one category of the elderly. As many as 59 percent of the female respondents were from the age group of 60-69, compared with 52 percent of the male respondents (Table 3.2).

In the age group of 70-79, there were more male respondents than the female respondents (33% of the male respondents were from this age category, compared with 28% of the female respondents). Similarly, in the age group of 80 and above, the male respondents outnumbered the female respondents (15% of the male respondents were from this age category, compared with 13% of the female respondents). Table 3.2 Percentage of Respondents by Gender and Age Group Age Group Male Female Total

60-69 51.9 (1,101) 58.5 (1,208) 55.1 (2,309) 70-79 33.1 (702) 28.3 (585) 30.7 (1,287) 80 and Above 15.1 (320) 13.3 (275) 14.2 (595)

TOTAL 100.0 (2,123) 100.0 (2,068) 100.0 (4,191) Overall, 55 percent of the respondents were in the age category of 60-69, 31 percent were in the age category of 70-79 and 14 percent were in the age category of 80 and above. The region-wise breakup of the urban and rural respondents, both male and female, of different age groups shows that the abovementioned trend was uniform throughout the province with the rural Central Punjab being the only exception, from where the female respondents (16%) outnumbered the male respondents (14%) in the age category of 80 and above (Table 3.3). Table 3.3 Percentage of Respondents by Region, Residence, Gender

and Age Group

Age



60-69 50.6 62.3 48.0 57.4 54.9 57.5 52.1 54.2 58.5 62.9 47.9 64.4 55.0 60.0 50.1 57.7 55.1

70-79 32.5 22.6 32.9 28.5 31.4 30.1 33.6 29.9 28.6 25.3 36.5 27.0 30.8 27.2 34.3 28.8 30.7

80 and Above 16.9 15.1 19.0 14.1 13.8 12.3 14.3 15.9 12.9 11.9 15.6 8.6 14.2 12.8 15.6 13.5 14.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 3.2 Place of Growing up The survey attempted to study the settlement patterns and trends of the elderly in Punjab by asking the respondents about their place of growing up. Almost all (99%) of the rural male respondents had grown up in villages (Table 3.4). The ratio was only slightly lower

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(97%) for the rural female respondents. The survey found that only 41 percent of the urban male respondents had grown up in cities, meaning that the majority (59%) of them had spent their childhood in villages. The percentage was even higher (63%) for the urban female respondents.

This finding was corroborated when the respondents were asked about the place of growing up of their spouses. The overwhelming majority (88%) of the respondents’ spouses had also grown up in villages (Table 3.5). The survey findings showed that the spouses of more than two-thirds of the urban respondents (67% males and females each) and almost all the rural respondents (99% females and 97% males) had spent their childhood in villages. This finding is in line with the increasing trend of urbanisation in Punjab. Table 3.4 Percentage of Respondents by Region, Residence, Gender

and Place of Growing Up

Place of Growing Up




City 45.6 34.2 2.4 3.5 33.5 36.2 1.0 3.0 49.6 42.3 0.7 1.3 40.9 37.5 1.2 2.6 14.9

Village 54.4 65.8 97.6 96.5 66.5 63.8 99.0 97.0 50.4 57.7 99.3 98.7 59.1 62.5 98.8 97.4 85.1

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Table 3.5 Percentage of Respondents by Region, Residence, Gender

and Place of Growing Up of Spouse

Place of Growing Up of Spouse


City 36.0 35.2 3.8 1.0 32.6 23.4 2.1 0.6 32.9 50.0 2.6 1.7 33.4 32.6 2.6 1.0 12.0 Village 64.0 64.8 96.2 99.0 67.4 76.6 97.9 99.4 67.1 50.0 97.4 98.3 66.6 67.4 97.4 99.0 88.0

TOTAL 114 54 183 100 242 128 481 343 155 60 304 180 511 242 968 623 2,344 3.3 Parents’ Age at and Cause of Death The survey also asked the respondents whether their parents were still alive. Only 2 percent of the respondents (94 of the 4,191) reported that their father was still alive, while 6 percent (262 of the 4,191) reported that their mother was still alive. Those respondents who said that one or both of their parents had passed away were further asked about the age at the time of death.

Only 13 percent of the respondents reported that their father’s age at the time of death was less than 60, against 27 percent who reported that it was between 80 and 89 (Appendix 1, Table 1). Similarly, only 17 percent of the respondents said that their

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mother’s age at the time of death was 60 or less, against 27 percent who reported that it was between 80 and 89 years (Appendix 1, Table 2).

Those respondents who said that one or both of their parents had passed away were also asked about the cause of death. The survey found that the significant majority of the respondents’ parents did not die of chronic or heart diseases. Only 14 percent of the respondents reported that their father died of chronic diseases.

Similarly, only 13 percent and 10 percent of the respondents reported that their father died of fever and heart diseases, respectively. In comparison, more than one-third (36%) of the respondents cited old age as the major cause of their father’s death (Appendix 1, Table 3).

Following a more or less similar pattern, 38 percent of the respondents reported that the cause of their mother’s death was old age. In comparison, only 17 percent of the respondents reported that their mother died of chronic diseases. Similarly, only 9 percent and 11 percent of the respondents reported that their mother died of fever and heart diseases, respectively (Appendix 1, Table 4). 3.4 Health Expectancy Healthy ageing refers to life of the elderly without illness and disease. Older persons often develop chronic diseases and illnesses that remain untreated and become the cause of death. The survey asked those respondents who had not mentioned chronic or heart diseases as the cause of their parents’ death to an earlier question that did their father/mother suffer from any illness before his/her death.

Only 43 percent of the respondents said that their father suffered from some illness before death, while more than one-half (51%) of them replied in the negative to this question (Table 3.6). In addition, 6 percent of the respondents said that they did not know whether their father suffered from some illness before death.

According to the survey findings, the only region from where the majority of the respondents (51% males and 53% females) reported that their father suffered from some illness before death was the rural Northern Punjab. These numbers indicate healthy ageing among the male older persons in Punjab. Table 3.6 Percentage of Respondents by Region, Residence, Gender

and Illness of Father before Death Illness of Father before Death


M F M F M F M F M F M F M F M F Yes 44.4 35.1 51.0 53.0 43.6 47.8 46.1 46.4 28.8 26.6 37.6 40.6 38.9 38.2 44.6 46.1 43.1 No 51.1 62.3 44.7 43.6 53.4 46.9 49.5 46.0 66.8 62.7 55.8 50.2 57.3 55.4 50.4 46.7 51.2 Do Not Know 4.5 2.6 4.3 3.5 3.0 5.3 4.4 7.6 4.3 10.8 6.6 9.3 3.8 6.4 5.0 7.2 5.7

TOTAL 133 114 208 202 236 226 549 528 184 158 303 281 553 498 1,060 1,011 3,122

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The situation of the respondents’ mothers was even better. Only 41 percent of the respondents said that their mother suffered from some illness prior to death, while more than one-half (52%) of them replied in the negative to this question (Table 3.7). In addition, 7 percent of the respondents said that they did not know whether their mother suffered from some illness prior to death. Surprisingly, the survey found that the urban Southern Punjab fared the best on this count: only 20 percent of the male respondents and 26 percent of the female respondents from this region reported that their mother suffered some illness prior to death. Table 3.7 Percentage of Respondents by Region, Residence, Gender

and Illness of Mother before Death

Illness of Mother before Death


M F M F M F M F M F M F M F M F Yes 44.5 45.8 45.8 50.0 45.9 47.5 39.2 43.1 19.7 25.5 36.0 43.6 37.0 40.1 39.6 44.6 40.8 No 51.6 51.4 49.5 44.7 51.1 46.0 54.3 48.7 73.4 63.4 56.5 46.3 58.5 52.9 54.0 47.3 52.4 Do Not Know 3.9 2.8 4.7 5.3 3.1 6.4 6.4 8.2 6.9 11.0 7.6 10.0 4.5 7.0 6.4 8.1 6.8

TOTAL 128 107 190 190 229 202 543 513 173 145 278 259 530 454 1,011 962 2,957 3.5 Marital Status In a traditional society like Pakistan, marital status determines support mechanisms for individuals. Demographically speaking, women generally have higher life expectancy than men. It is argued that widows outnumber widowers in the later age groups because of two reasons: first, they have higher life expectancy; and second, they are more often than not married to men who are older than them.

The survey findings substantiated this argument (Table 3.8). More than one-half of the female respondents (65% in the urban and 53% in the rural areas) were widowed, against only slightly over one-fourth of the male respondents (31% in the urban and 28% in the rural areas). Accordingly, the survey reported that more than two-thirds of the male respondents (70% in the rural and 68% in the urban areas) were currently married, against only 45 percent of the rural female and 34 percent of the urban female respondents.

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Table 3.8 Percentage of Respondents by Region, Residence, Gender and Marital Status

Marital Status Northern Punjab Central Punjab Southern Punjab Overall Punjab Total

Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Never Married 0.0 0.7 0.8 2.0 0.5 0.5 1.1 0.6 0.9 0.0 0.7 0.3 0.5 0.4 0.9 0.8 0.7 Currently Married 71.3 36.3 73.0 37.1 65.1 34.8 66.6 47.2 69.6 30.4 75.1 46.6 67.8 33.9 70.3 45.1 55.5 Separated/Divorced 1.3 1.4 1.2 1.2 0.5 1.4 1.3 1.7 0.9 0.5 0.2 1.0 0.8 1.2 1.0 1.4 1.1 Widowed 27.5 61.6 25.0 59.8 33.8 63.3 31.0 50.6 28.6 69.1 24.0 52.1 30.9 64.5 27.8 52.7 42.7

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 3.6 Morbidity In order to study the extent of morbidity among the elderly of Punjab, the widowed respondents were asked for how long their spouse remained ill before death. Exactly one-half of the respondents reported that their spouse remained ill for less than one year before death; while 15 percent of the respondents said that this period was from one to two years, 11 percent said that this period was from two to three years, and 25 percent said that this period was more than three years (Table 3.9).

More than one-third (36%) of the urban male respondents reported that their spouse remained ill for more than three years before death: 43 percent in Northern Punjab, 34 percent in Central Punjab and 36 percent in Southern Punjab. In comparison, only 27 percent of the urban female respondents reported that their spouse remained ill for more than three years before death: 26 percent in Northern Punjab, 25 percent in Central Punjab and 32 percent in Southern Punjab. Table 3.9 Percentage of Respondents by Region, Residence, Gender

and Illness Period before Death of Spouse

Illness Period before Death of Spouse


M F M F M F M F M F M F M F M F Less than 1 Year 28.6 50.9 50.0 59.8 34.4 51.6 53.0 54.0 44.4 51.4 47.8 47.8 36.1 51.4 51.0 53.3 50.0 1 to 2 Years 21.4 11.3 23.8 7.6 20.4 13.5 13.6 11.5 15.6 9.5 23.2 18.8 19.3 12.0 18.1 12.8 14.6 2 to 3 Years 7.1 11.3 11.9 15.2 10.8 9.7 15.9 8.7 4.4 6.8 10.1 10.9 8.4 9.2 13.6 10.6 10.6 More than 3 Years 42.9 26.4 14.3 17.4 34.4 25.2 17.4 25.8 35.6 32.4 18.8 22.5 36.2 27.3 17.3 23.3 24.8

TOTAL 28 53 42 92 93 155 132 252 45 74 69 138 166 282 243 482 1,173 The rural areas presented a completely different picture. According to the survey findings, spouses of only 17 percent of the rural male respondents remained ill for more than three years before death: 14 percent in Northern Punjab, 17 percent in Central

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Punjab and 19 percent in Southern Punjab. However, 23 percent of the rural female respondents reported that their spouse remained ill for more than three years before death: 17 percent in Northern Punjab, 26 percent in Central Punjab and 22 percent in Southern Punjab. 3.7 Education The survey found that the overwhelming majority (72%) of the respondents was illiterate (Table 3.10). In particular, 95 percent of the rural female respondents were illiterate. Unsurprisingly, Southern Punjab fared the worst on this count: 98 percent of the rural female respondents from this region reported that they were illiterate. It was closely followed by Central Punjab from where 95 percent of the rural female respondents reported that they were illiterate. The situation was only marginally better in Northern Punjab from where 92 percent of the rural female respondents reported that they were illiterate.

In comparison, the urban female respondents were slight better off and 81 percent of them reported that they were illiterate. Southern Punjab fared the worst on this count too: 87 percent of the urban female respondents from this region reported that they were illiterate. It was closely followed by Central Punjab from where 82 percent of the urban female respondents reported that they were illiterate. The situation was much better in Northern Punjab from where 71 percent of the urban female respondents reported that they were illiterate.

The survey made it clear that the male respondents of Northern Punjab were by far the most educated: only 24 percent of the urban male respondents from this region were illiterate and 25 percent of them had above secondary education, while 38 percent of the rural male respondents from this region were illiterate and 5 percent of them had above secondary education. Interestingly, only 3 percent of the female respondents from the urban Northern Punjab had above secondary education, which reflects well on the overall situation of women in Pakistan. Table 3.10 Percentage of Respondents by Region, Residence, Gender

and Education

Education Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Illiterate 23.8 70.5 37.7 91.8 45.7 81.6 59.4 94.9 54.9 87.1 75.1 97.9 43.8 80.9 60.0 95.2 72.0 Primary 15.6 8.9 22.6 7.0 16.2 10.7 18.3 4.0 17.0 7.7 12.3 1.8 16.3 9.5 17.3 3.9 11.5 Middle 15.0 6.8 18.3 0.8 10.8 2.2 10.7 0.8 10.7 3.1 6.9 0.3 11.7 3.4 11.0 0.7 6.5 Secondary 20.6 10.3 16.3 0.4 16.2 3.3 8.8 0.1 9.4 1.5 3.7 0.0 15.1 4.3 8.7 0.1 6.3 Above Secondary 25.0 3.4 5.2 0.0 11.1 2.2 2.8 0.1 8.0 0.5 2.0 0.0 13.1 2.0 3.0 0.1 3.7

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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The survey also solicited information about the education of the respondents’ spouses and found that more than three-fourths (78%) of them were illiterate (Table 3.11). In comparison, as we have already seen in Table 3.10, 72 percent of the respondents had reported that they were illiterate. Illiteracy was found be most common among the spouses of rural male respondents (92%). Opposed to this, less than one-half (49%) of the urban female respondents reported that their spouses had no education. Importantly, only 3 percent of the respondents said that their spouses had studied above the secondary level. Table 3.11 Percentage of Respondents by Region, Residence, Gender

and Education of Spouse

Education of Spouse Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Illiterate 57.5 40.7 82.1 53.0 70.2 48.8 92.3 71.4 83.9 55.0 97.0 85.0 71.6 48.5 91.9 72.4 77.8 Primary 14.2 14.8 12.5 13.0 13.2 11.0 5.8 10.5 5.8 20.0 3.0 7.2 11.2 14.1 6.2 9.9 9.1 Middle 15.0 3.7 1.6 21.0 8.3 11.8 0.8 7.9 1.9 5.0 0.0 3.3 7.9 8.3 0.7 8.7 5.2 Secondary 6.2 25.9 3.3 11.0 4.1 19.7 1.0 7.3 4.5 10.0 0.0 2.8 4.7 18.7 1.1 6.6 5.2 Above Secondary 7.1 14.8 0.5 2.0 4.1 8.7 0.0 2.9 3.9 10.0 0.0 1.7 4.7 10.4 0.1 2.4 2.8

TOTAL 114 54 183 100 242 128 481 343 155 60 304 180 511 242 968 623 2,344 3.8 Parents’ Education and Occupation The respondents were also asked about the education and occupation of their parents, assuming that the children of educated parents would have better health and socioeconomic status. Similarly, occupation of the parents could have a bearing on the socioeconomic status of the children. The survey showed that the overwhelming majority of the respondents’ parents (88% fathers and 98% mothers) were illiterate, especially in the rural areas (Appendix 1, Tables 5 and 6). More than one-half (53%) of the respondents said that the occupation of their father was agriculture (Appendix 1, Table 7), while almost all (94%) of them said that their mother was a housewife (Appendix 1, Table 8). 3.9 Attitudes and Beliefs The children are dependent on their parents when they are growing up. In traditional societies, this role reverses when the parents grow old; they become dependent on their children. Because the elderly do not receive many benefits, such as pension and social security, from the government, their dependence on their children increases manifold in countries such as Pakistan.

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Considering this, the respondents were asked whether children should take care of their old parents. As expected, almost all (98%) of the respondents agreed that children should take care of their old parents (Table 3.12). However, surprisingly, 6 percent of the male and female respondents each from Northern Punjab disagreed. Table 3.12 Percentage of Respondents by Region, Residence, Gender

and Beliefs regarding Rights and Responsibilities of Children


M F M F M F M F M F M F M F M F Children Should Take Care of Old Parents Agree 93.8 93.8 94.0 96.5 98.4 98.4 99.4 98.8 100.0 100.0 100.0 100.0 97.9 97.9 98.6 98.7 98.4 Disagree 6.2 6.2 6.0 3.5 1.6 1.6 0.6 1.2 0.0 0.0 0.0 0.0 2.1 2.1 1.4 1.3 1.6

Children who Take Better Care of Old Parents Should Receive Greater Portion of Inheritance Agree 7.5 2.1 4.0 4.7 5.7 5.5 5.2 4.6 1.8 3.6 0.5 4.2 4.9 4.3 3.6 4.5 4.2 Disagree 92.5 97.9 96.0 95.3 94.3 94.5 94.8 95.4 98.2 96.4 99.5 95.8 95.1 95.7 96.4 95.5 95.8

Old Parents Should Live with their Daughters Agree 5.6 12.3 14.7 4.7 15.7 14.2 14.6 14.1 4.9 4.1 5.9 6.3 10.3 11.0 12.0 10.1 11.0 Disagree 94.4 87.7 85.3 95.3 84.3 85.8 85.4 85.9 95.1 95.9 94.1 93.7 89.7 89.0 88.0 89.9 89.0

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 The overwhelming majority (96%) of the respondents disagreed when asked whether children who take better care of their old parents should receive greater portion of inheritance. Similarly, the vast majority (89%) of the respondents disagreed when asked whether old parents should live with their daughters. However, in the urban areas of Central Punjab, 16 percent and 14 percent of the male and female respondents agreed.

The survey also tried to explore the respondents’ perceptions of gender roles by asking them whether women should stay at home. More than three-fourths (77%) of the respondents agreed that women should stay at home (Table 3.13), implying that they should not be allowed to work outside. However, surprisingly, more urban female respondents (62%) from Northern Punjab endorsed this gender-biased viewpoint than the urban male respondents (51%) of the same region.

The survey findings revealed that a higher percentage of the respondents, both male and female, agreed with this proposition as we moved from Northern to Central and to Southern Punjab, and from the urban to the rural areas. The only exception was rural Southern Punjab, from where 74 percent of the female respondents (compared with 83 percent of the female respondents from Central Punjab) and 85 percent of the male respondents (compared with 88 percent of the urban male respondents from the same region) agreed that women should stay at home.

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Table 3.13 Percentage of Respondents by Region, Residence, Gender and Perception of Gender Roles

Women should Stay at Home


M F M F M F M F M F M F M F M F Agree 50.6 61.6 65.5 63.7 73.5 72.1 82.0 82.9 88.4 84.5 84.9 74.3 73.1 73.3 79.8 76.9 76.6 Disagree 49.4 38.4 34.5 36.3 26.5 27.9 18.0 17.1 11.6 15.5 15.1 25.7 26.9 26.7 20.2 23.1 23.4

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 When the respondents’ opinion was sought about the best living arrangement for older couples, 42 percent of them said that they should preferably live with a male child (Table 3.14). According to the survey findings, 46 percent and 48 percent of the rural male and female respondents, respectively, preferred this option, compared with 33 percent and 35 percent of the urban male and female respondents, respectively.

In addition, more female than male respondents chose this option. The only exceptions were the urban Northern Punjab and the rural Southern Punjab, from where fewer female than male respondents (36% against 39% and 36% against 42%, respectively) said that older couples should preferably live with a male child.

Only 3 percent of the respondents said that older couples should live by themselves. In comparison, 24 percent of them considered that the best arrangement for older couples was living by themselves but near one or more of their children. An even higher number of the respondents (26%) said that older couples should rotate residence among children. Table 3.14 Percentage of Respondents by Region, Residence, Gender

and Best Living Arrangement for Older Couples

Best Living Arrangement for Older Couples


Live by Themselves 4.4 4.8 3.2 3.1 4.3 2.7 3.4 2.9 4.5 2.1 3.0 2.4 4.4 3.0 3.2 2.8 3.3 Live by Themselves but Near their Children 30.6 34.9 21.4 30.5 29.2 26.6 18.1 16.3 25.9 35.6 17.3 27.7 28.5 30.8 18.5 22.2 23.6

Rotate Residence Among Children 18.1 19.9 26.2 16.8 30.0 30.1 25.0 21.2 33.0 26.3 30.6 29.3 28.4 26.9 26.9 22.6 25.8

Live with a Male Child 38.8 36.3 43.3 44.1 31.6 36.7 48.3 55.0 29.9 32.0 42.2 36.1 32.6 35.3 45.6 47.7 42.2 Others 8.1 4.1 6.0 5.5 4.9 3.8 5.2 4.6 6.7 4.1 6.9 4.5 6.1 3.9 5.8 4.7 5.2 TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

When asked about the best living arrangement for unmarried older persons, more than one-third (36%) of the respondents said that they should live with their siblings (Table 3.15). Another 19 percent said that they should live with their parents or by themselves, while 17 percent said that they should live with their relatives.

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According to the survey findings, 16 percent of the respondents suggested that the government should take care of unmarried older persons. A few (5%) of them went to the extent of saying that God should take care of them, implying that they should pass away. The respondents were also asked about the best living arrangement for widows and widowers (see Tables 9 and 10 of Appendix 1 for details). Table 3.15 Percentage of Respondents by Region, Residence, Gender

and Best Living Arrangement for Unmarried Older Persons

Best Living Arrangement for Unmarried Older Persons



Parents’ House/By Themselves 24.4 29.5 17.1 19.9 24.6 25.8 15.2 18.5 12.1 10.8 13.8 17.3 20.8 22.4 15.1 18.4 18.5

God Should Take Care 5.6 1.4 3.2 2.3 8.6 9.6 6.0 6.2 0.9 0.0 3.0 3.4 5.7 5.3 4.6 4.7 4.9 As they Wish 3.8 1.4 2.0 2.7 4.1 3.8 2.9 3.6 0.9 0.5 2.7 3.4 3.1 2.4 2.7 3.4 2.9 Sibling’s House 26.3 36.3 32.5 41.0 17.8 19.2 36.9 37.8 51.3 58.2 40.0 45.5 29.5 33.5 37.0 40.6 36.2 Relative’s House 13.8 15.1 18.3 17.2 11.6 11.2 17.0 15.6 25.0 25.3 21.7 17.0 16.0 15.9 18.6 16.3 16.9 Government Should Take Care 22.5 14.4 22.6 12.5 27.6 23.3 16.4 12.7 4.5 1.5 14.1 9.9 19.6 15.5 16.9 11.9 15.5

Others 3.8 2.1 4.4 4.3 5.7 7.1 5.5 5.7 5.4 3.6 4.7 3.4 5.2 5.1 5.1 4.8 5.0

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 3.10 Working Status The survey tried to assess how active the elderly of Punjab are in their later years by asking the respondents whether they were still working. The findings showed that 22 percent of the respondents, mostly from the rural areas, were still employed in one way or the other (Table 3.16). Against 41 percent of the rural male and 7 percent of the rural female respondents, 32 percent of the urban male and 5 percent of the urban female respondents reported that they were still working.

The overwhelming majority of the female respondents (85% in the rural and urban areas each) had never been employed in their entire lives. The survey findings also showed that the female respondents were much more dependent on others for their financial needs than their male counterpart, because a very few of them (7% in the rural and 5% in the urban areas) reported that they were still working.

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Table 3.16 Percentage of Respondents by Region, Residence, Gender and Current Working Status

Current Working Status


Working 29.4 3.4 35.3 3.5 31.4 4.1 44.7 5.8 33.9 8.2 37.3 11.0 31.7 5.1 40.8 6.8 22.1 Stopped Working 70.6 7.5 63.5 2.0 64.6 12.1 53.1 7.0 59.4 8.8 57.0 13.1 64.3 10.2 56.2 7.8 34.2 Never Worked 0.0 89.0 1.2 94.5 4.1 83.8 2.2 87.2 6.7 83.0 5.7 76.0 4.0 84.7 3.1 85.4 43.7

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Those respondents who reported that they had stopped working were further questioned about the reason for doing so. More than three-fourths (78%) of the respondents cited ill health as the reason because of which they had to stop working (Table 3.17). This speaks clearly about the deteriorating health of the elderly, especially rural women; almost all (96%) of the rural female respondents reported that they had to stop working because of ill heath.

The survey found that only 14 percent of the respondents had stopped working due to formal retirement. One plausible explanation for this could be that the majority of the respondents might not have been employed in the formal sector. The fact that the situation was markedly better in the urban areas of Northern Punjab, from where 46 percent of the male and female respondents each reported that they stopped working due to formal retirement, endorses this argument.

Furthermore, not even a single female respondent from either rural or urban Southern Punjab, as well as rural Northern Punjab, reported that she stopped working due to formal retirement. According to the survey findings, 8 percent of the respondents said that they stopped working for some other reason. Table 3.17 Percentage of Respondents by Region, Residence, Gender

and Reason Why Stopped Working

Reason Why Stopped Working



Retirement 46.0 45.5 30.2 0.0 22.1 20.5 11.6 3.9 23.5 0.0 10.0 0.0 27.6 20.0 14.5 2.1 13.8 Ill Health 44.2 27.3 61.6 100.0 66.3 68.2 82.3 94.1 64.4 94.1 74.5 96.0 61.1 66.8 76.2 95.7 78.3 Others 9.7 27.3 8.2 0.0 11.6 11.3 6.1 2.0 12.1 5.9 15.6 4.0 11.3 13.1 9.3 2.2 8.0

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 The survey also made an attempt to explore the different age groups in which the respondents had stopped working. The findings suggested that a significant percentage of

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both urban and rural male respondents (55 percent and 48 percent, respectively) stopped working in the age group of 60-69 (Table 3.18).

More than one-fourth (28%) of the respondents reported that they stopped working before reaching the formal age of retirement, which in Pakistan is 60 years. Of these, 23 percent stopped working in the age group of 50-59 and 5 percent when they were less than 50 years old. Surprisingly, 5 percent of the respondents also said that they stopped working in the age group of 80 and above. Table 3.18 Percentage of Respondents by Region, Residence, Gender

and Age When Stopped Working

Age When Stopped Working


Less than 50 5.3 18.2 6.3 25.0 4.2 11.4 4.0 5.9 3.8 0.0 2.6 6.0 4.3 9.7 4.1 6.7 4.6 50-59 21.2 54.5 25.8 25.0 21.8 38.6 21.4 23.5 23.5 35.3 20.3 32.0 22.1 40.3 22.0 27.6 23.4 60-69 53.1 27.3 42.1 25.0 54.0 36.4 45.5 51.0 59.8 58.8 55.4 50.0 55.4 40.3 47.8 49.5 50.1 70-79 17.7 0.0 18.9 25.0 17.2 9.1 21.7 15.7 9.8 0.0 18.6 10.0 15.3 5.6 20.2 13.3 17.3 80 and Above 2.7 0.0 6.9 0.0 2.9 4.5 7.4 3.9 3.0 5.9 3.0 2.0 2.9 4.1 6.0 2.8 4.6

TOTAL 113 11 159 4 239 44 378 51 132 17 231 50 484 72 768 105 1,429 Knowing the respondents’ current occupation was one of the main concerns of the survey, since it was crucial to determining their socioeconomic status. The findings showed that the current profession of more than one-third (36%) of the respondents was agriculture, followed by unskilled manual work (27%). More than one-half (51%) of the rural male and almost one-third (32%) of the rural female respondents reported that their current profession was agriculture (Table 3.19).

Only 9 percent of the respondents said that they worked in an office. This was most common in the urban areas, where 21 percent of the male and 17 percent of the female respondents worked in an office. According to the survey findings, only 12 percent of the respondents had a personal business. Again, this was most common in the urban areas, where 23 percent of the male and 6 percent of the female respondents had a personal business.

