A paper published in BOLD, a quarterly journal of the United Nations International Institute on Ageing, Malta.

1. AGEING IN INDIA:
CONCERNS AND CHALLENGES
NIDHI MISHRA
Demographic scenario
Population ageing is being witnessed in different
parts of the world. The main reason for this
demographic transition is the decrease in mortality
and fertility rates along with an increase in life
expectancy. With a rapidly increasing elderly
population (60+), India is no exception to this
worldwide phenomenon.
At present there are around 104 million elderly in
India. In 1961, the 60+ population was 24 million;
which increased to 33 million in 1971, 43 million
in 1981, 57 million in 1991, 77 million in 2001 and
103 million in 2011 (Census of India, 1961-2011).
According to projections by some demographers
(Rajan and Aliyar, 2008) the elderly population
is expected to reach 298 million by 2051 and 505
million by 2101. Percentage-wise this cohort has
gone up from 5.6 per cent of the total population
in 1961 to 6 per cent in 1971, 6.5 per cent in 1981,
6.8 per cent in 1991, 7.4 per cent in 2001 and 8 per
cent in 2011.
Among older persons in India, the percentage
of those aged over 70 and 80 years is also steadily
increasing. There were 9 million 70+ elderly in
India in 1961; the number rose to 29 million in
2001 and 42 million in 2011. They are expected to
reach 131 million in 2051 and 273 million in 2101.
The population of those aged over 80 years was 2
million in 1961; it increased to 8 million in 2001 and
to around 11 million in 2011. It is expected to rise to
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 5
Abstract
This paper gives an overview of the situation of older persons (60+) in India with a special focus on
demographic, psycho-social and policy issues related to the elderly in India. It also highlights the various
challenges faced at micro and macro level towards the promotion of the health and well-being of older
persons in India. This paper also highlights the contribution of various role players such as older persons,
family, educational institutions, civil society, for-profit ventures and government in facing those chal-lenges.
In the end, based on the review of the situation of older persons in India, it suggests some action
points which can be taken as a way forward towards promoting the health and well-being of older persons.
around 41 million in 2051 and around 106 million
in 2101 (Aliyar and Rajan, 2007).
In keeping with global trends, Indian women are
living longer than men. The sex ratio of the 60 plus
population rose from 94 women per 100 men in
1991 to 105 in 2011 and a projected 105 by 2026.
Among the oldest old (80+ years), the sex ratio is
expected to be as high as 136 women per 100 men
by 2026 (Subaiya and Bansod, 2011). With specific
reference to Indian states, the 2011 census shows
that the 60 plus female population is higher in all
the bigger states except Assam, Bihar, Himachal
Pradesh, Jammu and Kashmir and Jharkhand.
A higher proportion of older persons reside in
rural India. The 2001 census showed that 75 per
cent of the elderly population lived in rural areas
and 25 per cent in urban areas. In 2011 those aged
60 and above constituted 8.1 per cent of the total
population in rural areas; the 60 plus population
ranges from 5.4 per cent in Delhi to 12.6 per cent
in Kerala. In urban areas the 60 plus population
constitutes 7.9 per cent of the total population, in
most states it is lower than the corresponding rural
share except for Assam, Bihar, Delhi, Jammu and
Kashmir, Jharkhand, Rajasthan, and West Bengal.
With a rising elderly population in India, the
old dependency ratio has been increasing too. This
ratio is defined as the number of persons in the 60
plus age-group per 100 persons in proportion to the
15-59 age-group. The 1991 census showed that this
ratio was 122 older persons (60+) per 100 persons

2. in the 15-59 years age-group. It increased to 131 per
100 in 2001 and 142 per 100 in 2011. According
to the 2011 census, this ratio is highest (196:100)
in the state of Kerala, followed by states like Goa,
Himachal Pradesh, Punjab and Tamil Nadu.
In addition to these demographic issues there
are some socio-cultural issues which are posing
challenges to the promotion of the health and well-being
of older persons in India.
