Geriatric Care in Urban India: Challenges of an Ageing Population

India stands at a demographic crossroads. While celebrated for its young population, the country is simultaneously witnessing an unprecedented rise in its elderly population. With increasing life expectancy and declining fertility rates, urban India is facing a significant challenge: how to care for its ageing citizens. Geriatric care-healthcare for people aged 60 and above-is emerging as a critical concern for policymakers, healthcare providers, and families alike.

The growing elderly population in India 🔗

India’s elderly population is expanding at a remarkable pace. According to the UNFPA India Ageing Report 2023, the country had approximately 149 million people aged 60 and above in 2022, constituting around 10.5% of the total population. This figure is projected to surge to 347 million by 2050, making up over 20% of India’s population.

Perhaps more striking is the growth rate among the oldest-old. The population of people aged 80 and above is expected to grow by approximately 279% between 2022 and 2050. By 2046, the elderly population is likely to surpass the number of children aged 0 to 15 years-a fundamental shift in the country’s demographic structure. The decadal growth rate of India’s elderly population currently stands at about 41%, indicating an accelerating pace of ageing.

This demographic transition varies significantly across states. Southern states like Kerala, Tamil Nadu, along with Himachal Pradesh and Punjab, already have higher proportions of elderly residents compared to the national average. Kerala’s elderly population is projected to increase from 13% in 2011 to 23% by 2036, making it the state with the oldest demographic profile. Meanwhile, northern and eastern states like Bihar and Uttar Pradesh have younger populations but are expected to see rapid growth in their elderly segments.

Health challenges facing urban elderly 🔗

The health status of India’s elderly is marked by a high prevalence of chronic non-communicable diseases (NCDs). Research published in PLOS ONE reveals that approximately 21% of elderly Indians suffer from at least one chronic disease. Urban areas show significantly higher rates, with 29% of urban elderly affected compared to 17% in rural areas.

Prevalence of chronic conditions 🔗

Hypertension and diabetes dominate the chronic disease burden, accounting for roughly 68% of all chronic ailments among the elderly. The Longitudinal Ageing Study in India (LASI) confirms that cardiovascular diseases, diabetes, and respiratory conditions are the leading health concerns. Among those aged 75 and above, approximately 37% report cardiovascular diseases, 11% have diabetes, and 10% suffer from chronic lung disease.

The urban elderly face distinct health challenges. Higher rates of sedentary lifestyles, unhealthy dietary patterns, and greater exposure to air pollution contribute to elevated disease prevalence in cities. Urban men show higher likelihood of chronic diseases compared to rural men, while the reverse pattern is observed among women-rural elderly women face greater chronic disease risk than their urban counterparts.

Hospitalization and healthcare utilization 🔗

Healthcare utilization patterns reveal stark disparities. Data from the LASI survey shows that urban residents have significantly higher healthcare expenditures. The average expenditure on the last four inpatient visits was Rs 54,959 for urban residents compared to Rs 37,233 for rural residents. Urban elderly also spent more nights hospitalized during the year, reflecting both higher disease burden and better access to healthcare facilities.

Research on hospitalization trends indicates that non-communicable diseases have become the leading cause of hospitalization among the elderly. The contribution of NCDs to India’s total disease burden increased from 38.4% in 1990 to 64.2% in 2013, fundamentally altering the healthcare landscape.

Disability and functional limitations 🔗

Disability rates increase dramatically with advancing age. The 80-plus age group faces the highest disability burden, requiring substantially greater caregiving support. Functional limitations-difficulty in performing daily activities such as bathing, dressing, or mobility-are common among the oldest-old.

Mental health issues add another dimension to this challenge. Depression, dementia, and loneliness are rising, particularly among elderly living in nuclear families. The LASI data suggests that only about 10% of depressive disorders among older adults have been diagnosed and treated, pointing to a significant gap in mental health services.

Gender disparities in health and disability 🔗

Women face unique vulnerabilities in old age. With higher life expectancy, women at age 60 can expect to live an additional 20+ years in states like Rajasthan, Haryana, Gujarat, Kerala, and Himachal Pradesh. However, the UNFPA report notes that elderly widowed women often live alone with limited support, experience greater functional restrictions, and have fewer personal assets. The sex ratio among the elderly has been climbing steadily since 1991, with females per 1,000 males now exceeding 1,000 in most regions.

