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The feminisation of ageing observed across the world is a significant challenge in many societies. Women's greater longevity is associated with the increased likelihood of age-related disability and morbidity. Furthermore, gendered disadvantage and poverty can make access to health care increasingly problematic in later years. Among the Indian states, Kerala has the highest number of residents above the age of 60 and many are older widows. Given this context, this paper explores what promotes access to health care for older widows living alone in the south Indian state of Kerala. Thirty-two in-depth interviews, eight focus group discussions and eight units of participant observation were carried out among widows, health-care providers and key informants. Applying a reflexive inductive approach to our analysis, the main barriers to access that emerged were altered family structures and loneliness, whilst enablers included good social networks and access to neighbourhood clinics. Our participants' social networks were drawn from three levels: family, neighbourhood and the wider community. The ability to form a personal community from their social networks and the quality of relationships within this community strongly predicted the capacity to access health care. Efforts to improve access to health care for older widows requires a response that is rooted in the socio-cultural context of the community. Comprehensive social protection policies that promote initiatives to engender social capital among the older population, decentralised primary health-care services, and the training and sensitisation of health service staff would be key to promote equitable access for older widows. [ABSTRACT FROM AUTHOR]

Currently there is no specific policy on dementia care in India. Rather, the responsibility for care for people with dementia is not clearly articulated and formal care services straddle mental health and aged care. The result is that much care is placed upon individual families. This paper critically reviews Indian legislative and policy documents on this field of care, namely, the Mental Health Act 1987, the National Mental Health Programme, the National Policy on Older Persons and the Senior Citizen's Act 2007. The invisibility of dementia care in public policy translates into the absence of adequate treatment facilities and mental health staff, and leaves informal care-giving unsupported. This gap is replicated in mental health and dementia-care research and literature in India, with little being known about how family carers respond to the experiences of care-giving, manage the stigma, and access support. As India, like other middle-income and low-income countries, is experiencing an increase in its older population, more research is needed to develop the epidemiological, medical and anthropological understanding of ageing, dementia and care. This knowledge is vital to understanding the cultural context of the disease and must also be incorporated into public health policy if there is to be effective management of the rising need for personal care. [ABSTRACT FROM AUTHOR]