Daijiworld Media Network - New Delhi

New Delhi, Oct 15: India has spent decades celebrating its youthful population, but the country is ageing rapidly, placing growing pressure on healthcare, social security, housing, transport and family support systems.

The India Ageing Report 2023, published by the United Nations Population Fund (UNFPA) and the International Institute for Population Sciences (IIPS), projects that the share of Indians aged 60 and above will rise from around 10.5% in 2022 to 20.8% by 2050, reaching approximately 347 million people. The population aged 80 and above is projected to grow by around 279%.

The challenge is no longer whether India will age, but whether its people will be able to grow old with dignity and adequate support.

Ageing brings complex healthcare needs. Older people often live with multiple conditions, including hypertension, diabetes, cardiovascular disease, chronic lung disease, arthritis, sensory impairment, cognitive decline, frailty and depression.

Data from the Longitudinal Ageing Study in India (LASI) shows that around 32% of Indians aged 60 and above report hypertension, 14.2% have diabetes and 8.3% suffer from chronic lung disease. Stroke affects 2.7%, while cardiovascular disease affects approximately one-third of this population.

However, India's healthcare system remains largely organised around individual diseases rather than the overall wellbeing of patients. Older people often consult multiple specialists, making coordinated care essential. An integrated approach to geriatric healthcare would help manage medical conditions, review medications, assess functional and cognitive abilities, and ensure continuity of treatment.

Rural India faces an additional challenge, with limited access to diagnostic facilities and specialist doctors. Hypertension and diabetes may remain undetected for years, while breathlessness and other symptoms are sometimes dismissed as normal consequences of ageing. The overall shortfall of specialists in rural Community Health Centres (CHCs) stands at around 79.5% of the required strength.

Expanding diagnostic services at the primary-care level could help identify chronic diseases, anaemia, kidney dysfunction, nutritional deficiencies, sensory impairment, depression, cognitive problems and frailty at an early stage. For older patients, long journeys to healthcare facilities can mean substantial transport costs, physical exhaustion and lost income for accompanying family members.

Urban areas, despite having more specialists, also face problems caused by fragmented healthcare. Older patients may receive multiple prescriptions, undergo repeated investigations and face conflicting treatment recommendations. Such fragmentation can result in polypharmacy, unnecessary procedures and high out-of-pocket expenditure.

A designated physician or geriatric care team could coordinate treatment, review medications, prioritise health concerns and involve family members in follow-up planning.

Changing family structures have further complicated elderly care. Migration, urbanisation, smaller households and longer working hours mean that many older parents live apart from their children. Although money and medicines can be sent remotely, technology cannot replace personal attention and emotional support.

The India Ageing Report 2023 also highlights vulnerabilities linked to poverty, widowhood, rural residence and dependence, particularly among older women. Financial assistance alone cannot address the need for companionship, emotional care and everyday support.

Elder abuse remains another concern. It may involve physical harm, humiliation, denial of medical treatment, control over pensions or abandonment of dependent parents. Such incidents can remain hidden because victims may rely on those responsible for their care. Legal safeguards must therefore be accompanied by greater public awareness and a culture of respect for older people.

India already has the National Programme for Health Care of the Elderly and the Maintenance and Welfare of Parents and Senior Citizens Act. However, experts argue that the response must extend beyond hospitals and legal protection to create an age-friendly society.

Healthcare services need to incorporate screening for falls, frailty, cognitive impairment, depression, malnutrition, sensory problems and inappropriate medication use. Essential medicines and diagnostic facilities should be accessible at the primary-care level, while home-based healthcare, rehabilitation, physiotherapy, palliative care and assistive services require expansion.

Public infrastructure must also become more accessible. Safe pavements, accessible public transport, suitable buildings and public toilets can help older people and persons with disabilities maintain independence and participate in community life.

Financial protection is equally important. Much of elderly healthcare involves regular outpatient consultations, medicines, diagnostic tests, physiotherapy, spectacles, hearing aids, dental care and transport rather than hospitalisation alone. Public financing must address these recurring expenses so that older people are not forced to choose between food and essential medicines.

Digital health services can connect villages, Primary Health Centres, district hospitals and tertiary-care facilities. However, technology must complement rather than replace personal assistance. Community Health Officers, Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs) and primary-care teams can help older citizens access digital services and receive appropriate care.

A broader cultural shift is also necessary. Retirement should not diminish a person's citizenship, and dependence should not erode their dignity or rights. Older people should be treated as individuals entitled to respect, protection and support rather than as burdens on their families or society.

Five priorities can guide India's response: early disease detection through accessible primary care; integrated rather than fragmented treatment; financial protection covering medicines, diagnostics and rehabilitation; support for families through day-care, respite and home-based services; and stronger safeguards against abuse, exploitation and abandonment.

India's demographic dividend will not last indefinitely. Today's young workforce will eventually become tomorrow's elderly population, making preparations for ageing a long-term national priority.

The country's development must be measured not only through economic growth, infrastructure and hospitals, but also by whether an elderly woman living alone can obtain her medicines, a farmer can reach a doctor without financial hardship, a widower can live without fear of dispossession and an older person can seek help without feeling like a burden.

India's transition towards an ageing population is already underway. Ensuring that people can grow old with dignity will require coordinated healthcare reforms, financial security, accessible infrastructure and stronger family and community support.