Socio-cultural changes
In India the family has been the major source
of economic, physical, psychological and social
support to its elder members, who have depended
on their family for financial and emotional support
and care. Traditionally, the elderly were never
considered as a burden by their family; instead they
used to consider it as their moral responsibility to
take care of the elderly.
Elders also used to enjoy the role of the head of
the family and have been acting as the key decision-makers
in the family, based on their wisdom and
experience. Besides, most of them were taking care
of their grandchildren and in return were enjoying
the emotional bonding with them and other family
members. However, due to the phenomenon of
globalisation, modernisation and urbanisation,
certain changes in India have not only brought
cultural changes but have also impacted the socio-economic
aspects in people’s lives.
Some changes which have strongly impacted
the status of the elderly in their family and society
are the disintegration of the joint family system,
migration of the younger generation in search of
better prospects, the rising cost of living, due to
which younger family members often experience
financial constraints and thus find it difficult to take
care of their elder parents, and younger generation
opting for an individualistic lifestyle. These factors
to a large extent are further responsible for the
emergence of homes for the elderly, an increase in
the number of elderly living alone and the spread of
ageist views in Indian society.
These socio-cultural changes, coupled with the
demographic issues, are posing serious challenges
to the promotion of the health and well-being of the
elderly in India.
Challenges
Some of the major concerns and challenges
towards promotion of welfare of elderly are
healthcare, economic security, abuse and crime
against the elderly and enhancement of the elderly’s
rights.
Healthcare
Health is a matter of concern in old age due to
age-related physical and psychological changes.
Various studies conducted from time to time have
highlighted the poor health of older persons in India.
Irudaya Rajan (2007) mentioned that the major
diseases affecting the elderly are hypertension,
cardio-vascular disorders, renal problems, hepatitis
and diabetes.
In an epidemiological study on dementia in
Maharashtra (Saldanha et al., 2010), the prevalence
of dementia in the community was seen to be 4.1
per cent and the risk of dementia was found to be
increasing more than five-fold in the oldest old. A
study by Moneer Alam (2006) indicates that a very
large majority of the elderly suffer from curtailed
functional abilities in physical (eating, bathing,
dressing, walking, climbing stairs, getting-up from
a sitting position) as well as in sensory (hearing and
vision) health domains. This makes them depend on
others. These problems of incapacitation are found
to be particularly acute among the lower income
groups and women.
With the rise in longevity and the increasing cost
of medical care and treatment, elderly healthcare is
becoming a serious challenge both for the family and
society in India. With the feminisation of ageing and
the growing vulnerability of older women to health
problems this is an even more acute situation for
older women. Not only healthcare expenses but also
caregiving is becoming a serious challenge among a
growing number of nuclear families and especially
those where younger people have migrated and
women are in the workforce.
Economic security
Economic security plays an important role in the
well-being and health of older persons. However,
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 6

3. mostly due to retirement and limited income, the
achievement of economic security often becomes
challenging for older people, especially for those
belonging to the lower classes. Due to this, older
people often have to depend on their family for
financial support. The situation is worst for those
who do not own productive assets, have little or
no savings or income from investments, have no
pension or retirement benefits, and are not taken
care of by their children, or live in families that
have low and uncertain incomes and a large number
of dependants. In addition, older women are often
found to be disadvantaged economically mainly
due to widowhood, less workforce participation
and limited or no income. The seven-state survey
carried out by the United Nations Population Fund
(UNFPA) in India (2012) highlights that along
with other factors income insecurity and economic
dependency tend to make Indian elderly, particularly
women, vulnerable.
Economic security plays an important role in
meeting the healthcare expenses of older people.
Some researchers (Bloom, Mahal, Rosenberg and
Sevilla, 2010) based on data from the 60th round
of the National Sample Survey, concluded that the
annual per capita out-of-pocket health spending
in India was almost four times as high among the
elderly (INR 2,890) as among members of working-age
groups (INR 770).
There is no doubt that economic security is one
of the major determinants of well-being in old age.
However, maintenance of economic security is a
serious challenge facing older persons in India today.
