With a high youth population and an improved life expectancy rate, the elderly population in India is rapidly increasing. UN data shows that the number of Indians aged 60 and above is expected to reach 319 million by 2050. To understand this number, one can look at the 2011 census data, which shows that the population in India aged 60 and above stood at 104 million, constituting 8.6 percent of the total population.
This trajectory of India is similar to what China is presently experiencing with the rise in the elderly population. In 2022, China's elderly population aged 60 and above was 280.04 million; this grew to 296.97 million in 2023. Due to longer life expectancy and a declining fertility rate, it is projected that approximately 402 million people, or 28 percent of China's total population, will be over the age of 60.
As we look at these growing numbers and shifting demographics, we are presented with a new set of challenges that India must be prepared for, particularly regarding inclusive public healthcare to cater to the needs of the older population. This urgency has been highlighted by the report published by The Lancet journal, which brings attention to India’s dwindling total fertility rates, falling from nearly 6.2 in 1950 to just under 2 in 2021. In this light, the mitigation and provision of healthcare services for the aging population become extremely important.
| State of aging in India - What do numbers say? - The number of people aged 75 years and above is expected to increase by an astounding 340% between 2011 and 2050. - 71% of elderly persons reside in rural areas. - 75% of the elderly have one or more chronic diseases. - Every 4th Indian over 60 years reported having poor health. - Around 20% of the elderly in India have mental health issues. Source: Niti Aayog’s paper on senior care reforms in India |
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The elderly population is prone to a number of neurodegenerative disorders, in addition to increased issues of hypertension, obesity, social isolation, and depression. One of the most common neurodegenerative disorders is dementia. Known as the disease of the elderly, dementia is used to describe several conditions that impact memory, thinking, and the ability to perform daily activities, affecting various functions necessary for daily living.
Data from the WHO shows that more than 55 million people worldwide have dementia, making it the 7th leading cause of death globally. This mental health problem is more common in low and middle-income countries. India has an estimated dementia prevalence of about 7.4 percent for adults aged 60 and above, with approximately 8.8 million Indians older than 60 living with dementia.
The fall in fertility rates and increased lifespan means that the prevalence of dementia will rise rapidly in the coming years. With common risk factors such as diabetes, obesity, and hypertension, the older population becomes more vulnerable to this syndrome. Given the high cost and increased dependence associated with dementia, it is essential to reduce the burden through research and accessible healthcare, promoting early interventions such as dietary changes, increased physical activity, and control of vascular risks.
Recently in India, the Central Government expanded the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to provide health coverage to people aged 70 and above, regardless of their income level. There is also a provision of 5 lakh rupees on top of this insurance for healthcare. Although the amount may not be sufficient to cover all health expenses, it would reduce some of the burden and out-of-pocket expenses for the elderly.
Considering the high cost of private healthcare, the scheme aims to expand to include common geriatric conditions like dementia, heart failure, and cancer.
When looking at examples of improved accessibility to healthcare for the elderly, the AIIMS National Centre for Ageing in Delhi can be a good model to follow. The center provides geriatric care for the elderly, diagnosing multiple common health conditions in adults, such as heart diseases, arthritis, diabetes, and cognitive decline. Another National Centre for Ageing was also established at Guindy in Chennai on February 25, 2024.
The idea behind this integrated care model is that if elderly patients visit different specialists for each complaint, it not only increases the financial burden but also leads to the prescription of multiple medications. Geriatric care aims to streamline treatment by integrating therapy, except in cases where a specific problem is too severe, in which case the patient is referred to a specialist.
The AIIMS Aging Center also screens and tests all patients above 70 years for cognition, memory, depression, nutrition, mobility, muscle loss, vision, and hearing issues. These screenings help detect conditions like dementia early on, allowing for timely interventions and medication to slow cognitive decline. However, given that changes in the brain leading to dementia can start two decades before overt clinical symptoms appear, it is crucial to improve accessibility and promote early check-ups in the Indian public healthcare system.
Recently, NITI Aayog also released a position paper titled "Senior Care Reforms in India: Reimagining the Senior Care Paradigm," highlighting the need for action to enhance the focus on senior care.
According to the paper, achieving comprehensive senior care requires a fundamental shift towards addressing the specific needs of the elderly population. This transformation involves collaboration between public and private sector partners across the care continuum to provide high-quality support for the overall well-being of seniors.
The paper also states that the government must work towards expanding an integrated healthcare system that promotes fitness and health among senior citizens, including improving healthcare facilities and building a skilled workforce dedicated to aged care.
The paper also recommends establishing a comprehensive social safety and inclusion framework. This could be achieved by developing a consolidated portal, serving as a ‘one-stop’ platform for easy access to senior-related services. Additionally, introducing a care economy model for senior care is essential to ensure sustainable support for the elderly population, says the paper.
Recognizing how often people living with dementia are denied their human rights, the World Health Organization recommends a human rights-based approach for people living with dementia. WHO prescribes a PANEL+1 approach, which stands for participation, accountability, non-discrimination, empowerment, and legality. It is a framework provided to ensure the rights and dignity of people with dementia. This framework is crucial and must be considered when designing strategies and policies at international, national, and local levels.
Durrain Desnavi is pursuing a Masters in Development from Azim Premji University, Bangalore. She is currently a Research Intern with TA.
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