What India Needs To Do Urgently To Support Its Ageing Population

This is part of the demographic transition process, in which the number of births and deaths fall. When the birth rate remains constant as death rates of both children and the elderly decline, the population experiences a bulge (and an economic boom). However, if the birth rate falls, the number of working age people reduces and the proportion of the elderly increases.

The proportion of elderly is increasing in the less developed nations, with about eight in 10 of the world’s elderly people expected to be living in developing nations in 2050. This causes a change in the age-dependency ratio, which has consequences for the allocation of resources towards education, healthcare and social security for the population.

“As we live longer, it is important to ensure that the elderly are able to lead a healthy, fulfilling life,” says this United Nations Population Fund paper. Health and well-being are determined not only by our genes and personal characteristics but also by the physical and social environments in which we live our lives, said A.B. Dey, a geriatrics specialist and head of the geriatrics department at the All India Institute of Medical Sciences, who was also one of the principal investigators on the LASI team.

“Environments play an important role in determining the physical and mental capacity across a person’s life course and into older age, and also how well we adjust to loss of function and other forms of adversity that we may experience at different stages of life, and in particular in later years,” he explained.

With both older people and the environments in which they live poised to change, it is imperative that the government act now to allow healthy ageing, according to experts.

The first part of our series on ageing India analyses the problems before the country as it advances in age without necessarily advancing economically.

India’s demographic transition

In the year 2050, the proportion of children in the Indian population under the age of 14 will be less than that of the elderly (over 60 years) for the first time in India. While those over the age of 60 will be 19.5% of the population (nearly one in five), those under the age of 14 will be 18.5% of the population.

At present, Kerala has the highest proportion of elderly population at 19.6% (which is almost equal to the projected proportion of elderly for India in 2050). Himachal Pradesh, Tamil Nadu and Maharashtra also have a high number of people aged 60 and above, as per LASI.

More women are present in that age group than men: the sex ratio for 60 years and above is 1,065 females per 1,000 males. It is more skewed in urban areas (1,084 women per 1,000 men) than in rural areas (1,055 women per 1,000 men). In contrast, the sex ratio in the age group of children is higher in rural (941) than in urban areas (912).

That is because women live longer than men, as per economist Arun Kumar, a retired professor of economics from Jawaharlal Nehru University in New Delhi. “Women bear children, so they have a stronger immune system. Secondly, women have largely been at home, which is a less stressful thing than going out to work or in earlier times, hunting. High stress levels lead to earlier deaths,” he explained. Urban women have access to better healthcare, more nutrition and are less likely to be poor than rural women, which explains why the sex ratio is higher for urban women in that age group, he added.

Loss of income for country and household

India is one of the countries where the population is “growing old before growing rich”, meaning the growth in incomes for a large section of the population has not increased.

There are at present 62 dependents (children under the age of 14 and old people above the age of 65) for every 100 working people in India, as per the LASI report. While the population of the youth will continue to increase for the next 15-20 years, unless they have jobs, the dependency ratio will remain high and the demographic dividend will become a demographic disaster, said Kumar.

Automation also threatens to replace workers in call centres, back process jobs, etc., which will hurt employment prospects further, he added. “We need to address the problems of health, education and employment immediately,” said Kumar.

About 36% of the elderly (aged 60 years and older) are currently working. Of these, about a fifth (21%) are agricultural labourers, meaning they have no employer-provided social security or pensions.

Pensions and family support pay for the needs of the elderly, chief among which is healthcare. Only 5.7% of the country’s elderly get pensions, as per the LASI study. In addition, around 59% of older women do not receive any income.

Health, safety and dignity: What the state has to secure for the elderly

In addition to shortage in the labour force and reduced savings, population ageing presents a new set of challenges for the healthcare system. This may require realigning primary healthcare services to better care for the new diseases among the target population.

The leading cause of death in India are non-communicable diseases--heart disease, cancer, chronic respiratory diseases, diabetes etc.--for both men and women. Developed states such as Kerala and Tamil Nadu have a higher burden of NCDs than Uttar Pradesh, Bihar, etc., according to national health data analysed by the Indian Council of Medical Research, Public Health Foundation of India and the Institute for Health Metrics and Evaluation.

Attention is required for age-related diseases such as those caused by an inevitable biological decline (cataract and macular degeneration that affect eyesight, sensorineural deafness, osteoporosis and osteoarthritis which weaken the bones, cognitive impairments like Alzheimer's disease and dementia, heart failure, etc.), metabolic diseases (hypertension, coronary artery disease, stroke, diabetes), or environmental exposure (cancer, COPD, etc.), according to Dey.

“Older people commonly present to the health system with cognitive decline, frail health, increased risk of infection, heart attack, stroke, cancer, visual impairment, deafness, depression etc., in multiple numbers and combinations,” he said.

Government-funded health insurance is available under Pradhan Mantri Jan Arogya Yojana to the bottom 40% of the population. The Union government provides assistive devices to the elderly from the below-poverty-line category under the Rashtriya Vayoshri Yojana.

“Since 1999, after the adoption of the National Policy on Older Persons and the launch of the National Programme for Health Care of Elderly in 2010, initiation of the Integrated Programme for Older Persons in 2018, Ayushman Bharat and Health and Wellness Centers etc. were steps in the right direction in securing the welfare of older people,” said Dey.

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