While India’s celebrated demographic dividend has for decades underpinned its rapid economic progress, a countervailing force may offset some of the gains from having a relatively young population: rapid ageing at the top end of the scale. This is a cause of deep concern for policymakers as India already has the world’s second largest population of the elderly, defined as those above 60 years of age. As this 104-million-strong cohort continues to expand at an accelerating pace, it will generate enormous socio-economic pressures as the demand for healthcare services and tailored accommodation spikes to historically unprecedented levels. It is projected that approximately 20% of Indians will be elderly by 2050, marking a dramatic jump from the current 6%. However, thus far, efforts to develop a regime of health and social care that is attuned to the shifting needs of the population have been insufficient. While more mature economies have created multiple models for elder care, such as universal or widely accessible health insurance, networks of nursing homes, and palliative care specialisations, it is hard to find such systemic developments in India. Experts also caution that as the proportional size of the elderly population expands, there is likely to be a shift in the disease patterns from communicable to non-communicable, which itself calls for re-gearing the health-care system toward “preventive, promotive, curative and rehabilitative aspects of health”.
Advocacy and information campaigns may be necessary to redirect social attitudes toward ageing, which often do not help the elderly enjoy a life of stability and dignity. As highlighted in ‘Uncertain Twilight’, a four-part series in The Hindu on the welfare of senior citizens, the ground realities faced by the elderly include abandonment by their families, destitution and homelessness, inability to access quality health care, low levels of institutional support, and the loneliness and depression associated with separation from their families. On the one hand, the traditional arrangements for the elderly in an Indian family revolve around care provided by their children. According to the National Sample Survey Organisation’s 2004 survey, nearly 3% of persons aged above 60 lived alone. The number of elderly living with their spouses was only 9.3%, and those living with their children accounted for 35.6%. However, as many among the younger generation within the workforce are left with less time, energy and willingness to care for their parents, or simply emigrate abroad and are unable to do so, senior citizens are increasingly having to turn to other arrangements. In the private sector, an estimated demand for 300,000 senior housing units, valued at over $1 billion, has led to a variety of retirement communities emerging across the country, in addition to innovations in healthcare delivery for this group. Yet the poor among the elderly still very much depend on the government to think creatively and come up with the resources and institutions to support their needs.