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Table 3.19 Percentage of Respondents by Region, Residence, Gender and Current Occupation

Current Occupation


Office Worker 14.9 40.0 6.7 0.0 22.2 13.3 4.7 0.0 22.1 12.5 6.6 0.0 20.7 16.6 5.5 0.0 9.4 Skilled Manual 19.1 0.0 15.7 33.3 11.1 0.0 9.7 4.8 9.1 6.3 5.3 7.1 12.0 2.8 9.5 8.6 9.8 Unskilled Manual 21.3 0.0 20.2 22.2 32.5 33.3 17.9 31.0 33.8 43.8 32.5 52.4 30.7 33.3 22.2 39.8 26.6 Domestic Services 0.0 60.0 0.0 11.1 0.0 33.3 0.9 21.4 0.0 31.3 2.0 7.1 0.0 36.1 1.1 13.9 3.4 Agriculture 10.6 0.0 41.6 33.3 7.7 0.0 54.9 35.7 14.3 0.0 47.0 28.6 10.4 0.0 50.7 32.3 36.4 Personal Business 25.5 0.0 13.5 0.0 25.6 13.3 11.3 7.1 18.2 0.0 2.6 2.4 23.2 5.5 9.3 4.3 12.3 Others 8.5 0.0 2.2 0.0 0.9 6.7 0.6 0.0 2.6 6.3 4.0 2.4 2.9 5.6 1.8 1.1 2.2

TOTAL 47 5 89 9 117 15 319 42 77 16 151 42 241 36 559 93 929 The respondents were also asked whether they had formally retired from some other job before adopting their current profession. The vast majority (91%) of them replied in the negative to this question (Table 3.20). However, the situation was slightly different in the urban Northern Punjab, from where 40 percent of the female and 38 percent of the male respondents reported that they had formally retired from some other job before adopting their current occupation. The fact that the majority of the respondents were not employed with the formal sector explains this phenomenon. Table 3.20 Percentage of Respondents by Region, Residence, Gender

and Working after Retirement

Working after Retirement


Yes 38.3 40.0 21.3 11.1 12.0 0.0 6.6 0.0 11.7 0.0 2.0 0.0 17.0 5.6 7.7 1.1 9.4 No 61.7 60.0 78.7 88.9 88.0 100.0 93.4 100.0 88.3 100.0 98.0 100.0 83.0 94.4 92.3 98.9 90.6

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 When the survey asked the respondents about their longest occupation, the results showed that the majority of them had worked in the informal sector (Table 3.21). More than one-half of the male respondents from the rural Central and Southern Punjab (54% and 51%, respectively) reported that agriculture was their longest occupation. The same was also true for 48 percent and 41 percent of the female respondents from the rural Central and Southern Punjab, respectively. Only in Northern Punjab, the majority of the respondents (63% females and 59% males) said that working in an office was their longest occupation.

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Table 3.21 Percentage of Respondents by Region, Residence, Gender and Longest Occupation

Longest Occupation


Office Worker 58.8 62.5 37.5 21.4 30.0 20.7 11.4 6.4 27.8 6.1 10.0 0.0 35.7 22.5 15.9 4.5 21.3 Skilled Manual 16.3 18.8 9.7 21.4 18.6 17.2 10.9 8.5 11.3 24.2 7.4 4.3 16.0 19.6 9.7 7.5 11.9 Unskilled Manual 11.9 0.0 19.4 7.1 29.7 22.4 17.7 19.1 32.1 33.3 28.7 43.5 26.5 22.4 21.2 29.5 23.6 Domestic Services 0.0 18.8 0.0 14.3 0.0 22.4 0.9 13.8 0.0 18.2 0.5 7.6 0.0 20.6 0.6 11.0 2.2 Agriculture 3.1 0.0 30.6 35.7 8.9 8.6 53.5 47.9 17.5 6.1 50.8 41.3 10.1 6.5 48.4 44.0 34.3 Personal Business 8.1 0.0 1.6 0.0 11.1 5.2 5.2 4.3 9.4 3.0 1.3 1.1 9.9 3.7 3.4 2.5 5.4 Others 1.9 0.0 1.2 0.0 1.7 3.4 0.4 0.0 1.9 9.1 1.3 2.2 1.8 4.7 0.8 1.0 1.3

TOTAL 160 16 248 14 360 58 695 94 212 33 380 92 732 107 1,323 200 2,362 As discussed earlier, the significant majority (72%) of the respondents were illiterate and had worked in the informal sector, where age may not be a prerequisite. Accordingly, the survey found that almost two-third (65%) of the respondents started working as early as in the age group of 10-19 (Table 3.22). This trend was particularly common in the rural areas, from where 74 percent of the male and 52 percent of the female respondents reported that they started working in this age group.

It is obvious that had the respondents been receiving education, their entry into the job market would not have been possible at such an early age. The analysis of these three variables – education, type of occupation and age of starting work – made it clear that most of the respondents did not have a high socioeconomic status. Table 3.22 Percentage of Respondents by Region, Residence, Gender

and Age When Started Working Age When Started Working


10-19 54.1 25.0 70.6 38.5 57.9 50.9 75.9 47.8 52.8 57.6 71.9 59.3 55.6 49.1 73.8 52.4 65.2 20-29 43.4 50.0 27.8 30.8 38.7 24.6 22.9 35.9 39.6 21.2 27.0 29.7 40.0 27.3 25.0 32.7 30.4 30 and Above 2.5 25.0 1.6 30.8 3.3 24.6 1.2 16.3 7.5 21.2 1.0 11.0 4.3 23.6 1.2 14.9 4.4

TOTAL 160 16 248 14 360 58 695 94 212 33 380 92 732 107 1,323 200 2,362 3.11 Financial Needs This section in the survey questionnaire aimed at soliciting information about the respondents’ independent source of income, which denotes financial independence, as

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well as other basic necessities of life available to them. The objective was to assess as to what extent the primary needs of the elderly of Punjab were being met.

The respondents were first asked whether they had any independent source of income. Though almost two-thirds (66%) of them replied in the negative to this question, the disparity between the male and female was huge (Table 3.23). According to the survey findings, the majority of the male respondents had an independent source of income, while only a tiny minority of the female respondents could make this claim. Moreover, this disparity was more profound in the rural than the urban areas.

In comparison with a meagrely 17 percent of the urban female respondents, more than one-half (55%) of the urban male respondents reported having an independent source of income. Similarly, against a paltry 13 percent of the rural female respondents, more than one half (53%) of the rural male respondents had an independent source of income. The male respondents of the rural Northern Punjab, more than two-thirds of whom (67%) of whom reported that they had an independent source of income, fared the best on this count. Table 3.23 Percentage of Respondents by Region, Residence, Gender

and Independent Source of Income

Independent Source of Income


M F M F M F M F M F M F M F M F Yes 65.0 16.4 66.7 10.9 53.2 17.5 53.2 11.3 50.0 16.5 42.7 17.3 54.8 17.0 52.6 12.9 34.1 No 35.0 83.6 33.3 89.1 46.8 82.5 46.8 88.7 50.0 83.5 57.3 82.7 45.2 83.0 47.4 87.1 65.9

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Next, the respondents were asked to tell who was most likely to help them in case they needed financial assistance. More than three-fourths of the female respondents (80% in the urban and 76% in the rural areas) said that their children were most likely to help them in case they needed financial help (Table 3.24). In comparison, a lesser proportion of the male respondents (65% in the urban and 60% in the rural areas) made such an assumption.

In fact, a sizable proportion of the male respondents (24% in the rural and 21% in the urban areas) said that they did not need financial assistance from anyone. A much lesser proportion of the female respondents (4% in the rural and 5% in the urban areas) could make such a claim, reinforcing that the women generally are economically dependent on others in the Pakistani society. Surprisingly, according to the survey findings, only 4 percent of the respondents said that their spouses were most likely to help them in case they needed money.

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Table 3.24 Percentage of Respondents by Region, Residence, Gender and Who Most Likely to Help Financially

Who Most Likely to Help Financially



Children 50.6 80.8 48.0 77.7 71.1 80.3 60.4 76.7 64.7 77.3 67.2 74.9 64.8 79.6 60.1 76.4 69.5 Sibling 3.8 2.1 3.6 3.5 1.9 1.9 3.2 2.2 4.9 2.6 6.2 3.4 3.2 2.1 4.2 2.8 3.2 Relatives 1.3 2.7 2.8 4.3 1.4 2.2 2.2 1.8 8.5 7.2 8.1 5.0 3.5 3.7 4.1 3.2 3.6 Spouse 0.0 6.2 1.2 5.5 1.4 6.8 0.7 10.6 0.4 3.1 0.5 4.5 0.8 5.7 0.7 7.9 3.9 No Need 35.6 5.5 31.0 1.6 18.6 4.9 29.1 4.1 12.9 3.6 9.9 5.2 20.5 4.7 23.8 3.9 13.5 Others 8.8 2.7 13.5 7.4 5.7 3.8 4.4 4.6 8.5 6.2 8.1 7.1 7.2 4.2 7.2 5.8 6.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 The next question from the respondents was that how much money they needed each month. The responses varied from 1,000 rupees or less to over 5,000 rupees per month. Briefly, 27 percent of the respondents said that they needed 1,000 rupees or less, 23 percent needed 1,001-2,000 rupees, 13 percent needed 2,001-3,000 rupees, 7 percent needed 3,001-4,000 rupees, 13 percent needed 4,001-5,000 rupees and 17 percent needed over 5,000 rupees per month (Table 3.25).

The survey findings revealed that the monthly financial need of the male and female respondents was more or less the same, except for the category of over 5,000 rupees per month in which the former significantly outnumbered the latter (24% against 18% in the urban areas and 19% against 11% in the rural areas). Moreover, the findings showed that the monthly financial need of the residents of urban areas was more than that of the residents of rural areas. Table 3.25 Percentage of Respondents by Region, Residence, Gender

and Monthly Financial Need

Monthly Financial Need (in Rupees)


1,000 or Less 9.4 8.2 8.7 13.7 25.4 28.5 17.3 32.3 38.8 43.3 41.0 35.3 26.0 28.4 22.7 29.6 26.5 1,001-2,000 10.0 18.5 27.0 27.7 16.2 20.0 21.9 25.0 29.0 21.6 25.4 28.0 18.7 20.1 23.9 26.3 23.1 2,001-3,000 17.5 15.1 18.7 24.2 11.6 12.6 11.8 11.7 12.5 11.3 8.6 11.0 13.1 12.8 12.1 13.8 13.0 3,001-4,000 11.9 15.1 5.2 5.9 4.6 5.5 6.0 6.8 4.9 3.1 11.4 9.2 6.2 6.8 7.5 7.3 7.1 4,001-5,000 17.5 23.3 19.0 12.5 13.2 10.4 16.6 12.6 5.8 13.9 9.6 10.2 11.9 14.0 15.0 11.9 13.3 Over 5,000 33.8 19.9 21.4 16.0 28.9 23.0 26.4 11.7 8.9 6.7 4.0 6.3 24.0 17.9 18.9 11.0 17.1

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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The elderly need to travel occasionally for various purposes, but using public transport requires money (we have already seen in Chapter 2 that ownership of transport is rare among the elderly). Considering this, the respondents were asked whether they could afford to pay for public transport (Table 3.26). Almost three-fourths (73%) of the respondents replied in the affirmative to this question.

However, more than one-half (52%) of the female respondents from the rural Southern Punjab said that they did not have the money to pay for public transport. In comparison, 89 percent of the male and 77 percent of the female respondents from the urban Northern Punjab reported that they could afford to pay for public transport. Table 3.26 Percentage of Respondents by Region, Residence, Gender

and Money to Pay for Public Transport

Money to Pay for Public Transport


Yes 89.4 76.7 81.0 75.4 81.4 74.0 81.9 72.4 82.6 65.5 61.2 47.9 83.5 72.2 75.6 66.1 73.4 No 10.6 19.2 16.7 23.4 17.8 24.1 17.8 25.9 16.5 33.5 38.3 51.8 15.9 25.7 23.7 32.7 25.5 Not Available 0.0 4.1 2.4 1.2 0.8 1.9 0.3 1.7 0.9 1.0 0.5 0.3 0.7 2.1 0.7 1.2 1.1

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Although most of the elderly live with their families, it is not very often that the children take them out. When the respondents were asked whether their family takes them along when it goes outside for recreation or social activities, more than one-half (53%) of them replied in the negative (Table 3.27). The percentage of such respondents was more in Southern Punjab than in Central or Northern Punjab. In the urban Southern Punjab, 63 percent of the male and female respondents each complained that their family members did not take them along when they went outside. The situation was even worse in the rural Southern Punjab, from where 77 percent of the male and 71 percent of the female respondents reported the same. Table 3.27 Percentage of Respondents by Region, Residence, Gender

and Does Family Take for Outings

Does Family Take for Outings


Yes 55.0 56.2 49.6 51.2 46.2 55.9 56.3 56.6 36.6 36.6 22.7 29.3 45.2 50.6 45.1 47.9 47.0 No 45.0 43.2 49.2 48.8 53.8 44.1 43.7 43.3 63.4 62.9 77.0 70.7 54.8 49.1 54.6 52.0 52.9 Not Available 0.0 0.7 1.2 0.0 0.0 0.0 0.0 0.1 0.0 0.5 0.2 0.0 0.0 0.3 0.3 0.1 0.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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The survey also asked the respondents how often they changed their clothes and found that only 8 percent of them changed their dress daily (Table 3.28). The male respondents of the urban Northern Punjab fared the best on this count and 20 percent of them reported changing their clothes daily. Almost one-half (48%) of the respondents said that they changed their dress twice a week. It was also reported by 19 percent of the respondents that they changed their clothes twice a month. This trend was more common in the urban areas than the rural areas; and among the male respondents than the female respondents. Table 3.28 Percentage of Respondents by Region, Residence, Gender

and How Often Change Clothes

How Often Change Clothes


Daily 20.0 13.7 11.1 7.4 14.3 10.7 8.4 5.7 4.0 6.7 2.2 1.3 12.4 10.2 7.1 4.8 7.8 Weekly 16.3 17.1 31.7 35.2 17.3 11.2 17.7 25.1 25.0 21.6 38.0 45.3 19.4 15.3 26.3 32.7 25.3 Twice a Week 38.1 44.5 39.3 43.4 43.0 54.2 47.1 49.8 57.6 59.3 49.1 46.6 46.3 53.6 46.3 47.7 48.0 Twice a Month 25.6 24.7 17.9 14.1 25.4 23.8 26.8 19.4 13.4 12.4 10.6 6.8 21.9 20.9 20.4 14.9 18.9

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Finally, the respondents were asked whether they used fan in the summer and heater in the winter. The overwhelming majority (93%) of the respondents reported using fan in the summer (Table 3.29). Their high percentage also owed to the fact that 96 percent of them had access to electricity (as we have already seen in Chapter 2).

On the other hand, more than three-fourths of the respondents said that they did not use heater in the winter. This might be due to the fact that most households in Punjab, especially those in rural areas, still do not have gas connections. Table 3.29 Percentage of Respondents by Region, Residence, Gender,

and Use of Fan and Heater

Use of Fan


Yes 97.5 99.3 95.6 96.1 95.9 96.2 95.5 97.1 97.8 96.9 76.5 81.4 96.8 97.0 89.9 92.5 93.2 No 2.5 0.7 4.4 3.9 4.1 3.8 4.5 2.9 2.2 3.1 23.5 18.6 3.2 3.0 10.1 7.5 6.8

Use of Heater Yes 55.6 50.7 17.1 22.7 42.4 38.9 5.2 5.5 14.7 21.1 1.7 0.8 37.0 36.4 6.4 7.4 17.3 No 43.1 47.9 72.6 69.1 55.1 57.3 84.6 84.0 84.8 78.4 85.2 91.9 61.4 61.2 82.5 83.4 75.4 Other Methods 1.3 1.4 10.3 8.2 2.4 3.8 10.3 10.5 0.4 0.5 13.1 7.3 1.6 2.4 11.1 9.2 7.3

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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Chapter 4 Health and Disabilities As a policy concern, population ageing is also accompanied by what is termed an ‘epidemiological transition’ – a shift in the patterns of morbidity and the causes of mortality. Because the number of the elderly is growing rapidly and they are living longer, the incidence of infectious and nutritional disorders is increasing, making chronic, degenerative and mental illness the leading causes of morbidity and mortality.

Many disabling diseases and impairments – such as heart ailments, stroke, hearing and visual impairment, etc – among the elderly need long-term care, so do terminal diseases such as cancer and Alzheimer’s disease. Such an epidemiological transition necessitates a policy framework that ensures older persons’ access to quality health care services.

Diabetes, hypertension and arthritis are the most common chronic diseases afflicting the elderly globally. However, in Pakistan, as in many other developing countries, they go largely undetected and untreated. Even when diagnosed, affordability of treatment and availability of caregivers remains an issue for the majority of the elderly, particularly in the rural Southern Punjab.

From capturing a general health outlook of the ageing population, through subject perception, to ascertaining major ailments of the elderly, and from studying health services utilisation to taking an account of affordability of treatment and availability of caregivers, the survey looked into several aspects of the health status of the elderly in Punjab. These have been summarised in the following: 4.1 Current Health Status To ascertain their health status, the respondents were asked to self-assess whether they were very healthy, healthier than average, of average health, somewhat unhealthy or very unhealthy. Only 14 percent of the respondents considered themselves to be very healthy, as opposed to 19 percent who thought they were very unhealthy (Table 4.1).

The survey found that more urban than rural, and more male than female, respondents considered themselves to be very healthy: 25 percent of the urban male and 13 percent of the urban female respondents, against 15 percent of the rural male and 8 percent of the rural female respondents. About one-third (31%) of the respondents considered themselves to be healthier than average, while 29 percent reported that they were of average health.

According to the survey findings, the health of the respondents from Northern Punjab was better than those from Central and Southern Punjab. More than one-third (35%) of the male and 14 percent of the female respondents from the urban Northern Punjab, and 18 percent of the male and 9 percent of the female respondents from the rural Northern Punjab, considered themselves to be very healthy. In comparison, only 17 percent of the male and 7 percent of the female respondents from the urban Southern Punjab, and 11 percent of the male and 6 percent of the female respondents from the rural Southern Punjab, reported the same.

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Table 4.1 Percentage of Respondents by Region, Residence, Gender and Current Health Status

Current Health Status Northern Punjab Central Punjab Southern Punjab Overall Punjab Total


Very Healthy 35.0 14.4 18.3 9.0 24.6 15.1 16.9 8.4 17.0 7.2 11.1 6.0 24.6 12.8 15.4 7.8 14.2 Healthier than Average 25.0 34.2 33.7 35.2 30.3 30.7 41.2 36.3 19.6 16.5 24.4 22.0 26.0 27.5 34.8 32.1 31.1 Of Average Health 16.9 21.9 21 27.7 18.6 25.8 22.8 33.4 32.6 41.2 37.8 41.1 22.4 29.2 26.9 34.5 29.0 Somewhat Unhealthy 5.6 8.2 6.7 6.3 5.9 8.2 3.1 4.6 7.1 14.9 6.9 8.6 6.2 10.0 4.9 6.0 6.4 Very Unhealthy 17.5 21.2 20.2 21.9 20.5 20.3 16.2 17.4 23.7 20.1 19.8 22.3 20.8 20.4 18.0 19.6 19.4

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 To confirm the respondents’ perception, they were further asked, compared with people of same age, whether their health was relatively better, the same or worse. Only 27 percent of the respondents considered their health to be relatively better than that of the people of same age, while 43 percent of them said it was worse (Appendix 1, Table 11). When asked to compare their current health status with last year’s, the majority (62%) of the respondents said that it was worse (Appendix 1, Table 12). The people who enjoy good health in their childhood and youth are likely to stay healthy in the old age too. When asked about their health status while growing up, the overwhelming majority (95%) of the respondents reported that they were very healthy (Appendix 1, Table 13). 4.2 Chronic Illnesses and Disabilities To determine the current health status of the respondents and their spouses (if alive), several questions were asked from them. Some of the major illnesses – chronic diseases (high blood pressure, diabetes, cancer, tuberculosis and digestive illness); heart diseases (angina, heart attack, cerebrovascular ailments, cerebral thrombosis and stroke); joint pains (arthritis, back pain, shoulder pain, neck pain and headache); ailments of the liver or gallbladder (Hepatitis and jaundice); and fractures (hip, thigh and pelvis/broken hip) – were read out to the respondents, and responses were noted separately for them and their spouses.

Almost one-half (49%) of the respondents reported suffering from chronic diseases, while almost two-thirds (65%) from joint pains (Table 4.2). Not surprisingly, the survey found that a much higher percentage of the female respondents suffered from most of the illnesses than their male counterparts. For example, 65 percent of the urban female and 56 percent of the rural female respondents reported that they suffered from chronic diseases, while 44 percent of the urban male and 37 percent of the rural male respondents reported the same. The same is also true for joint pains: 76 percent of the rural female and 65 percent of the urban female respondents reported that they suffered from this illness, while 59 percent of the rural male and 51 percent of the urban male respondents reported the same. It is important to mention that many respondents reported more than one illness

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for themselves and their spouses and Tables 4.2 and 4.3 are based on total positive responses. Table 4.2 Percentage of Respondents by Region, Residence, Gender

and Illness

Illness Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Chronic Diseases 38.8 63.7 41.7 62.5 48.9 70.4 39.6 60.7 38.4 54.6 27.7 42.9 43.6 64.7 36.5 56.0 48.9 Heart Diseases 15.6 13.7 13.9 12.5 16.2 18.6 8.8 9.9 12.1 16.0 8.6 6.0 14.9 16.9 9.7 9.3 11.7 Joint Pains 35.0 55.5 47.2 70.3 60.8 78.4 65.2 79.3 46.0 60.8 54.1 72.3 50.9 68.8 58.6 75.6 64.5 Liver/Gallbladder Ailments 4.4 11.6 4.0 4.7 7.0 9.6 3.8 6.5 1.8 1.0 4.0 4.5 4.9 7.6 3.9 5.6 5.3 Fractures 3.1 6.8 3.2 4.3 10.8 10.4 4.1 8.8 2.2 5.2 6.4 6.5 6.6 8.2 4.6 7.3 6.5 Artificial Joints 0.0 2.1 0.8 0.0 2.2 1.6 1.4 2.6 3.1 7.2 2.5 2.9 2.0 3.2 1.6 2.2 2.1 Respiratory Problems 10.0 10.3 11.9 13.7 13.0 12.3 11.5 11.6 16.1 8.8 19.3 21.7 13.3 10.9 13.9 14.8 13.6 Others 10.0 2.1 10.4 9.8 8.2 7.9 13 10.7 10.7 7.7 14.7 13.8 9.3 6.7 13.1 11.4 10.8

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 The survey showed that the respondents perceived the health of their spouses to be better than their own. While 49 percent of the respondents reported that they were suffering from chronic diseases, only 37 percent of them said the same about their spouses (Table 4.3). Similarly, only 7 percent and 54 percent of the respondents reported that their spouses were suffering from heart diseases and joint pains, respectively. Table 4.3 Percentage of Respondents by Region, Residence, Gender

and Illness of Spouse

Illness of Spouse Northern Punjab Central Punjab Southern Punjab Overall Punjab Total



Chronic Diseases 43.9 32.1 37.0 35.8 57.7 37.8 42.4 30.1 31.4 23.7 28.9 23.6 46.6 33.1 37.1 29.1 36.7

Heart Diseases 2.6 9.4 6.5 14.7 12.9 10.2 5.5 7.6 4.5 16.9 4.3 6.7 8.0 11.7 5.3 8.5 7.4

Joint Pains 32.5 13.2 36.4 43.2 63.9 55.9 62.9 66.4 41.7 39.0 53.3 61.2 50.1 42.3 54.8 61.3 54.2

Liver/Gallbladder Ailments 1.8 3.8 1.6 5.3 4.6 10.2 1.9 5.6 0.0 3.4 3.0 4.5 2.5 7.1 2.2 5.2 3.6

Fractures 1.8 3.8 1.6 5.3 4.6 10.2 1.9 5.6 0.0 3.4 3.0 4.5 2.5 7.1 2.2 5.2 3.6

Artificial Joints 0.9 0.0 1.1 0.0 2.1 0.0 1.1 0.9 3.2 5.1 1.0 1.7 2.2 1.3 1.0 1.0 1.3

Respiratory Problems 4.4 7.5 8.2 7.4 5.0 7.9 5.1 12.3 7.1 23.7 9.2 13.5 5.5 11.7 7.0 11.9 8.4

Others 5.3 5.7 4.8 5.3 2.8 5.6 8.9 8.8 5.1 10.2 5.5 14.1 4.2 6.7 7 9.8 7.1

TOTAL 114 53 184 95 241 127 474 342 156 59 304 178 511 239 962 615 2,327

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Those respondents who had reported suffering from an illness were further asked whether they were taking any medicines for its treatment. The significant majority of them replied in the affirmative to this question: 90 percent of those suffering from chronic diseases, 87 percent of those suffering from heart diseases, 87 percent of those suffering from respiratory diseases, 85 percent of those suffering from liver or gallbladder ailments and 81 percent of those suffering from joint pains reported taking medicines (Table 4.4). Though the overall situation of the urban respondents was slightly better than that of their rural counterparts, there was not much disparity between the two. Similarly, there was not much to choose between the male and female respondents. Table 4.4 Percentage of Respondents by Region, Residence, Gender

and Taking Medicines for Illness

Taking Medicines for Illness


M F M F M F M F M F M F M F M F Chronic Diseases 88.7 92.5 85.7 90.6 90.6 94.9 90.8 90.9 82.6 87.7 78.6 85.4 88.1 92.8 87.0 89.7 89.5 Heart Diseases 92.0 80.0 85.7 87.5 95.0 82.4 90.5 86.1 85.2 80.6 88.6 91.3 92.0 81.5 88.7 87.4 87.4 Joint Pains 78.6 75.3 71.4 81.7 87.1 87.8 81.0 83.3 76.7 78.8 71.7 78.6 83.1 83.5 77.1 81.8 80.9 Liver/Gallbladder Ailments 57.1 76.5 100.0 83.3 88.5 85.7 92.6 80.9 100.0 100.0 81.3 88.2 83.8 83.3 90.6 82.9 85.0

Fractures 100.0 60.0 37.5 81.8 77.5 86.8 69.0 79.7 60.0 40.0 65.4 36.0 78.0 74.1 63.5 69.0 70.5 Artificial Joints 100.0 100.0 50.0 75.0 78.6 70.0 75.9 100.0 90.5 60.0 66.7 36.0 86.8 69.6 71.2 50.9 68.3 Respiratory Problems 100.0 100.0 86.7 88.6 91.7 91.1 84.1 85.7 80.6 82.4 84.6 85.5 89.0 90.9 84.7 86.1 86.8 Others 93.8 100.0 84.6 84.0 86.7 72.4 76.1 87.2 70.8 93.3 70.0 71.7 82.9 80.9 75.3 81.4 79.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Those respondents who had reported that their spouses were suffering from an illness were also asked whether they were taking any medicines for its treatment. The survey found that there was not much difference between the respondents and their spouses in this regard. A slightly higher percentage of the respondents’ spouses than the respondents themselves were taking medicines for illness: 94 percent of those suffering from chronic diseases, 91 percent of those suffering from respiratory diseases, 90 percent of those suffering from heart diseases, 87 percent of those suffering from liver or gallbladder ailments and 83 percent of those suffering from joint pains (Table 4.5).

It was surprising to note that the spouses of only 47 percent of the rural female and 71 percent of the urban female respondents were taking medicines after fracturing bones. Similarly, the spouses of only 79 percent of the urban female respondents were taking medicines for heart diseases. However, because of the small sample size, it would be unsafe to draw any firm conclusions on the basis of this data.

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Table 4.5 Percentage of Respondents by Region, Residence, Gender and Spouse Taking Medicines for Illness

Spouse Taking Medicines for Illness


M F M F M F M F M F M F M F M F Chronic Diseases 94.0 94.1 92.6 88.2 95.7 93.8 94.0 97.1 91.8 92.9 90.9 90.5 94.5 93.7 93.0 93.9 93.7 Heart Diseases 100.0 80.0 100.0 85.7 90.3 84.6 92.3 88.5 100.0 70.0 92.3 91.7 92.7 78.6 94.1 88.5 89.5 Joint Pains 91.9 57.1 74.6 80.5 90.3 93.0 82.6 81.9 86.2 73.9 77.8 84.4 89.5 86.1 80.1 82.5 83.2 Liver/Gallbladder Ailments 100.0 100.0 50.0 100.0 88.2 100.0 84.6 80.0 83.3 100.0 100.0 83.3 89.7 100.0 83.3 82.6 86.7

Fractures 100.0 0.0 100.0 40.0 90.9 92.3 88.9 42.1 0.0 0.0 62.5 64.7 92.3 70.6 79.2 47.4 67.2 Artificial Joints 100.0 0.0 50.0 0.0 80.0 0.0 80.0 66.7 100.0 100.0 66.7 100.0 90.9 100.0 70.0 83.4 83.3 Respiratory Problems 80.0 100.0 80.0 100.0 91.7 100.0 95.8 92.9 90.9 85.7 85.7 91.7 89.3 92.9 88.1 93.2 90.8 Others 83.3 66.7 77.8 100.0 71.4 85.7 92.9 93.3 75.0 83.3 70.6 64.0 76.2 81.3 85.3 81.7 82.4

TOTAL 114 53 184 95 241 127 474 342 156 59 304 178 511 239 962 615 2,327 4.3 Age at the Onset of Illness The age at which illness sets in is a major indicator of how the quality of remaining life will be affected. It was, therefore, asked from all those respondents who had reported suffering from an illness that at what age did they start to experience the symptoms. First, the respondents were asked about the starting age of chronic diseases. Only 1 percent of them reported it to be below 40. In comparison, the survey findings showed, 30 percent and 42 percent of the respondents developed chronic diseases in the age groups of 50-59 and 60-69, respectively (Appendix 1, Table 14).