Economic burden on families 🔗

Healthcare costs impose a crushing financial burden on elderly households. According to research published in Springer, the mean out-of-pocket expenditure on hospitalization for elderly patients was approximately $423, with the highest costs incurred for cancer treatment followed by heart diseases. More than one-quarter of the older population (28%) experienced catastrophic health spending.

Out-of-pocket expenditure crisis 🔗

India’s healthcare financing system places an enormous burden on individuals. A Scientific Reports study found that out-of-pocket health spending constitutes about 47.1% of total health expenditure in India-one of the highest rates globally. Older adults spend approximately 17.4% of household consumption expenditure on healthcare services. The poorest elderly spend the highest share (24.8%) of their consumption budget on healthcare, making them particularly vulnerable to financial catastrophe.

More than 40% of India’s elderly belong to the poorest wealth quintile, with about 18.7% living without any income. This economic vulnerability severely affects their quality of life and healthcare access. Households with more elderly members face greater catastrophic health expenditure burdens, with 74.75% of such households experiencing financial hardship due to NCD-related hospitalization at private hospitals.

Insurance coverage gaps 🔗

Health insurance coverage remains inadequate. Less than 20% of India’s population is covered under any health insurance scheme, and many existing schemes exclude chronic illness coverage. The rural elderly, in particular, face barriers including cost, distance to healthcare facilities, and quality of care available. While programs like Ayushman Bharat and the National Programme for Health Care of the Elderly (NPHCE) aim to address these gaps, their reach remains limited.

Addressing the geriatric care challenge 🔗

Meeting the healthcare needs of India’s ageing urban population requires a multi-pronged approach. The government has launched several initiatives including the Atal Vayo Abhyudaya Yojana (AVYAY), which provides elderly homes and continuous care centres, and the Rashtriya Vayoshri Yojana (RVY), which distributes assistive devices to below-poverty-line seniors.

Experts recommend expanding geriatric infrastructure by establishing dedicated geriatric departments in every medical college and increasing specialist doctor availability. Integrating hospital care with community-level screening, follow-up, and home visits can improve outcomes while reducing costs. The UNFPA report emphasizes encouraging in-situ (at-home) ageing through day-care facilities and short-term care options, recognizing that elderly individuals typically receive better care when living with their families.

The thematic review of literature on elderly healthcare underscores the importance of family involvement in caregiving and the need to expand insurance coverage to protect the poor elderly against financial catastrophe.

Looking ahead 🔗

India’s ageing population presents both a challenge and an opportunity. The “silver economy”-goods and services targeted at older persons-represents a growing sector that could drive innovation and employment. However, realizing this potential requires addressing the immediate health and care needs of the current elderly population.

Urban planning must adapt to accommodate an ageing demographic, with accessible infrastructure, age-friendly public spaces, and healthcare facilities equipped for geriatric care. Strengthening data systems on ageing populations will help governments tailor services and programmes to specific needs.

The coming decades will test India’s capacity to care for its elders. A lot of the wealth generated by those working today will support the senior citizens of 2050. The time to build an elder-inclusive society is now.

What do you think? As India’s population ages rapidly, how should cities redesign their infrastructure and healthcare systems to better support the elderly? What role should families and communities play alongside government initiatives in ensuring dignified ageing for all citizens?

References

1. https://india.unfpa.org/en/news/india-ageing-elderly-make-20-population-2050-unfpa-report
2. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2183196
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC8916671/
4. https://iipsindia.ac.in/sites/default/files/other_files/LASI_KeyFindings_EPW2022.pdf
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC12398264/
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC5786114/
7. https://india.unfpa.org/en/news/indias-ageing-population-why-it-matters-more-ever
8. https://link.springer.com/10.1007/978-981-16-1914-4_25-1
9. https://www.nature.com/articles/s41598-024-55142-1
10. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0260628
11. https://www.insightsonindia.com/2025/04/16/indias-elderly-population/
12. https://www.sciencedirect.com/science/article/pii/S266703212100010X