Abuse and crime against the elderly
Recently, elder abuse and crime against the
elderly have been increasing. Such cases are often
reported among the elderly or elderly couples living
alone. Often widowed elderly and oldest old elderly
are also found to be the soft targets of such crimes.
A study (Patel, 2010) based on content analysis
of reports published in two leading newspapers
between 2004 and 2008 showed that most of the
crimes against the elderly remain unreported. Female
victims outnumber males. More crimes against the
elderly were reported in urban areas as compared to
rural areas (78 per cent and 22 per cent respectively).
Sixty per cent of the crimes were committed indoors,
most of them during the day. It was also found that
25 per cent of the culprits were family members.
In its 2012 report, UNFPA India highlighted
the fact that, compared to older men, older women
experience more abuse, mainly physical, followed
by economic, psychological and verbal abuse. In
most cases the abusers are family members and the
inter-generational gap in the family is a major cause
of such abuses.
Thus, abuse and crime against the elderly raise a
serious challenge for the maintenance of well-being
of older persons.
Rights of the elderly
It is essential that older persons in India must
be aware of their rights such as: the right to
independence, the right to be informed of social
security schemes, the right to participate in societal
development, the right to care, the right to self-fulfilment,
the right to dignity, the right to financial
security, the right to protection against crime and
abuse and the right to employment.
However, elderly persons have often been found to
be ignorant of such rights and are generally reluctant
to claim such rights. Besides, the government agency
concerned frequently doesn’t pay much attention to
such rights. Thus, all this makes the attainment of a
better quality of life for older persons in India even
more of a challenge.
In view of the foregoing, it can be said that
healthcare, economic security, abuse and crime
against the elderly and enhancement of the rights
of the elderly are some serious challenges to the
promotion of the health and well-being of elderly
persons in India. All these challenges are the result
of socio-demographic changes. Various people are
playing an important role in facing these challenges
and making an effort to promote the well-being of
older persons.
Role players: Older persons
Older persons themselves are major role players
in facing some of the challenges for India’s ageing
population. More elderly persons than ever before
are aware of the importance of mental and physical
fitness and its impact on their health and well-being.
This awareness is increasing due to certain intrinsic
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 7

4. reasons and also thanks to the media. Thus many
senior citizens are now participating in various
marathons and other forms of physical exercise
organised in different parts of India. Also some are
aware of their diet and nutritional intake.
To lead an active, independent and productive
life some senior citizens are also opting for a second
career and pursuing hobbies. In most cases a second
career is sought to provide economic security and
to meet healthcare expenses. And while practising
hobbies such as painting, origami, writing, singing,
dancing, etc, elderly persons are also educating and
training the younger generation. Through this and
also through good upbringing and socialisation of
their grandchildren, the elderly are contributing to
the development of society.
Some elderly are also doing this by participating
in various human rights organisations promoting
the empowerment of various sectors of society
like women, children, the poor, senior citizens, etc.
One such movement was started on August 16,
2010 to raise awareness about the human rights of
older persons; since then every year on the same
day elderly persons from different parts of India
make their voices heard to promote the well-being
of older persons. In this, various non-government
organisations and the All India Senior Citizens
Confederation (AISCCON) has a role to play.
AISCCON is a national body of senior citizens
formed in 2001 and has 500,000 members.
Thus, it can be said that older persons in India
are becoming aware of their rights and health issues;
however, this applies to only a small percentage of
the total elderly population of 104 million. Yet, with
the help of print and social media, this awareness is
increasing, but older persons, their families, society
and government need to make a greater effort to
raise awareness.
The family
In spite of the disintegration of the joint family
system, the migration of the younger generation and
increasing work participation of women, the family
is still a major source of economic, psychological
and social support for older persons in many parts
of India, especially in smaller cities and rural areas.
Some researchers (Bloom, Mahal, Rosenberg and
Sevilla, 2010) found that support from family
members remains a key player of old-age income
security in India. Others (Devi and Murugesan,
2006) mentioned that family support is an important
factor for the psycho-social well-being of the elderly.