Next, the respondents were asked about the starting age of heart diseases. The results were more or less similar to those for the chronic diseases. Only 2 percent of the respondents reported that they developed heart diseases before reaching 40. In comparison, 25 percent and 42 percent of them developed heart diseases in the age groups of 50-59 and 60-69, respectively (Appendix 1, Table 15).

The survey also asked the respondents about the starting age of joint pains and found that, like chronic and heart diseases, they are a phenomenon of later years in life. Only a fraction (0.4%) of the respondents reported that they developed joint pains before reaching 40. In comparison, 27 percent and 45 percent of them developed joint pains in the age groups of 50-59 and 60-69, respectively (Appendix 1, Table 16).

Finally, the respondents were asked about the starting age of fractures. Only 3 percent of the respondents reported that they started fracturing bones before reaching 40. In comparison, 21 percent and 41 percent of them started fracturing bones in the age groups of 50-59 and 60-69, respectively (Appendix 1, Table 17).

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4.4 Heart Attack The survey also asked the respondents whether they ever had a heart attack. Those who replied in the affirmative were then asked at what age did they had the heart attack. Only 6 percent of the respondents said that they had a heart attack before reaching 50 (Table 4.6). In comparison, 41 percent of them had a heart attack in the age group of 60-69, 30 percent in the age group of 70 and above, and 23 percent in the age group of 50-59. Interestingly, more female than male respondents from the urban areas (8% against 5%) and more male than female respondents (7% against 5%) from the rural areas reported having a heart attack when they were below 50. Table 4.6 Percentage of Respondents by Region, Residence, Gender

and Age at Heart Attack

Age at Heart Attack


M F M F M F M F M F M F M F M F Below 50 0.0 0.0 4.8 8.3 3.2 3.7 5.3 4.2 20.0 20.0 13.3 0.0 5.3 7.5 7.3 5.1 6.3 50-59 20.0 33.3 23.8 16.7 22.6 29.6 10.5 20.8 30.0 20.0 26.7 33.3 23.2 27.5 20.0 20.5 22.6 60-69 46.7 0.0 42.9 50.0 48.4 44.4 31.6 37.5 30.0 50.0 26.7 66.7 44.7 42.5 34.6 43.6 41.1 70 and Above 33.3 66.7 28.6 25.0 25.8 22.2 52.6 37.5 20.0 10.0 33.3 0.0 26.8 22.5 38.2 30.8 30.0

TOTAL 15 3 21 12 31 27 19 24 10 10 15 3 56 40 55 39 190 More than three-fourths (77%) of the respondents reported that they were taking medicines after having a heart attack (Table 4.7). The survey found that more respondents from the urban than the rural areas (81% against 71% for males, and 82% against 77% for females) were taking medicines after having a heart attack. Surprisingly, 67 percent of the female respondents from the urban Northern Punjab and 43 percent of the male respondents from the rural Southern Punjab said that they were not taking any medicines despite having a heart attack. However, please note that Tables 4.6 and 4.7 are based on a small number of cases and are, thus, subject to very high sampling variability. Table 4.7 Percentage of Respondents by Region, Residence, Gender

and Taking Medicines after Heart Attack

Taking Medicines after Heart Attack




Yes 86.7 33.3 76.2 84.6 81.3 88.5 73.7 70.8 70.0 80.0 57.1 100.0 80.7 82.2 71.4 77.3 77.3

No 13.3 66.7 23.8 15.4 18.8 11.5 21.1 29.2 30.0 20.0 42.9 0.0 19.3 17.8 28.6 22.7 22.2

TOTAL 15 3 21 12 31 27 19 24 10 10 15 3 56 40 54 39 190

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4.5 Loss of Vision Old age often brings in its wake loss of vision. Considering this, the interviewers were instructed to note the respondents’ vision in one or both eyes. The overwhelming majority (93%) of the respondents had vision in both eyes, while only 6 percent of them had vision in one eye and 1 percent had no vision in both eyes (Table 4.8). Overall, more female than male respondents had vision in both eyes: 94 percent against 92 percent in the urban areas, and 94 percent against 93 percent in the rural areas. Table 4.8 Percentage of Respondents by Region, Residence, Gender

and Vision

Vision Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural

M F M F M F M F M F M F M F M F Vision in Both Eyes 93.8 95.9 92.9 95.3 90.8 93.7 94.4 94.3 92.9 93.3 90.4 92.4 92.1 94.0 92.8 94.0 93.2 Vision in One Eye 5.6 3.4 6.0 4.7 7.6 5.8 5.1 4.8 4.9 6.2 7.7 6.8 6.4 5.4 6.0 5.3 5.8 No Vision in Both Eyes 0.6 0.7 1.2 0.0 1.6 0.5 0.6 0.8 2.2 0.5 2.0 0.8 1.6 0.5 1.1 0.7 1.0

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,370 1,362 4,191 The respondents who had vision in one or both eyes were further asked whether they wore glasses. Only 40 percent of them replied in the affirmative to this question (Table 4.9). The survey findings showed that the trend of wearing glasses was most common in the urban Northern Punjab, from where 69 percent of the male and 63 percent of the female respondents reported the same; while it was least common in the rural Southern Punjab, from where only 26 percent of the male and 22 percent of the female respondents reported the same. Table 4.9 Percentage of Respondents by Region, Residence, Gender

and Wearing of Glasses Wear Glasses



TOTAL 159 144 249 256 364 363 708 719 221 193 397 380 744 700 1,354 1,355 4,153 Those respondents who had reported wearing glasses were also asked how well they could see with or without them. Only 12 percent of them said that they could not see very well even with the glasses (Table 4.10). In comparison, 41 percent and 48 percent of the respondents could see very well and quite well, respectively, with the glasses.

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Table 4.10 Percentage of Respondents by Region, Residence, Gender and Vision with Glasses

Vision with Glasses


M F M F M F M F M F M F M F M F Very Well 64.5 61.4 51.5 45.5 49.5 43.4 38.6 26.1 34.9 26.7 21.4 28.2 50.4 44.3 38.6 31.2 40.6 Quite Well 32.7 35.2 38.2 48.2 42.8 48.5 53.0 56.0 46.5 57.3 54.4 54.1 40.8 47.1 48.9 53.7 47.9 Not Very Well 2.8 3.4 10.3 6.4 7.7 8.1 8.4 17.9 18.6 16.0 24.3 17.6 8.8 8.6 12.6 15.0 11.5

TOTAL 107 88 136 110 194 198 215 257 86 75 103 85 387 361 454 452 1,654 4.6 Difficulty in Hearing Just like vision, old age often brings in its wake hearing problems. To assess their hearing ability, the survey asked the respondents whether they felt any difficulty in hearing in both ears. Only 20 percent of the respondents replied in the affirmative to this question (Table 4.11). However, this finding does not go hand in hand with common experience and may be attributed to reporting problems. Table 4.11 Percentage of Respondents by Region, Residence, Gender

and Difficulty in Hearing in Both Ears

Difficulty in Hearing in Both Ears



TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Of those respondents who had reported difficulty in hearing in both ears, only 3 percent were using hearing aids (Table 4.12). More urban than rural, and more male than female, respondents said that they were using hearing aids: 6 percent of the urban male and 3 percent of the urban female respondents, against 3 percent of the rural male and 2 percent of the rural female respondents.

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Table 4.12 Percentage of Respondents by Region, Residence, Gender and Use of Hearing Aids

Use Hearing Aids



TOTAL 22 21 52 58 87 67 135 149 45 34 88 63 154 122 275 270 821 4.7 Sleep Duration The elderly are mostly not able to get a full night’s sleep. They wake up early and take a nap later in the day or are unable to get sufficient sleep at all. The respondents were asked that on average how many hours they sleep every night. More than two-fifths (41%) of the respondents said that they slept four to six hours every night (Appendix 1, Table 18).

The respondents were next asked whether they were satisfied with their sleep. More than two-thirds (67%) of the respondents replied in the affirmative to this question (Appendix 1, Table 19). The survey findings showed that more female than male respondents (41% against 29% in the rural areas and 33% against 23% in the urban areas) were unsatisfied with their sleep. In the rural Southern Punjab, almost one-half (47%) of the female respondents reported the same.

The respondents were also asked whether they took naps during the day. Almost one-half (46%) of them said that they took a nap daily (Appendix 1, Table 20). This trend was much more common in Northern and Central Punjab. Finally, the survey asked the respondents about the duration of their naps. Almost one-half (49%) of them said that they ranged between 30 minutes and one hour (Appendix 1, Table 21). 4.8 Body Pain Body pain is a fact of life for most of the elderly. It can be associated with joints, back or shoulders, or with an assortment of health conditions. The respondents were asked whether they experienced any body pain in the last month. More than one-third (37%) of the respondents said that they did not experience any body pain, while 36 percent of them said that they experienced mild body pain during the last month (Table 4.13).

The male respondents fared much better than the female respondents on this count. While 49 percent of the urban and 45 percent of the rural male respondents said that they did not experience any body pain in the last month, only 30 percent of the urban and 26 percent of the rural female respondents reported the same. Interestingly, only a fraction (0.2%) of the respondents reported extreme body pain during the last month.

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Table 4.13 Percentage of Respondents by Region, Residence, Gender and Body Pain during Last Month

Body Pain during Last Month


None 57.5 35.6 42.1 22.7 35.9 14.5 40.4 18.6 62.9 53.1 55.5 40.8 48.5 29.5 45.2 25.6 36.7 Mild 25.0 39.0 29.4 41.0 43.5 53.4 40.0 47.2 13.8 10.3 19.5 25.4 30.8 38.6 32.0 39.9 35.5 Moderate 11.9 11.6 14.3 18.4 15.9 23.3 14.2 26.1 15.6 22.7 18.8 23.3 15.0 20.7 15.6 23.9 19.0 Severe 5.6 13.0 13.9 18.0 4.6 8.2 5.3 8.0 7.7 13.4 6.2 10.2 5.7 10.6 7.1 10.5 8.6 Extreme 0.0 0.7 0.4 0.0 0.0 0.5 0.0 0.1 0.0 0.5 0.0 0.3 0.0 0.5 0.1 0.1 0.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 753 704 1,369 1,363 4,191

When asked whether body pain affected their activities of daily living, 39 percent of the respondents said that it occasionally did, while 26 percent of them said it often did (Appendix 1, Table 22). Similarly, more than one-half (53%) of the respondents reported a combination of pain in the back, joints, shoulders and head (Appendix 1, Table 23). The survey findings showed that slightly more female that male respondents (56% against 50% in the rural and 52% against 50% in the urban areas) were afflicted. 4.9 Bladder and Bowel Control The loss of bladder and bowel control is another matter of concern for the elderly. However, when the respondents were asked whether they experienced loss of bladder and/or bowel control, more than two-thirds (70%) of them did not report any problem and only 10 percent of them said that they suffered from both (Table 4.14). The female respondents from the rural Central Punjab fared the worst on this count: 17 percent of them reported that they experienced loss of bladder and bowel control, while 27 percent of them said that they suffered from loss of bladder control.

Table 4.14 Percentage of Respondents by Region, Residence, Gender

and Bladder and Bowel Control

Bladder and Bowel Control


Loss of Both 3.1 5.5 12.3 13.7 12.2 9.9 11.7 17.4 4.9 3.6 6.7 6.0 8.1 7.3 10.3 13.5 10.4 Loss of Bladder Control 4.4 6.8 6.7 7.0 14.9 20.5 20.4 27.4 8.5 6.7 10.4 11.5 10.8 13.9 14.9 19.1 15.4 Loss of Bowel Control 9.4 4.1 7.5 3.9 4.9 6.3 2.9 4.0 4.9 1.5 5.9 5.2 5.9 4.5 4.6 4.3 4.7 No Problem 83.1 83.6 73.4 75.4 68.1 63.3 65.0 51.2 81.7 88.1 77.0 77.2 75.3 74.3 70.1 63.0 69.5

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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Those respondents who had mentioned loss of bladder and/or bowel control were further asked about the intensity. Almost one-half (46%) of the respondents often experienced one of both of these conditions, while 14 percent of them very often (Table 4.15). The survey found that the problem was more common among the female than the male respondents: 20 percent against 19 percent in the urban and 13 percent against 10 percent in the rural areas said that they very often experienced one of both of these conditions. Similarly, 43 percent of the female respondents against 37 percent of the male respondents in the urban and 51 percent against 46 percent in the rural areas said that they often experienced one of both of these conditions.


and Difficulty in Bladder and/or Bowel Control

Difficulty in Bladder and/or Bowel Control




Very Often 22.2 8.3 4.5 14.5 15.8 20.9 9.2 10.7 26.8 29.2 15.1 19.3 19.1 20.3 9.8 12.7 13.8

Often 29.6 33.3 47.0 64.5 35.8 43.3 45.0 51.7 46.3 50.0 49.5 36.4 37.2 42.9 46.3 50.6 46.2

Seldom 40.7 54.2 40.9 21 42.5 34.3 45 37.1 24.4 20.8 35.5 43.2 38.3 35.1 42.2 36.2 38.2

Rarely 7.4 4.2 7.6 0.0 5.8 1.5 0.8 0.6 2.4 0.0 0.0 1.1 5.3 1.7 1.7 0.6 1.8

TOTAL 27 24 66 62 120 134 249 356 41 24 93 88 188 182 408 506 1,284 4.10 Health Services The provision of health services is a complex combination of treatment, medication and care when it comes to the elderly, for they have peculiar and more frequent needs. The survey aimed at assessing the respondents’ related needs by taking stock of their visits to hospitals as inpatients as well outpatients, besides inquiring about their arrangements of caregivers.

The respondents were first asked who usually took care of them when they fell ill. Though the majority of the respondents had someone to look after them as a caregiver in case of need, a small minority (3%) of them also reported that they had no one to take care of them when they fell ill (Table 4.16). The survey found that children were caregivers for 39 percent, sons-/daughters-in-law for 34 percent and spouses for 19 percent of the respondents.

As is the norm in our society, a much higher percentage of the male than the female respondents reported that their spouses were their caregivers: 33 percent against 4 percent in the urban and 34 percent against 4 percent in the rural areas. In contrast, more female than male respondents (43% against 35% in the urban and 39% against 38% in the rural areas) said that their children were their caregivers. Similarly, more female than male respondents (45% against 22% in the rural and 44% against 25% in the urban areas) reported their sons-/daughters-in-law to be their caregivers.

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and Caregivers

Caregivers Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Children 26.3 31.5 31.7 35.2 31.8 35.1 37.9 35.6 47.8 67.5 40.7 49.2 35.4 43.3 37.6 39.3 38.6 Sons-/Daughters-in-Law 22.5 52.1 22.2 48.4 31.9 53.2 23.0 49.4 16.5 21.6 19.3 34.6 25.3 44.3 21.8 45.0 33.8 Grandchildren 1.9 2.7 2.0 5.9 1.6 2.7 1.8 3.6 0.9 1.5 2.0 2.6 1.5 2.4 1.9 3.7 2.5 Spouses 45.0 5.5 39.7 1.6 30.0 2.5 30.6 4.1 30.4 4.1 35.8 6.3 33.3 3.6 33.8 4.2 19.0 Siblings/Relatives 1.3 4.1 3.6 4.7 2.2 2.2 2.8 1.4 1.3 1.0 1.0 2.6 1.7 2.3 2.4 2.4 2.2 Yourself 2.5 1.4 0.8 2.3 2.2 3.6 3.7 5.7 2.7 3.6 1.2 4.7 2.4 3.1 2.4 4.8 3.3 Others 0.6 2.7 0.0 2.0 0.3 0.8 0.1 0.3 0.4 0.5 0.0 0.0 0.4 1.1 0.1 0.5 0.4

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 4.11 Health Care Utilisation Health need rise with age. The survey found that 92 percent of the respondents were taken to hospital or outpatient facility at least once during the last 12 months (2008-2009). Of these, 12 percent spent at least one night or more in the hospital. This near universal self-reported utilisation of health care services should be interpreted with caution, because it is not consistent with the other information reported in the survey. 4.11.1 Inpatient Utilisation When the respondents were asked whether they had stayed overnight at a hospital because of an illness or accident during the last year, only 12 percent of them replied in the affirmative (Table 4.17). The percentage was the highest (18%) among the male respondents from the rural Northern Punjab. Overall, almost an equal percentage of male and female respondents stayed overnight at a hospital because of an illness or accident during the last year. Table 4.17 Percentage of Respondents by Region, Residence, Gender

and Overnight Stay at Hospital during Last Year

Overnight Stay at Hospital during Last Year


Yes 11.9 11.6 17.5 12.9 12.4 12.9 10.1 11.4 12.9 11.9 10.1 9.4 12.4 12.4 11.5 11.1 11.7 No 88.1 88.4 82.5 87.1 87.6 87.1 89.9 88.6 87.1 88.1 89.9 90.6 87.6 87.6 88.5 88.9 88.3

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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Those respondents who had reported staying overnight at a hospital in the last year were asked about the number of times. The majority (81%) of the respondents said that just once (Table 4.18). However, 13 percent of them also said that they twice stayed overnight at a hospital in the last year. The survey found that only 1 percent of the respondents stayed overnight at a hospital five or more times in the last year, but most of them were female respondents. Surprisingly, not even a single male respondent from the urban areas stayed overnight at a hospital five or more times in the last year. Table 4.18 Percentage of Respondents by Region, Residence, Gender

and Number of Times Overnight Stay at Hospital during Last Year

Number of Times Overnight Stay at Hospital during Last Year



1 63.2 70.6 75.0 80.6 73.9 70.2 87.5 84.3 93.1 91.3 82.9 86.5 77.6 75.8 82.8 84.1 81.0 2 15.8 11.8 15.9 12.9 17.4 17.0 11.1 10.8 6.9 0.0 14.6 13.5 13.8 11.5 13.4 11.9 12.7 3 15.8 11.8 4.5 6.5 6.5 2.1 1.4 1.2 0.0 8.7 0.0 0.0 6.4 5.7 1.9 2.0 3.5 4 5.3 5.9 4.5 0.0 2.2 6.4 0.0 1.2 0.0 0.0 0.0 0.0 2.1 4.6 1.3 0.7 1.8 5 and More 0.0 0.0 0.0 0.0 0.0 4.3 0.0 2.4 0.0 0.0 2.4 0.0 0.0 2.3 0.6 1.3 1.0

TOTAL 19 17 44 31 46 47 72 83 29 23 41 37 94 87 157 151 489 Those respondents who had reported staying overnight at a hospital at least once in the last year were further asked about the type of medical facility they used. More than two-fifths (42%) of the respondents said that they were admitted to a district hospital, while more than one-third (36%) of them to a private hospital (Table 4.19). The survey findings showed that there was not much variation between either the urban and rural areas or the male and female respondents. Table 4.19 Percentage of Respondents by Region, Residence, Gender

and Type of Medical Facility (Inpatients)

Type of Medical Facility (Inpatients)


Basic Health Unit 0.0 0.0 0.0 3.0 0.0 2.1 0.0 2.4 0.0 0.0 0.0 10.8 0.0 1.1 0.0 4.6 1.6 Municipal Hospital 10.5 5.9 11.4 3.0 15.2 6.4 16.9 6.1 6.9 8.7 19.5 13.5 11.7 6.9 16.0 7.2 10.8 District Hospital 15.8 29.4 38.6 33.3 52.2 55.3 33.8 43.9 51.7 43.5 43.9 43.2 44.7 47.1 37.8 41.4 41.9 Private Clinic 5.3 5.9 2.3 3.0 6.5 2.1 4.2 2.4 0.0 8.7 9.8 2.7 4.3 4.6 5.1 2.6 4.1 Private Hospital 52.6 47.1 38.6 39.4 26.1 29.8 40.8 41.5 37.9 39.1 19.5 27.0 35.1 35.6 34.6 37.5 35.8 Military Hospital 5.3 11.8 9.1 15.2 0.0 4.3 2.8 2.4 0.0 0.0 7.3 0.0 1.1 4.6 5.8 4.6 4.3 Others 10.5 0.0 0.0 3.0 0.0 0.0 1.4 1.2 3.4 0.0 0.0 2.7 3.2 0.0 0.6 2.0 1.4

TOTAL 19 17 44 33 46 47 71 82 29 23 41 37 94 87 156 152 489

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The survey also included questions to ascertain the reasons for the respondents’ hospitalisation and discovered a variety of them. According to its findings, 25 percent of the respondents were taken to hospital for chronic diseases (Table 4.20). The survey also found that more female than male respondents (35% against 16% in the urban and 28% against 22% in the rural areas) were admitted to a hospital for chronic diseases. On the other hand, more male than female respondents (23% against 15% in the urban and 15% against 11% in the rural areas) were admitted to a hospital for heart diseases. Table 4.20 Percentage of Respondents by Region, Residence, Gender

and Reason for Hospitalisation Reason for Hospitalisation


Chronic Diseases 26.3 23.5 20.5 42.4 15.2 34.0 23.9 25.6 10.3 43.5 19.5 18.9 16.0 34.5 21.8 27.6 24.7 Heart Diseases 26.3 11.8 22.7 3.0 23.9 14.9 9.9 13.4 20.7 17.4 14.6 10.8 23.4 14.9 14.7 10.5 15.1 Joint Pains 0.0 5.9 0.0 3.0 2.2 4.3 7.0 3.7 6.9 8.7 2.4 10.8 3.2 5.7 3.8 5.3 4.5 Fever of All Types 0.0 5.9 2.3 6.1 2.2 0.0 4.2 6.1 3.4 0.0 2.4 16.2 2.1 1.1 3.2 8.6 4.3 Kidney Problem 15.8 11.8 9.1 9.1 8.7 2.1 7.0 2.4 6.9 4.3 9.8 0.0 9.6 4.6 8.3 3.3 6.3 Eye Operation or Blindness 21.1 23.5 20.5 12.1 19.6 19.1 12.7 20.7 6.9 13.0 17.1 16.2 16.0 18.4 16.0 17.8 17.0 Others 10.5 17.6 25.0 24.2 28.3 25.5 35.2 28.0 44.8 13.0 34.1 27.0 29.8 20.7 32.1 27.0 28.0

TOTAL 19 17 44 33 46 47 71 82 29 23 41 37 94 87 156 152 489 Finally, those respondents who had been admitted to a hospital in the last year were asked who paid for their hospitalisation. More than two-thirds of the respondents (69%) said that their children bore the expenses (Table 4.21). However, quite a few male respondents (22% in the rural and 18% in the urban areas) also paid for their hospitalisation themselves. The survey also showed that spouses of 14 percent and 10 percent of the female respondents in the rural and urban areas, respectively, bore the cost of their hospitalisation. Table 4.21 Percentage of Respondents by Region, Residence, Gender

and Who Paid for Hospitalisation Who Paid for Hospitalisation


Yourself 21.1 11.8 31.8 12.1 15.2 0.0 22.5 6.1 20.7 21.7 12.2 5.4 18.1 8.0 22.4 7.2 14.3 Spouses 0.0 5.9 4.5 15.2 2.2 8.5 4.2 13.4 3.4 17.4 4.9 13.5 2.1 10.3 4.5 13.8 8.0 Children 68.4 82.4 54.5 54.5 71.7 80.9 69.0 70.7 58.6 60.9 73.2 78.4 67.0 75.9 66.0 69.1 68.9 Grandchildren 0.0 0.0 0.0 3.0 0.0 2.1 0.0 2.4 0.0 0.0 0.0 0.0 0.0 1.1 0.0 2.0 0.8 Siblings/Relatives 0.0 0.0 0.0 12.1 0.0 2.1 0.0 1.2 0.0 0.0 0.0 0.0 0.0 1.1 0.0 3.3 1.2 Others 10.5 0.0 9.1 3.0 10.9 6.4 4.2 6.1 17.2 0.0 9.8 2.7 12.8 3.4 7.1 4.6 6.7

TOTAL 19 17 44 33 46 47 71 82 29 23 41 37 94 87 156 152 489

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4.11.2 Outpatient Utilisation The data gathered on those who required medical care but did not need to be admitted to a hospital showed that the significant majority (92%) of such respondents had been to an outpatient medical facility (Table 4.22). More female than male respondents (94% against 88% in the urban and 93% against 91% in the rural areas) reported that they had been to an outpatient medical facility. Table 4.22 Percentage of Respondents by Region, Residence, Gender

and Medical Care without Overnight Stay Medical Care without Overnight Stay



Yes 85.1 97.7 94.2 96.9 89.5 95.9 92.5 93.6 86.7 86.0 86.5 90.4 87.7 93.5 91.0 93.3 91.6 No 14.9 2.3 5.8 3.1 10.5 4.1 7.5 6.4 13.3 14.0 13.5 9.6 12.3 6.5 9.0 6.7 8.4

TOTAL 141 129 208 223 324 318 641 643 195 171 364 345 660 618 1,213 1,211 3,702 When asked about the kind of medical facility they had been to as outpatients, almost one-half (48%) of the respondents said that they visited a private clinic (Table 4.23). In addition, 15 percent of them also said that they visited a private hospital. This clearly shows that the elderly trust private facilities more than the government ones. As expected, more rural than urban respondents (14% against 4% in the case of females and 10% against 5% in the case of males) reported visiting a basic health unit. A few (3%) respondents also reported visiting a dispensary. Table 4.23 Percentage of Respondents by Region, Residence, Gender

and Type of Medical Facility (Outpatients) Type of Medical Facility (Outpatients)


Basic Health Unit 4.2 2.4 11.7 16.7 8.6 4.9 13.2 18.4 0.0 1.4 3.8 3.8 5.2 3.5 10.2 14.1 9.5 Municipal Hospital 3.3 3.2 5.1 3.7 1.4 0.3 4.9 6.0 8.9 8.8 12.7 9.6 4.0 3.1 7.2 6.5 5.7 District Hospital 10.0 17.5 10.2 15.3 18.3 18.0 13.8 15.1 19.5 16.3 13.7 13.5 16.9 17.5 13.1 14.7 15.0 Private Clinic 50.0 45.2 40.3 43.1 45.9 51.5 47.2 36.2 59.2 56.5 57.5 58.0 50.6 51.4 48.9 43.5 47.8 Private Hospital 20.0 23.8 19.9 14.8 18.6 18.4 13.5 17.4 10.1 15.0 7.6 11.5 16.4 18.7 13.0 15.3 15.3 Dispensary 0.8 0.0 2.0 0.5 4.5 4.9 4.6 5.0 0.6 0.7 2.9 2.9 2.6 2.8 3.6 3.5 3.3 Military Hospital 9.2 7.9 8.2 5.6 0.0 0.3 0.8 0.2 0.0 0.0 0.0 0.0 1.9 1.9 1.9 1.2 1.7 Others 2.5 0.0 2.6 0.5 2.8 1.6 2.0 1.7 1.8 1.4 1.9 0.6 2.4 1.2 2.1 1.2 1.7

TOTAL 120 126 196 216 290 305 593 602 169 147 315 312 579 578 1,104 1,130 3,391

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The survey also asked those respondents who had been to an outpatient medical facility in the last year that mostly what type of health practitioners they consulted. The vast majority (71%) of them reported that they visited a doctor for their health problems (Table 4.24). However, 19 percent of the respondents also went to traditional practitioners (hakeems or homeopathic doctors). Not surprisingly, more rural than urban respondents (21% against 10% in the case of females and 24% against 14% in the case of males) reported visiting a traditional practitioner for their health problems. Table 4.24 Percentage of Respondents by Region, Residence, Gender

and Type of Health Practitioner

Type of Health Practitioner


Traditional Practitioner 11.7 6.3 21.9 21.8 14.1 13.1 23.1 20.3 14.8 7.5 26.3 22.4 13.8 10.2 23.8 21.2 18.9 Doctor 87.5 93.7 76.5 78.2 72.1 72.1 64.6 68.1 84.6 89.8 57.1 60.6 78.9 81.3 64.6 68.0 71.0 Nurse 0.0 0.0 0.0 0.0 6.9 4.9 2.7 3.3 0.0 1.4 2.9 4.8 3.5 2.9 2.3 3.1 2.9 Midwife 0.8 0.0 0.0 0.0 0.0 0.3 0.0 0.5 0.0 0.0 0.0 0.6 0.2 0.2 0.0 0.4 0.2 Dispenser 0.0 0.0 1.0 0.0 6.6 9.2 7.8 6.8 0.0 1.4 13.3 11.5 3.3 5.2 8.2 6.8 6.4 Others 0.0 0.0 0.5 0.0 0.3 0.3 1.9 1.0 0.6 0.0 0.3 0.0 0.3 0.2 1.2 0.5 0.6

TOTAL 120 126 196 216 290 305 593 602 169 147 315 312 579 578 1,104 1,130 3,391 The elderly generally develop a tendency to ignore minor ailments until they become acute. To have a holistic view of their health status, the survey asked the respondents whether they chose not to visit a health practitioner even when needed. More than one-third (36%) of the respondents replied in the affirmative to this question (Table 4.25). As expected, more rural than urban respondents (42% against 32% in the case of females and 36% against 27% in the case of males) reported not visiting a health practitioner even when needed. Table 4.25 Percentage of Respondents by Region, Residence, Gender

and Not Visiting a Health Practitioner

Chose Not to Visit a Health Practitioner


Yes 21.3 21.9 32.5 33.2 34.3 36.4 32.4 41.5 19.6 29.9 45.7 49.7 27.2 31.6 36.4 42.2 35.8 No 78.8 78.1 67.5 66.8 65.7 63.6 67.6 58.5 80.4 70.1 54.3 50.3 72.8 68.4 63.6 57.8 64.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 Those respondents who had reported that they did not visit a health practitioner even when needed were also asked about the reasons. Almost three-fourths (73%) of the respondents cited financial constraints as the major reason, while 13 percent of them said

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that they preferred self-medication (Table 4.26). Not surprisingly, more rural than urban respondents (16% against 5% in the case of females and 15% against 6% in the case of males) opted for self-medication instead of visiting a health practitioner. The survey also found that 7 percent of the urban female respondents did not visit a health practitioner even when needed because there was nobody to accompany them. Table 4.26 Percentage of Respondents by Region, Residence, Gender

and Reason for Not Visiting a Health Practitioner

Reason for Not Visiting a Health Practitioner


M F M F M F M F M F M F M F M F Not Enough Money 81.8 71.9 63.4 65.9 70.9 74.6 65.0 61.7 79.1 87.7 85.3 88.0 74.4 77.6 72.2 71.0 72.8 Not Enough Time 9.1 6.3 12.2 4.7 13.4 7.5 5.6 6.7 2.3 1.8 2.2 4.2 10.3 5.8 5.4 5.6 6.2 Self-Medication 3.0 9.4 9.8 8.2 7.9 5.2 23.9 26.7 4.7 1.8 5.4 3.7 6.4 4.9 14.8 16.3 12.8 No Transport 0.0 0.0 3.7 5.9 0.8 0.7 1.7 0.0 0.0 0.0 1.1 2.1 0.5 0.4 1.8 1.6 1.3 Too Far 3.0 3.1 7.3 11.8 2.4 2.2 0.4 0.3 2.3 0.0 1.1 0.5 2.5 1.8 1.8 2.1 2.0 Nobody to Accompany 3.0 6.3 1.2 2.4 3.9 6.7 2.1 2.3 7.0 8.8 3.3 1.6 4.4 7.2 2.4 2.1 3.3 Others 0.0 3.1 2.4 1.2 0.8 3.0 1.3 2.3 4.7 0.0 1.6 0.0 1.5 2.2 1.6 1.4 1.6

TOTAL 33 32 82 85 127 134 234 300 43 57 184 191 203 223 500 576 1,502 4.12 Mental Health Until recently, many people used to die even before reaching the age of 60, but things are fast improving in Pakistan. Not only the age structure is altering, but family relationships are also undergoing a dramatic transformation in the country. On the one hand, improved health care, better sanitation facilities, and enhanced hygiene and nutrition awareness are leading to increasing life expectancy; and on the other, the nuclear family system is rapidly replacing the traditional joint family system. As a result, many people may live long enough to see the old age, but their children may not be living with them, either due to occupational reasons or migration.

