India is ageing, rapidly. And it is women who are living longer, but less healthily.
According to the India Ageing Report 2023 as published by the International Institute for Population Sciences and the United Nations Population Fund, there will be a significant decadal increase in India’s elderly population, with people aged 60 years and older estimated to comprise over 20% of the population by 2050. Further, the average lifespan of women is more than that of men by 2.7 years, resulting in a demographic tilt favouring more elderly women. However, the McKinsey Health Institute estimates that women are likely to spend 25% more time in poor health compared to men, much of those in their later years, highlighting a further health gap to be bridged.
Despite these sobering figures, the conversations about elderly women and their health stay in the shadows, with society treating them as passive dependents rather than as individuals with distinct needs and challenges. Add to this their care-giving and self-sacrificing instinct, and we have a large majority of grey-haired women, navigating public spaces in silence.
This article attempts to place elderly women where they belong – at the centre. We explore their health-seeking behaviours as well as health conditions that are unique to them or are known to disproportionately affect them, while also highlighting potential ways to empower them to live better, as they live longer.
Care-seeking behaviour
The social determinants of women’s health go well beyond medical causes to include socio-cultural, economic, and structural factors. Health seeking behaviour is defined as what, if any, action an individual undertakes to obtain medical attention, what type of care they seek and how they continuously manage that condition. Typically, this is influenced by access to information, disease perception, demographics, economic status, access to facilities, perceived quality of services, and socio-cultural beliefs. In the case of women, we need to layer on additional factors such as education attainment, social conditioning, marital status, financial and digital dependency, and lack of gender-sensitive care facilities.
We can extend the Three-Delays framework to provide a coherent hypothesis on the barriers to older women’s health-seeking behaviours. The first delay is due to dynamics within the household that result in a de-prioritisation of elderly women’s needs and related health actions. The second delay is typically due to access to healthcare facilities and services, which can be a deterrent for chronic conditions requiring multiple periodic visits. The third delay is related to receiving adequate and timely care at the facility, from having gender-appropriate capabilities and personnel to health financing mechanisms.
Indian women are socialised to prioritise family wellbeing over their own, and therefore, tend to deprioritise their health needs even as they care for their spouse, children, and grandchildren. In many patriarchal households, the spouse or adult children tend to be gatekeepers of the decision about when and whether an elderly woman seeks care, emotionally complicating the access to timely interventions. Also, women tend to be psychologically conditioned to assume that the problem lies within them, rather than the system, especially when facing difficulties, such as scheduling a clinic visit, further inhibiting seeking necessary care.
Formerly married elderly women, dealing with the loss of a spouse due to widowhood, divorce, or separation, are likely to experience a shift in their living arrangements. Family has been a strong institution of support in the Indian culture; however, job-related migrations and shift to more nuclear family structures are resulting in new norms for living arrangements, such as living alone or moving into a senior citizen community. This may disrupt or improve their access to care, depending on the situation.
Financial insecurity is a significant vulnerability among older women. A UNFPA study from 2011 reported that almost 60% of older women have no personal income and this income insecurity advances with age. Few elderly women have health insurance coverage, and the access to health insurance tends to be dependent on a woman’s higher education, their decision-making powers over their own money and healthcare, and their mobility. Less than 20% of women are able to pay their own medical bills, while this number doubles for elderly men. This high economic dependency tends to hold women back from seeking appropriate medical care early.
In many patriarchal households, the spouse or adult children tend to be gatekeepers of the decision about when and whether an elderly woman seeks care, emotionally complicating the access to timely interventions |Photograph used for representational purpose only
| Photo Credit:
ANI
The digital gender gap is accentuated amongst the elderly, with far fewer women having access to digital devices. This limited tech literacy impacts their ability to access health information and services.
Distance, lack of transport, and needing support from a family member (usually a male member) to access healthcare are other barriers to women seeking health care. An UNFPA study to understand the needs and challengers of older women in India, uncovered that two-thirds of older women are accompanied by their children or grandchildren (versus 41% among older men), indicating a higher level of dependency.
Insufficient access to female health providers as well information and diagnostics for women’s health issues can delay care even if one reaches the facility. Once within the health system, women often need support in navigating its complex processes, which also deters them from accessing health services.
