How Did the Elderly in Tamil Nadu Weather the COVID-19 Lockdown? Evidence from the Tamil Nadu Aging Panel

Home , Tamil Nadu

The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

September 6, 2020

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 1 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Outline

• The Tamil Nadu Aging Panel and Government Partnership

• What we know about the lives of the elderly (Baseline: Jan - Jun 2019)

• How the elderly are coping with the coronavirus pandemic

• Improving mental health and economic well-being

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 2 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

The Tamil Nadu Aging Panel Government Partnership

• Challenge: Demographic transition, with elderly population (55 years or above) in developing countries slated to grow more than three-fold between 2011 and 2050 • Tamil Nadu: from 7.2% in 2011 to 22%+ by 2050 • Insuﬃcient data to inform policy to address this changing context

• Solution: create a high-quality 7-year-long panel dataset

• Inform design and implementation of social safety schemes (pensions, cash transfers, public distribution), health policy, mental health interventions • Launch an RCT with an intervention to ﬁght loneliness among the elderly living alone

• Collaborating with Government of Tamil Nadu to collect data, part of the larger J-PAL institutional partnership since 2014 • The Department of Economics and Statistics collected self-reported survey data; medical staﬀ at the Directorate of Public Health collected health measurements; • J-PAL provided technical guidance and research support; principal investigators designed and piloted project and interventions

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 3 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

A representative sample of TN’s elderly

• Census: 61,954 households (HHs) from 5 state-representative districts, further stratiﬁed into district-representative Primary Sampling Units, were surveyed to identify eligible households (those with at least one elderly) • Panel sample: 5,000 HHs with at least one elderly member (55 years or over) • Subgroups of interest • Elderly living alone (ELA), i.e., single-member HHs (1530) • Elderly potentially eligible for but not receiving Old Age Pensions (OAP) (1279)

• Stratiﬁed random sampling, by village/town, identiﬁed a panel sample with three subgroups from the census listing: a random sample, the ELA, and the OAP

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 4 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Panel Survey Waves and COVID-19 Update

• Baseline survey: January-June 2019. Future waves: 2021, 2023, 2025. • Economic well-being (consumption, income, food security) • Health (mobility, diagnosed diseases, health-seeking behavior and utilization) • Mental health (depression, loneliness) • Social interaction (community activities, family) • Health measures (blood pressure, diabetes, mobility)

• COVID update: Two short phone surveys. April and July 2020. • Awareness of symptoms/lockdown, prevalence of symptoms • Coping: access to the government’s COVID welfare measures, food security, economic situation, physical and mental health.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 5 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

The Elderly Living Alone (ELA) are predominantly female

Female and ELA Male and ELA 15

• TN census exercise with 61,954 households

10 • 13% of households with elderly are single-member households, i.e. elderly living alone.

5 • 87% of the ELA are female; written another way, 15% of elderly females are ELA. Percent of Elderly that ELA are of Percent Elderly

0 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80+ Age

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 6 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Poverty is very high among the elderly

Elderly Living with Others Elderly Living Alone

15 15 • Extreme poverty: Extreme poverty: 25% of the elderly living 38 Rs or $1.9/day 38 Rs or $1.9/day with others fall under the Low-middle Low-middle income poverty: income poverty: extreme poverty line, $1.90 64 Rs or $3.2/day 64 Rs or $3.2/day 10 10 per person per day.

Percent Percent • 28% of the elderly living alone are below the extreme 5 5 poverty line

• Compared to 12% of the state as a whole. 0 0 0 100 200 300 0 100 200 300 Daily per-capita household expenses (Rs.) Daily per-capita household expenses (Rs.)

Notes: Extreme and low-middle income poverty lines are taken from the World Bank. USD coversions are PPP.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 7 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Self-described ﬁnancial situations are worse for the ELA

Elderly Living with Others Elderly Living Alone • The average elderly household 30 30 rated their ﬁnancial situation as “diﬃcult,” a 3 on a 1-10 scale.

20 20 • 1 reflects an extremely difficult financial situation; 10 reflects extremely comfortable. Percent Percent

10 10 • Despite an only slightly higher ELA poverty rate, nearly 60% of the ELA rated their financial situation as “extremely or very 0 0 2 4 6 8 10 2 4 6 8 10 Self-rated financial health (1-10) Self-rated financial health (1-10) difficult.”