To assess how the respondents felt as they grew old, a series of questions was asked from them. They were supposed to tell to what extent did they feel during the last week that they were happy; that they enjoyed life; that they were hopeful about the future; that their appetite was poor; that they were depressed; that everything was an effort; that their sleep was restless; that they were lonely; that people were unfriendly to them; that they were sad; that people disliked them; and that they could not get going. The responses were classified into three categories: often, occasionally and not at all.

The Tables 4.27 to 4.29 summarise the results for the three regions. It should be recognised that answers to such questions are very subjective and needs careful interpretation. These tables have been discussed in detail in the following; however, the

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discussion has been restricted to a few interesting questions related to extreme responses – those enjoying their life versus those not very happy with their life.

According to the survey findings, the urban male respondents from Northern Punjab were the most happy in the region: more than one-third (34%) of them often felt happy, almost one-third (33%) of them often enjoyed life and more than one-half (54%) of them often felt hopeful about the future (Table 4.27). They were followed by the urban female respondents: 22 percent of them often felt happy, more than one-fourth (26%) of them often enjoyed life and 45 percent of them often felt hopeful about the future.

In comparison, more than one-fourth (28%) of the rural male respondents from Northern Punjab often felt happy, 25 percent of them often enjoyed life and almost one-third (33%) of them often felt hopeful about the future. The survey showed that the rural female respondents were the least happy in the region: only 21 percent of them often felt happy, 22 percent of them often enjoyed life and 21 percent of them often felt hopeful about the future. Table 4.27 Percentage of Respondents (Northern Punjab) by

Residence, Gender and Feelings

Feelings URBAN RURAL Male (160) Female (146) Male (252) Female (256)

1 2 3 1 2 3 1 2 3 1 2 3 Appetite was Poor 75.0 17.5 7.5 60.3 17.8 21.9 56.0 25.4 18.7 44.9 28.9 26.2 Felt Depressed 59.4 23.8 16.9 32.9 32.9 34.2 46.0 33.7 20.2 28.1 38.3 33.6 Everything was an Effort 65.0 21.9 13.1 53.4 27.4 19.2 61.5 25.8 12.7 63.3 23.4 13.3 Felt Happy 37.5 28.1 34.4 42.5 35.6 21.9 36.9 35.3 27.8 39.8 39.5 20.7 Sleep was Restless 73.1 11.3 15.6 56.8 17.8 25.3 54.8 16.3 29.0 45.3 14.5 40.2 Felt Lonely 78.8 8.8 12.5 59.6 16.4 24.0 61.9 17.1 21.0 51.2 24.2 24.6 People were Unfriendly 91.3 5.6 3.1 87.7 6.2 6.2 86.5 5.6 7.9 84.0 9.8 6.3 Enjoyed Life 41.3 26.3 32.5 48.6 25.3 26.0 42.1 32.5 25.4 43.4 35.2 21.5 Felt Sad 72.5 13.8 13.8 57.5 19.2 23.3 58.3 19.4 22.2 47.7 23.0 29.3 People Dislike Me 95.6 1.9 2.5 91.1 2.7 6.2 94.0 3.2 2.8 89.5 5.5 5.1 Could Not Get Going 66.9 19.4 13.8 58.9 26.0 15.1 64.7 22.2 13.1 52.3 26.6 21.1 Felt Hopeful about the Future 26.3 19.4 54.4 26.0 29.5 44.5 29.0 37.7 33.3 33.6 45.7 20.7

1 Rarely 2 Occasionally 3 Often

Furthermore, the rural female respondents from Northern Punjab were the least optimistic in the region: more than one-fourth (26%) of them often felt that their appetite was poor, more than one-third (34%) of them often felt depressed, 13 percent of them often felt that everything was an effort, 40 percent of them often felt that their sleep was restless, 25 percent of them often felt lonely, 6 percent of them often felt that people were unfriendly to them, almost one-third (29%) of them often felt sad, 5 percent of them often felt that people disliked them and more than one-fifth (21%) of them often felt that they could not get going.

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In contrast, the urban male respondents from Northern Punjab were the most optimistic in the region: only 8 percent of them often felt that their appetite was poor, 17 percent of them often felt depressed, 13 percent of them often felt that everything was an effort, 16 percent of them often felt that their sleep was restless, 13 percent of them often felt lonely, 3 percent of them often felt that people were unfriendly to them, 14 percent of them often felt sad, 3 percent of them often felt that people disliked them and 14 percent of them often felt that they could not get going.

In Central Punjab, the rural male respondents were the happiest: 40 percent of them said that they often felt happy and enjoyed life, respectively; while almost one-third (33%) of them that they often felt hopeful about the future (Table 4.28). They were followed by the urban male respondents: almost one-third (32%) of them often felt happy, almost two-fifths (39%) of them often enjoyed life and more than one-third (36%) of them often felt hopeful about the future.

In comparison, almost one-third (33%) of the rural female respondents from Central Punjab often felt happy, more than one-third (35%) of them often enjoyed life and more than one-fifth (21%) of them often felt hopeful about the future. The survey showed that the urban female respondents were the least happy in the region: only 26 percent of them often felt happy, 29 percent of them often enjoyed life and 25 percent of them often felt hopeful about the future. Table 4.28 Percentage of Respondents (Central Punjab) by Residence,

Gender and Feelings

Feelings URBAN RURAL Male (370) Female (365) Male (712) Female (725)

1 2 3 1 2 3 1 2 3 1 2 3 Appetite was Poor 62.4 21.4 16.2 49.9 30.4 19.7 57.3 32.4 10.3 45.8 41.2 13.0 Felt Depressed 32.4 47.0 20.5 13.7 52.3 34.0 23.1 49.7 27.2 34.0 53.5 12.5 Everything was an Effort 31.9 45.4 22.7 22.5 56.2 21.4 50.4 39.7 9.8 45.7 42.6 11.7 Felt Happy 24.3 43.2 32.4 27.1 46.6 26.3 15.9 44.5 39.6 18.5 48.6 33.0 Sleep was Restless 64.1 15.4 20.5 53.4 19.2 27.4 59.3 23.3 17.4 44.0 29.0 27.0 Felt Lonely 42.7 33.8 23.5 27.1 35.6 37.3 53.4 32.3 14.3 39.7 35.6 24.7 People were Unfriendly 69.5 18.9 11.6 67.9 23.3 8.8 77.9 16.2 5.9 71.9 19.7 8.4 Enjoyed Life 19.5 41.6 38.9 19.2 52.3 28.5 12.9 47.2 39.9 15.4 49.4 35.2 Felt Sad 37.3 38.1 24.6 20.5 41.1 38.4 40.9 44.8 14.3 24.8 50.8 24.4 People Dislike Me 76.2 15.7 8.1 77.0 17.3 5.8 83.7 12.9 3.4 79.4 15.7 4.8 Could Not Get Going 37.6 35.4 27.0 24.7 39.5 35.9 40.3 45.5 14.2 24.1 49.8 26.1 Felt Hopeful about the Future 26.2 37.8 35.9 30.1 44.9 24.9 17.7 49.2 33.1 24.8 54.6 20.6

1 Rarely 2 Occasionally 3 Often Furthermore, the rural female respondents from Central Punjab were the least optimistic in the region: 20 percent of them often felt that their appetite was poor, more than one-

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third (34%) of them often felt depressed, more than one-fifth (21%) of them often felt that everything was an effort, more than one-fourth (27%) of them often felt that their sleep was restless, more than one-third (37%) of them often felt lonely, 9 percent of them often felt that people were unfriendly to them, more than one-third (38%) of them often felt sad, 6 percent of them often felt that people disliked them and more than one-third (36%) of them often felt that they could not get going.

In contrast, the rural male respondents from Central Punjab were by far the most optimistic in the region: only 10 percent of them often felt that their appetite was poor, 27 percent of them often felt depressed, 10 percent of them often felt that everything was an effort, 17 percent of them often felt that their sleep was restless, 14 percent of them often felt lonely, 6 percent of them often felt that people were unfriendly to them, 14 percent of them often felt sad, 3 percent of them often felt that people disliked them and 14 percent of them often felt that they could not get going.

In Southern Punjab, the urban male respondents were the happiest: 18 percent of them often felt happy, 25 percent of them often enjoyed life and more than one-fifth (23%) of them often felt hopeful about the future (Table 4.29). They were followed by the rural male respondents: 17 percent of them often felt happy, almost one-fourth (24%) of them often enjoyed life and more than one-fourth (26%) of them often felt hopeful about the future.

In comparison, 16 percent of the urban female respondents from Southern Punjab often felt happy, 21 percent of them often enjoyed life and 38 percent of them often felt hopeful about the future. The survey showed that the rural female respondents were the least happy in the region: only 13 percent of them often felt happy, 16 percent of them often enjoyed life and 38 percent of them often felt hopeful about the future.

Furthermore, the rural female respondents from Southern Punjab were the least optimistic in the region: 25 percent of them often felt that their appetite was poor, more than one-third (38%) of them often felt depressed, more than one-fifth (21%) of them often felt that everything was an effort, more than one-third (37%) of them often felt that their sleep was restless, more than one-third (36%) of them often felt lonely, 9 percent of them often felt that people were unfriendly to them, more than one-third (38%) of them often felt sad, 8 percent of them often felt that people disliked them and 25 percent of them often felt that they could not get going.

In contrast, the urban male respondents from Southern Punjab were the most optimistic in the region: only 13 percent of them often felt that their appetite was poor, 23 percent of them often felt depressed, almost one-fifth (19%) of them often felt that everything was an effort, more than one-fifth (21%) of them often felt that their sleep was restless, 18 percent of them often felt lonely, 8 percent of them often felt that people were unfriendly to them, almost one-fifth (19%) of them often felt sad, 6 percent of them often felt that people disliked them and 13 percent of them often felt that they could not get going.

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Table 4.29 Percentage of Respondents (Southern Punjab) by Residence, Gender and Feelings

Feelings URBAN RURAL

Male (224) Female (194) Male (405) Female (382) 1 2 3 1 2 3 1 2 3 1 2 3

Appetite was Poor 60.3 27.2 12.5 46.4 30.4 23.2 62.0 21.2 16.8 42.1 32.7 25.1 Felt Depressed 39.3 37.9 22.8 26.8 35.1 38.1 41.7 32.1 26.2 23.6 38.5 38.0 Everything was an Effort 59.8 21.0 19.2 56.7 24.7 18.6 43.2 35.1 21.7 42.7 36.1 21.2 Sleep was Restless 54.9 24.1 21.0 42.3 27.3 30.4 50.1 22.5 27.4 43.2 19.6 37.2 Felt Happy 47.8 33.9 18.3 53.1 31.4 15.5 48.6 34.6 16.8 48.4 38.7 12.8 Felt Lonely 57.6 24.6 17.9 42.8 31.4 25.8 48.9 29.6 21.5 34.0 29.6 36.4 People were Unfriendly 75.0 17.0 8.0 71.6 18.0 10.3 76.5 19.0 4.4 66.0 24.6 9.4 Enjoyed Life 42.4 32.1 25.4 45.9 33.0 21.1 35.6 40.2 24.2 45.8 38.2 16.0 Felt Sad 47.8 33.0 19.2 38.1 34.5 27.3 41.5 37.8 20.7 27.2 34.6 38.2 People Dislike Me 79.5 14.7 5.8 76.8 17.5 5.7 78.5 17.5 4.0 70.4 21.2 8.4 Could Not Get Going 60.3 27.2 12.5 46.4 30.4 23.2 62.0 21.2 16.8 42.1 32.7 25.1 Felt Hopeful about the Future 39.3 37.9 22.8 26.8 35.1 38.1 41.7 32.1 26.2 23.6 38.5 38.0

1 Rarely 2 Occasionally 3 Often 4.13 Satisfaction with Present Life To assess the overall perception of the elderly, the respondents were asked whether they were satisfied with their present life. They had to choose one of the three options: very satisfied, somewhat satisfied and unsatisfied. About one-half (49%) of the respondents said that they were somewhat satisfied, while more than two-fifths (42%) of them said that they very satisfied with their present life (Table 4.30). The survey found that only 10 percent of the respondents were unsatisfied with their present life. More than one-half (54%) of the urban male respondents reported that they were satisfied with their present life, as opposed to only almost one-third (33%) of the rural female respondents. Table 4.30 Percentage of Respondents by Region, Residence, Gender

and Satisfaction with Present Life

Satisfaction with Present Life


Very Satisfied 76.3 74.0 60.3 50.4 48.4 27.9 41.3 27.4 46.0 38.7 39.3 30.6 53.6 40.4 44.2 32.6 41.5

Somewhat Satisfied 20.0 21.2 29.8 41.8 41.6 57.8 52.8 62.2 47.8 55.2 49.6 52.1 38.8 49.5 47.6 55.6 48.9

Unsatisfied 3.8 4.8 9.9 7.8 10.0 14.2 5.9 10.3 6.3 6.2 11.1 17.3 7.6 10.1 8.2 11.8 9.6

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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A major part of satisfaction with present life would be the extent to which family, relatives and friends were willing to listen to an older person’s worries and problems. According to the survey findings, more than one-half (52%) of the respondents said that their family, relatives and friends liked to listen to them very much (Appendix 1, Table 24). However, the percentage of the female respondents who reported the same was lower than their male counterparts (45% against 54% in the rural areas and 54% against 59% in the urban areas). Sadly, 13 percent (the highest in this category) of the rural female respondents from Southern Punjab reported that their family, relatives and friends did not like to listen to them at all.

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Chapter 5 Physical, Social and Recreational Activities

Social and recreational activities for the elderly are essential for good physical and mental health. These activities, which range from joining a social club for older persons to learning a new hobby, provide the elderly with a forum to interact with other people of their age in the local community. The major constraint for the elderly to participate in such activities is their inability to perform activities of daily living (ADLs), which are defined as “the things we normally do in daily living, including any daily activity we perform for self-care (such as feeding ourselves, bathing, dressing, grooming, etc), work, homemaking and leisure.” 5.1 Activities of Daily Living The elderly are likely to falter in seven activities of daily living (ADLs). These are: 1) taking a bath; 2) changing clothes; 3) eating meal; 4) standing up from a bed or chair; 5) walking around house; 6) going outside house; and 7) using toilet. Usually a person having severe problem in performing any of these activities has to be helped by someone.

The survey asked from the respondents how difficult it was for them to perform each of the ADLs and who assisted them in case of need. Many respondents reported difficulty in performing more than one of the ADLs. Of the respondents, 13 percent had difficulty in taking a bath; 7 percent in changing clothes; 2 percent in eating meal, 34 percent in standing up from bed or chair; 26 percent in walking around house; 42 percent in going outside house; and 21 percent in using toilet (Table 5.1).

More female respondents reported difficulty in performing each of the seven ADLs than their male counterparts: for taking a bath, 16 percent against 10 percent; for changing clothes, 9 percent against 5 percent; for eating meal, 3 percent against 2 percent; for standing up from bed or chair, 39 percent against 29 percent; for walking around house, 31 percent against 21 percent; for going outside house, 48 percent against 37 percent; and for using toilet, 24 percent against 18 percent. Table 5.1 Percentage of Respondents by Gender and Difficulty in

Performing ADLs Activity Male Female Total Taking a Bath 9.5 15.9 12.6

Changing Clothes 5.1 9.4 7.2

Eating Meal 1.8 2.8 2.3

Standing Up from Bed or Chair 29.3 39.3 34.3

Walking Around House 20.8 30.6 25.6

Going Outside House 36.6 48.4 42.4

Using Toilet 18.4 24.4 21.4

TOTAL 2,123 2,068 4,191

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As mentioned already, the respondents found it most difficult to go outside house (42%), stand up from bed or chair (34%) and walk around house (26%). The survey found that the percentage of female respondents from Central Punjab who had difficulty in performing the ADLs was much higher than that of all the other respondents (Table 5.2). The urban female respondents from the region topped in five of the seven ADLs, while the rural female respondents in the remaining two. In fact, the findings were so clear that they could not be attributed to sampling error or small sample size.

More than one-fifth (22%) of the urban female respondents from Central Punjab reported difficulty in taking a bath, against the overall average of 13 percent; 13 percent of them in changing clothes, against the overall average of 7 percent; 5 percent of them in eating meal, against the overall average of 2 percent; more than one-half (57%) of them in standing up from bed or chair, against the overall average of 34 percent; and more than one-third (35%) of them in using toilet, against the overall average of 21 percent. Similarly, more than one-third (39%) of the rural female respondents from Central Punjab reported difficulty in walking around house, against the overall average of 26 percent; and more than one-half (59%) of them in going outside home, against the overall average of 42 percent. Table 5.2 Percentage of Respondents by Region, Residence, Gender

and Status of ADLs

Status of ADLs Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural M F M F M F M F M F M F M F M F

Taking a Bath 1 6.9 9.6 5.5 9.9 14.8 21.7 10.2 18.0 2.8 9.7 10.8 15.7 9.6 15.9 9.5 15.8 12.6

2 93.1 90.4 94.5 90.1 85.2 78.3 89.8 82.0 97.2 90.3 89.2 84.3 90.4 84.1 90.5 84.2 87.4

Changing Clothes 1 4.3 7.2 5.5 7.8 6.1 12.6 5.8 11.1 2.4 7.6 4.6 6.0 4.6 10.1 5.4 9.1 7.2

2 95.7 92.8 94.5 92.2 93.9 87.4 94.2 88.9 97.6 92.4 95.4 94.0 95.4 89.9 94.6 90.9 92.8

Eating Meal 1 1.6 0.6 1.8 2.1 2.6 4.6 1.8 3.2 0.8 2.1 1.6 2.1 1.9 3.1 1.7 2.7 2.3

2 98.4 99.4 98.2 97.9 97.4 95.4 98.2 96.8 99.2 97.9 98.4 97.9 98.1 96.9 98.3 97.3 97.7

Standing Up from Bed or Chair

1 13.8 23.5 27.0 27.6 44.4 56.8 33.2 46.1 9.2 16.0 27.5 35.5 27.4 38.7 30.4 39.7 34.3

2 86.2 76.5 73.0 72.4 55.6 43.2 66.8 53.9 90.8 84.0 72.5 64.5 72.6 61.3 69.6 60.3 65.7

Walking Around House

1 16.0 23.5 23.4 22.3 21.4 36.5 25.6 38.5 11.2 21.9 17.4 22.4 17.2 29.8 22.8 30.9 25.6

2 84.0 76.5 76.6 77.7 78.6 63.5 74.4 61.5 88.8 78.1 82.6 77.6 82.8 70.2 77.2 69.1 74.4

Going Outside House

1 17.0 33.7 36.5 34.6 38.6 55.5 43.3 58.7 23.7 35.4 37.8 43.8 29.6 45.5 40.4 50.0 42.4

2 83.0 66.3 63.5 65.4 61.4 44.5 56.7 41.3 76.3 64.6 62.2 56.2 70.4 54.5 59.6 50.0 57.6

Using Toilet 1 8.0 17.5 14.6 15.9 27.5 34.6 17.3 25.8 6.0 14.3 25.4 25.5 17.0 25.5 19.2 23.9 21.4

2 92.0 82.5 85.4 84.1 72.5 65.4 82.7 74.2 94.0 85.7 74.6 74.5 83.0 74.5 80.8 76.1 78.6

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

1 Difficulty Found 2 No Difficulty

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Following an almost similar pattern, a higher percentage of the male respondents from Central Punjab had difficulty in performing the ADLs than their counterparts from Northern and Southern Punjab. The urban male respondents from the region topped in five of the seven ADLs, while the rural male respondents in the remaining two.

For taking a bath, 15 percent of the urban male and 10 percent of the rural male respondents from the region reported difficulty, against the overall average of 10 percent for both. For changing clothes, 6 percent of the urban male and rural male respondents each reported difficulty, against the overall average of 5 percent. For eating meal, 3 percent of the urban male and 2 percent of the rural male respondents reported difficulty, against the overall average of 2 percent. For standing up from bed or chair, 44 percent of the urban male and 33 percent of the rural male respondents reported difficulty, against the overall average of 27 percent and 30 percent, respectively. For using toilet, 28 percent of the urban male and 17 percent of the rural male respondents reported difficulty, against the overall average of 17 percent and 19 percent, respectively. For walking around house, 26 percent of the rural male and 21 percent of the urban male respondents from Central Punjab reported difficulty, against the overall average of 23 percent and 17 percent, respectively. For going outside house, 43 percent of the rural male and 39 percent of the urban male respondents from the region reported difficulty, against the overall average of 40 percent and 30 percent, respectively.

In developed countries, most people experiencing difficulty in the ADLs are aged 85 and above. However, due to poor health conditions and lack of health care services, Pakistanis start finding it difficult to perform the ADLs much earlier in life. Life becomes even harder for those living below the poverty line or those with no one to take care of them. The majority of the respondents who had reported difficulty in performing five of the ADLs said that they needed assistance: for taking a bath, 60 percent; for changing clothes, 73 percent; for eating meal, 70 percent; for walking around house, 51 percent; and for going outside house, 61 percent (Table 5.3). In comparison, only 37 percent and 45 percent of the respondents who had reported difficulty in standing up from bed or chair and using toilet, respectively, said that they needed assistance.

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Table 5.3 Percentage of Respondents by Region, Residence, Gender and Need for Assistance in Performing ADLs

Need for Assistance in Performing ADLs



Taking a Bath 1 61.5 81.3 73.3 75.0 55.4 55.6 58.1 59.3 100.0 91.3 45.6 58.8 60.0 64.9 55.5 61.0 60.3

2 38.5 18.8 26.7 25.0 44.6 44.4 41.9 40.7 0.0 8.7 54.4 41.3 40.0 35.1 44.5 39.0 39.7

Changing Clothes 1 75.0 75.0 73.3 77.3 69.6 70.2 76.2 63.9 100.0 83.3 76.2 92.3 75.0 73.7 75.7 71.4 73.4

2 25.0 25.0 26.7 22.7 30.4 29.8 23.8 36.1 0.0 16.7 23.8 7.7 25.0 26.3 24.3 28.6 26.6

Eating Meal 1 100.0 100.0 60.0 66.7 50.0 76.5 76.9 54.2 100.0 60.0 85.7 90.0 66.7 74.6 75.6 63.9 69.6

2 0.0 0.0 40.0 33.3 50.0 23.5 23.1 45.8 0.0 40.0 14.3 10.0 33.3 25.4 24.4 36.1 30.4

Standing Up from Bed or Chair

1 57.7 36.8 35.1 31.2 32.7 36.8 36.7 30.9 69.6 65.8 42.5 45.4 39.1 40.1 38.0 34.6 37.3

2 42.3 63.2 64.9 68.8 67.3 63.2 63.3 69.1 30.4 34.2 57.5 54.6 60.9 59.9 62.0 65.4 62.7

Walking Around House

1 56.7 41.0 51.6 47.6 56.8 55.1 47.3 37.8 53.6 65.4 72.4 64.9 56.2 54.9 53.8 44.6 50.7

2 43.3 59.0 48.4 52.4 43.2 44.9 52.7 62.2 46.4 34.6 27.6 35.1 43.8 45.1 46.2 55.4 49.3

Going Outside House

1 65.6 78.6 68 73.5 58.2 57.0 57.7 56.8 61.0 78.6 57.6 59.8 59.8 64.9 59.4 59.7 60.6

2 34.4 21.4 32 26.5 41.8 43.0 42.3 43.2 39.0 21.4 42.4 40.2 40.2 35.1 40.6 40.3 39.4

Using Toilet 1 66.7 41.4 45.0 40.0 38.8 40.3 47.2 40.7 66.7 79.4 47.7 46.7 44.5 46.5 47.1 42.4 44.9

2 33.3 58.6 55.0 60.0 61.2 59.7 52.8 59.3 33.3 20.6 52.3 53.3 55.5 53.5 52.9 57.6 55.1

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 1 Difficulty Found 2 No Difficulty

It is generally argued that difficulty in performing the ADLs is directly related with the age of the elderly. The survey findings substantiated this argument: the majority of the respondents who reported difficulty in performing any of the seven ADLs were aged 70 and above (Table 5.4). For taking a bath, 61 percent of the respondents aged 70 and above needed assistance, against 39 percent of those in the age group of 60-69; for changing clothes, 69 percent against 31 percent; for eating meal, 70 percent against 30 percent; for standing up from bed or chair, 52 percent against 48 percent; for walking around house, 59 percent against 41 percent; for going outside house, 55 percent against 45 percent; and for using toilet, 55 percent against 45 percent (Table 5.4). Table 5.4 Percentage of Respondents by Difficulty in Performing

ADLs and Age

Age Group Taking a Bath

Changing Clothes Eating Meal Standing Up from

Bed or Chair Walking

Around House Going Outside

House Using Toilet

60-69 39.0 31.4 30.4 48.4 40.7 44.9 45.1

70 and Above 61.0 68.6 69.6 51.6 59.3 55.1 54.9

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5.2 Involvement in Recreational and Social Activities This section provides information about recreational activities of the elderly. The survey investigated to what extent the elderly were engaged in social and recreational activities, and to what extent they socialised. Questions were also asked about their participation in volunteer work and familiarity with latest information technology. The involvement of the elderly in various types of social and recreational activities can be linked with their education, resources available to them and their socioeconomic status.