Many times family members found it difficult
to take care of their elderly members, not because
they are not concerned about them but because they
often don’t have the proper care-giving skills and
knowledge of financial planning. Due to problems
in taking care of older persons, especially of those
suffering from diseases such as dementia and
Alzheimer’s, families in bigger cities often prefer to
put them in institutional care. All this raises the need
for the implementation of care-giving and financial
planning training programmes for families to be
better able to look after the health and well-being
of their elderly members.
Non-Government Organisations (NGOs)
Most of the NGOs working for the welfare of
the elderly in India are now playing an important
role in promoting the rights of the elderly and work
on different issues concerning their welfare. For
example, most of them do advocacy work to ensure
their rights are respected, for destitute and abandoned
elderly some have old age homes, for lonely elderly
some have companionship services, for dementia
sufferers some NGOs provide day care centres
and assisted living facilities, for protection against
crime and abuses some have helpline services and
for promotion of active and productive ageing some
provide services such as help in choosing a second
career, recreational facilities of different kinds and
computer training.
Despite their efforts and good intentions, however,
some NGOs have problems in implementing
effective programmes for the welfare of the elderly,
mainly because of certain resource constraints (both
human resource and financial).
For-profit ventures
With the growth of India’s elderly population,
older persons are now being considered as a potential
consumer base for healthcare products and services
by various for profit-organisations working in the
healthcare sector.
However, though they are contributing in their
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 8

5. own way towards elderly healthcare, their services
and products are available only to those who can
pay for them. Thus, to provide good healthcare
services to all older persons, for-profit ventures
need to subsidise the healthcare of those elderly who
cannot afford it.
Educational institutions
Educational institutions can play an important
role in creating awareness on ageing issues and
providing skills-based training to professionals and
families for the healthcare of elderly persons.
Some of the institutions in India which are
actively contributing towards this end are the Centre
for Gerontological Studies, Kerala; Tata Institute of
Social Sciences, Mumbai; the Centre for Research on
Ageing, Department of Psychology, S.V. University,
Tirupati; Nirmala Niketan, Mumbai and S.N.D.T.
Women’s University, Mumbai.
A few medical institutions, like the All India
Institute of Medical Sciences (AIIMS) and Madras
Medical College, have also taken up the task of
providing geriatric healthcare services and the
training of geriatric health professionals.
Despite the gowing need for healthcare and for
a better quality of life for older persons in India,
very few research and educational institutions
offer courses and skills-based training programmes
on ageing issues. This shows the need for such
initiatives from other research and educational
institutions in India.
Government
The Indian government is the main role player
in meeting the challenges of an ageing population.
The government has passed various constitutional
and legal provisions and has implemented various
programmes, schemes and policies from time to time
for the welfare of senior citizens. They are briefly
discussed in this section.
Constitutional provisions
The Constituent Assembly of India, which was
elected to formulate the Constitution of India, took
cognisance of the social security concerns of the
elderly and highlighted them in Article 41 and
Article 47 of the Directive Principles of the State
Policy; old age pensions are dealt with in Article
246, item 24 of List III – Concurrent List. Most of
the social security schemes have been implemented,
based on these provisions.
Legal provision
One major legal provision passed by the
government for the protection of older persons
is the Maintenance and Welfare of Parents and
Senior Citizens Act of 2007. It provides that a
senior citizen, including a parent, who is unable
to maintain himself from his own earnings or on
income from his property, is entitled to apply for a
maintenance allowance of up to Rs 10,000 a month
by his children/relatives.
For the convenience of the elderly, this act states
that the application filed for a monthly allowance
shall be dealt with by the tribunal within 90 days
and that maintenance allowance shall be deposited
by children/relatives within 30 days from the
announcement of the order by the tribunal. It also
states that any senior citizen or a parent, aggrieved
by an order of a tribunal, can appeal to the appellate
tribunal within 60 days.
The act also provides for the state governments
in India to look after the well-being of older
persons through the implementation of various
welfare services. Some states have implemented it
successfully and some are in the process of doing so.