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 8 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Objective disease prevalence is high yet not self-reported

Percent of all elderly 0 20 40 60

Arthritis

Lung or heart disease • Very high disease prevalence among the Kidney disease elderly when medically examined

Hearing loss • Awareness gap: much lower self-reported Cataract prevalence of most diseases. Diabetes

Hypertension

Objectively measured prevalence Self-reported prevalence

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 9 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Disease prevalence increases in age

Avg. no. of common diseases - Males Avg. no. of common diseases - Females 2.4 2.4

• Of the seven common 2.2 2.2 diseases listed above, prevalence is increasing in 2 2 age.

1.8 1.8 • Particularly steep increase among males, as females

1.6 1.6 have higher disease prevalence early on, especially the female ELA 1.4 1.4 55 60 65 70 75 80 85 55 60 65 70 75 80 85 Age Age

Non-ELA ELA

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 10 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Signiﬁcant functional impairment, especially for the ELA

Percent with severe difﬁculty completing 0 10 20 30 40 50

Moving around at home Getting dressed Washing whole body Eating Getting to and using toilet Picking items up with fingers Tending to household duties • ELA considerably more likely to Lifting arms above shoulders Concentrating for 10 minutes have difficulty completing Joining community activities Getting out of home various activities of daily living; Walking 100 meters Sitting for long periods Getting up from lying down • Disparity grows with activity Using transportation Standing up from sitting difficulty. Learning a new task Carrying things Standing for long periods Stooping or kneeling Walking long distances (1km) Climbing a flight of stairs

Elderly Living with Others Elderly Living Alone

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 11 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Functional impairment increases steeply with age

No. of deficient ADLs - Males No. of deficient ADLs - Females 7 7 • “Functional impairment” is the 6 6 number of ADLs (of 22 listed previously) which respondents have 5 5 at least severe difficulty completing.

4 4 • Females and the female ELA are

3 3 more likely to be functionally impaired.

2 2 • Functional impairment grows 1 1 55 60 65 70 75 80 85 55 60 65 70 75 80 85 sharply with age. Age Age

Non-ELA ELA

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 12 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Cognitive impairment is very high for females

Pct. with cognitive impairment - Males Pct. with cognitive impairment - Females

80 80 • High prevalence of cognitive impairment, as measured by the Mini Mental State Examination 60 60 • Higher for the ELA and far higher for females, across ages. 40 40

• 80% of females over 80 demonstrate mild or severe cognitive impairment. 20 20 55 60 65 70 75 80 85 55 60 65 70 75 80 85 Age Age

Non-ELA ELA

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 13 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

The ELA are far more likely to demonstrate depression

Pct. suggestive of depression - Males Pct. suggestive of depression Females 60 60

Elderly Prisoners over 60 in the UK Elderly Prisoners over 60 in the UK

ELA over 60 in Shanghai ELA over 60 in Shanghai 50 50 • High absolute rates of depression, as has commonly been seen for the elderly. 40 40

• More females and many more 30 30 ELA show symptoms of UK Elderly over 65 depression depression. UK Elderly over 65

20 20 55 60 65 70 75 80 85 55 60 65 70 75 80 85 Age Age

Non-ELA ELA

Notes: Depression scores from 15-item Geriatric Depression Scale: scores above 5 (out of 15) are suggestive of depression and scores above 9 are almost always indicative of depression. Values for elderly prisoners from O’Hara et al. 2016, ELA in Shanghai from Chen and While 2018, UK elderly from D’Ath et al. 1994.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 14 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

We measure loneliness in two ways

• Directly-reported loneliness: “Do you often feel lonely?”

• UCLA Loneliness Scale: • Short-form (four-item) version; • “I feel in tune with the people around me” • “No one really knows me well” • “I can ﬁnd companionship when I want it” • “People are around me but not with me” • Responses on 3-point Likert scale. Items are reverse or forward-scored, depending on direction. • Not validated in the Indian context

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 15 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Among males, the ELA are especially lonely

Pct. Who Often Feel Lonely - Males Pct. Lonely from UCLA Scale - Males 90 90

70 70 • Loneliness among males diﬀers signiﬁcantly between direct reports and that from 4-item 50 50 UCLA scale, but considerable rate of loneliness persists.

30 30 • Loneliness among the male ELA is extremely high, around 60%.

10 10 55 60 65 70 75 80 55 60 65 70 75 80 Age Age

Male living with others Male living alone

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 16 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Among females as well, the ELA demonstrate outsized loneliness

Pct. Who Often Feel Lonely - Females Pct. Lonely from UCLA Scale - Females 70 70

60 60 • Among females, the high rate of

50 50 loneliness roughly doubled for the female ELA.

40 40 • Mirrors male loneliness, as does the discrepancy between direct 30 30 reports and UCLA loneliness scale.