Furthermore, the level of involvement in recreational activities could vary among men and women. Older men are more likely to be engaged in outdoor activities than their women counterparts, who are more likely to be involved in indoor activities, such as taking care of the grandchildren and helping out family members with household chores. There are also some activities in which both men and women may be involved, such as reading newspaper, listening to radio, watching TV, etc.

All the respondents were asked how frequently (daily, once a week, several times a week, once a month, a few times a year or never) they engaged in the following activities: 1) listening to radio; 2) reading newspapers and magazines; 3) watching television; 4) attending social activities; 5) doing physical exercise; 6) gardening; 7) hanging out with friends and neighbours; 8) watching movies outside the house; and 9) engaging in volunteer work. 5.2.1 Listening to Radio The vast majority of the respondents (86%) said that they never listened to radio, 8 percent said that they listened to radio occasionally and only 6 percent said that they listened to radio daily (Table 5.5). The largest percentage of the respondents who listened to radio daily was of the male respondents from Northern Punjab: 20 percent of the rural and 16 percent of the urban respondents reported listening to radio daily. More than one-half (57%) of the respondents reported that they listened to radio alone (Appendix 1, Table 25). Table 5.5 Percentage of Respondents by Region, Residence, Gender

and Listening to Radio Listen to Radio


M F M F M F M F M F M F M F M F Daily 15.6 0.0 19.8 3.1 8.6 1.6 9.0 1.2 11.2 2.6 7.4 2.9 10.9 1.5 10.5 2.0 6.3 Occasionally 10.6 4.8 7.1 2.0 5.7 4.1 15.6 10.8 4.9 4.1 7.2 3.4 6.5 4.2 11.6 7.1 8.0 Never 73.8 95.2 73.0 94.9 85.7 94.2 75.4 88.0 83.9 93.3 85.4 93.7 82.6 94.2 77.9 90.9 85.7

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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5.2.2 Reading Newspapers and Magazines It has been discussed earlier that the majority (72%) of the respondents had never been to school. Hence, it was not surprising that 97 percent of the rural female and 87 percent of the urban female respondents did not read newspapers and magazines (Table 5.6). The trend of reading newspapers and magazines daily was the most common among the urban male respondents: 38 percent, 32 percent and 16 percent in Northern, Central and Southern Punjab, respectively. Those respondents who said that they read newspapers and magazines were asked whether they did their reading with someone and, if yes, with whom. Nearly all (86%) of the respondents reported that they did their reading alone (Appendix 1, Table 26). Table 5.6 Percentage of Respondents by Region, Residence, Gender,

and Reading of Newspaper and Magazines

Read Newspapers and Magazines


M F M F M F M F M F M F M F M F Daily 37.5 14.4 15.1 0.4 32.4 7.1 12.6 0.8 15.6 2.6 5.7 0.0 28.5 7.4 11.0 0.5 10.1 Occasionally 20.6 5.5 21.4 2.3 12.7 6.0 17.0 3.2 17.0 3.6 9.4 1.6 15.7 5.2 15.6 2.6 9.6 Never 41.9 80.1 63.5 97.3 54.9 86.8 70.4 96 67.4 93.8 84.9 98.4 55.9 87.4 73.4 96.9 80.2

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 5.2.3 Watching Television More than one-half (51%) of the respondents reported that they did not watch television (Table 5.7). The survey findings showed that among those who watched television daily there was a much higher percentage of the urban than the rural respondents (51% against 25% in the case of males and 36% against 17% in the case of females). Surprisingly, 41 percent of the urban female and 34 percent of the urban male respondents reported that they never watched television, while 60 percent of the rural female 57 percent of the rural male respondents reported the same. Table 5.7 Percentage of Respondents by Region, Residence, Gender

and Watching Television Watch Television


Daily 73.1 49.3 37.3 26.6 55.9 42.7 30.9 18.3 26.8 14.4 8.1 8.4 50.9 36.3 25.3 17.1 29.1 Occasionally 13.8 20.5 16.7 21.9 17.0 26.0 23.0 29.1 12.1 18 8.9 10.5 14.9 22.7 17.7 22.5 19.6 Never 13.1 30.1 46.0 51.6 27.0 31.2 46.1 52.6 61.2 67.5 83.0 81.2 34.2 41.0 57.0 60.4 51.3

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 704 1,369 1,364 4,191

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More than three-fourths (76%) of the respondents said that they watched television with their family, while 22 percent of them watched television alone (Table 5.8). In the urban areas of Northern Punjab, 70 percent of the male and 82 percent of the female respondents reported watching television with their family. In the urban areas of Central Punjab, 71 percent of the male and 80 percent of the female respondents watched television with their family. In the case of Southern Punjab, 58 percent of the male and 83 percent of the female respondents from the urban areas said that they watched television with their family. Table 5.8 Percentage of Respondents by Region, Residence, Gender

and with whom Watch Television

With whom Watch Television


M F M F M F M F M F M F M F M F Alone 26.5 12.9 21.3 8.9 29.3 18.5 33.5 10.9 42.5 16.9 27.5 4.2 30.8 16.9 30.0 9.5 22.1 Family 69.9 82.2 76.5 87.8 70.7 80.3 61.8 87.4 57.5 83.1 68.1 95.8 68.1 81.2 65.9 88.6 75.6 Friends and Others 3.7 5.0 2.2 3.3 0.0 1.2 4.7 1.8 0.0 0.0 4.3 0.0 1.0 1.9 4.1 1.9 2.4

TOTAL 136 101 136 123 270 249 385 341 87 65 69 71 493 415 590 535 2,034 Those respondents who said that they watched television were further asked for how long did they watch it on average daily. Almost one-third of the respondents (33%) reported that they watched television for 30 to 60 minutes daily (Table 5.9). Only 13 percent of the respondents watched television for more than two hours. The highest percentage (26%) of respondents who watched television for more than two hours was of the urban male respondents from Southern Punjab. Table 5.9 Percentage of Respondents by Region, Residence, Gender

and Duration of Watching Television

Average Duration of Watching Television


30 Minutes or Less 15.1 22.3 27.2 34.2 25.8 36.1 34.6 42.6 21.0 27.1 37.9 36.2 22.0 31.4 33.3 39.9 31.9 30-60 Minutes 35.3 41.7 44.1 41.7 26.6 18.8 31.8 34.0 37.0 42.4 30.3 33.3 30.8 27.8 34.5 35.7 32.5 One to Two Hours 35.3 23.3 19.1 17.5 29.9 26.3 26.6 12.7 16.1 20.4 19.7 20.3 29.1 24.7 24.1 14.8 23.0 More than Two Hours 14.4 12.6 9.6 6.6 17.8 18.7 7.0 10.6 25.9 10.2 12.1 10.0 18.2 16.0 8.2 9.6 12.6

TOTAL 139 103 136 120 271 255 387 338 81 59 66 69 491 417 589 527 2,024 5.2.4 Attending Social Activities A major issue for the elderly is social isolation and loneliness. It has been observed that grown up children with families often go out to meet friends or for entertainment, leaving

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the parents alone at home. At times, the elderly may find themselves too old and ailing to participate in social gatherings on a daily basis. Only 10 percent of the respondents reported that they attended social activities daily, 63 percent that they attended social activities occasionally and 27 percent that they never attended social activities (Table 5.10). The survey found that the respondents from Southern Punjab lagged behind others in this regard: 55 percent of the urban male and 53 percent of the urban female respondents, and 39 percent of the rural male and female respondents each, never attended social activities. Table 5.10 Percentage of Respondents by Region, Residence, Gender

and Attending Social Activities Attend Social Activities


Daily 3.1 2.7 4.8 1.2 23.0 23.8 15.7 11.4 3.1 2.6 3.5 1.8 12.9 13.6 10.1 6.8 10.1 Occasionally 67.5 69.2 63.9 69.5 60.5 55.3 71.3 72.0 42.4 44.8 58.0 59.2 56.6 55.3 66.0 67.9 63.1 Never 29.4 28.1 31.3 29.3 16.5 20.8 12.9 16.6 54.5 52.6 38.5 39.0 30.5 31.1 23.9 25.3 26.7

TOTAL 160 146 252 256 370 365 711 725 224 194 405 382 754 705 1,368 1,363 4,191 Those respondents who said that they attended social activities were further asked who accompanied them. The majority (62%) of them said that they were accompanied by their family when they went out to attend social activities (Appendix 1, Table 27). However, more than one-half (54%) of the male respondents from Southern Punjab reported going out alone to attend social activities. 5.2.5 Physical Exercise It is widely recognised that physical exercise, such as walking and jogging, has a marked effect on the health of the elderly. The people suffering from hypertension, diabetes and obesity can benefit the most from regular exercise. More than two-thirds (67%) of the respondents reported that they never did physical exercise (Table 5.11). However, the survey found that 46 percent of the urban male and 35 percent of the urban female, and 37 percent of the rural male and 29 percent of the rural female respondents from Northern Punjab did physical exercise daily. When those respondents who had reported doing physical exercise were asked about their partner, the overwhelming majority (93%) said that they did physical exercise alone (Appendix 1, Table 28).

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Table 5.11 Percentage of Respondents by Region, Residence, Gender and Doing Physical Exercise

Do Physical Exercise




Daily 46.3 34.9 36.5 28.5 38.9 28.5 32.8 17.7 17.9 5.2 28.4 17.0 34.2 23.4 32.1 19.5 26.9

Occasionally 8.1 6.8 4.4 4.3 7.0 7.7 3.9 4.1 5.8 4.1 8.4 6.0 6.9 6.5 5.3 4.7 5.6

Never 45.6 58.2 59.1 67.2 54.1 63.8 63.3 78.2 76.3 90.7 63.2 77.0 58.9 70.1 62.5 75.8 67.4

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,368 1,363 4,191 5.2.6 Gardening The significant majority (88%) of the respondents had never done gardening, while only 5 percent of them engaged in this activity daily (Table 5.12). The largest percentage of the respondents who said that they did gardening daily was of the male respondents from the urban Northern Punjab (8%) and the rural Central Punjab (8%). Interestingly, only 1 percent of the rural female respondents from Southern Punjab reported that that they did gardening daily. Overall, the trend was more common among the male respondents than their female counterparts: 6 percent of the male respondents, against 4 percent of the female respondents, in both urban and rural areas said that they engaged in this activity daily. Table 5.12 Percentage of Respondents by Region, Residence, Gender

and Gardening Gardening Northern Punjab Central Punjab Southern Punjab Overall Punjab Total



TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,364 4,191 5.2.7 Hanging Out with Friends and Neighbours Less than one-third (32%) of the respondents said that they hung out with their friends daily (Table 5.13). However, more than one-half (51%) of them reported hanging out with friends occasionally. According to the survey findings, more than one-fourth (28%) of the male respondents from the urban Northern Punjab said that they never hung out. In comparison, only 14 percent and 25 percent of the urban male respondents from Central Punjab and Southern Punjab, respectively, reported the same.

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Table 5.13 Percentage of Respondents by Region, Residence, Gender and Hanging Out with Friends and Neighbours

Hang Out with Friends and Neighbours



TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 5.2.8 Watching Movies Outside the House Another source of entertainment for the elderly is going to cinemas. The survey showed that only a fraction of the respondents went outside the house to watch movies (Table 5.14). The fact that the overwhelming majority (99%) of the respondents never went outside the house to watch a movie could be attributed to the invasion of cable in both urban and rural areas of Punjab. Table 5.14 Percentage of Respondents by Region, Residence, Gender

and Watching Movies Outside the House Watch Movies Outside the House




TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,364 4,191 5.2.9 Engaging in Volunteer Work The respondents were also asked whether they engaged in any volunteer work in the community. The survey found that the overwhelming majority (87%) of the respondents had never engaged in volunteer work (Table 5.15). The highest percentage of the respondents (29%) who engaged in volunteer work was from the urban Northern Punjab.

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Table 5.15 Percentage of Respondents by Region, Residence, Gender and Engaging in Volunteer Work

Engage in Volunteer Work



TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191 More than one-fifth (22 percent) of the female respondents from the urban Northern Punjab also said that they engaged in volunteer work. Even from the rural areas of Northern Punjab, 28 percent of the male and 13 percent of the female respondents reported the same. From the urban Southern Punjab, only 12 percent of the male and 1 percent of the female respondents said that they engaged in volunteer work.

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Chapter 6 Conclusions and Recommendations The purpose of the survey is to bring population ageing to the forefront of national policy agenda through a combination of applied research and advocacy. To study the living conditions of the elderly is only a first step in that direction. The survey also aims at contextualising population ageing in relation to the global understanding of the issue; bringing Pakistan’s policy thinking in line with the several international conventions on ageing to which the country already is a signatory; and engaging the public, private and voluntary sectors in a meaningful debate on the issue.

As a policy issue, population ageing has multiple aspects. Changes in economic, political, social, legal and demographic environment are seemingly breaking down the traditional family system as well as the in-built support structures for the elderly. Trends in industrialisation and urbanisation, together with increased economic constraints, have started to necessitate a shift from joint to nuclear family households. The number of the elderly is rising, quietly but surely, while the societal capacity to take care of them is fast diminishing. Informed by empirical research, culturally sensitive new mechanisms are required to cope with such a momentous shift.

According to the International Labour Organisation (ILO) and World Health Organization (WHO), a key strategy to address economic challenges posed by population ageing is to increase employment opportunities for the population. The elderly can play an important role towards this end. For example, they could be involved in training and skill building of Pakistan’s rapidly increasing youth population. Moreover, the elderly are our major source of critical indigenous and experiential knowledge. Through optimal utilisation of this knowledge and experience for the benefit of the country, especially in areas such as agriculture and the environment, the elderly could be transformed into a productive asset.

Similarly, it is important to consider the elderly, especially women, as a disadvantaged section of the population and take affirmative action to help ameliorate their living conditions. Universal pension reform is on the agenda in many developing countries, but such a reform might not be relevant especially for Pakistan, where the majority of workers are engaged in the informal sector.

For Pakistan to extricate itself from this deepening demographic quagmire, a multi-pronged approach is needed. A composite strategy has to be employed, involving stakeholders from a cross section of the society. But, foremost is the need for recognising the impending crisis and the will to act now. Considering this, the survey aims at providing a basis for a comprehensive plan of action for catering to the physical, emotional, social and economic needs of the elderly.

The first survey of its kind executed in Panjab on the basis of a representative sample found striking differences between the living conditions and health status of the respondents from Northern, Central and Southern regions of the province. Overall the conditions in Southern Punjab were much worse than the other two regions. Similarly, the survey found that there were disparities between the living conditions and health status of the respondents based on their gender; and concluded that women were more vulnerable to problems associated with ageing, such as chronic illnesses, economic

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dependency, widowhood and lack of mobility. Finally, the survey found that the living conditions and health status of the respondents from rural and urban areas were not the same; and concluded that the people living in rural areas faced more health-related problems in their later years compared to people in urban areas.

Not surprisingly, a reasonable number of the elderly enjoyed healthy ageing. Their parents had also died of natural causes without preceding illnesses. The majority of the elderly population was poor and illiterate. A very few of them listened to radio or read newspapers and magazines. Similarly, even though most households had television, only a few of the elderly watched it.

The survey findings provide enough evidence to identify the major issues faced by the elderly and could provide a basis for developing a comprehensive plan of action. Senior citizens of Pakistan have been a marginalised section of the population so far. The way the population of the elderly is increasing, it is a matter of time when they will be an influential political block, as they are in some of the industrialised countries. In the following paragraphs, the major findings of the survey have been are summarised and discussed, followed by a set of recommendations/plan of action: 6.1 Demographic and Socioeconomic Profile Over one-half of both male and female respondents from the three regions of Punjab were aged 60-69. In stark contrast to global and regional trends, the survey found that men outnumbered women in two of the three categories (in the age groups of 70-79, and 80 and above) of the elderly. This trend, which suggests high mortality rates among older women compared with older men, may be attributed to the fact that women are a disadvantaged segment of our society with lesser access to nutrition and health care.

This finding also corroborates an earlier study (GoP 2000) that concluded: “Pakistan also has a unique situation in that it has more elderly men than women. The standard demographic pattern in both rich and poor countries is that there are more women than men for each age cohort after 10 years of age. Even in countries where maternal mortality keeps the ratio of men to women about equal until age 45, there are usually more women than men for each age cohort of 45 and older, and the standard pattern is that the proportion of women increases for each age cohort. In contrast, Pakistan has more men than women for each age cohort. This difference increases with age, even after 45, when maternal mortality has no impact. Pakistan’s National Plan of Action for Women and the joint Pakistan/UNICEF Master Plan of Operation for Girl Children and Younger Women suggests that this unusual difference may be due to a gender bias in nutrition and/or access to medical care, but there is no data to support or refute this.”

A large proportion of both male and female respondents had grown up in rural areas. This pattern indicates migration from rural to urban areas. Among the female respondents, migration might be a consequence of their marriage in urban areas; while for male respondents, it might be related to their employment.

Surprisingly, three-fourths of the respondents reported that their parents died at age 70 and above, the majority of them of old age and frailty without experiencing any major disease prior to their death. In addition, the overwhelming majority of parents (88%

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fathers and 98% mothers) were illiterate. Over one-half of the respondents said that the occupation of their father was agriculture, while mothers of almost all of them were housewives.

The overwhelming majority of the respondents were illiterate, 54 percent males and 90 percent females. Since education is considered as an important indicator of income and social status, these statistics indicate nearly total disempowerment of women and their dependence on men. The situation of rural male respondents was also pathetic and three-fifths of them reported having no education. A relatively larger percentage of urban male respondents, regardless of region, had some education.

This finding suggests that at the time when both male and female respondents were growing up, either there was a lack of access to education in the rural areas or it was not given much importance. As expected, the majority (55%) of the urban male respondents from Southern Punjab reported having no education. Southern Punjab has always been a less developed area and the survey findings endorsed this fact; even those living in the urban areas of the region lacked access to education.

Nearly all the male respondents were gainfully employed: 41 percent in the rural and 31 percent in the urban areas. However, the female labour force participation was negligible. Nearly two-thirds of the male respondents were unskilled labourers and only 9 percent had a white-collar job.

As expected, over one-half of the female respondents (65% in the urban and 53% in the rural areas) were widowed against only over one-fourth of the male respondents (31% in the urban and 28% in the rural areas). Furthermore, over two-thirds of the male respondents (70% in the rural and 68% in the urban areas) were living with their spouses, as against only 45 percent of the female respondents in the rural and 34 percent in the urban areas.

The survey found that 94 percent of both male and female respondents lived in a house owned by them. The quality of the materials used in the construction of houses was good even in the rural areas, from where 63 percent of the respondents reported living in a concrete house. The access to electricity and water supply was nearly universal; however, only 7 percent of the rural households used treated water.

Although one-half of the households had a flush toilet in the house, 21 percent of both male and female respondents still used open spaces, mainly in the rural areas. Three-fourths of the urban households used natural gas and 90 percent of the rural households used wood or dung as cooking fuel. Nearly two-thirds of the urban households had a washing machine and a refrigerator/freezer, while only one-third of the rural households had these facilities.

Overall, urban households had much more access to information and communication technologies (ICTs) than the rural households. Nearly three-fourths of both male and female respondents had a cell phone, two-thirds had a television and only one-fourth had a radio in the house. Though rural-urban gap in access to ICTs existed, it was much narrower than for other household items. Bicycle was still the most common mode of transportation in both urban and rural areas, followed by motorcycle.

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It is commonly believed that in the Pakistani society, the elderly are looked after by their sons and families, they are given a lot of respect and status in the household, and all their financial needs are met. However, a study conducted in the rural areas of all of Pakistan’s provinces shattered this myth. It revealed that only one-half of the older men and women were financially supported by their sons (Clark et al, 2002). Sons of the other half either did not earn much or did not care to financially support their parents.

The findings of this survey are no different; about one-third of both male and female respondents reported that they did not get much respect from their family. Over one-fourth of the male and about one-third of the female respondents said that they suffered loss of status in the family due to old age. Almost one-third of both male and female respondents also felt lonely or very lonely. Hence, it is not surprising that a significant proportion of both male and female respondents also said that they suffered from depression. 6.2 Mental Health Both male and female respondents were asked to state their feelings about various daily experiences on a scale of three: often, sometimes and not at all. Overall, both urban and rural respondents reported similar experiences though the intensity slightly varied. However, there was a significant variation between the regions. The respondents from Southern Punjab were relatively more content and they were also the happiest. The urban respondents felt relatively lonelier as compared with the rural respondents, and the former also suffered more from poor appetite. Surprisingly, the respondents generally reported that the people were unfriendly to them.

In order to assess their perception about their health, both male and female respondents were asked whether they were satisfied with their present life. They were asked to choose the status of their satisfaction from one of the three options: very satisfied, somewhat satisfied and unsatisfied. Nearly one-half of them said that they were somewhat satisfied and two-fifths that they were very satisfied. Surprisingly, only 10 percent of both male and female were unsatisfied with their present life. 6.3 Health Status and Disability When both male and female respondents were asked to self-assess whether they were very healthy, healthier than average, of average heath, somewhat unhealthy or very unhealthy, only 14 percent of them said that they considered themselves to be very healthy, as opposed to 19 percent who reported that they were very unhealthy. More urban than rural, and more male than female, respondents considered themselves to be very healthy. About one-third of both male and female respondents considered themselves to be healthier than average, while one-fourth reported that they were of average health. When asked to compare their health with the people of same age (whether their health was relatively better, the same or worse), only 27 percent of both male and female respondents considered their health to be relatively better, while 43 percent of

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them said that it was worse. Interestingly, the survey showed that both male and female respondents perceived the health of their spouses to be better than their own.

Almost one-half of both male and female respondents reported suffering from chronic diseases, while two-thirds of them from joints pain. The female respondents suffered more from illnesses than their male counterparts. Those respondents who had reported suffering from any illness were further asked whether they were taking medicines for its treatment. The significant majority of them replied in the affirmative to this question.

Only 5 percent of both male and female respondents reported a heart attack and three-fourths of them were taking medicines for that. Relatively more female than male respondents reported suffering from body pains. When asked whether body pains affected their activities of daily living (ADLs), two-fifths of them said that it occasionally did, while one-fourth said that it often did. Similarly, over one-half of both male and female respondents reported a combination of pains in the back, joint, shoulders and head.

Usually a person having difficulty in performing any of the ADL needs to be helped by someone, depending upon the severity of the problem. More female than male respondents reported difficulty in performing the seven ADLs. The respondents found it most difficult to go outside the house (42%), stand up from a bed or chair (34%) and walk around house (26%). There was considerable variation between the three regions, and between urban and rural areas.

In developed countries, most people experiencing difficulty in performing the ADLs are aged 85 and above. Due to poor health conditions and lack of heath care services, Pakistanis start finding it difficult to perform the ADLs much earlier in life. The majority of both male and female respondents who reported difficulty in performing any of the seven ADLs were aged 70 and above. 6.4 Health Care Utilisation Health needs rise with age. The survey found nearly universal utilisation (hospitalisation and consultation): 12 percent of both male and female respondents had spent at least one night in hospital during the last 12 months. Nearly three-fourths of them reported that the hospitalisation charges were paid by their children, while nearly 21 percent paid these from their own pocket. Of those respondents who had reported using outpatient services, nearly one-half visited a private clinic and 15 percent a private hospital. Basic health units were used mostly by the rural respondents, who also visited a traditional health practitioner (hakeem or homeopath) for their health problems more than their urban counterparts. Nearly one-third of both male and female respondents did not consult a health practitioner for minor illnesses, especially in the rural areas. 6.5 Support Systems for the Elderly In Pakistan, the elderly find limited social support outside the family; and children are the main source of their economic, social and emotional support. Nearly all the male and female respondents believed that the children should take care of their old parents.

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Interestingly, when asked whether children who take better care of their old parents should receive greater portion of their inheritance, almost all of them disagreed. There was a strong sex bias towards sons to take care of the elderly; over two-thirds of both male and female respondents said that they would prefer to stay with a male child. Three-fourths of the respondents said that the women should stay at homes. When asked about the best living arrangements for older persons who never married, one-third of both male and female respondents said they should live with their siblings.

Two-thirds of the respondents (86% female and 47% male) had no independent source of income. When asked who is most likely to help them financially in case of need, three-fourths of the female and two-thirds of the male respondents reported that their children are most likely to help them. When asked how much money they need each month to meet their daily needs, the responses varied from 1,000 and below to over 5,000 rupees per month. Surprisingly, the financial needs of both male and female respondents were more or less similar. Interestingly, financial constrains did not hinder the mobility of the elderly, three-fourths of both male and female respondents said that they could afford to pay for public transport. The majority of both male and female respondents reported that they were not taken along when their family went out for recreation.

The involvement of the elderly in recreational and social activities – such as listening to radio, reading newspapers and magazines, watching television, attending social activities, doing physical exercise, gardening, hanging out with friends and neighbours, watching movies outside the house, and engaging in volunteer work – was limited. According to the survey findings, 86 percent of both male and female respondents never listened to radio; 80 percent of them never read newspapers and magazines; 51 percent of them never watched television; 27 percent never attended social activities; 67 percent never did physical exercise; 88 percent never did any gardening; 99 percent never watched movies outside the house; 17 percent never hung out with friends and neighbours; and 87 percent never engaged in volunteer work. 6.6 Views about Old People’s Homes and Community

Centres The Pakistani society is fast moving away from a joint family living to a nuclear living, mainly due to urbanisation and diminishing landholdings and tenancy arrangements. This is affecting social support systems, especially those meant for the elderly. The survey attempted to gauge how the elderly would feel if the government established old people’s homes and recreational centres for them. Both male and female respondents were first told in detail about old people’s homes – a place where the elderly live together away from their families – and then asked whether they supported such facilities.

Over three-fourths of both male and female respondents supported the idea of old people’s homes and agreed that there should be such facilities. Interestingly, there was very little difference between the perception of urban and rural, as well as male and female, respondents in this regard. When those respondents who had opposed the idea of old people’s homes were asked to state the reasons, the majority of them said it was the responsibility of the family to take care of the elderly.

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Furthermore, even though the majority of both male and female respondents supported the idea of old people’s homes, three-fifths of them were opposed to living there themselves. This is a challenge for the society to convince the elderly to live in old people’s homes. It should also be realised that this discussion is based on the perception of the elderly and tells only their part of the story. A similar study should be conducted to study how young people feel about old people’s homes and the possibility of living there themselves when they grow old.

The survey also solicited views of both male and female respondents about community centres; a place where the elderly could engage in various kinds of activities, such as meeting people of their age, getting checked up by a nurse, gardening, watching television, reading newspapers and magazines, etc. The survey ascertained whether they liked the idea and if such a facility was available to them, would they avail it. The respondents were asked whether they would want to visit a community centre right now if such a facility existed in their locality. Almost three-fifths of the respondents replied in the affirmative to this question. However, more male than female respondents said that they wanted to visit a community centre right now. 6.7 Recommendations One of the main objectives of the survey was to remind both the government and civil society of their responsibilities towards the elderly. The government specifically needs to fulfil its obligations under the Madrid International Plan of Action on Ageing (MIPAA) and work towards the creation of a society ‘for all ages’. Similarly, civil society needs to impart awareness on the issues of the elderly among the public, as well as launch policy advocacy campaigns to ensure that older persons get their due rights.

The National Assembly should pass the law for the establishment of Council for Senior Citizens to safeguard the interests of the elderly.

The government should introduce universal pension system for all the elderly, both contributing and non-contributing, as has been done in neighbouring countries like India and Nepal.

Day care/Recreational centres for the elderly should be established throughout the country.

Old people’s homes should be established in urban areas immediately and in rural areas gradually.

Special units should be established at hospitals to provide free health services and medicines to the poor elderly.

The age of retirement, which currently is 60 in Pakistan, should be increased considering that the country would not have the human resource to fill the gap created by the retirement of experienced professionals, especially in the area of education and development.

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A membership-based national advocacy organisation should be set up to mobilise resources and public opinion in favour of the elderly, as well as to monitor the implementation of the relevant laws.

Universities, research institutes, civil society groups and non-governmental organisations should conduct longitudinal studies on various aspects affecting the life of the elderly, with the main purpose of improving their overall wellbeing.

In conclusion, it is important to mention that this survey report is just a beginning towards creating a society ‘for all ages’. At the next stage, these preliminary findings would be cross-tabulated and statistically analysed to see whether the variations based on sex, urban/rural residence and region reported in the survey exist in reality or are an artefact of sampling design or statistical variability. Moreover, the University of Gujrat (UOG) plans to conduct longitudinal studies on and anthropometric tests for the elderly. A national survey based on a revised questionnaire and lessons learnt from the present survey is also on the cards.