The traditional practice of elders being looked after
by their family is promoted by this act which seeks to
place the primary responsibility of care on families.
However, elderly persons are often unaware of it.
Policy initiatives
The Government of India announced a National
Policy on Older Persons (NPOP) in January, 1999.
In January 2010, the Ministry of Social Justice and
Empowerment, nodal ministry on matters affecting
older persons, set up a committee to assess the
various issues concerning senior citizens in general,
and the implementation of the NPOP in particular,
and to draft a new policy.
The review committee drafted and submitted
the National Policy on Senior Citizen (NPSC) on
March 30, 2011. It is under consideration by the
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 9

6. government. The salient feature of this policy is that
it gives priority to the needs of senior citizens aged
80 and above, elderly women, and the rural poor.
When implemented this policy will be a major
step by the government towards enhancing the well-being
of the elderly in India.
Welfare programmes and schemes
Integrated Programme for Older Persons (IPOP)
This scheme was implemented in 1992 and
revised in 2008. It is of great relevance for poor
and destitute elderly. Under this scheme, financial
assistance is provided to NGOs to establish and
maintain old age homes, mobile medicare units,
respite care homes, day care centres for Alzheimer’s
and dementia patients, physiotherapy clinics,
helplines and counselling centres, regional resource
and training centres of caregivers, senior citizens
associations and to promote awareness programmes
for older persons and caregivers.
The National Programme for the Health Care of the
Elderly (NPHCE)
NPHCE is a crucial programme launched
under the Ministry of Health and Family Welfare
to provide health services to the elderly. It was
launched during the 11th Five-Year Plan. Its main
objective is to provide preventive, curative and
rehabilitative services to elderly persons at various
levels of the country’s health care delivery system.
Its other objectives are to strengthen referral systems,
to develop specialised manpower and to promote
research in the field of diseases related to old age.
National Initiative on Care for Elderly (NICE)
The National Institute of Social Defence (NISD),
an autonomous body under the Ministry of Social
Justice and Empowerment, launched a unique
project called a National Initiative on Care for
Elderly (NICE) in 2000, basically to prepare a team
of skilled and committed geriatric professionals to
plan and provide services for the growing elderly
population. The institute conducts some courses
with this aim in view.
NICE is a very useful step taken towards
generation of skilled and committed human
resources for elder care but its awareness is not high
among the students and professionals who want to
contribute towards this field. Steps should be taken
to increase its awareness among those groups.
Indira Gandhi National Old Age Pension Scheme
(IGNOAPS)
The National Old Age Pension Scheme, launched
in 1995, was renamed Indira Gandhi National Old
Age Pension Scheme (IGNOAPS) in 2007. Under
this scheme, all Below Poverty Line (BPL) elderly
aged 60 plus are given a pension of Rs. 200; the
pension amount is Rs. 500 per month for those aged
80 years or above. The respective state governments
are expected to contribute a matching amount for
each beneficiary of this scheme.
Annapurna Scheme
This scheme was launched on April 1, 2000. It
does not provide direct financial aid but provides
food security to senior citizens who, though eligible,
have not been covered under the IGNOAPS. Under
this scheme, 10 kilograms of food grains are
provided free to each beneficiary on a monthly basis.
Both IGNOAPS and the Annapurna scheme
are an essential step taken by the Ministry of
Rural Development towards economic and food
security of older persons. However, a lower level
of awareness and utilisation of such schemes have
been noted among BPL elderly. In addition, the
seven-state survey report of UNFPA India (2012)
has highlighted the wrong targeting of these schemes
in the survey states.
Apart from the above programmes and schemes
some other welfare schemes for the older persons
by different ministries are:
• Income tax exemption up to Rs. 250,000
per annum for people aged 60 and above
• Postal service schemes like Senior Citizens
Saving Schemes (for 55-60 years) and
Monthly Income Scheme (for 60 +)
• 40% and 50% concession on rail fares for
men aged 60 years and above and women
aged 58 years and above, respectively
• Reservation of two front row seats for
senior citizens in buses of state road
transport
• The national carrier Air India provides a
concession of up to 50 per cent in air fares
for senior citizens aged 63 years and above
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 10

7. • Older persons are given preference in
getting telephone connections
In addition to these programmes and schemes,
every year, on the occasion of World Day of Older
Persons (October 1), senior citizens and institutions
doing great work for older person are honoured for
their contribution by the government.
