Elderly-focussed health care is a demographic imperative

India’s elderly face a health care ecosystem marked by structural gaps. A majority of the services are scattered and disjointed, leading to lack of coordination

India stands at a critical demographic crossroads — by 2050, the share of the elderly in the national population will double from 10.1% (2021) to 20.8%, fundamentally reshaping our social fabric and health care needs. This shift will disproportionately affect women and the oldest-old as they form increasingly larger proportions of this population.  

For rural seniors especially, establishing district-level help desks for the elderly can provide crucial navigation assistance for those with limited mobility, resources, and digital literacy

Our elderly already navigate a health care landscape filled with formidable barriers: Limited access to health care services, shortage of experts in geriatric care, fragmented delivery, inadequate elder-friendly systems, lack of independent financial reserves, and low health-seeking behaviours. For rural seniors, these challenges intensify dramatically. The Longitudinal Age Survey of India (LASI) data reveal that 31% must travel more than 30 kilometres simply to access basic medical attention — an arduous journey for those with limited mobility and resources. One can’t ignore the gender dynamics wherein women over 49 find themselves virtually invisible in medical care planning.  

India must create a comprehensive, dignity-centred, integrated health care ecosystem for the elderly. Over 70% of India’s seniors struggle with chronic diseases, with nearly a quarter navigating the complexity of multiple conditions. In the absence of a health care delivery system that is designed to facilitate easy availability, accessibility of treatment and management, the result is a cascade of preventable complications that diminish independence and dignity, while straining already limited health care resources.

India’s elderly face a health care ecosystem marked by structural gaps. A majority of the health care services are scattered and disjointed, leading to lack of coordination, duplication of services, and poor outcomes. The specialised care gap is particularly indefensible. Rural India faces an even more dire reality, with over 70% of community health centres missing essential specialists.

Meanwhile, financial vulnerability transforms health care gaps from challenging to catastrophic. 

Over 40% of our elderly fall within the poorest wealth quintile, while nearly one-fifth survive without any income whatsoever. A HelpAge India report highlights that approximately 75% of elderly women have no personal financial reserves — a finding that exposes a gendered dimension of ageing. With more than half of these women never having participated in formal employment, we are witnessing the compounded effects of lifetime economic exclusion. This economic precarity directly impacts health outcomes, as regular treatment for non-communicable diseases — often excluded from special schemes or individual insurance coverage — becomes financially unsustainable.  

Perhaps most troubling is our collective neglect of elderly mental health. The LASI report found that depression rates are 10 times higher than self-reported. The diagnosed cases signify not just an unattended medical need but a profound social one. We have normalised the suffering of our elders, accepting their isolation and despair as inevitable byproducts of ageing rather than addressable health concerns. How can we reconcile our cultural reverence for elders with the harsh realities they face?

Our current approach indicates two misconceptions. First, we have cast our elderly as passive recipients of care rather than potential contributors. Second, we have failed to conceptualise a longevity dividend that could benefit both seniors and society. Our policy frameworks — including the National Policy on Older Persons and the Maintenance and Welfare of Parents and Senior Citizens Act — articulate high aspirations, yet millions of seniors go without regular treatment and essential medicines. Initiatives like Ayushman Bharat and the National Insurance Scheme for Senior Citizens above 70 represent meaningful steps forward, offering annual health insurance coverage of ₹5 lakh to 4.5 crore families regardless of the senior citizen’s socio-economic status. However, expanding this coverage to encompass India’s diverse elderly population in its entirety, constitutes an urgent policy imperative as the demographic transition accelerates.

The stark reality that only 18% among those over 60 have health insurance reveals the vulnerability of our elderly. This coverage gap calls for immediate, comprehensive action. We must prioritise developing multi-tiered health care delivery systems that recognise the unique needs of the ageing population. This means establishing comprehensive networks that integrate specialised care including mental wellbeing with robust preventive and functional-ability-maintaining initiatives. The current reactive approach must give way to a proactive and preventive approach.

For rural seniors especially, establishing district-level help desks for the elderly can provide crucial navigation assistance for those with limited mobility, resources, and digital literacy.

Enabling telehealth utilisation, online appointment management, and virtual consultations for the elderly can also transform health care for the elderly. Many organisations in India have already piloted successful hybrid approaches that combine digital technology with human support systems. These changes should go hand-in-hand with elevating elderly voices from the margins to the centre of policy discussions.  

Anupama Datta is head (policy research & advocacy), and Ritu Rana is mission head (health care), HelpAge India. The views expressed are personal