In India, the highest population of senior citizens reside in the southern and western States. The number of people aged 60 and above in the country was 14 crores and 90 lakhs in 2022, accounting for 10.5% of the total population. This is expected to rise to 15% by 2036. If this continues, by 2046, in India, the elderly population will surpass the number of children aged 0 to 14. What does this mean? Currently, there is one elderly person for every 12 people in India. By 2050, one in five could be a senior citizen.
At this juncture, it would be prudent to go back and see what the conditions were like, for someone who was a senior citizen about 30 years ago, what it is like for the 60+ age group today, and imagine what it will be like, 25 years from now.
The past
When I started the Geriatric Medicine department, at the Government General Hospital in Chennai in 1978, geriatrics was an unfamiliar field not only to the elderly it was meant to serve, but also to doctors. Back then, of course, people were living only up to the age of 60 or 65, in general.
Whenever an elderly patient (aged 60 to 65 in most cases) fell ill, in those days, we used to see an entire contingent — of children, in-laws, and grandchildren — accompanying them to the hospital. It was the era of strong joint family systems. Espousing deep concern for the elder’s health, the family would plead with the doctor to somehow cure their relative’s illness. It is another issue that there was not much that healthcare infrastructure at that time could do for these patients. They were lucky if they went back home.
For example, surgical procedures for heart attacks, modern treatments for bone fractures, remedies for blood vomiting, kidney issues, liver failure, antibiotics for infections, and appropriate treatments for cancer were not widely available then, leading to many elderly people passing away without suitable care. Back then, government hospitals were few and far between in rural areas. Highly-trained doctors were not available in rural areas, and there were no government healthcare facilities in small villages. In serious cases, doctors would refer patients to the nearest taluk hospital. In those days, if there was an emergency, the doctor himself would visit the patient’s house and render appropriate treatment. Since infectious diseases were more common back then, this was what many seniors were afflicted with. In cases where death did not occur, the patients would usually make a full recovery: it was quite rare for patients to be bedridden for several months or years.
That was an era when traditional joint family structures held strong, and when many of our senior citizens had support systems in place from younger generations in their family.
The present
Today, with the rise in the non-communicable disease burden in India, there is a corresponding increase in the number of senior citizens affected by disorders such as dementia, Parkinson’s Disease, obesity, diabetes, hypertension, heart disease, osteoporosis, cancer and falls. These non-communicable diseases often require treatment for several months or in some cases, treatment may be lifelong.
Infectious diseases such as pneumonia, influenza, urinary tract infections, and fungal diseases have become less common now, and are usually treatable with proper antibiotics, if diagnosed early.
Due to increased awareness, many elderly citizens are now also getting vaccinated against pneumonia and influenza.
In the nearly 50 years since the field of geriatric medicine first began in India, there are now many cities that have treatment centres exclusively for the elderly.
The problem now lies not so much in healthcare services, the availability of which is increasing, though accessibility often remains an issue, but in family and care structures. With the erosion of the traditional joint family set up, both in urban and rural settings and a change in mindsets, what is afflicting the elderly population now, is ageing-related ailments, loneliness, poverty, and lack of safety. We have also noticed the reliance on home-cooked meals waning, and more senior citizens now consuming food from outside, which may or may not be healthy, or adequately meet their nutritional needs.
When seniors live alone, they often battle isolation, hardship, and insecurity. With changes in the traditional family structure becoming more common, and the number of nuclear families rising, there is an increasing number of professional caregivers for the elderly. Assisted living facilities too, are growing in number for elderly people. Some seniors who cannot be continuously cared for at home or those who suffer from chronic illnesses are placed in these facilities, while many others choose to live in community residences, which provide them with a sense of peace and security. However, at present, only a few can afford these facilities.
When I was chairman of the Senior Citizens Bureau, I launched the Geriatric Housecall Project on February 17, 2008 — a novel initiative to provide medical care to elders at their doorstep. This would enable senior citizens or their family members to call doctors who would visit the patient at home, and this came to the rescue of a number of senior citizens living alone.
The future
What will the condition of elderly people in our country be like, 25 years from now? And what can be done to safeguard their physical and mental health and safety?
All evidence points to the rising tide of non-communicable diseases in the country. These conditions require long-term treatment, putting great financial stress on seniors and their caregivers. As life expectancy increases, we may see more people living into their 90s, even going past this mark. Medical advancements will become more robust, allowing for treatment of a number of illnesses and age-related issues.
The elderly will dominate society demographically. The younger population will shrink. Hence, the government will have to step in with comprehensive social security systems to care for the elderly. Senior citizen marriages may rise in number as the elderly seek companionship.
The need for homecare services will rise, and this is where the government and NGOs could step in to run such facilities. Corporates have already begun such services, but they need to be of high quality and standardised.
Geriatric hospitals will become more common in the country. Private hospitals may also open geriatric units as a business venture. As the number of disabled elderly people increases, special counselling centres and medical institutions for them will be needed. Specialties within geriatric medicine will grow; for example, geriatric cardiology, geriatric neurology, and geriatric psychiatry.
Discourse around end-of-life care may increase, and this should be handled with sensitivity and clarity. And so, it is perhaps time for politicians, economists, and the younger generation to seriously reflect on this issue.
As the number of disabled elderly people increases, special counselling centres and medical institutions for them will be needed. File photograph used for representational purposes only
Government measures
A separate Ministry should be formed by the State and Central governments to look after the welfare of the elderly.
Fixed Deposit (FD) interest rates should be increased in all banks for senior citizens.
A 40% concession should be provided for individuals aged above 60 in all State and Centrally-owned transport systems – including railways, airlines, and buses.
Health insurance policies should be brought in for individuals above the age of 60.
National councils for ageing should be established in all States.
Assisted living centres should be established in all taluks.
Old age homes should be set up in all major villages.
Hearing aids and dentures should be provided at subsidised rates.
The government should enforce a policy requiring children to take responsibility for the care of their elderly parents, especially those living below the poverty line. If the parents are admitted to a home for the aged, the cost of their care should be borne by the children.
We must prepare
The path ahead is clear: there are numerous models that can be scaled and replicated in other parts of the country.
For instance, as part of the Dr. V.S. Natarajan Geriatric Foundation’s outreach work, from February 17, 2017, we have managed to create a sustainable ecosystem that supports the elderly in leading a comfortable life in their twilight years. The foundation works in three core areas: media to create awareness, including a Tamil monthly magazine and a YouTube channel; community development; and academics and skill development.
These, and other such measures, combined with social welfare measures by the government, alongside sensitisation of the public and all stakeholders, could go a long way towards helping the elderly live comfortable, dignified, healthy lives.
(Dr. V.S. Natarajan is a senior Chennai-based geriatrician. He started India’s first outpatient department, inpatient ward and postgraduate course in geriatrics at the Madras Medical College.)