20 20 55 60 65 70 75 80 55 60 65 70 75 80 Age Age

Female living with others Female living alone

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 17 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Social interaction with individuals and community

• Elderly report having sources Interaction with Individuals Community Interaction of support in times of trouble Percent of Respondents Percent of Respondents 0 20 40 60 80 100 0 20 40 60 80 100 and feel respected in their Had conversation in last day Meets with community leaders community.

Visited someone in last week Attends cultural events • Little in-person and phone Was visited in last week interaction, as well as low

Can make phone call Currently works community engagement.

Talks on phone at least weekly Trusts neighbors considerably • For ELA, all forms of Has someone to borrow money from community interaction slightly Feels respected in community Has someone to call in emergency less likely, as are phone use and having sources of

Elderly Living with Others Elderly Living Alone emergency support.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 18 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

The ELA own far fewer assets enabling connection

(1) (2) Living with others Living alone mean mean • ELA far less likely to own Bicycle 30 3 assets enabling both in-person Scooter 47 2 and remote connection Car 4 1 Phone 84 36 • Raises concerns about reaching Computer 5 1 the ELA in times of crisis Internet connection 11 1 Observations 4760 1534

Table: Asset ownership (percentage who own each asset)

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 19 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Two waves of COVID-19 phone surveys

• Two waves of phone surveys were planned to understand the effects of COVID-19 and the lockdown on the elderly, specifically: • Access to government COVID welfare measures, food security, economic situation, physical and mental health. • The role of state pensions and welfare measures in alleviating the pandemic’s effects over time. • Target sample: 4,929 elderly with phone access, from the 6,294 baseline sample.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 20 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Receipt of government schemes

Percent of card holders receiving scheme

80 • The state of Tamil Nadu launched two schemes for

60 ration card holders (1) Free rations from April to July, doubling the rice entitlement 40 (2) Cash transfer of Rs. 1000 (about USD 14) per ration card for April and May 20 • The schemes reached most, although not all,

0 intended recipients. Free rations (April) Cash transfer Free rations (July)

Elderly Living with Others Elderly Living Alone

Notes: During Wave 1 (April), the ELA were surveyed one week earlier than all others.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 21 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Health challenges and food insecurity at the beginning of the lockdown

Percent 0 10 20 30 40 50

Needed to visit doctor but could not

Needed medication but could not buy • At the start of the lockdown, the elderly faced signiﬁcant health and food-security challenges. Had to skip meals

• Nearly 50% reported not having More worried than usual about having food enough resources for food in the next week. Has no resources for food next week

Living with Others April Living Alone April

Notes: During Round 1, the ELA were surveyed one week earlier than all others.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 22 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Health challenges and food insecurity later in the lockdown

Percent 0 20 40 60

Needed to visit doctor but could not • The number of elderly unable to buy medicine or see a doctor since Needed medication but could not buy April has fallen.

Had to skip meals • Food insecurity, however, has risen and is high, particularly among the elderly living alone. Has no resources for food next week

Living with Others April Living Alone April Living with Others July Living Alone July

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 23 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Among the pension-eligible, recipients and non-recipients are equally well-oﬀ in April

• Not all eligible for the Old Age pension receive it. Percent 0 20 40 60 • In the census exercise, a group of 1,124 Needed medication but could not buy individuals were identiﬁed as OAP eligible but not receiving it. These individuals were randomized into a Had to skip meals treatment group or a control group for receiving the pension. 42% of the treatment group, compared to 8% of Needed to visit doctor but could not the control group, now receive the pension.

Has no resources for food next week • Those in the treatment and control groups were of equal ﬁnancial stability Assigned OAP Control April Assigned OAP Treatment April in April, when pension payouts were delayed.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 24 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Those randomized to receive the pension fare better as the lockdown progresses (July)

Percent 0 20 40 60 80

Needed medication but could not buy • By the July survey, Old Age pension payments had resumed for Had to skip meals a number of weeks.

• The treatment group, relative to Needed to visit doctor but could not control, was now much less likely to report having not having enough

Has no resources for food next week resources for food in the next week.

Assigned OAP Control April Assigned OAP Treatment April Assigned OAP Control July Assigned OAP Treatment July

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 25 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Most elderly with COVID symptoms did nothing or self-medicated

Actions taken by elderly with COVID-19 symptoms (%) 0 10 20 30 40 • 1.4% of the elderly reported having COVID-19 Called government helpline symptoms during the April phone surveys.