In addition, UOG intends to continue its efforts for building the capacity of various stakeholders to undertake research on the rapidly changing population age structure and its implications, as well as for developing advocacy strategies leading to policy action for the elderly. Finally, it wants to elicit international development assistance on the issue and help create platforms for the elderly to articulate their needs and demands.

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References Afzal, M. 1994. Local Level Policy Development on Consequences of Ageing: Country Case Study in Pakistan (Asian Population Studies Series No 131-D). United Nations Economic and Social Commission for Asia and the Pacific (ESCAP): New York, USA. Afzal, M. 1999a. Growing Old in Pakistan: Challenges for the New Millennium. United Nations Fund for Population (UNFPA): Islamabad, Pakistan. Afzal, M. 1999b. ‘Family Structure and the Elderly in Pakistan’ in The Family and Older Persons in Bangladesh, Pakistan and Sri Lanka (Asian Population Studies Series No 151). ESCAP: New York, USA. Ali, S. M. and Kiani, M.F.K. 2003. Ageing and Poverty (Monograph). Pakistan Institute of Development Economics: Islamabad, Pakistan. Clark, G. 1999. Pakistan’s Zakat and Ushr System and Older People in Pakistan (Paper delivered at the Fourth International Conference on Global Ageing). International Federation on Ageing: Montreal, Canada (Unpublished). Clark, G. Zaman, H. and Ghafoor, C.A. 2002. Pakistan Ageing Study, Preliminary Report on Six Sites in Punjab: Testing Traditional Assumptions about Family Support: Islamabad, Pakistan (Unpublished). Dar, R.H. 1996. Status of the Aged in Modernizing Society (Master’s Thesis). Department of Sociology, University of the Punjab: Lahore, Pakistan (Unpublished). Government of Pakistan. 2000. Pakistan Ageing Survey. National Council of Social Welfare. Ministry of Women Development, Social Welfare and Special Education: Islamabad, Pakistan. Hafeez, M. 2004. Perceived life-situation of an elderly population in Pakistan: Gender-based findings from urban Lahore (Paper delivered at the Fifth Annual Population Research Conference on ‘Sharing Population and Development Research Across South and West Asia’). Population Association of Pakistan in collaboration with the Department of Sociology, University of Karachi: Karachi, Pakistan (Unpublished). Nizamuddin, M. and Ahmad, J.S. 2003. Report of the First International Summer Workshop on Population Ageing. UNFPA and Columbia University: New York, USA (Unpublished). Pakistan Medical Research Council. 2003. Survey on the Health and Living Conditions of the Elderly Population of Pakistan: Islamabad: Pakistan (Unpublished). UNDESA (United Nations Department of Economic and Social Affairs). 2009. World Population Prospects: The 2008 Revision. United Nations: New York, USA.

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Appendix 1: Additional Tables Table 1 Percentage of Respondents by Region, Residence, Gender

and Father’s Age at Death Father’s Age at Death


M F M F M F M F M F M F M F M F Below 60 19.0 19.9 10.8 12.7 13.3 15.0 9.7 15.2 15.3 11.1 12.6 12.8 15.1 14.9 10.8 14.1 13.3 60-69 17.1 14.2 12.8 12.3 10.6 13.6 12.1 9.2 11.3 14.8 11.3 10.7 12.2 14.1 12.0 10.2 11.8 70-79 24.7 22.0 25.2 23.8 19.4 15.8 21.8 20.1 25.7 24.3 22.4 25.3 22.4 19.4 22.6 22.3 21.9 80-89 19.6 24.1 29.2 27.5 25.8 24.6 28.4 28.7 30.2 23.8 23.6 29.3 25.8 24.3 27.1 28.6 26.9 90 and Above 15.2 16.3 19.6 18.4 28.3 27.4 26.6 24.8 14.0 19.6 24.6 19.5 21.2 23.0 24.7 22.1 23.0

Do Not Know 4.4 3.5 2.4 5.3 2.5 3.7 1.4 2.0 3.6 6.3 5.5 2.4 3.2 4.4 2.8 2.7 3.1

TOTAL 158 141 250 244 360 354 703 703 222 189 398 375 740 684 1,351 1,322 4,097 Table 2 Percentage of Respondents by Region, Residence, Gender

and Mother’s Age at Death Mother’s Age at Death


M F M F M F M F M F M F M F M F Below 60 29.6 17.2 10.3 15.8 18.6 21.8 14.5 15.4 15.5 15.5 16.0 16.6 20.0 19.1 14.2 15.8 16.6 60-69 10.5 17.2 18.1 19.6 14.0 16.5 15.2 12.4 14.1 16.0 20.9 19.1 13.3 16.5 17.4 15.6 15.9 70-79 22.4 28.4 23.7 22.9 18.3 20.3 20.3 20.7 31.0 23.2 26.6 22.6 23.0 22.7 22.8 21.7 22.4 80-89 22.4 20.9 29.7 27.1 27.8 25.0 30.0 31.9 20.2 26.5 20.4 24.0 24.4 24.6 27.1 28.8 26.7 90 and Above 15.1 11.9 14.2 10.8 18.3 14.4 18.9 18.5 16.0 13.3 12.7 15.1 16.9 13.6 16.2 16.1 15.9

Do Not Know 0.0 4.5 3.9 3.8 2.9 2.1 1.0 1.0 3.3 5.5 3.4 2.6 2.4 3.5 2.2 2.0 2.4

TOTAL 152 134 232 240 349 340 676 675 213 181 387 350 714 655 1,295 1,265 3,929

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Table 3 Percentage of Respondents by Region, Residence, Gender and Cause of Father’s Death

Cause of Father’s Death


Chronic Diseases 9.5 9.9 8.8 9.8 18.3 18.1 14.2 14.5 9.5 9.0 16.8 15.5 13.8 13.9 14.0 13.9 13.9 Heart Diseases 8.2 10.6 6.8 7.4 16.7 19.2 8.4 10.8 10.4 7.4 7.3 8.3 13.0 14.2 7.8 9.5 10.3 Respiratory Illness 5.1 2.1 2.4 9.8 2.8 3.4 4.3 6.1 4.5 7.9 4.3 5.6 3.8 4.4 3.9 6.6 4.9 Fever of All Types 13.3 8.5 20.4 18.9 6.1 10.5 14.9 13.2 5.4 9.5 14.1 17.3 7.4 9.8 15.7 15.4 13.1 Kidney Problem 0.6 2.1 1.6 0.8 0.8 1.4 1.4 1.3 2.7 2.1 1.0 2.4 1.3 1.7 1.3 1.5 1.5 Paralysis 5.1 2.8 7.6 3.7 2.8 2.8 2.3 2.4 1.8 2.6 2.8 2.7 3.0 2.7 3.4 2.7 3.0 Accident 8.2 2.1 2.0 3.7 3.9 2.0 2.0 1.8 4.1 5.3 3.3 3.7 4.9 2.9 2.4 2.7 3.0 Old Age 36.1 50.4 36.4 33.2 38.3 28.2 40.0 32.7 52.7 35.4 36.4 29.3 42.2 34.8 38.3 31.8 36.3 Others 5.7 5.7 8.8 6.1 7.2 7.3 6.8 7.7 3.6 6.9 8.0 7.2 5.8 6.9 7.5 7.3 7.0 Do Not Know 8.2 5.7 5.2 6.6 3.1 7.1 5.7 9.5 5.4 13.8 6.0 8.0 4.9 8.7 5.7 8.5 7.0


and Cause of Mother’s Death Cause of Mother’s Death


M F M F M F M F M F M F M F M F Chronic Diseases 10.5 16.4 13.4 12.5 20.9 27.4 13.3 16.3 14.6 13.8 20.2 15.1 16.8 21.4 15.4 15.2 16.6 Heart Diseases 9.9 7.5 6.9 9.2 15.8 12.6 7.2 9.9 6.1 9.9 6.2 9.7 11.7 10.8 6.8 9.7 9.3 Respiratory Illness 2.0 4.5 5.2 4.2 2.6 2.6 3.7 3.6 3.3 2.2 4.4 6.3 2.7 2.9 4.2 4.5 3.8 Fever of All Types 17.8 12.7 15.5 19.2 10.0 7.6 8.7 9.9 4.7 7.2 11.9 14.9 10.1 8.5 10.9 13.0 11.0 Kidney Problem 0.0 1.5 0.9 0.8 0.3 0.6 0.6 0.9 0.0 0.6 1.3 1.1 0.1 0.8 0.9 0.9 0.7 Paralysis 3.9 2.2 5.2 2.5 3.2 2.6 4.1 3.4 0.5 2.8 3.1 2.6 2.5 2.6 4.0 3.0 3.2 Accident 1.3 0.7 0.9 1.7 2.6 2.1 1.0 1.8 1.9 1.7 1.8 1.1 2.1 1.7 1.2 1.6 1.6 Old Age 38.2 38.1 39.7 33.3 33.5 25.9 47.9 35.6 54.0 42.5 33.9 28.6 40.6 33.0 42.2 33.2 37.5 Others 9.9 11.2 7.3 9.6 7.2 10.3 5.9 9.2 6.6 7.2 8.8 12.6 7.6 9.6 7.0 10.2 8.6 Do Not Know 6.6 5.2 5.2 7.1 4.0 8.2 7.4 9.5 8.5 12.2 8.5 8.0 5.9 8.7 7.3 8.6 7.7

TOTAL 152 134 232 240 349 340 676 675 213 181 387 350 714 655 1,295 1,265 3,929

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Table 5 Percentage of Respondents by Region, Residence, Gender and Father’s Education

Father’s Education




Illiterate 70.6 76.0 89.7 89.1 77.0 77.3 91.7 91.4 85.7 88.7 96.0 96.9 78.2 80.2 92.6 92.5 87.9

Primary 11.9 10.3 5.2 3.5 11.1 10.1 5.1 3.6 5.4 5.2 2.2 1.8 9.6 8.8 4.3 3.1 5.6

Middle 6.3 5.5 3.2 2.7 5.1 4.1 2.1 2.2 4.0 2.1 1.0 0.8 5.0 3.8 2.0 1.9 2.8

Secondary 7.5 6.2 1.6 3.5 4.9 5.2 1.0 2.2 4.5 3.6 0.5 0.5 5.3 5.0 1.0 2.0 2.7

Above Secondary 3.8 2.1 0.4 1.2 1.9 3.3 0.1 0.6 0.4 0.5 0.2 0.0 1.9 2.3 0.2 0.5 1.0


and Mother’s Education

Mother’s Education




Illiterate 94.4 92.5 98.8 98.8 93.8 94.8 99.6 99.2 98.7 98.5 100.0 99.7 95.4 95.3 99.6 99.3 98.0

Primary 2.5 1.4 1.2 0.8 3.0 4.1 0.3 0.4 0.9 1.5 0.0 0.3 2.3 2.8 0.4 0.4 1.2

Middle 1.3 4.1 0.0 0.0 1.6 1.1 0.1 0.3 0.4 0.0 0.0 0.0 1.2 1.4 0.1 0.2 0.5

Secondary 1.9 1.4 0.0 0.4 1.6 0.0 0.0 0.1 0.0 0.0 0.0 0.0 1.2 0.3 0.0 0.1 0.3

Above Secondary 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

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Table 7 Percentage of Respondents by Region, Residence, Gender and Father’s Occupation

Father’s Occupation




Office Worker 29.4 24.0 13.5 12.5 15.4 15.1 4.2 5.9 10.7 11.3 1.2 2.9 17.0 15.9 5.0 6.3 9.4

Skilled Manual 8.8 14.4 8.3 9.0 13.2 16.7 8.1 7.0 9.8 10.3 6.4 5.8 11.3 14.5 7.6 7.0 9.2

Unskilled Manual 18.1 15.8 14.3 17.6 31.4 23.8 16.3 15.2 25.0 33.0 29.6 24.6 26.7 24.7 19.9 18.3 21.4

Domestic Services 0.0 0.0 0.0 0.0 0.3 0.0 1.1 0.8 0.4 0.5 0.5 0.8 0.3 0.1 0.7 0.6 0.5

Agriculture 37.5 37.7 60.3 57.8 31.6 32.3 65.9 66.5 42.0 37.6 58.8 63.1 35.9 34.9 62.8 63.9 53.6

Personal Business 3.8 5.5 1.6 0.4 4.9 8.8 3.8 3.3 10.3 4.6 0.7 0.3 6.3 7.0 2.5 1.9 3.7

Others 2.5 2.7 2.0 2.7 3.2 3.3 0.6 1.2 1.8 2.6 2.7 2.7 2.6 3.0 1.5 1.9 2.1


and Mother’s Occupation

Mother’s Occupation




Office Worker 0.0 1.4 0.0 0.4 0.0 0.0 0.0 0.7 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.4 0.2

Skilled Manual 0.0 0.0 0.0 0.0 0.0 1.4 0.3 0.6 0.4 1.0 0.7 1.0 0.1 1.0 0.4 0.6 0.5

Unskilled Manual 0.0 0.0 0.0 0.0 0.8 0.5 0.4 0.7 2.2 3.6 5.7 4.5 1.0 1.3 1.9 1.6 1.5

Domestic Services 0.6 0.0 0.0 0.0 0.0 0.5 0.1 0.1 1.3 1.0 2.0 1.8 0.5 0.5 0.6 0.6 0.6

Agriculture 0.0 0.0 1.2 0.8 0.0 0.8 1.1 1.1 3.1 5.2 8.2 8.4 0.9 1.8 3.2 3.1 2.5

Personal Business 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 0.0 0.0 0.1 0.0

Housewife 99.4 97.9 98.4 98.4 97.8 95.3 98.0 96.8 92.9 89.2 83.4 83.5 96.7 94.2 93.8 93.4 94.2

Others 0.0 0.7 0.4 0.4 1.4 1.4 0.0 0.0 0.0 0.0 0.0 0.3 0.7 0.9 0.1 0.2 0.3

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

100

Table 9 Percentage of Respondents by Region, Residence, Gender and Best Living Arrangement for a Widow

Best Living Arrangement for a Widow


Live by Herself 1.9 2.1 1.2 2.0 1.6 1.4 1.8 2.3 2.7 1.0 1.2 0.5 2.0 1.4 1.5 1.7 1.7 Live by Herself but Near Children 28.1 34.

9 19.8 30.9 27.6 25.5 18.0 16.1 25.9 34.0 17.8 27.7 27.2 29.8 18.3 22.1 23.1

Rotate Residence Among Children 16.9 13.

0 25.0 14.5 27.8 31.5 26.4 18.1 25.4 20.6 24.2 27.5 24.8 24.7 25.5 20.1 23.5

Live with a Male Child 45.0 45.9 48.4 48.4 39.7 38.9 50.6 60.0 40.2 40.7 50.4 37.7 41.0 40.9 50.1 51.6 47.4

Others 8.1 4.1 5.6 4.3 3.2 2.7 3.2 3.4 5.8 3.6 6.4 6.5 5.0 3.2 4.6 4.4 4.4

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

Table 10 Percentage of Respondents by Region, Residence, Gender

and Best Living Arrangement for a Widower

Best Living Arrangement for a Widower


M F M F M F M F M F M F M F M F Live by Himself 1.9 3.4 1.6 2.0 2.7 0.8 2.9 2.1 4.9 2.1 2.0 0.8 3.2 1.7 2.4 1.7 2.2 Live by Himself but Near Children 26.9 34.9 20.2 30.1 28.6 26.3 16.7 16.4 26.3 35.6 19.5 25.4 27.6 30.7 18.2 21.5 23.0

Rotate Residence Among Children 15.0 17.8 25.0 21.5 27.6 29.6 25.7 19.4 25.9 21.6 27.2 31.4 24.4 25.0 26.0 23.2 24.6

Live with a Male Child 46.9 40.4 48.8 41.0 38.1 40.5 51.0 59.0 37.9 37.6 44.2 37.4 39.9 39.7 48.6 49.6 45.8 Others 9.4 3.4 4.4 5.5 3.0 2.7 3.7 3.0 4.9 3.1 7.2 5.0 4.9 3.0 4.9 4.0 4.3

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

101

Table 11 Percentage of Respondents by Region, Residence, Gender and Health Comparison with People of Same Age

Health Comparison with People of Same Age


M F M F M F M F M F M F M F M F Relatively Better 48.8 32.9 27.4 25.0 37.8 19.7 26.4 16.7 38.8 22.7 33.1 17.8 40.4 23.3 28.6 18.6 26.6 Same 25.0 17.1 32.5 30.9 28.6 35.9 36.7 36.0 17.9 20.1 23.7 27.7 24.7 27.7 32.1 32.7 30.2 Worse 25.6 50.0 39.3 44.1 33.5 43.8 36.5 47.0 41.5 55.2 43.2 54.2 34.2 48.2 39.0 48.5 42.8 Not Sure 0.6 0.0 0.8 0.0 0.0 0.5 0.4 0.3 1.8 2.1 0.0 0.3 0.7 0.8 0.4 0.2 0.5


and Health Comparison with Last Year

Health Comparison with Last Year


M F M F M F M F M F M F M F M F Relatively Better 14.4 9.6 7.5 8.2 16.5 9.3 10.8 7.0 17.0 13.9 13.6 7.6 16.2 10.6 11.0 7.4 10.7 Same 31.3 30.1 33.7 29.7 26.8 26.3 35.1 27.0 25.0 14.9 24.7 22.0 27.2 23.9 31.8 26.1 27.8 Worse 54.4 60.3 58.7 62.1 56.8 64.4 54.1 65.9 58.0 71.1 61.7 70.4 56.6 65.4 57.2 66.4 61.5


and Health Status while Growing Up

Health Status while Growing Up


M F M F M F M F M F M F M F M F Very Healthy 98.8 95.9 99.2 97.7 93.8 91.0 96.2 93.9 96.4 98.5 95.6 94.2 95.6 94.1 96.6 94.7 95.4 Healthier than Average 1.3 4.1 0.8 2.3 3.5 7.7 3.2 5.4 2.7 0.5 3.7 4.2 2.8 5.0 2.9 4.5 3.7 Of Average Health 0.0 0.0 0.0 0.0 1.4 0.5 0.0 0.6 0.9 0.5 0.7 1.6 1.0 0.4 0.2 0.8 0.6 Somewhat Unhealthy 0.0 0.0 0.0 0.0 1.1 0.8 0.1 0.0 0.0 0.5 0.0 0.0 0.5 0.6 0.1 0.0 0.2 Very Unhealthy 0.0 0.0 0.0 0.0 0.3 0.0 0.4 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.2 0.1 0.1

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

102

Table 14 Percentage of Respondents by Region, Residence, Gender and Starting Age of Chronic Diseases

Starting Age of Chronic Diseases



Below 40 3.2 2.2 1.0 1.3 1.1 1.9 0.7 0.7 0.0 2.8 0.0 1.8 1.2 2.2 0.6 1.1 1.2 40-49 1.6 11.8 3.8 1.9 3.3 5.1 3.5 2.5 7.0 6.6 2.7 1.2 3.9 6.8 3.4 2.1 3.8 50-59 29.0 29.0 21.0 32.5 25.4 35.0 27.3 30.9 26.7 39.6 22.3 36.6 26.4 34.8 24.9 32.5 30.2 60-69 40.3 36.6 36.2 41.9 46.4 40.1 40.8 43.2 52.3 39.6 43.8 39.6 46.8 39.3 40.5 42.2 41.9 70-79 22.6 14.0 23.8 15.6 17.1 13.6 19.1 15.5 11.6 10.4 25.0 15.2 16.7 12.9 21.4 15.5 16.5 80 and Above 3.2 6.5 14.3 6.9 6.6 4.3 8.5 7.3 2.3 0.9 6.3 5.5 4.8 4.0 9.2 6.8 6.5

TOTAL 62 93 105 160 181 257 282 440 86 106 112 164 329 456 499 764 2,048 Table 15 Percentage of Respondents by Region, Residence, Gender

and Starting Age of Heart Diseases Starting Age of Heart Diseases



Below 40 0.0 5.0 5.7 0.0 0.0 1.5 0.0 0.0 0.0 6.5 2.9 4.3 0.0 3.6 1.9 1.2 1.6 40-49 4.0 0.0 0.0 0.0 4.9 2.9 1.6 2.7 14.8 0.0 0.0 0.0 7.7 1.5 0.8 1.5 2.4 50-59 28.0 20.0 25.7 34.4 21.3 16.2 20.6 23.3 22.2 25.8 31.4 34.8 23.0 19.6 24.8 28.6 24.8 60-69 40.0 45.0 40.0 37.5 44.3 57.4 39.7 38.4 33.3 58.1 34.3 43.5 40.1 55.0 38.1 39.6 41.8 70-79 24.0 20.0 25.7 18.8 26.2 19.1 30.2 28.8 11.1 0.0 22.9 13.0 21.3 14.0 27.2 22.5 22.4 80 and Above 4.0 10.0 2.9 9.4 3.3 2.9 7.9 6.8 18.5 9.7 8.6 4.3 8.0 6.3 7.2 6.6 7.0

TOTAL 25 20 35 32 60 68 63 72 27 31 35 23 112 119 133 127 491

103

Table 16 Percentage of Respondents by Region, Residence, Gender and Starting Age of Joint Pains

Starting Age of Joint Pains


M F M F M F M F M F M F M F M F Below 40 0.0 1.2 0.8 0.0 0.0 0.7 0.4 0.3 0.0 0.0 0.0 1.1 0.0 0.6 0.4 0.5 0.4 40-49 7.1 2.5 0.8 1.7 4.9 2.1 1.7 1.4 2.9 4.2 0.9 2.5 4.7 2.7 1.3 1.7 2.2 50-59 21.4 33.3 18.5 31.1 23.1 32.9 21.3 26.1 29.1 38.1 23.3 32.2 24.5 34.2 21.4 28.6 26.9 60-69 35.7 44.4 40.3 44.4 43.6 43.0 47.4 47.5 52.4 39.8 42.0 43.8 44.8 42.5 44.9 46.0 44.8 70-79 30.4 16.0 28.6 15.6 21.3 16.1 20.7 16.9 8.7 14.4 26.5 15.9 19.2 15.7 23.5 16.4 18.8 80 and Above 5.4 2.5 10.9 7.2 7.1 5.2 8.4 7.8 6.8 3.4 7.3 4.3 6.8 4.3 8.5 6.8 6.8

TOTAL 56 81 119 180 225 286 464 575 103 118 219 276 384 485 802 1,031 2,702 Table 17 Percentage of Respondents by Region, Residence, Gender

and Starting Age of Fractures Starting Age of Fractures


M F M F M F M F M F M F M F M F Below 40 20.0 0.0 0.0 0.0 10.0 5.3 6.9 0.0 0.0 0.0 0.0 0.0 10.0 3.5 3.2 0.0 3.3 40-49 0.0 0.0 12.5 18.2 10.0 0.0 10.3 1.6 0.0 10.0 3.8 4.0 8.0 1.7 7.9 4.0 5.2 50-59 0.0 10.0 25.0 0.0 22.5 21.1 20.7 18.8 20.0 0.0 23.1 44.0 20.0 15.5 22.2 23.0 20.7 60-69 40.0 40.0 25.0 45.5 30.0 57.9 31.0 48.4 40.0 40.0 50.0 24.0 32.0 51.7 38.1 42.0 41.3 70-79 40.0 40.0 12.5 27.3 22.5 5.3 20.7 15.6 20.0 40.0 11.5 24.0 24.0 17.3 15.9 19.0 18.8 80 and Above 0.0 10.0 25.0 9.1 5.0 10.5 10.3 15.6 20.0 10.0 11.5 4.0 6.0 10.3 12.7 12.0 10.7

TOTAL 5 10 8 11 40 38 29 64 5 10 26 25 50 58 63 100 271

104

Table 18 Percentage of Respondents by Region, Residence, Gender and Sleep Duration

Sleep Duration Northern Punjab Central Punjab Southern Punjab Overall Punjab Total


Less than 2 Hours 3.1 4.1 7.1 6.3 5.1 6.0 3.8 5.1 5.4 5.7 6.7 13.4 4.8 5.5 5.3 7.6 6.0 2-4 Hours 10.6 19.9 17.1 30.9 17.0 24.4 16.7 26.1 22.3 29.9 26.9 28.0 17.2 25.0 19.8 27.5 22.7 4-6 Hours 36.3 34.9 42.1 35.2 43.5 44.7 42.1 45.7 42.0 41.2 37.8 33.2 41.5 41.7 40.8 40.2 40.9 6-8 Hours 49.4 39.7 31.7 25.8 32.4 23.3 33.8 21.1 28.1 22.2 28.1 25.1 34.7 26.4 31.7 23.1 28.6 More than 8 Hours 0.6 1.4 2.0 2.0 1.9 1.6 3.5 2.1 2.2 1.0 0.5 0.3 1.7 1.4 2.3 1.6 1.8


and Sleep Satisfaction Sleep Satisfaction


M F M F M F M F M F M F M F M F Yes 86.9 77.4 73.8 65.2 74.9 65.8 74.3 60.0 70.5 57.2 62.7 51.3 76.1 65.8 70.8 58.5 66.9 No 12.5 22.6 25.8 34.8 24.9 34.2 25.4 39.7 27.7 40.2 37.0 46.6 23.1 33.4 28.9 40.7 32.5 Not Sure 0.6 0.0 0.4 0.0 0.3 0.0 0.3 0.3 1.8 2.6 0.2 2.1 0.8 0.7 0.3 0.7 0.6

TOTAL 160 146 252 256 370 365 712 725 224 194 405 382 754 705 1,369 1,363 4,191

105

Table 20 Percentage of Respondents by Region, Residence, Gender and Naps

Naps Northern Punjab Central Punjab Southern Punjab Overall Punjab Total




and Duration of Naps

Duration of Naps Northern Punjab Central Punjab Southern Punjab Overall Punjab Total Urban Rural Urban Rural Urban Rural Urban Rural

M F M F M F M F M F M F M F M F Less than 30 Minutes 21.7 26.4 19.8 18.6 14.4 14.1 11.7 15.1 4.8 6.9 9.6 13.5 13.6 15.4 12.8 15.4 14.2 30-60 Minutes 45.7 55.2 41.1 62.3 34.2 47.2 43.3 48.0 58.9 72.4 58.3 53.2 43.2 54.6 46.5 51.7 49.0 60-90 Minutes 3.1 1.6 3.1 0.5 11.3 7.9 11.9 8.4 8.9 5.2 9.2 9.9 8.8 5.8 9.6 7.3 8.0 90-120 Minutes 25.6 15.2 30.2 16.4 32.9 21.4 27.7 24.3 18.5 9.5 15.4 16.7 27.5 17.3 25.2 21.2 23.0 120-150 Minutes 0.8 0.0 0.0 0.0 2.4 4.8 1.8 1.6 0.7 1.7 3.8 3.6 1.6 3.0 1.9 1.7 2.0 150-180 Minutes 3.1 1.6 5.7 2.2 2.7 3.4 2.5 2.1 5.5 0.9 2.9 0.9 3.5 2.4 3.2 1.9 2.7 More than 180 Minutes 0.0 0.0 0.0 0.0 2.1 1.0 1.2 0.5 2.7 3.4 0.8 2.3 1.8 1.3 0.9 0.8 1.1

TOTAL 129 125 192 183 292 290 564 617 146 116 240 222 567 531 996 1,022 3,116

106

Table 22 Percentage of Respondents by Region, Residence, Gender and Body Pain Effect on Activities of Daily Living

Body Pain Effect on Activities of Daily Living



Never 13.4 4.2 6.8 4.0 3.8 2.6 1.7 1.5 16.7 8.8 5.6 5.3 8.2 4.0 3.6 2.8 4.1 Rarely 28.4 24.2 26.7 25.8 29.8 23.4 27.3 22.0 13.1 22.0 16.7 14.9 26.0 23.3 24.6 21.1 23.2 Occasionally 34.3 49.5 34.9 39.4 27.7 35.9 40.4 40.2 48.8 37.4 39.4 45.6 33.4 38.8 39.1 41.2 39.0 Often 23.9 16.8 27.4 27.3 28.2 28.8 24.0 29.2 19.0 26.4 25.6 21.1 25.5 26.1 25.0 27.0 26.1 Always 0.0 5.3 4.1 3.5 10.5 9.3 6.7 7.1 2.4 5.5 12.8 13.2 6.9 7.8 7.7 7.8 7.6

TOTAL 67 95 146 198 238 312 421 590 84 91 180 228 389 498 747 1,016 2,650 Table 23 Percentage of Respondents by Region, Residence, Gender

and Pain in Body Parts

Pain in Body Parts


Back Pain 8.6 5.5 8.6 4.8 6.1 4.3 5.0 4.6 8.3 16.9 7.7 6.9 6.9 6.7 6.3 5.1 6.0 Headache 3.4 3.3 2.9 2.1 5.7 4.6 1.9 2.1 4.2 3.6 2.4 0.5 5.0 4.2 2.2 1.8 2.8 Joint Pains 36.2 45.1 38.8 41.8 21.7 21.3 33.3 28.5 31.9 24.1 24.3 23.1 26.1 26.3 32.3 29.9 29.3 Shoulder Pain 1.7 7.7 2.2 2.1 4.3 6.2 2.4 3.4 1.4 12.0 5.9 3.2 3.3 7.5 3.2 3.1 4.0

All the Above 41.4 35.2 34.5 41.8 57.0 61.3 54.0 58.6 36.1 38.6 52.7 61.1 50.3 52.4 50.0 56.0 52.8

Others 8.6 3.3 12.9 7.4 5.2 2.3 3.4 2.7 18.1 4.8 7.1 5.1 8.3 2.9 6.1 4.1 5.0

TOTAL 58 91 139 189 230 305 417 582 72 83 169 216 360 479 725 987 2,551

107

Table 24 Percentage of Respondents by Region, Residence, Gender and Attitude of Family, Relatives and Friends

Family, Relatives and Friends Like to Listen


M F M F M F M F M F M F M F M F Very Much 75.6 69.2 68.3 60.2 56.5 50.7 54.8 44.7 52.7 46.9 43.5 35.6 59.4 53.5 53.9 45.0 52.0 To a Great Extent 19.4 24.0 22.2 26.2 29.2 32.3 37.4 42.9 34.4 35.6 36.0 41.9 28.7 31.5 34.2 39.5 34.5 To Some Extent 0.6 2.1 4.8 5.5 8.4 10.7 3.9 6.8 7.6 10.3 10.4 9.9 6.5 8.8 6.0 7.4 7.0 Not at All 4.4 4.8 4.8 8.2 5.9 6.3 3.9 5.7 5.4 7.2 10.1 12.6 5.4 6.2 5.9 8.1 6.6


and with whom Listen to Radio

With whom Listen to Radio




Alone 76.7 42.9 70.0 35.7 70.6 52.4 57.7 15.9 88.9 15.4 82.8 29.2 77.7 39.0 65.3 20.6 56.8 Family 23.3 57.1 24.3 57.1 27.5 47.6 35.4 78.4 11.1 84.6 17.2 70.8 21.6 61.0 29.4 74.6 39.3 Friends and Others 0.0 0.0 5.7 7.2 2.0 0.0 6.9 5.7 0.0 0.0 0.0 0.0 0.8 0.0 5.3 4.8 3.9

TOTAL 43 7 70 14 51 21 175 88 36 13 58 24 130 41 303 126 600 Table 26 Percentage of Respondents by Region, Residence, Gender

and with whom Read Newspapers and Magazines

With whom Read Newspapers and Magazines



Alone 67.4 82.8 75.3 100.0 88.4 89.6 91.6 92.9 94.6 83.3 88.3 100.0 83.9 86.5 86.8 95.1 86.0 Family 17.4 13.8 11.8 0.0 7.9 10.4 4.9 7.1 1.4 16.7 5.0 0.0 9.1 12.4 6.7 4.9 8.2 Friends and Others 15.2 3.4 12.9 0.0 3.7 0.0 3.4 0.0 4.1 0.0 6.7 0.0 7.0 1.1 6.5 0.0 5.8

TOTAL 92 29 93 7 164 48 203 28 74 12 60 6 330 89 356 41 816

108

Table 27 Percentage of Respondents by Region, Residence, Gender and with whom Attend Social Activities

With whom Attend Social Activities




and with whom Do Physical Exercise

With whom Do Physical Exercise



TOTAL 87 61 103 82 167 132 257 158 53 17 147 87 307 210 507 327 1,351

109

Appendix 2: Sampling Design This appendix contains information about districts, tehsils, and urban and rural blocks selected for the survey. In addition, it contains detailed information about urban and rural blocks identified for the survey.