Conclusion and way forward
With the growth of the elderly population in India
some serious challenges have emerged regarding
the maintenance of their physical, mental and social
well-being. These challenges have become even
more acute due to certain socio-demographic and
cultural changes.
To meet these challenges various role players
ranging from older persons themselves to the Indian
government are taking initiatives and making efforts
to overcome these challenges. Among other things,
Government is playing a major role by implementing
various programmes and schemes for older persons.
Though these initiatives are very useful, older persons
are often found to be unaware of them and at times
some initiatives have had implementation problems.
Based on the review of the status of older persons
in India and the limitations they face, some ways
forward for the promotion of well-being of elderly
in India are shared here:
• Training in financial planning for elderly
persons and their families
• Training family members to provide care
• Awareness and sensitisation programmes
on ageing issues
• National surveys to assess the needs and
demands of older persons for an effective
implementation of schemes and services
• Proper implementation of programmes and
schemes by government agencies
• Funding from for-profit ventures to
implement need-based services by NGOs
• More centres and training programmes for
the training of professionals in elder care
• Promotion of an elderly-friendly
environment
Dr Nidhi Mishra, Ph.D., is co-founder and CEO
of Life Circle Senior Citizens Foundation, India.
E-mail: nidhi@lifecircle.in
BOLD ■ Vol. 24 No. 4 ■ August 2014 – page 11
References
Alam, Moneer, 2006. Ageing in India: Socio-economic and health dimensions. Academic Foundation, New Delhi.
Aliyar, S. and Irudaya Rajan, S. 2007. Population Projections for India, 2001-2101. Centre for Development Studies.
Thiruvananthapuram, Unpublished.
Bloom, D.E., Mahal, A., Rosenberg, L., and Sevilla, J. (2010). International Social Security Review, Vol. 63, 3-4.
Devi, N. Prabhavathy and P. Tamilarasi Murugesan, 2006. ‘Institutional care for the elderly’, Journal of the Indian Academy
of Geriatrics, 2 (1), March 2006, pp. 15-20.
Irudaya, Rajan, S. (2007). Aging, Pension and Social Security in South Asia. Chapter 1, Pp. 1-38 in S. Irudaya Rajan. (ed).
Social Security for the Elderly: Experiences from South Asia. Routledge, Taylor & Francis Group. London/ New York/ New Delhi.
Irudaya Rajan (2010). Demographic ageing and employment in India. International Labour Organisation; ILO Regional Office
for Asia and the Pacific. Bangkok: ILO, vi, 23 p. (ILO Asia-Pacific Working paper series)
Irudaya Rajan, S.; Aliyar, S. 2008. “Population aging in India”, in S. Irudaya Rajan, C. Risseeuw; M. Perera (eds): Institutional
provisions and care for the aged: Perspectives from Asia and Europe (London/New York/New Delhi, Anthem Press).
Patel, Mamta, 2010. Crimes against the Elderly. Indian Journal of Gerontology. 24 (3), pp. 395-403.
Saldanha D., Maj. Raghunandan Mani, Kalpana Srivastava, Sunil Goyal and D. Bhattacharya, 2010. An epidemiological study
of dementia under the aegis of mental health program, Maharashtra, Pune chapter. Indian Journal of Psychiatry. 52 (2). pp. 131-39.
Subaiya, Lekha and Dhananjay W. Bansod. 2011. Demographics of Population Ageing in India: Trends and Differentials,
BKPAI Working Paper No. 1, United Nations Population Fund (UNFPA), New Delhi.
United Nations Population Fund (2012), Report on the Status of Elderly in Selected States of India, 2011.
Census of India: http://www.censusindia.gov.in/