Does India Have the Infrastructure to Support Its Elderly?

The Hindu

4 days ago

Published : Jul 18, 2025 15:49 IST - 13 MINS READ
Nalini (name changed), 82, who lives alone in Bengaluru, suffers from asthma, eczema, and mobility issues. For each ailment, she visits a different specialist. But often, it takes her weeks to get an appointment. When she does get one, she has to wait for hours to see the doctor because the hospitals are crowded. For her fragile body, the experience is stressful.
Her story is not unique—it is the stark reality for millions of India's older adults. India is on the cusp of a demographic revolution, projected to have the world's largest population of older adults by 2067, according to a recent report by Dalberg, Ashoka and Rohini Nilekani Philanthropies. The life expectancy of Indians is expected to increase from 72 in 2023 to 77 by 2045 and 83 by 2080. Alarmingly, the report says the country's older adults rank poorly on several critical health indicators—52 per cent suffer from at least one non-communicable disease (NCD) such as diabetes or cardiovascular ailments. Is our healthcare system prepared for this ageing population and the immense burden of chronic diseases?
'Our current healthcare system is designed for challenges like acute illnesses and infectious diseases that we as a country faced in the last century,' said Dr Gopukrishna Pillai, public health director at Palliative and Old Age Care at One Billion Lives Foundation, an NGO based in Bengaluru and the US. He added that the incidence of NCDs is rising because both government- and private-sector healthcare is overly focussed on hospital-based care, neglecting health promotion and disease prevention, and not addressing the risk factors for conditions like diabetes and hypertension. 'We need a fundamental shift towards population-level NCD management, integrating early surveillance with stronger, more accessible primary healthcare.'
Sumit Tayal, CEO of Give Grants, a platform that helps organisations raise funds, said, 'The reality is that our current public health infrastructure is already struggling. With a rapidly ageing population, particularly a growing number of elderly women living alone with little economic agency, the strain will become critical.' Give Grants released a report titled 'India's Ageing Society: The Landscape Today' in March 2025, which had [DP1] health statistics that were similar to those of the Dalberg report.
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The Give report states that there are only 270 geriatricians for a population of 140 million senior citizens. While private home care and assisted living communities exist, they remain financially out of reach for most. This leaves a gaping hole in accessible care for older adults.
Tayal added, 'The preparedness, or even the acknowledgement that we are headed in that direction, is currently missing. It's not that the technology is missing or the solutions are missing, but funding and deployment are far short of the requirement. The sheer gap in healthcare infrastructure for specialised geriatric and palliative care and what is needed is a big concern.'
One way to address this gap is to 'reframe the global megatrend of an ageing population as an opportunity for development', opined Vijeth Iyengar, a contributor to the Dalberg report and global ageing director at AARP, US, a non-profit organisation that focusses on the priorities of older adults. He said there were four broad areas ripe for further growth and development—boosting infrastructure, better data collection and standardisation, strengthening research, and increasing the size of the medical workforce including geriatricians specialised in treatment and care of older populations.
'Additionally, there is also a need to analyse the geographic status and population trends, including urbanisation and fertility rates, understand the global ageing landscape, and investigate the role of research, impact, quality, and funding in addressing ageing-related challenges.'
Funding and policy challenges
India aims to be a $10-trillion economy by the mid-2030s. But this aspiration faces a significant demographic challenge. By 2045, the number of older adults is projected to reach 300 million, double the current figure, states the Dalberg report. Tayal added, 'In less than a decade we will have a large number of people above 60. If you compare the sheer size of these numbers with any government or philanthropic initiative in India, there are hardly any initiatives that is targeting older adults.'
The investment in healthcare industry is largely focussed on women, maternal health, young adults, and children, observed Asha Banu Soletti, professor at the Centre for Health and Mental Health, Tata Institute of Social Sciences (TISS), Mumbai. 'For age-related vulnerability, we have to really look in terms of how much we are investing, and evolve context-specific interventions.'
Iyengar added that ageism is a pervasive issue that prevents society from adequately addressing the needs of our ageing populations. This widespread bias leads to a critical lack of policy development, causing health and social issues faced by older adults, including elder abuse, to be largely ignored. 'Here at AARP, we have a huge nationwide network of volunteers who help create advocacy, and raise awareness about the lived experiences of older adults and their family/caregivers. Creating advocacy is essential for policy to move.'