110

Table 1 Regional Distribution of Punjab Northern Punjab Central Punjab Southern Punjab 1. Rawalpindi 1. Faisalabad 10. Pakpattan 1. Bahawalnagar 10. Vehari 2. Attock 2. Gujranwala 11. Narowal 2. Bahawalpur 11. Layyah 3. Chakwal 3. Gujrat 12. Okara 3. Dera Ghazi Khan 12. Bhakkar 4. Jhelum 4. Hafizabad 13. Sargodha 4. Khanewal 5. Mandi Bahauddin 5. Jhang 14. Sialkot 5. Multan 6. Khushab 6. Kasur 15. Toba Tek Singh 6. Lodhran 7. Mianwali 7. Lahore 16. Nankana Sahib 7. Muzaffargarh

8. Sheikhupura 17. Chiniot* 8. Rajanpur 9. Sahiwal 9. Rahim Yar Khan

* Chiniot, which earlier used to be a tehsil (sub-district) of Jhang district, was upgraded as a district after the survey had begun. Therefore, it has been excluded from the remaining tables.

111

Table 2 Selected Districts of Each Region (in Bold) Sr No District Population Cumulative Population Random Numbers Northern Punjab 1 Rawalpindi 4,137,000 4,137,000 2,324,000 2 Attock 1,508,000 5,645,000 3 Chakwal 1,259,000 6,904,000 4 Jhelum 1,097,000 8,001,000 5 Mandi Bahauddin 1,336,000 9,337,000 8,797,000 6 Khushab 1,057,000 10,394,000 7 Mianwali 1,262,000 11,656,000 TOTAL 11,656,000 Central Punjab 8 Faisalabad 6,555,000 6,555,000 1,560,000 9 Gujranwala 4,210,000 10,765,000 10 Gujrat 2,421,000 13,186,000 12,625,000 11 Hafizabad 988,000 14,174,000 12 Jhang 3,333,000 17,507,000 13 Kasur 2,894,000 20,401,000 19,723,000 14 Lahore 8,188,000 28,589,000 15 Sheikhupura 2,508,000 31,097,000 16 Sahiwal 2,167,000 33,264,000 17 Narowal 1,466,000 36,283,000 35,129,000 18 Pakpattan 1,553,000 34,817,000 19 Okara 2,678,000 38,961,000 20 Sargodha 3,091,000 42,052,000 21 Sialkot 3,277,000 45,329,000 22 Toba Tek Singh 1,902,000 47,231,000 46,970,000 23 Nankana Sahib 1,457,000 48,688,000 TOTAL 48,688,000 Southern Punjab 24 Bahawalnagar 2,470,000 2,470,000 25 Bahawalpur 3,064,000 5,534,000 26 Dera Ghazi Khan 2,106,000 7,640,000 27 Khanewal 2,486,000 10,126,000 95,675,000 28 Multan 3,825,000 13,951,000 29 Lodhran 1,439,000 15,390,000 14,085,000 30 Muzaffargarh 3,393,000 18,783,000 31 Rajanpur 1,410,000 20,193,000 32 Rahim Yar Khan 3,990,000 24,183,000 33 Vehari 2,559,000 26,742,000 25,936,000 34 Bhakkar 1,389,000 28,131,000 35 Layyah 1,415,000 29,546,000 TOTAL 29,546,000

112

Table 3 Selected Tehsils of Each District (in Bold)

District Sr No Tehsil/Town Population Cumulative Population

Random Numbers Northern Punjab Rawalpindi 1 Gujar Khan Town 584,000 584,000 519,000

2 Kahuta Town 181,000 765,000 3 Kotli Sattian Town 88,000 853,000 788,000 4 Murree Town 191,000 1,044,000 5 Rawal Town 1,055,000 2,099,000 6 Potohar Town 559,000 2,658,000 7 Kallar Syedan Town 187,000 2,845,000 8 Taxila Town 481,000 3,326,000 3,225,000 9 Rawalpindi Cantt 847,000 4,173,000 3,932,000 TOTAL 4,173,000

Mandi Bahauddin

1 Malakwal 331,000 331,000 2 Mandi Bahauddin 542,000 873,000 506,000 3 Phalia 471,000 1,344,000 893,000 TOTAL 1,344,000

Central Punjab Faisalabad 1 Iqbal Town 1,012,000 1,012,000 528,000

2 Jinnah Town 984,000 1,996,000 3 Lyallpur Town 925,000 2,921,000 4 Madina Town 1,013,000 3,934,000 5 Chak Jhumra Town 274,000 4,208,000 4,139,000 6 Jaranwala Town 1,204,000 5,412,000 4,488,000 7 SammundriTown 580,000 5,992,000 8 Tandlianwala Town 615,000 6,607,000 6,417,000 TOTAL 6,607,000

Kasur 1 Chunian 707,000 707,000 160,000 2 Kasur 1,428,000 2,135,000 3 Pattoki 783,000 2,918,000 2,444,000 TOTAL 2,918,000

Gujrat 1 Gujrat 1,306,000 1,306,000 902,000 2 Kharian 923,000 2,229,000 1,978,000 3 Sarai Alamgir 209,000 2,438,000 TOTAL 2,438,000

Narowal 1 Narowal 737,000 737,000 2 Shakargarh 738,000 1,475,000 948,000 TOTAL 1,475,000

Toba Tek Singh

1 Gojra 576,000 576,000 222,000 2 Kamalia 613,000 1,189,000 Toba Tek Singh 726,000 1,915,000 1,350,000 TOTAL 1,915,000

Southern Punjab

113

Khanewal 1 Khanewal 662,000 662,000 268,000 2 Kabirwala 783,000 1,445,000 3 Mian Channu 757,000 2,202,000 1,478,000 4 Jahanian 304,000 2,506,000 TOTAL 2,506,000

Lodhran 1 Dunyapur 412,000 412,000 409,000 2 Karor Pacca 441,000 853,000 3 Lodhran 599,000 1,452,000 1,164,000 TOTAL 1,452,000

Vehari 1 Burewala 894,000 894,000 2 Mailsi 876,000 1,770,000 1,022,000 3 Vehari 811,000 2,581,000 1,994,000 TOTAL 2,581,000

114

Table 4 Selected Urban Blocks

District Tehsil Total Households Average Households with Elderly Total Blocks Selected Blocks Average No of Elderly Northern Punjab Rawalpindi Gujar Khan Town 2,768 923 18 1 51

Rawalpindi-I 4,411 1,470 18 1 82 Rawalpindi-II 4,116 1,372 21 2 65

Mandi Bahauddin

Mandi Bahauddin 3,394 1,131 16 1 71 Phalia 3,330 1,110 15 1 74

Central Punjab Faisalabad Chak Jhumra Town 3,391 1,130 15 1 75

Jaranwala Town 4,339 1,446 19 1 76 Iqbal Town 1,2131 4,044 35 2 116 Tandlianwala Town 3,588 1,196 17 1 70

Gujrat Gujrat 5,829 1,943 25 2 78 Kharian 2,394 798 10 1 80

Kasur Chunian 2,653 884 12 1 74 Pattoki 3,881 1,294 14 1 92

Narowal Shakargarh 2,981 994 12 1 83 Toba Tek Singh Gojra 5,131 1,710 30 2 57

Toba Tek Singh 3,358 1,119 12 1 93

Southern Punjab Khanewal Khanewal 5,745 1,915 20 2 96

Mian Channu 3,669 1,223 14 1 87 Lodhran Dunyapur 2,720 907 11 1 82

Lodhran 5,065 1,688 21 2 80 Vehari Mailsi 2,023 674 12 1 56

Vehari 2,895 965 12 1 80 TOTAL 89,782 29,936 379 28 1,718

Table 5 Selected Rural Blocks District Tehsil Total Households Average Households with Elderly Total Blocks Selected Blocks Average No of Elderly Northern Punjab Rawalpindi Gujar Khan Town 14,041 4,680 62 3 75

Kotli Sattian Town 4,955 1,652 23 1 72 Rawalpindi Cantt 21,789 7,263 78 4 93 Taxila Town 8,777 2,926 33 1 89

Mandi Bahauddin Mandi Bahauddin 6,776 2,259 27 1 84 Phalia 8,395 2,798 30 1 93

Central Punjab Faisalabad Chak Jhumra Town 9,052 3,017 38 2 79

Jaranwala Town 26,637 8,879 107 5 83 Iqbal Town 11,056 3,685 45 2 82 Tandlianwala Town 15,406 5,135 62 3 83

Gujrat Gujrat 21,357 7,119 82 4 87 Kharian 8,357 2,786 34 2 82

Kasur Chunian 19,482 6,494 88 4 74 Pattoki 19,396 6,465 88 4 73

Narowal Shakargarh 5,407 1,802 34 2 53 Toba Tek Singh Gojra 15,956 5,319 61 3 87

Toba Tek Singh 32,001 10,667 126 6 85 Southern Punjab Khanewal Khanewal 13,308 4,436 54 3 82

Mian Channu 18,625 6,208 56 3 111 Lodhran Dunyapur 8,850 2,950 31 2 95

Lodhran 14,379 4,793 50 2 96 Vehari Mailsi 11,595 3,865 62 3 62

Vehari 9,881 3,294 60 3 55 TOTAL 325,478 108,492 1,331 64 1,875

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Table 6 Identification of Urban Blocks District Tehsil/Town EB Code Selected Block Pin Code No of Households Average Households with Elderly Northern Punjab Rawalpindi Gujar Khan Town 102040410 Gujar Khan 11011010 202 67

Rawalpindi-I 102053415 Rawal 11015107 227 76

Rawalpindi-II 102052903 Rawal 11015313 120 40 102053145 Rawal 11015317 161 54

Mandi Bahauddin Mandi Bahauddin 131010114 Mandi Bahauddin 11141004 230 77 Phalia 131020111 Phalia 11143006 195 65

Central Punjab Faisalabad Chak Jhumra Town 107080116 Chak Jhumra 11321010 200 67

Jaranwala Town 107070313 Jaranwala 11322014 262 87

Iqbal Town 107032102 Allama Iqbal 11326216 261 87 107032733 Allama Iqbal 11326109 248 83

Tandlianwala Town 107020117 Tandlianwala 11328015 277 92 Gujrat

Gujrat 104020202 Jalalpur Jattan 11151005 175 58 104070325 Gujrat 11151018 340 113

Kharian 104040103 Kharian 11152004 269 90 Kasur Chunian 121090110 Kanganpur 11212012 274 91

Pattoki 121070208 Pattoki 11213012 242 81 Narowal Shakargarh 133050106 Shakargarh 11122002 362 121 Toba Tek Singh

Gojra 125030118 Gojra 11331004 280 93 125030512 Gojra 11331017 242 81

Toba Tek Singh 125010208 Toba Tek Singh 11333005 206 69

Southern Punjab Khanewal

Khanewal 129010219 Khanewal 11241006 183 61 129070101 MPR 11241018 207 69

Mian Channu 129040304 Mian Channu 11243011 282 94

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Lodhran Dunyapur 135020105 Dunyapur 11231004 325 108

Lodhran 135010117 Lodhran 11233008 172 57 135010131 Lodhran 11233014 230 77

Vehari Mailsi 122060110 Jalla Jeem 11252012 182 61 Vehari 122010207 Vehari 11253005 250 83

TOTAL 6,604 2,202

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Table 7 Identification of Rural Blocks District Tehsil Selected Block Pin Code Part No No of Households Average Households with Elderly Northern Punjab Rawalpindi Gujar Khan Town Maira Shamas 12011016 2 204 68

Ahdi 12011021 1 231 77 Mastala 12011004 1 271 90

Kotli Sattian Town Wahgal 12013009 2 206 69 Rawalpindi Cantt Lilla Kamalpur 12016002 1 164 55

Sangral 12016013 1 204 68 Dhalla 12016006 1 260 87 Chak Jalal Din 12016026 4 252 84

Taxila Town Wah 12018011 3 229 76

Mandi Bahauddin

Mandi Bahauddin Chak Fateh Shah 12141013 1 223 74 Phalia Jajja Ur 12143009 1 330 110

Central Punjab Faisalabad Chak Jhumra Town 043/Jb Peroana 12321001 1 356 119

Chak 107/JB Sikhanwala 12321009 1 297 99 Jaranwala Town Chak 029/GB Qila Sardar Hara

Singh 12322019 1 260 87

Chak 357/GB Neelianwala 12322029 1 310 103 Chak 380/GB Budhana 12322040 2 311 104 Chak 375/GB Doranwan 12322015 2 227 76 Chak 145/GB Jhok Sarwar Wali 12322038 2 230 77

Iqbal Town Chak 264/RB Nag Khurd 12326011 1 351 117 Chak 222/RB Fatehabad 12326009 2 279 93

Tandlianwala Town

Jangal Sarkar 12328005 1 252 84 Chak 412/GB Kamman 12328025 2 186 62 Chak 427/GB Jhok Sajawal 12328016 1 254 85

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Gujrat Gujrat Bhagowal Khurd 12151020 1 249 83 Daulat Nagar 12151034 3 286 95 Khokhar 12151031 1 297 99 Bhagowal 12151039 2 254 85

Kharian Pindi Awan 13592005 1 204 68 Gotriala 20792025 1 230 77

Kasur Chunian Makhanewala 12212014 1 204 68 Dhuttee 12212028 3 254 85 Dao Ki Khaniana 12212022 4 202 67 Kot Sandras (Chunian Utar) 12212023 7 261 87

Pattoki Bhoe Asal 12213026 1 161 54 Jamber Khurd 12213030 4 354 118 Chak 031 (Nanjirwal Niaz Beg) 12213017 1 273 91 Jajja Kalan 12213021 3 183 61

Narowal Shakargarh Lagwal 12122017 1 152 51 Ghamrula 12122026 1 253 84

Toba Tek Singh

Gojra Chak 352/Jb Tegh Bahadurpur 12331018 1 277 92 Chak 369/Jb Santokhsar 12331027 2 290 97 Chak 281/Jb Rajo Doakhri 12331032 2 349 116

Toba Tek Singh Chak 515/Gb Jhok Yara 12333017 1 376 125 388/Jb Basti Qasoo 12333023 2 347 116 Chak 323/Jb Tarandi 12333031 1 384 128 Chak 410/Jb Kaluwal 12333003 1 258 86 Chak 332/Gb Hawas 12333027 3 353 118 Chak 327/Jb Chando Paholair 12333034 1 215 72

Southern Punjab Khanewal Khanewal Chak No 009/V 12241016 1 336 112

Chak No 025/10-R 12241008 1 261 87 Chak No 004/9-R 12241021 1 463 154

Mian Channu Chak No 075-A/15-L 12243016 1 298 99

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Chak No 054/15-L 12243006 1 253 84 Chak No 076/15-L 12243026 1 400 133

Lodhran Dunyapur Chak No 356/W.B 12231019 2 287 96 Chak No 348/W.B 12231008 1 270 90

Lodhran Salsadar 12233020 5 346 115 Gogran 12233022 1 335 112

Vehari Mailsi Jhandir 12252033 1 252 84 Chak No 215/W.B 12252023 1 336 112 Fatehpur 12252012 3 280 93

Vehari Luddan 12253029 1 289 96 Chak No 553/E.B. 12253018 1 244 81 Daulatabad 12253032 1 237 79

TOTAL 17,440 5,814

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Table 8 Selection and Identification of Urban Blocks of Lahore and Multan

Sr No

Tehsil Town EB Code Pin Code No of Households

Average Households with Elderly

Lahore 1 Lahore Cantonment 109017320 11160214 192 64

2 Data Ganj Baksh 109014805 11162216 229 76

3 Ravi 109010157 11165214 371 124 4 Gulberg 109012108 11169215 253 84 5 Wagha 109011475 11167206 224 75 TOTAL 1,269 423 Multan 1 Multan Bosan 115040342 11201209 391 130

2 Jalalpur Pirwala

Jalalpur Pirwala 115020118 11205005 284 95

3 Shujabad Shujabad 115010202 11206007 129 43

TOTAL 804 268

Table 9 Selection and Identification of Urban Blocks of

Muzaffargarh and Chakwal Districts Tehsil/Town EB Code Selected Block Pin Code Muzaffargarh Jatoi 114010110 Jatoi 11282005

Muzaffargarh 114030302 Muzaffargarh 11284011 114030207 11284002

Chakwal Chakwal 130010121 Chakwal 11031012 130010401 11031027

Talagang 130020113 Talagang 11033005 Table 10 Selection and Identification of Rural Blocks of

Muzaffargarh and Chakwal District Tehsil/Town Selected Block Pin Code Muzaffargarh Jatoi Chhina Malana 12282005

Murad Pur Shumali 12282015 Muzaffargarh Khushak 12284007

Chabar Khor Sherin 12284020 Inayatpur 12284034 Bet Qaim Shah 12284049

Chakwal Chakwal Panjain 12031004

Sadwal 12031017 Talagang Misrial 12033008

Jhatla 12033018

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Appendix 3: Questionnaire

IDENTIFICATION

L1 PROVINCE __________________________________________________________________ 1____Northern Punjab 2____Central Punjab 3____Southern Punjab

L2 District __________________________________________________________________

L3 Tehsil __________________________________________________________________

L4 Section __________________________________________________________________

L5 URBAN/RURAL __________________________________________________________________ 1___URBAN 2___ RURAL

L6 HOUSEHOLD CONTROL NUMBER _________________________________________________

L7 NAME OF HOUSEHOLD HEAD_________________________________________________________

L8 NAME OF OLDER PERSON __________________________________________________________

L9 ADDRESS__________________________________________________________________________

INTERVIEW RECORD

1 2 3 FINAL VISIT DATE __________________ __________________ __________________

DAY MONTH YEAR

INTERVIEWER’S CODE

INTERVIEWER’S NAME __________________ __________________ __________________

RESULT __________________ __________________ __________________

NEXT VISIT: DATE TIME

__________________ __________________

__________________ __________________

TIME TOTAL NUMBER OF VISITS START END

RELUST CODES: 1 COMPLETED 4 REFUSED COMPLETELY 2 NOT AT HOME 5 PARTIALLY COMPLETED 3 POSTPONED 96 OTHER (SPECIFY) _____________________________

LOCAL LANGUAGE OF RESPONDENT LANGUAGE OF INTERVIEW

1___Urdu 2___Punjabi 3___Saraiki 4___Potohari 96____Other, specify _________________________

SUPERVISOR _________________ ____________ Name and Signature Date

FIELD EDITOR _________________ ____________ Name and Signature Date

OFFICE EDITOR ENCODER

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SECTION A BASIC ATTRIBUTES AND FAMILY MAKE-UP

First, you will be asked questions about yourself.

A1. What is your date of birth? (Get Month, Day and Year of Birth)

Month ________________

Day ________________

Year ________________ A2. How old are you now? ___________ Years old

1___Years _____________

A3 Gender (to be filled in by the interviewer)

1___Male 2___Female

A4. What type of community did you live in when you were growing up (from birth to age 12)?

1____City 3____Rural 2____Town 4____Not Sure

A5. How many grades of education have you completed? (if grades <4 ask A6, else skip to A7)

00____ Illiterate 01____ One year schooling completed 02____ Two year schooling completed 03____ Three year schooling completed 16____ University 18____Above University

A6. Can you read and understand a letter or newspaper easily, with difficulty, or not at all?

1____Easily 2____With difficulty 3____Not at all

A7. Are you currently working? 1____Working GO TO A8 2____Stopped working completely GO TO A7.1 3____Not working but looking for work GO TO A7.3 4____Never worked and not looking for work GO TO A9

A7.1 Why did you stop working permanently?

1____Retired formally 2____Ill health/Health reasons 3____Opportunities not available

You will be asked a number of questions during this survey. You do not have to respond to any question that you feel uncomfortable answering. Also, please rest assured that your responses will be used for study purposes only and the purpose of asking these questions is just to examine the living conditions and health status of the elderly.

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A7.2 At what age did you stop working completely?

96___ Other, specify ________________________ _____Years GO TO A9

A7.3 Did you ever work before? 1____Yes GO TO A9 2____No GO TO A11

A8. What type of work are you currently engaged in? RECORD VERBATIM RESPONSE ____________________________________________

01___ Professional, Technical, Managerial 02___ Clerical 03___ Sales and Services 04___ Skilled Manual 05___ Unskilled Manual 06___ Domestic Services 07___ Agriculture 96___ Other, specify ________________________

A8.1 Are you working full time or part time? 1____Yes, full time 2____Yes, part time

A8.2 Before the current job, did you retire from any job because you reached the retirement age? A8.3 If yes, why are you still working?

1____Yes 2____No GO TO A9 Specify ___________________________________________

A9. Which occupation were you engaged in for the longest duration? RECORD VERBATIM RESPONSE ____________________________________________


A10 At what age did you start working? ________Years

A11. What is your current marital status?

1___Never married GO TO SECTION B 2___Currently married GO TO A12 3___Separated/Divorced 4___Widowed GO TO A13

A12 How would you rate your relationship with your current spouse?

1___Very good 2___Good 3___Normal 4___Not good

A13 In which year did you officially marry? (In reference to first marriage) _____________Month ___________ Year

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NOTE TO INTERVIEWER: IF A11= 4, CONTINUE. OTHERWISE, GO TO A14

A13.1 How old was your husband/wife when he/she passed away? (Reference is the last partner) _______Years old

A13.2 When did he/she die? _____________Month ___________ Year

A13.3 What was the cause of death? ____________________________________________ NOTE TO INTERVIEWER: IF CAUSE OF DEATH IN A13.3 IS ILLNESS, CONTINUE. OTHERWISE, GO TO A14

A13.4 For how long was he/she ill before he/she died? _________ Months _________ Years

The next are a few questions about your spouse (Current spouse for those who are currently married, last partner for widowed/separated/ divorced)

A14. What type of community did your spouse live in when he/she was growing up (from birth to age 12)

1___City 3___Rural 2___Town 95___Not sure

A15. What was the highest educational level your spouse completed?


IF WIDOWED/SEPARATED/DIVORCED, GO TO SECTION B

A16. Is your spouse currently working? 1___Working CONTINUE 2___Stopped working completely GO TO A18 3___Not working but currently looking for work

4___Never worked and not GO TO SECTION B looking for work 96___ Other, specify ______________________________

A17. What type of work is your spouse currently engaged in?

RECORD VERBATIM RESPONSE ____________________________________________


A18. Which occupation was your spouse engaged in for the longest duration?

RECORD VERBATIM RESPONSE

01___ Professional, Technical, Managerial 02___ Clerical 03___ Sales and Services 04___ Skilled Manual 05___ Unskilled Manual

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____________________________________________

06___ Domestic Services 07___ Agriculture 96___ Other, specify ________________________

A19. At what age did your spouse start working? ________Years

97______Do not know

END OF SECTION A. PROCEED TO SECTION B

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SECTION B HEALTH STATUS

These questions are about your parents

Relationship with Subject Own Father Own Mother

B1. Is your_____alive? 1____Alive B1.1 How old is your father?_______years → Go to B4 2____Deceased ↓ B1.2 How old was your father at death? ________years Go to B2

1____Alive B1.1 How old is your mother?_______years →Go to B4 2____Deceased ↓ B1.2 How old was your mother at death? ________years Go to B2

B2. What was the cause of_____ passing away? (only for natural parents)

1___Chronic diseases (Cancer, Diabetes, Blood Pressure) 2____Heart diseases Go to B4 (Heart Attack, Cerebrovascular Ailments, Stroke, Cerebral Thrombosis) 3____Accident 4____Old age (frailty caused by ageing) 97____Do not know 96____Other, specify _______________________

1___Chronic diseases (Cancer, Diabetes, Blood Pressure) 2____Heart diseases Go to B4 (Heart Attack, Cerebrovascular Ailments, Stroke, Cerebral Thrombosis) 3____Accident 4____Old age (frailty caused by aging) 97____Do not know 96____Other, specify _______________________

B3 Did your_____suffer from any illness before his/her death? RECORD VERBATIM RESPONSE

___________________________

1____Yes 2____No Specify: _________________________________

1____Yes 2____No Specify: _________________________________

B4 What is/was your_____ father’s/mother’s highest educational attainment?



B5 What is/ was your father/ mother’s occupation?

RECORD VERBATIM RESPONSE

___________________________

01.___ Professional, Technical, Managerial 02.___ Clerical 03.___ Sales and Services 04.___ Skilled Manual 05.___ Unskilled Manual 06.___ Domestic Services 07.___ Agriculture 96.___ Other, specify ________________________

01.___ Professional, Technical, Managerial) 02.___ Clerical 03.___ Sales and Services 04.___ Skilled Manual 05.___ Unskilled Manual 06.___ Domestic Services 07.___ Agriculture 96.___ Other, specify ________________________

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The next questions will be regarding your health and health care behaviour. B6 In general, how would you describe your state of health? (READ OUT RESPONSES)

1____Very healthy 2____Healthier than average 3____Of average health 4____Somewhat unhealthy 5____Very unhealthy 95____Not sure B6.1 In general, compared to people of your age, would you say your state of health is better, relatively the same or worse?

