Ageing
Rapid changes in life expectancy and fertility rates are leading to prominent demographic changes across the globe. Resultingly, the world is experiencing a shift in population age structures, with the proportion and size of elderly persons increasing swiftly. The World Health Organization estimates that the number of people aged above 60 years is expected to double from one billion, as of 2020 to 2.1 billion by 2050, making up 22% of the total world population. It is also estimated that one in six people will be over the age of 60 years by 2030, a number that deserves immediate attention.
High-income countries like Japan, Italy and Germany have some of the highest proportions of elderly people, reaching more than 20% of their total population. This has posed significant challenges for countries and their institutional systems.
India too is witnessing rapid demographic shifts and an uptick in elderly population. In 2022, elderly made up 10% of the total population, with 140 million older persons. By 2050, it is expected that elderly will make up 20% of the total population, reaching 347 million people. Southern states report some of the highest proportions of older adults, resulting in relatively increased old-age dependency ratios. As per the Census of India 2011, Kerala recorded the highest proportion of elderly at 12.6%, followed by Tamil Nadu at 10.4%. States in other parts of the country are experiencing a similar shift. Himachal and Punjab already have 13.1% and 12.6% elderly in their population.
Understanding the Multi-Dimensional Challenges of India’s Elderly (Source: LASI, Wave-1, 2017-18)
Healthcare concerns
- Chronic conditions are extremely common in the later years of life. In fact, nearly a fifth of the elderly population reported more than one chronic condition, i.e., multi-morbidity.
- Health insurance coverage of the elderly remains critically low, with only 18.6% elderly covered in rural areas and 17.3% in urban areas.
- Access to assistive devices is another observable gap with regards to elderly health. 24% of the elderly with visual impairments and 92% of the elderly with hearing impairments did not use spectacles and hearing aids, respectively.
Economic concerns
- 70% of the elderly are dependent on their families or pensions for basic sustenance.
- Nearly 78% of the elderly population is not covered by any pension support.
- 40% of the elderly in rural areas are still part of the workforce and 26% elderly in urban areas, hinting at a high level of financial insecurity amongst this group.
- One out of four elderly attributed 1 out of 4 elderly attributed healthcare-related expenses as the primary cause of indebtedness in urban areas.
Social concerns
- Disintegration of traditional joint family systems and rise of nuclear families has left many elderly living alone. Approximately 2.5% of the elderly men and 8.6% of the elderly women in India live alone. Tamil Nadu has reported the highest percentage of elderly living alone, followed by Nagaland and Telangana.
- Discrimination and stereotyping against the aged, known as ‘ageism’, leads to a rise in isolation and increased morbidity. This creates greater concerns regarding their safety and security.
- A large proportion of the elderly are not literate, making them more vulnerable to crimes such as financial or digital frauds. As per a report by Agewell Foundation published in 2018, 93.7% of the elderly did not know how to use any digital tools.
Recognising the unique needs and heightened vulnerability of the elderly, India has established a robust governance framework to support their well-being. This includes a combination of constitutional guarantees, legislative frameworks, and targeted policies and programmes
Beyond constitutional and legal safeguards, India implements a range of programmes and schemes for the elderly, delivered through the coordinated efforts of various ministries, with the Ministry of Social Justice and Empowerment being the nodal organisation. Other Ministries include the Ministry of Health and Family Welfare, Ministry of Rural Development, Ministry of Finance, and the Ministry of Housing and Urban Affairs.
A significant step in this direction was the enactment of the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, which lays down legal provisions for the maintenance and support of elderly individuals, ensuring their social and financial security. Additionally, the National Policy on Older Persons (NPOP), introduced in 1999, serves as the foundation for state interventions, focusing on providing financial security, healthcare, shelter, and protection against abuse for older adults.
To cater to the complex healthcare needs of the elderly, the Ministry of Health and Family Welfare launched the National Programme for the Health Care of the Elderly (NPHCE) in 2011, focusing on providing accessible, affordable, and high-quality healthcare services to older individuals. Under the NPHCE, several efforts have been made at primary, secondary as well as tertiary levels of care, such as creation separate geriatric wards, provision of physiotherapy and laboratory services, capacity building and research activities.
Despite a robust governance framework, gaps remain. For the past year, Sankala Foundation has been closely analysing trends in India’s elderly population and the policy landscape concerning them. A status report, titled, ‘Ageing in India: Challenges and Opportunities’ has emerged from this meticulous exercise. The report utilises data secondary data along with insights from existing scholarship on this matter to provide readers an overview of the global scenario of ageing, focussing on the challenges faced by India’s elderly, along with key recommendations as we move forward.