Tayal added that lack of sensitisation kept the subject of ageing largely out of public discourse. 'Schools, colleges, healthcare professionals, and most importantly, policymakers need to be sensitised about ageing. It is not just about putting in the dollars and hoping that will build up the infrastructure. Without sensitisation, it will be very difficult to attract investment or attention.'
Social isolation and mental health
Perhaps because of ageist attitudes and lack of sensitisation, India lacks sufficient avenues for older adults to lead meaningful lives, unlike the numerous options available for children, said Soletti. 'As traditional roles and livelihood opportunities diminish, many older individuals experience a profound loss of productivity and purpose.' Age-related limitations can further isolate them, even from customary social engagements like religious activities. This social isolation contributes significantly to loneliness and mental health issues among seniors.
The Dalberg report found that 8 per cent of older adults display symptoms of depression, with the number expected to double in the next two decades. Soletti added, 'To my knowledge, very few older adults are referred to a counsellor. Even if they are referred, it is debatable if the counsellor is an expert in geriatric counselling. We need to urgently develop and strengthen this discipline to address the mental well-being of our ageing population.'
For those who are housebound or disabled, the situation is even worse. 'We need some models where a trained professional such as physiotherapist can visit and also handle some of the mental healthcare aspects,' she said. Additionally, in rural areas, where access to public health centres (PHC) is already a challenge, people struggle as many become immobile as they deal with arthritis or find themselves becoming hunchbacked after a lifetime of carrying heavy loads.
According to Ranjana Vishe, who works on a TISS field action project in Maharashtra's Waghivali village, accessing the nearest PHC, which is five kilometres away, is difficult as there are no convenient public transport options. She said: 'While ASHA workers visit periodically, they mainly attend to the needs of pregnant women and children. The older adults, many of whom are frail, have to walk 5 km to the PHC, and to do this they have to depend on someone to help them and also take periodic rests on the way.'
Soletti added, 'Even when older adults access a hospital or clinic, the full scope of the problem is not captured. For example, if there is anuresis [inability to urinate] or bedwetting, it is normally diagnosed from a point of medical sciences, whereas it could be a psychological issue. The illness may also be a sign of emotional abuse.' The healthcare system should be equipped and trained to handle these issues.
Need for multidisciplinary approach
'Ageing cannot be looked at through the lens of health alone. It's an infrastructure issue, demographics issue, housing issue, and transportation issue. We need to determine social determinants of health and look at it holistically,' said Iyengar.
Dr Pillai added, 'Geriatric care should combine medical management of diseases with evidence-based risk-reduction strategies as appropriate to each individual's life stage and goals of care. There is also a need for substantive advocacy component and forging of interdisciplinary collaborations.'
For example, fall risk mitigation is extremely important in an older adult because their bones are weak and a fall leads to a drastic downturn in overall health. 'A conventional solution would be to set up a hospital-based fall prevention unit with a physician and a physiotherapist. This is all essential. However, there is a difference between what is sufficient and what is necessary,' Dr Pillai said. He explained that while a patient is being treated for fall risk, their neighbourhood has to be checked for better street lighting or better pavements to prevent fall. 'We need to look at each of our systems—from public services such as transportation to policies—to assess how fit they are for an older person at risk of fall. That is the degree of intentionality and seriousness that needs to come into this.'
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'We need more trained professionals, more structured systems. But most of all, we need to start with empathy,' said Dr Jonita Furtado, senior consultant at St. John's Geriatric Centre, Bengaluru.
Providing quality healthcare to older adults involves understanding their lives, their limitations, and their often-unspoken needs. In crowded hospital settings, this is easier said than done. 'Every patient that comes to us undergoes a holistic screening: from fall risk, cognition, mood and sleep patterns, to vision and hearing. Strength and balance are assessed by physiotherapists. Their social context is also evaluated—whether they live alone, if they have a support system, and how engaged they remain in community life,' Dr Furtado said. This ensures that the underlying problems do not go unnoticed.