Saw private doctor • Of the elderly reporting symptoms, nearly 80% did nothing or self-medicated. Saw government health provider • No one reported calling the government helpline in Did nothing April; only 0.1% reported having called the government helpline in July. Self-medicated

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 26 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

COVID-19 awareness

Percent 0 20 40 60 80 100

Knew how COVID-19 spread

• Awareness of COVID-19 spread, symptoms, and precautions is Knew COVID-19 symptoms moderate.

• Awareness has grown among the elderly living alone, presumably as information Knew COVID-19 precautions percolates through networks.

Living with Others April Living Alone April Living with Others July Living Alone July

Notes: During Round 1, the ELA were surveyed one week earlier than all others. Tamil Nadu’s Elderly and COVID-19 September 6, 2020 27 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Social connection was very low early lockdown (April)

Percent 0 10 20 30 40 50

Had regular visits in last week • At the beginning of the lockdown, social interaction was low for the elderly, both in-person and remote.

• Early on, the ELA were less likely to have regular Had regular phone calls in last week phone calls.

Living with Others April Living Alone April

Notes: During Round 1, the ELA were surveyed one week earlier than all others.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 28 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Social connection increased mildly throughout lockdown (July)

Percent 0 20 40 60

Had regular visits in last week

• By July, both regular in-person visits and calls had picked up moderately for the elderly living alone and elderly living with others.

Had regular phone calls in last week

Living with Others April Living Alone April Living with Others July Living Alone July

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 29 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

The ELA demonstrate outsized loneliness and depression early lockdown (April)

Percent 0 5 10 15 20

Afraid bad thing would happen to them • At the beginning of the lockdown, the elderly living alone were about twice as likely to indicate feelings of loneliness and depression.

Felt their situation was hopeless • These indicators reﬂect lower loneliness and depression than those at the baseline survey. This may be due to nature of the COVID survey - shorter and via the phone - being Often felt lonely less conducive to rapport-building between surveyors and respondents.

Living with Others April Living Alone April

Notes: During Round 1, the ELA were surveyed one week earlier than all others. Tamil Nadu’s Elderly and COVID-19 September 6, 2020 30 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Loneliness and depression spike signiﬁcantly during the lockdown (July)

Percent 0 10 20 30

Afraid bad thing would happen to them • As the lockdown progressed, all elderly became far more likely to express feelings of loneliness and depression. Felt their situation was hopeless • This was especially true for the ELA, 32% of whom reported often feeling lonely, when asked in July. Often felt lonely

Living with Others April Living Alone April Living with Others July Living Alone July

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 31 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Improving mental health, food security, and health access: background

• We were on the cusp of starting an in-person therapy and group counseling intervention when COVID-19 crisis began.

• But, it is obviously no longer safe to have older people meet together and to have young people travel from village to village to spend extended periods of time with them.

• The elderly are most vulnerable to COVID-19, and those living alone are completely left alone from any support system: starkly more likely to report being lonely (32% vs 15%) and having to skip meals in last week (20% vs 15%)

• Suggestive indication that pension receipt mitigates food insecurity and health access.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 32 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Improving mental health, food security, and health access: proposed intervention

Cross-randomized RCT with a therapy and a cash component for 1,530 participants across 5 districts

• Therapy: Delivered over the phone for 6 weeks (meticulous IRB-approved protocol to ensure safety of the elderly and interviewer) • Counseling to address depression • Companionship to address loneliness • Self-efficacy and problem-solving for addressing financial and/or health concerns • Follows non-specialist therapy approach that was found highly effective in low-resource settings (Singla et al. 2017)

• Cash transfer: One-time, Rs. 1000, equivalent one-time government COVID-19 cash transfer for ration-card holders • Enable elderly to meet immediate needs: health, food • Delivered after therapy sessions • Considerable evidence that cash and other transfers improve mental health (Ridley et al. 2020)

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 33 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Main intervention outcomes

• Depression: geriatric depression scale

• Food security: Skipping meals in the last week or month

• Mobility and health (access and adherence)

• Social interaction with family members and other community members

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 34 / 35 The Tamil Nadu Panel Elderly Well-Being at Baseline (2019) COVID-19 Data Collection Well-Being in the COVID-19 Lockdown Counseling Intervention

Conclusion

• The elderly living alone are not assumed to exist in India; they constitute a blind spot in economic policy-making.

• The COVID-19 crisis has given new urgency to monitoring what is happening to the elderly and ELA and helping them, as they are particularly vulnerable both in terms of their health and the ﬁnancial situations.

• At the same time, COVID-19 makes any intervention for this group more diﬃcult to implement; it is a unique opportunity to see what might work.

Tamil Nadu’s Elderly and COVID-19 September 6, 2020 35 / 35