Ageing unequally
The more commonly discussed ageing-driven chronic conditions are cardiovascular (heart), cancers, and neurodegenerative (brain) diseases. However, the nuances of how women experience these conditions due to their physiological transitions and caregiving burdens are less acknowledged and far less studied. Also, in order to experience healthy ageing, women should have access to affordable and adequate healthcare throughout their lives. In India, healthcare expenditure is far less on women than men across all ages and socio-economic groups, further worsening health conditions later in life that are more likely to impede quality of life and cause disability.
Even in their 60s and 70s, many Indian women continue to shoulder caregiving duties, for spouses, children and grandchildren, and sometimes extended family | Photograph used for representational purpose only
| Photo Credit:
File Photograph
Due to the hormone shifts post menopause, loss of muscle mass and nutritional deficiencies, the non-communicable diseases of hypertension, diabetes and cardiovascular illnesses tend to have more severe outcomes and complications in women. Furthermore, the decline in bone health is a substantial risk for osteoporosis and arthritis, that are much more common in women, yet under diagnosed. The risk of fractures from falls is also significantly higher in women and can result in disability or limited movement that affects their mental wellbeing. A lack of proper diagnostics, especially in rural health systems, and the limited knowledge and training of health workers results in normalising much of women’s musculoskeletal pain.
Once women move past the reproductive phase, the healthcare system barely considers their uro-gynaecological health. In lower income settings, women rarely have a gynaecological examination post childbirth. Conditions such as uterine prolapse, urinary incontinence and pelvic floor dysfunction are widespread but dismissed as embarrassing to talk about, with multitudes of women suffering in silence.
Some cancers, such as liver or colon cancers, affect women differently, with more severe forms of the disease likely. Cancers of the breast, cervix, ovaries, and uterus disproportionately affect older women and often go undiagnosed until late stages. Over 50% of breast cancer cases in India occur in post-menopausal women, yet screening awareness drops sharply with age. A study analysing treatment patterns in Indian women aged 65 and above with breast cancer found that on average, treatment was less aggressive, but appropriate therapies (e.g., surgery, chemotherapy) can improve survival rates and lead to favourable outcomes.
The awareness and availability of vaccines is helping reduce the risk of cervical cancer amongst younger women; however, older women are still susceptible with limited access to, and frequency of, pap smears. Worse still is ovarian cancer, the most lethal gynaecological cancer, with a five-year relative survival rate of 17 percent for a patient diagnosed at an advanced stage. This cancer often presents with vague symptoms, such as bloating, abdominal discomfort and urinary urgency, all of which are often misattributed to normal ageing, thereby resulting in diagnosis only in the advanced stages.
Certain neurodegenerative diseases, like Alzheimer’s and other dementias, are more likely to develop in women, both due to biological factors (oestrogen decline) and social conditions (longer lifespan, isolation due to loss of spouse). According to the Longitudinal Aging Study in India (LASI), women over 70 report higher levels of cognitive impairment, yet go less diagnosed and treated compared to men.
Mental health among elderly women is under-reported, under-diagnosed, and under-treated. Even in their 60s and 70s, many Indian women continue to shoulder caregiving duties, for spouses, children and grandchildren, and sometimes extended family. With elderly women more likely to outlive their spouses, lose peer support systems, experience loneliness, and internalised stress from years of emotional labour and caregiving, they tend to have higher rates of depression and anxiety. Yet, as per HelpAge India, only 1 in 10 elderly women with depressive symptoms seek help — due to stigma as well as limited access to mental health services for the elderly.
Better care
Despite the many systemic challenges, elderly women in India proactively engage in many activities that enhance their well-being.
Socially, elderly women tend to be deeply embedded in family and community networks (e.g., participating in religious or spiritual activities, volunteering at local non-profits, and staying active in grandchildren’s lives). These social engagements are potential protective factors against loneliness and cognitive decline. Based on the data from LASI, the prevalence of poor health decreased by 9 percentage points among elderly women with higher social engagement levels. The same is true for elderly men as well.
Many women also find joy and purpose in routines that keep them physically and mentally active, such as walking groups, yoga classes, or taking up new hobbies like painting or music. Compared to their male counterparts, they tend to build deeper relationships, seeking emotional support and building routines post-retirement.
Finally, educated women avail of better outpatient care, both in public and private facilities, making years of schooling the primary driver of choice. Other significant enabling factors include wealth status, place of residence, and health insurance coverage.
From insight to action
To truly support and empower elderly women in their health-seeking behaviours, India needs to move to more inclusive gender-sensitive health systems. Policies need to acknowledge the gendered path of Indian women – significant unpaid caregiving, interrupted careers, lower financial autonomy, differentiated physiology and life stages – and how these factors shape their ageing.