Home and community-based services
The St. John's Geriatric Centre was started based on learning from the Senior Citizen Health Service initiative launched in 2003 by St. John's Medical College. The Senior Citizen Health Service has set up clinics for elderly people in rural and urban areas, and visits by doctors and nurses to old age homes are organised; elderly patients who live in their own homes are also visited. 'The same set of doctors and nurses undertake these visits once a month to check their health—these also serve as social visits as the doctors have built familiarity in the community,' said Dr Pretesh Kiran, associate professor in the Department of Community Medicine as St. John's Medical College, who coordinates the service. 'We need to ensure healthy ageing so that older adults can live a healthy productive life in their own homes, and this service is one way of ensuring realisation of this goal.'
But the public healthcare system is not equipped to provide this kind of homecare for older adults. Dr Pillai said: 'In geriatrics and palliative care, the sickest and the most vulnerable patient you are meant to support is not a patient who can walk into a hospital. It is a patient who probably cannot even walk to their own toilet. But currently, if at all there is any home care, it is left to the least experienced, least trained person in the public healthcare system.' He added that while there is investment on building expertise, it is only serving the ones who can access healthcare services. Those with severe needs often cannot access the experienced physicians they urgently require.
For instance, Lakshmi, a domestic worker in Bengaluru, bears the heavy burden of caring for her 95-year-old mother-in-law who has been bedridden since she had a fall six months ago. Lakshmi said: 'Local doctors refused treatment due to her old age, saying nothing can be done.' Hospitals are expensive for Lakshmi and her husband, who works for daily wages. Unable to afford care or adult diapers, her mother-in-law is forced to sleep on the ground without a bed, and it is left to Lakshmi to clean her soiled clothes.
Soletti pointed out that solutions available for the problems of elderly patients are mostly piecemeal and stressed the need for holistic care. 'In one of my visits to a rural area, I found people with redness in their eyes after cataract surgery that was conducted by some charitable organisations; it happened because of inadequate post-surgery care. We need to have periodic outreach camps for older adults in urban slums and rural areas.'
Some organisations, such as Pillai's One Billion Lives Foundation (OBLF), have come up with some solutions. In Anekal, OBLF has implemented a grassroots, decentralisedcare model serving approximately 75,000 people of all ages across five gram panchayats since August 2024. Dr Pillai said: 'We provide clinical services tailored to their care goals at various locations, including our centre, through home care, and at community clinics within government hospitals or partner NGOs such as destitute homes.'
Training and government initiatives
Dr Pillai acknowledges that every hospital or organisation cannot conduct home care visits. 'But within the constraints we have, we need to make sure that every person is supported to the extent possible. A lot of the work done by doctors can be and should be picked up by other professionals augmented by training and technology. And it needs to be done in a focussed manner.' He explained that while the overall accountability for patient care needs to remain with doctors, responsibility for specific tasks could be transferred to others in a responsible manner.
That is where training, culture, and technology come in. By leveraging these additional resources, it can be ensured that each patient encounter is matched to the person most well-suited to their current need—be it a community volunteer, nurse or a senior physician, he added.
Modules to train master trainers in geriatrics were developed by the National Health Skills Resource Center in 2019-20. Dr Pretesh Kiran of St. John's Medical College underwent this training and is now a master trainer. 'We train State level trainers who are then supposed to train different cadres of workers such as medical officers, nurses, ASHA workers, and so on, in geriatric care. Unfortunately, it has not trickled down to the last level. The knowledge is there, but willingness to implement this is lacking.'
He added that several government health programmes exist in silos such as National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), National Mental Health Programme (NMHP), and the National Programme for Healthcare of the Elderly (NPHCE). 'They all need to talk to each other in order to provide comprehensive care for older adults.'
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The NPHCE, launched in 2011, envisaged providing holistic care and geriatric centres for older adults at all levels—from PHCs, community health centres, taluk hospitals, district and tertiary centres. 'However, it requires complete and robust implementation at all levels, especially primary and secondary care,' said Kiran.
The Central government's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY) is intended to provide health coverage for all adults over 70. However, many seniors struggle to access these benefits due to eligibility criteria and a lack of necessary documents. One doctor said that many hospitals had stopped accepting the scheme as the government had not cleared past dues.
Dr Pillai said: 'There is a lot of well-intentioned work going on, but that work does not have the depth of understanding that is needed to handle the complexity of the field and produce outcomes. Geriatric care is much more than just medical management of diseases.'
Deepa Padmanaban is an author and independent journalist writing on public health, environment, science, wildlife conservation and climate change. Her articles have been published in The Guardian, Scientific American, Discover Magazine, The Hindu, Mint and other publications.