1____Better 3_____Worse 2____Relatively the same 95_____Not sure

B6.2 Do you believe your health is better, relatively the same, or worse than it was one year ago?

1____Better 3_____Worse 2____Relatively the same 95_____Not sure

B7 Consider your health while you were growing up, from birth to age 16. Would you say that during that time you were:

1____Very healthy 2____Healthier than average 3____Of average health 4____Somewhat unhealthy 5____Very unhealthy 95____Not sure

The next questions will be about your experience of physical illnesses. NOTE TO INTERVIEWER: Ask about the following illnesses and record responses in table below. If the respondent

answers in the affirmative, ask next question.

ILLNESS

B8 Do you have this condition? 1__Yes 2__No GO TO 97__DK NEXT 98__NI ILLNESS

B9 At present, do you take any medicine for _____________?

1__Yes 2__No

B10 At what age did you start to have this condition?

Self Spouse Self Spouse Self Spouse 1. Chronic diseases (High Blood Pressure, Diabetes, Cancer, Tuberculosis, Digestive Illness)

2. Heart diseases (Angina, Heart attack, Cerebrovascular Ailments, Cerebral Thrombosis, Stroke)

3. Joint Pain (Arthritis, Back Pain, Shoulder Pain, Neck Pain)

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4. Ailments of the Liver or Gallbladder (Hepatitis A, B or C, Jaundice)

5. Fractures (Hip, Thigh and Pelvis/Broken hip)

6. Artificial Fractures (Hip, Thigh and Pelvis/Broken hip)

7. Respiratory (Asthma) 96.___ Other, specify ________________________

B11 Have you ever had a heart attack?

1___Yes GO TO B11.1 2___No SKIP TO B12 B11.1 At what age did you experience a heart attack? _____years old B11.2 At present, do you take any medicine for your heart condition?

1___Yes 2___No

B12 Whenever you get sick, who usually takes care of you? ______________________________ (STATE RELATIONSHIP AND SEX)

The following questions are related to vision. NOTE TO INTERVIEWER: A loss of vision in a given eye means completely no vision in that eye. B13 Do you have vision in both eyes?

1____Have vision in both eyes 2____Loss of vision in one eye 3____Loss of vision in both eyes (completely no vision) GO TO B15

B14 Do you wear eyeglasses (including reading glasses or contact lenses)?

1___Yes 2___No B14.1 How well can you see B14.2 How well can you see?

with your glasses or contact lenses?

B14.1 & B14.2 1___Very well

2___Quite well 3___Not too well 97___DK 98___NI

The following questions are related to hearing. NOTE TO INTERVIEWER: Not able to hear in a given ear means the complete lack of hearing in that ear. B15 Are you able to hear in both ears?

1____Both ears able to hear 2____Not able to hear in one ear 3____Not able to hear in either ear GO TO B17

B16 Do you use hearing aids?

1___Yes 2___No SLEEP

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B17 On average, approximately how much do you sleep per night? ____________Hours _____________Minutes 95____________Not sure B18 Are you satisfied with your sleep? 1_____Yes 2_____No 95_____Not sure B19 Do you take naps? 1_____Yes, regularly 2_____Yes, not regularly 3_____No SKIP TO B21 B20 How long do you take naps? __________Hours___________Minutes 95____________Not sure (Note to interviewer: Ask average duration of naps) PAIN B21 Overall, in the last 30 days, how much of bodily aches or pains did you have? 0___None 1___Mild 2___Moderate 3___Severe 4___Extreme/Cannot function because of pain SKIP TO B23 B22 Did the pain affect your daily activities? 0 ___Not at all 1 ___Rarely 2 ___Sometimes 3 ___Often 4 ___All the time B23 In what parts of your body did you feel pain? (MULTIPLE RESPONSE) 1 ___ Lower back 2 ___ Head 3 ___ Joints of the legs 4 ___ Joints of the hands/arms 5 ___ Shoulders 6 ___ Back 7 ___ Neck 96 ___ Others, Specify __________________

END OF SECTION B. PROCEED TO SECTION C

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SECTION C PHYSICAL ABILITY AND DISABILITY (SELF)

ABILITY TO PERFORM ACTIVITIES OF DAILY LIVING (ADL) The next questions are concerning your and your spouse’s ability to perform activities of daily living (ADL). Please respond to what extent you find each of the following activities difficult to perform without the assistance of a person or assistive device. (First ask C1, then C2. Continue with C3 through C5, if applicable.)

# Activities of Daily Life/ Description of Difficulty Self Spouse

1 Take a bath/shower by yourself C1: Do you find it difficult to _______ due to your health or physical state

_Difficult (Go to C2) 2_Not difficult GO TO 95_Not sure # 2


C2: How difficult do you find it to _______ by yourself?

1___Somewhat difficult 2___Very difficult GO TO C3

1___Somewhat difficult GO TO 2___Very difficult C3

C3: When did you begin to experience this condition? If it has been less than one year, please respond in months. If it has been more than one year, please respond in years.

1_______Months 2_______Years 95_______Not sure


C4: Do you need assistance to ____________? 1____Yes 2____No (Go to #2) 95____Not sure

1____Yes 2____No (Go to #2) 95____Not sure

C5: Who primarily helps you perform this activity? (In the event that the caretaker is a family member, record the name in the space provided)

0__None 1__Live-in family member (Specify___________) 2__Non co-resident family member 3__Housemaid/Houseboy 95__Not sure 96__Other (Specify_____)


2 Dress C1: Do you find it difficult to _______ due to your health or physical state

__Difficult (Go to C2) 2_Not difficult GO TO 95_Not sure # 3










C5: Who primarily helps you perform this activity?

0__None 1__Live-in family member

0__None 1__Live-in family member

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(In the event that the caretaker is a family member, record the name in the space provided)

(Specify___________) 2__Non co-resident family member 3__Housemaid/Houseboy 95__Not sure 96__Other (Specify_____)

(Specify___________) 2__Non co-resident family member 3__Housemaid/Houseboy 95__Not sure 96__Other (Specify_____)

3 Eat C1: Do you find it difficult to _______ due to your health or physical state





1___Somewhat difficult GO TO C3 2___Very difficult









4 Stand up from a bed or chair; sit down on a chair C1: Do you find it difficult to _______ due to your health or physical state









C4: Do you need assistance to ____________? 1____Yes 2____No (Go to 5) 3____Not sure


C5: Who primarily helps you perform this activity? (In the event that the caretaker is a family member, record the name

0__None 1__Live-in family member (Specify___________) 2__Non co-resident family member

0__None 1__Live-in family member (Specify___________) 2__Non co-resident family member

134

in the space provided) 3__Housemaid/Houseboy 95__Not sure 96__Other (Specify_____)

3__Housemaid/Houseboy 95__Not sure 96__Other (Specify_____)

5 Walk (around the house) C1: Do you find it difficult to _______ due to your health or physical state














6 Go outside (leave the house) C1: Do you find it difficult to _______ due to your health or physical state




1___Somewhat difficult 2___Very difficult GO TO C3 3___Unable to perform activity 95___Not sure GO TO #7

1___Somewhat difficult GO TO C3 2___Very difficult 3___Unable to perform activity 95___Not sure GO TO #7







0__None 1__Live-in family member (Specify___________) 2__Non co-resident family member 3__Housemaid/Houseboy

0__None 1__Live-in family member (Specify___________) 2__Non co-resident family member 3__Housemaid/Houseboy

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C6 If the respondent reported difficulty in any of items 1-7 in C1 above ask: (Multiple response) What is the cause of the difficulty?

RECORD VERBATIM RESPONSE (Self)

______________________________________________________________________________________________

______________________________________________________________________________________________

RECORD VERBATIM RESPONSE (Spouse)

______________________________________________________________________________________________

______________________________________________________________________________________________

C7A Do you experience loss of bladder or bowel movement control? (Self)

95__Not sure 96__Other (Specify_____)

95_Not sure 96__Other (Specify_____)

7 Using toilet C1: Do you find it difficult to _______ due to your health or physical state

_Difficult (Go to C2) 2_Not difficult 95_Not sure

_Difficult (Go to C2) 2_Not difficult 95_Not sure2


1___Somewhat difficult 2___Very difficult GO TO C3 3___Unable to perform activity 95___Not sure GO TO #2

1___Somewhat difficult GO TO C3 2___Very difficult 3___Unable to perform activity 95___Not sure GO TO #2




C4: Do you need assistance to ____________? 1____Yes 2____No Go to C6 95____Not sure

1____Yes 2____No Go to C6 95____Not sure




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1___Loss of both bladder control and bowel movement 4___No loss of control 2___Loss of bladder control only 97___DK GO TO NEXT PAGE 3___Loss of bowel movement control only 98___NI C7A.1 How often? 1___Very often 3___Seldom 2___Often 4___Very seldom Do you experience loss of bladder or bowel movement control? (Spouse) C7B 1___Loss of both bladder control and bowel movement 4___No loss of control 2___Loss of bladder control only 97___DK GO TO NEXT PAGE 3___Loss of bowel movement control only 98___NI C7B.1 How often? 1___Very often 3___Seldom 2___Often 4___Very seldom

END OF SECTION C. PROCEED TO SECTION D

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SECTION D MENTAL HEALTH

NOTE TO INTERVIEWER: THIS SECTION CANNOT BE ASKED THROUGH PROXY. During the past week, to what extent has the following been true to you? There may be some questions for which you have no answer or which seem the same as another question, but the same questions are used internationally in studies and tests. We ask for your full cooperation. Ask all of questions D1 through D12.

1___Rarely/Not at all 2___ Sometimes 3___Often

SELF SPOUSE D1. My appetite was poor D2. I felt depressed D3. I felt that everything I did was an effort D4. My sleep was restless D5. I felt happy D6. I felt lonely D7. I felt people were unfriendly D8. I enjoyed life D9. I felt sad D10. I felt that people dislike (do not like) me D11. I could not get “going” D12. I felt hopeful about the future

D13 Are you satisfied with your present life? (READ OUT RESPONSES) 1 ___ Yes, Very satisfied 2 ___ Yes, Somewhat satisfied 3 ___ No, Not satisfied D14 How much do you feel that your family, relatives, or friends are willing to listen when you need to talk about your worries or problems? (READ OUT RESPONSES) 1_____A great deal 5______Not at all 2_____Quite a bit 6______Keep to myself 3_____Some 97______Don’t know 4_____Very little

END OF SECTION D. PROCEED TO SECTION E

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SECTION E HEALTH UTILISATION

IN-PATIENT UTILISATION E1 Within the past year, have you ever stayed overnight in a hospital or any other medical facility because of an illness or accident? 1___Yes CONTINUE 2___No 97___DK SKIP TO E2 98___NI E1.1 How many times within the past year did you stay at least overnight in a hospital or medical facility? _____times E1.2 The last time you were hospitalized, what type of facility did you use? 01___Basic Health Unit 05___Private hospital 02___Municipal hospital 96___Others (SPECIFY _______________) 03___District hospital 04___Private Clinic E1.3 What was/were the reason(s) why you were hospitalized the last time? SPECIFY__________________________________ E1.4 Who paid the most for your hospitalization? (CHOOSE ONLY ONE) 01___Respondent 05___Other relatives 02___Spouse 06___Friends 03___Children 96___Others (SPECIFY _________________________) 04___Grandchildren OUT-PATIENT UTILISATION NOTE TO INTERVIEWER: Out-patient means that the patient did not spend a night at a medical facility. E2 Within the past year, have you received medical care for an illness or accident from any medical facility or practitioner

without staying overnight? 1___Yes GO TO E2.1 2___No 97__DK GO TO E3 98__NI E2.1 In the past year, which medical facility did you visit most as an out-patient? (CHOOSE ONLY ONE) 01___Basic Health Unit 05___Private hospital 02___Municipal hospital 96___Others (SPECIFY _______________) 03___District hospital 04___Private Clinic E2.2 In the past year, which health practitioner did you see most often for your health problems? (CHOOSE ONLY ONE) 1___Traditional practitioner 96___Other (SPECIFY________________) 2___Doctor 97___Don’t know 3___Nurse 98___NI 4___Midwife 99___Not applicable

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E3 In the last year, have you felt ill, and thought about going to see a doctor, but didn’t 1___Yes GO TO E3.1

2___No 97___Don’t know GO TO SECTION-F 98___NI E3.1 Why didn’t you go? (MULTIPLE RESPONSE) 01___Not enough money 97___DK 02___Not enough time 98___NI 03___Self-medication 99___NAP 04___Couldn’t find a doctor 05___No transportation 06___Couldn’t take time off from work to see a doctor 07___Illness was not serious/need is not urgent 08___Was afraid to find out about the illness 10___Too far 11___Don’t know how to get there 12___Couldn’t find someone to go with me 96___Other (SPECIFY) ______________________________________ IF MORE THAN ONE ANSWER IN E3.1 CONTINUE, OTHERWISE SKIP TO SECTION F. E3.2 Of the reasons given in E3.1, what was the most important reason for not going to see a doctor? (CHOOSE ONLY ONE)

01___Not enough money 97___DK 02___Not enough time 98___NI 03___Self-medication 99___NAP 04___Couldn’t find a doctor 05___No transportation 06___Couldn’t take time off from work to see a doctor 07___Illness was not serious/need is not urgent 08___Was afraid to find out about the illness 10___Too far 11___Don’t know how to get there 12___Couldn’t find someone to go with me 96___Other (SPECIFY) ______________________________________

END OF SECTION E. PROCEED TO SECTION F

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SECTION F TASKS AND ACTIVITIES

Now let us talk about your activities. F1 Could you please tell me how often you engage in the following activities? (RECORD RESPONSE IN THE TABLE BELOW) RECORD FREQUENCY OF PARTICIPATION AS FOLLOWS (F1): 1____Every day 4____About once a month 99___Not applicable 2____Several times a week 5____A few times a year 3____About once a week 6____Never

Activities F1 How often?

(If F1 = 6 or 99 GO TO NEXT ROW)

*F2 With whom do you do these activities

a. Listen to radio 1 2 3 4 5 6 99 b. Read newspapers, magazines or books 1 2 3 4 5 6 99 c. Watch TV 1 2 3 4 5 6 99 d. Watch movies outside the house 1 2 3 4 5 6 99 e. Attend social activities (e.g. going together with friends, family or neighbours, going out to eat, walking for pleasure, attend parties, fiestas, etc)

1 2 3 4 5 6 99

f. Physical exercise such as walking, jogging etc. 1 2 3 4 5 6 99 g. Gardening 1 2 3 4 5 6 99 h. Hangout with friends and neighbours 1 2 3 4 5 6 99

*Categories for F2 01____R alone 05____Male friend or neighbour 02____Spouse 06____Female friend or neighbour 03____One or more children with or without spouse 96____Other (SPECIFY) __________________________ 04____Relative other than child or spouse If C = 6 or 99 SKIP TO F4 F3 On average, how many hours of television do you watch in one day? This includes watching TV while engaged in another activity, such as eating. ____________hrs. ________________ min. 95_______ Not sure NOTE TO INTERVIEWER: In the event that the respondent gives a time-range, take the average time for the range as the answer. For example, a response of 1-2 hours becomes 1 hour 30 minutes. F4 Are you engaged in any volunteer work in community, such as feeding program, community services, etc.? 1____Yes 2____No 95____Not sure INFORMATION TECHNOLOGY The next questions are about information technologies and information/telecommunication services. F5 Do you know how to use a cellular phone to call? 1_____Yes F5.1 Do you use a cellular phone to call? 1___Yes 2____No 2_____No F5.2 Would you like to learn how to use a cellular phone to call? 1___Yes 2____No (SKIP TO SECTION-G) F6 Do you know how to use a cellular phone to text? 1_____Yes F6.1 Do you use a cellular phone to text? 1___Yes 2____No 2_____No F6.2 Would you like to learn how to use a cellular phone to text? 1___Yes 2____No (SKIP TO SECTION G)

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F7 Do you know how to use electronic mail/ e-mail? 1_____Yes F7.1 Do you use e-mail? 1___Yes 2____No 2_____No F7.2 Would you like to learn how to use e-mail? 1___Yes 2____No (SKIP TO SECTION G)

END OF SECTION F. PROCEED TO SECTION G

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SECTION G ATTITUDES AND BELIEFS

NOTE TO INTERVIEWER: THIS SECTION CANNOT BE ASKED THROUGH PROXY. Please tell whether you agree or disagree with the following statements. CIRCLE RESPONSE AS FOLLOWS: 1___Agree 2___Disagree

Organizations Agree Disagree G1. A child is expected to support and take care of his or her aged parents, as the child should feel a sense of gratitude to the parents for raising him/her.

1 2

G2. It is acceptable for children who looked after their parents to inherit larger portion of their estate when they pass away.

1 2

G3. It is better for the elderly parent to live with a daughter than with a son. 1 2 G4. Men should work to support the family, and women should stay home and take care of the household.

1 2

G5 For older couples today, what do you think is the best living arrangement, should they (READ OUT RESPONSES) 1___Live by themselves 2___Live by themselves but near one or more children 3___Rotate residence among children 4___Live with a child 5___Depends, other G5.1 Are they better off living with a son or a daughter?

1___Son 2___Daughter

G5.2 On what does it depend? Specify:__________________ G6 What do you think is the best living arrangement for a widow? (READ OUT RESPONSES)

1___Live by herself 2___Live by herself but near one or more children 3___Rotate residence among children 4___Live with a child

5___Depends, other G6.1 Are they better off living with a son or a daughter?


G6.2 On what does it depend? Specify:__________________ G7 What is the best living arrangement for a widower? (READ OUT RESPONSES)

1___Live by himself 2___Live by himself but near one or more children 3___Rotate residence among children 4___Live with a child

5___Depends, other G7.1 Are they better off living with a son or a daughter?


G7.2 On what does it depend? Specify: __________________ G8 What is the best living arrangement for an older person who has never married? RECORD VERBATIM RESPONSE _________________________________________________________

END OF SECTION G. PROCEED TO SECTION H

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SECTION H PERCEPTION ABOUT SERVICES FOR THE ELDERLY

H1 Do you think it is a good idea to have “Homes for the Aged or the elderly” in Pakistan? “Homes for the Aged” is a place where older people can live together with other older people away from their families.

1___Yes H1.1 Why? (CIRCLE ALL THAT APPLY) 1___Spare the family from burden of caring for the elderly

2___Health will be better taken care of 3___Better chance to socialize with people of same age 4___Beneficial for those who have no one to care for them 96___Other (SPECIFY) _______________________________

2___No H1.2 Why not? (CIRCLE ALL THAT APPLY)

1___The family should take care of the elderly 2___Elderly will miss family 3___Elderly will not want to live with strangers 4___Expensive 5___Shameful for the family 96___Other (SPECIFY) ________________________________

3___It depends (SPECIFY) ______________________________________________ H2 If there were “Homes for the Aged” near your current residence, would you ever want to live in such a place?

1___Yes 2___No 97__DK 98__NI 3___It depends (SPECIFY) _________________________________________________

H3 If there were “Homes for the Aged” near your current residence, would you want to live there now?

1___Yes 2___No 97__DK 98__NI 3___It depends (SPECIFY) _________________________________________________

Now I would like to ask your opinion about community center for elderly people. A community center is a place where elderly can have opportunity to engage in various kind of activities of their interest e.g. meeting with people of their own age, getting themselves checked up by a nurse, enjoying activities of their own interest, like gardening, watching TV, reading newspapers, magazines etc. In these community centers elderly people don’t have to stay overnight rather than they come back to their homes after spending some time. H4 If such community center be established near your current residence, would you ever like to go to there right now? 1___Yes

2___No 97__DK 98__NI 3___It depends (SPECIFY) _________________________________________________

H5 If such community center be established near your current residence, would you want to go there?

1___Yes 2___No 97__DK 98__NI

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3___It depends (SPECIFY) _________________________________________________

END OF SECTION H. PROCEED TO SECTION I

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SECTION I FINANCIAL NEEDS

This section is about your basic financial and other needs.

I1 Do you have independent source of income? 1___Yes 2___No If Yes, Specify ___________________________

I2 If you need some money, who is most likely to help you?

1___Children 2___Sibling 3___Relative 96__Other, Specify _________________________

I3 How much money do you need every month to meet your basic necessities?

1___500 or less 2___501 to 1,000 3___1,001 to 2,000 4___2,001 to 3,000 5___3,001 to 4,000 6___4,001 to 5,000 7___Above 5,000

I4 Do you have money to use public transport if you need to go somewhere?

1___Yes 2___No 99__Not available

I5 Does your family take you with them when they go out for shopping or just for an outing?

1___Yes 2___No

I6 How often do you change your clothes?

1___Daily 2___Once a week 3___Twice a week 4___Thrice a week or more

I7 In summers, do you have a fan for your personal use?

1___Yes 2___No 96__Other, Specify _________________________

I8 Do you have a heater in winters for your personal use?

1___Yes 2___No 96__Other, Specify _________________________

END OF SECTION I. PROCEED TO SECTION J

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SECTION J HOUSEHOLD FACILITIES

Now questions about facilities in the household.

NO. QUESTIONS CODING CATEGORIES SKIP

J1 Does your household have electricity? 1___Yes 2___No

J2 How many rooms are in this house? No. of Rooms …………

J3 Do you have a separate room for sleeping purposes? (Just for you and/or your spouse) 1___Yes

2___No

J4 Does your household or any member of your household have:

YES NUMBER NO RADIO/RADIO CASSETTE………… 1 _______ 2 TELEVISION ………………………… 1 _______ 2 LANDLINE TELEPHONE.................... 1 _______ 2 CELLULAR PHONE……..................... 1 _______ 2 WASHING MACHINE………............... 1 _______ 2 REFRIGERATOR/FREEZER ............. 1 _______ 2 CD/VCD/DVD PLAYER ……............... 1 _______ 2 PERSONAL COMPUTER ….………… 1 _______ 2

J5 Does your household or any member of your household own:

YES NUMBER NO TRACTOR................................. 1 _______ 2 CAR/JEEP/VAN.......................... 1 _______ 2 MOTORCYCLE……………........ 1 _______ 2 BICYCLE…………......……….... 1 _______ 2

J6 What is the main source of drinking water for members of your household?

PIPED WATER PIPED INTO DWELLING……………… 11 PIPED TO YARD/PLOT……………..... 12 PUBLIC TAP/STAND PIPE …………... 13 TUBE WELL OR BOREHOLE……………………. 21 HAND PUMP……………………………………….. 22 DUG WELL PROTECTED WELL…………………… 31 UNPROTECTED WELL……………… 32 WATER FROM SPRING PROTECTED SPRING/KAREZ……… 41 UNPROTECTED SPRING…………… 42 RAINWATER………………………………………. 51 TANKER TRUCK…………………………………... 61 CART WITH SMALL TANK………………………. 71 SURFACE WATER (RIVER/DAM/LAKE/POND/STREAM/CANAL)…. 81 BOTTLED WATER………………………………… 91 OTHER ____________________________ (SPECIFY) 96

SKIP TO J8 SKIP TO J8

SKIP TO J8 SKIP TO J8 SKIP TO J8

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J7 How long does it take you to go there, get water, and come back?

MINUTES …………

ON PREMISES …………………………. 996

J8 In the last month, how frequently is water available from (SOURCE IN J6)?

USUALLY ALWAYS AVAILABLE …….............. 1 SEVERAL HOURS PER DAY …………............. 2 ONCE OR TWICE A WEEK …………................ 3 INFREQUENTLY…………………………............ 4

J9 How do you make your water safe for drinking?

PROBE: Anything else?

CIRCLE ALL MENTIONED. DO NOT READ OUT RESPONSES.

BOILING ………………………………………….. 1 CHLORINATION ………………………………… 2 FILTER EQUIPMENT …………………………… 3 IMPROVISED FILTER ………………………….. 4 NONE …………………………………………….. 5 OTHER _______________________________ (SPECIFY)

96

J10 What kind of toilet facility does your household use?

ON PREMISES FLUSH TOILET……….……………… 1 SEPTIC TOILET……… 2 NO FACILITY ON PREMISES PUBLIC LATRINE….. ………………. 3 BUSH/FIELD………………………… 4 OTHER _______________________________ (SPECIFY)

96

J11 Who owns this house you are currently residing in?

OWNED...................................................................... 1 RENTED.................................................................... 2 RENT FREE WITH CONSENT OF OWNER............. 3 RENT FREE WITHOUT CONSENT OF OWNER..... 3 PROVIDED BY GOVERNMENT................................ 4 OTHER (SPECIFY).................................................... 96

J12 Main material of the floor RECORD OBSERVATION.

NATURAL FLOOR EARTH/SAND …………………..……. 11 RUDIMENTARY FLOOR WOOD PLANKS ……………………… 21 PALM/BAMBOO ………………..……. 22 FINISHED FLOOR PARQUET OR POLISHED WOOD 31 VINYL OR ASPHALT STRIPS…….... 32 CERAMIC TILES …………………….. 33 CEMENT ……………………………… 34 MARBLE ………………………………. 35 OTHER (SPECIFY) _____________ 96

J13 Main material of outer walls RECORD OBSERVATION.

CONCRETE/BRICK/STONE …………............... 11 WOOD ………………………………… …………. 12 HALF CONCRETE/BRICK/STONE/AND HALF WOOD …………………………. 13 GALVANIZED IRON/ALUMINUM …….............. 14 BAMBOO/SAWALI/COGON/NIPA …................. 15 ASBESTOS ……………………………................ 16 GLASS ……………………………………………. 17 MAKESHIFT/SALVAGED/IMPROVISED MATERIALS ………………………….. 18 NO WALLS ……………………………………….. 19 OTHER (SPECIFY) _____________________ 96

148

J14 What type of fuel does your household mainly use for cooking?

ELECTRICITY……………………………………… 01 LIQUEFIED PETROLEUM GAS (LPG)…………. 02 KEROSENE………………………………………… 03 CHARCOAL………………………………………… 04 WOOD………………………………………………. 05 WOOD SHAVINGS/RICE HUSKS/STRAW…….. 06 OTHER (SPECIFY) ______________________ 96

END OF INTERVIEW

149

Appendix 4: Project Team Core Project Team Prof Dr Mohammad Nizamuddin (Director)

Dr Fauzia Maqsood (Deputy Director)

Javed Sajjad Ahmad (Consultant)

Mustafa Nazir Ahmad (Editor)

Syed Hussain Sajjad Rizvi (Senior Research Officer)

Sarwat Khurshid (Research Officer)

Zaheer Abbas (Research Officer)

Maria Abbas Gondal (Research Officer)

Anila Iram (Research Officer) Technical Advisory Committee Dr Mohammad Nizamuddin, Vice Chancellor, University of Gujrat

Shamim Rafique, Director General, Bureau of Statistics, Government of Punjab

Dr Fauzia Maqsood, Associate Director, Centre for Population, Urban and Environment Studies, University of Gujrat Sajid Rasul, Deputy Director, Bureau of Statistics, Government of Punjab

Dr Zahoor Ahmad, Assistant Professor, Department of Statistics, University of Gujrat

Arif Bhatti, Research Officer, Bureau of Statistics, Government of Punjab

Mirza Rizwan Sajid, Lecturer, University of Gujrat. Field Teams

Northern Punjab Johnson Tahir (Field Supervisor), Maria Abbas Gondal (Field Editor) Interviewers: Abdul Mannan, Aneela Shahzadi, Nadeem Ahmed, Saba Anwar, Sadaf Khan and Sania Zafar

Central Punjab-I Mushtaq Ahmed (Field Supervisor), Anila Iram (Field Editor) Interviewers: Abida Khan, Huma Mustafa Toor, Riaz Ahmed Moazamy Rizwana Ghafoor and Safoora Manzoor

Central Punjab-II Liaquat Ali Yousaf (Field Supervisor), Sarwat Khurshid (Field Editor) Interviewers: Ayeza Zafar, Muhammad Hamza, Nabeela, Tanzila Zakir Hussain and Uzma Iqbal

150

Southern Punjab Riaz Ahmed Khand (Field Supervisor), Zaheer Abbas (Field Editor) Interviewers: Asia Noureen, Bilal Mustafa, Muhammad Humza, Sadia Shahzadi and Shahzadi Iram Data Entry Operators/Office Editors Abdul Mannan, Affaq Shehzad, Aneela Latif, Asjad Cheema, Azhar Waqar, Bilal Mustafa, Huma Mustafa Toor, Marriyam Ilyas, Muhammad Hamza, Muhammad Humza, Natiq Rahil, Riaz Ahmed Moazamy, Sadaf Khan, Sadaf Nawaz, Saheem Riaz, Shahzadi Iram, Tauqeer Ahmed and Umer Hayaat Management and Accounts Faisal Iqbal, Tahir Hameed and Waheed Butt

151

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