Large-scale studies of the health behaviours, including the burden of access and affordability, of this growing elderly Indian population are scarce. Systematic gender-disaggregated data collection and analysis, including using AI/ML models to limit biases, can help improve the understanding of biological and social barriers, leading to nuanced interventions.
Healthcare delivery, through frontline workers, health volunteers, and mobile health units, can help increase access to women who are unlikely to seek help on their own. For example, the Vayomithram Project in Kerala provides mobile clinics staffed by medical professionals to offer healthcare assistance and free medicines to the elderly, including women. Scaling up such programmes with adequate funding as well as audit oversight and healthcare training can help enhance accessibility for elderly women.
Geriatric screening should encompass conditions more prevalent or under-diagnosed in women—such as osteoporosis, Alzheimer’s, urinary incontinence, and gynaecological cancers. The National Programme for Health Care of the Elderly aims to provide accessible, affordable, and high-quality long-term, comprehensive, and dedicated care services to the ageing population. The planning, implementation and monitoring of this programme requires the joint commitment and collaboration of several Ministries as well as the States and the Centre. Select states such as Tamil Nadu, Kerala, Punjab, Gujarat, Andhra Pradesh, and Telangana have demonstrated a shift in their service delivery; however, in most States across the country, implementation is sporadic and ridden with challenges, due to low programme expenditure and lack of availability of equipment or skilled health workers.
Health insurance must also evolve to reflect the realities of older women |Photograph used for representational purpose only
| Photo Credit:
AFP
There is a need to recommit to the original intent of this programme by strengthening its sustainable implementation with focused training and resources to effectively addresses the unique health needs of the elderly at large, and women, specifically.
Pension reforms must acknowledge and account for these informal work histories. One potential approach is expanding eligibility for contributory schemes like the Atal Pension Yojana to include care credits or informal labour indexing for women who have not been in formal employment. State-level pension schemes, such as the Indira Gandhi National Old Age Pension Scheme, could also be scaled up with gender-sensitive eligibility criteria, streamlined navigation of the process, improved efficiency and accuracy, as well as increased payouts indexed to inflation and health needs.
Complementing financial assistance, the Rashtriya Vayoshri Yojana provides essential assistive devices, such as walking sticks, hearing aids, and spectacles, to senior citizens from lower economic households who suffer from age-related disabilities. While helpful, such schemes can be strengthened by integrating them with local health worker outreach or community groups, making them more accessible for elderly women who may feel inhibited to navigate the process of availing them.
Health insurance must also evolve to reflect the realities of older women. Many women above 60 are not covered under employer-sponsored or private insurance plans, and government schemes often prioritise hospitalisation but neglect outpatient care, preventive diagnostics, and long-term needs. Programmes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) could introduce add-on packages specifically for women-specific geriatric care—such as mammograms, osteoporosis screening, mental health consultations, and home-based physiotherapy and regular diagnostic testing.
At the community level, investment in women-led social support groups can leverage their strengths in relationship-building and caregiving. The Kudumbashree initiative in Kerala, for example, has established a network of women’s self-help groups, fostering social engagement and economic empowerment among elderly women. Under the Smart Cities Mission, senior citizen centres are being set up across Uttar Pradesh to address the emotional, social, and health needs of the elderly.
| SEGMENT | TYPICAL BEHAVIOUR | POTENTIAL INTERVENTIONS |
| URBAN, EDUCATED | More likely to have access to facilities, preventive care | Support to navigate facilities, tailored elder insurance |
| RURAL, LOW-INCOME | Reluctant care-seeking unless critical | Doorstep outreach, mobile clinics |
| LIVING ALONE | Emotional-driven consultations, irregular preventive checks | Community mental health + physical health integration |
| INSTITUTIONALISED (ELDER HOMES) | Facility-dependent, mixed quality | Facility audits, grievance mechanisms |
Women spend their lives holding families and communities together. As they age, it is our turn to support them—with healthcare that listens, systems that include, and policies that understand their journeys. When we centre elderly women, we build a stronger fabric for everyone that is foundational to the sustainable economic growth of a caring society.
(Sathya Sriram is a healthcare strategist with over two decades of private and public sector experience, working to make care more accessible, preventive, and people centred. sathya.r.sriram@gmail.com)
