India’s population is also greying

With India on the brink of a demographic shift, the care and well-being of its senior citizens must become a national priority

Even though the 34th International Day of Older Persons has passed (October 1) — a day that the United Nations General Assembly designated in 1990 — it is still a time to draw attention to the importance of caring for older adults, not only as a global necessity but also as an imperative for India. According to recent data, 1.1 billion people aged 60 years or above worldwide, accounted for 14.16% of the total population in 2023. This is a number that is expected to double by 2050, reaching 2.1 billion, or 22% of the global population. The designation of this day by the UN was following the Vienna International Plan of Action on Ageing, adopted in 1982. A key theme of UN Secretary-General António Guterres’s message this year was “Strengthening care systems that honour the dignity of older persons and their caregivers”. With India’s rapidly shifting demographics, this message is especially critical.

Socioeconomic status of the elderly

Over the past few decades, India has made remarkable progress in fertility reduction, maternal mortality, poverty alleviation, and controlling communicable diseases. However, little deliberation has happened around the services and care required for the rapidly ageing population. To an extent, we are oblivious to the fact that the population is greying.

In India, there are currently 149 million people aged 60 years or above, representing 10.5% of the population. By 2050, this figure is expected to surge to 347 million, or 20.8% of the population. India’s elderly population is growing faster than its younger age groups. Life expectancy has risen to 70 years, yet healthy life expectancy lags 6.5 years behind. By 2046, the number of elderly people in India will surpass the population of children aged 0-14 years.

The distribution of the elderly population is not even across the country. As per the India Ageing Report 2023, the southern States have a higher proportion of the elderly population as compared to the northern States. Kerala has the highest elderly population in India, at 16.5%, followed by Tamil Nadu, at 13.7%, while Bihar has the lowest proportion, at 7.7%. However, in absolute numbers, Uttar Pradesh has the highest elderly population. Rural areas are home to 70.6% of India’s senior citizens, and access to health care and social services is often limited. The old-age dependency ratio, which measures the number of older adults relative to the working-age population, has reached 15.7 per 100 in India.

Challenges that senior citizens face

According to the India Ageing Report 2023 (jointly published by the UN Population Fund and the International Institute for Population Sciences), 40% of India’s elderly population belongs to the poorest quintile, with 18.7% living without income. Further, only 18.7% of senior citizens have health insurance coverage, leaving the vast majority vulnerable to financial strain in the event of illness. The Longitudinal Ageing Study in India (LASI) conducted in 2017-18 revealed that women, who tend to live longer than men, are at a higher risk of suffering from multiple chronic conditions. Over 28% of men and 30% of women, respectively, are affected by one chronic morbidity. Almost 25% of men and women have two or more chronic morbidity. As people age, this condition gets worse, emphasising the need for ongoing medical help. Yet, access is still restricted. The LASI study also showed that 59% of elderly individuals used outpatient services 12 months before the survey. Two-thirds of elderly individuals see treatment from private providers due to a lack of trust or access to public health care. Only 23% of elderly patients utilised public health services, which underlines the shortcomings of India’s primary health-care system, especially in the rural areas. The report on health-care infrastructure and human resources released by the Ministry of Health and Family Welfare exposes these shortcomings. The complete spectrum of specialists needed is absent from about 79.9% of rural community health centres (CHCs); surgeons make up 83.37%, obstetricians and gynaecologists 74.57%; physicians 81.93%, and paediatricians 80.58%. Due to the high out-of-pocket health-care costs brought on by these shortages, many elderly people become impoverished and are unable to receive the treatment they so sorely need.

Elderly people deal with issues such as disabilities, undernourishment, obesity, and social isolation in addition to health care. Many elderly people, especially in rural areas, suffer from physical impairments that limit their ability to perform basic daily tasks such as dressing, bathing and walking. Moreover, the rising migration of younger family members to urban areas or abroad has left many elderly individuals living alone, increasing their risk of loneliness, depression, and even neglect. These difficulties have been made worse by climate change, especially for older people living in rural areas, who are more susceptible to sudden and severe weather fluctuations.

While the government has taken several steps to address the needs of senior citizens, such as the extension of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) to cover those above 70 years who were not covered under any other public health insurance, the National Policy for Older Persons, introduced in 1999, and the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, are commendable initiatives that offer a framework for social and economic security. In addition, preventive, curative, and rehabilitative treatment are offered by the National Programme for the Health Care for the Elderly (NPHCE). However, these actions alone are not enough to address the increasing problems that older people are facing.

Reshape policy as demands will rise

As India is on the brink of a demographic shift, the care and well-being of its senior citizens must become a national priority. This shifting demographic calls for immediate attention to ensure that its senior citizens are adequately supported in connection with health, social security, and dignity. As the elderly population grows, the demand for caregiving, both social and financial, from the younger generation will increase significantly. In order to support its older population, our nation needs to build strong policies and mechanisms to anticipate this growing reliance burden.

We have both a chance and a problem when it comes to our social policies, health-care systems, and community support networks in light of the growing senior population. Investing in comprehensive health care, creating age-friendly environments and ensuring robust long-term care can empower older persons to live healthier, more dignified lives. The time to act is now. Caring for our senior citizens is not just a moral obligation. It is an investment in the social fabric of our country. A society that honours its elders values its history and builds a more resilient, compassionate future.

Nitin Kumar is a student at the Indira Gandhi National Open University (IGNOU), an independent researcher and Legislative Assistants to Members of Parliament (LAMP) Fellow (2023-24), New Delhi. Archana Kujur is Assistant Professor, Department of Geography, Central University of Karnataka, Karnataka. The views expressed are personal

Published - October 05, 2024 12:04 am IST