India Is Ageing. Can Its Health and Social Systems Keep Pace?

India is often described as one of the world’s youngest nations, but another demographic reality is taking shape alongside its celebrated youth dividend: India is ageing, and doing so at a pace that could fundamentally reshape the country’s health, social protection and development priorities. By 2050, the number of Indians aged 60 and above is projected to reach nearly 350 million. Yet the question is not simply whether people are living longer, but whether they are able to live those additional years with health, dignity, independence and purpose.

For Ms. Sujaya Krishnan, Former Joint Secretary, Ministry of Health and Family Welfare, Government of India; President, Venu Charitable Society; Executive Member, Guild of Service; and Advisor, Dementia India Alliance, healthy ageing demands a far more expansive understanding of development. It touches healthcare, livelihoods, caregiving, housing, social security, digital inclusion and community participation. In this insightful conversation, she explores whether India is prepared for the demographic transition ahead, the gaps that remain in its ageing ecosystem, and what it will take to ensure that longevity becomes an opportunity rather than a source of vulnerability.

Read her expert perspectives below.

Q&A

Q. How prepared is India for the demographic shift arising from a rapidly growing elderly population?

A. Population ageing is no longer a future concern but an ongoing demographic reality, both globally and in India. Data from sources such as the World Health Organization (WHO), The Lancet, and India’s demographic projections show that the population aged 60 and above is expected to rise sharply over the coming decades, making India home to one of the world’s largest elderly populations. A significant proportion of older adults live below the poverty line, with women constituting the majority of the elderly population and facing heightened risks of poverty, dependency and social isolation.

India has made important gains through increased life expectancy, reduced mortality rates and improved healthcare systems, but the country remains only partially prepared for the scale of the transition ahead. Initiatives such as the National Programme for Health Care of the Elderly (NPHCE), Ayushman Bharat, and various social protection measures provide important foundations. However, implementation remains uneven across states and districts, with persistent gaps in infrastructure, trained workforce and age-friendly services.

Ageing presents challenges that extend far beyond healthcare. It affects employment, social security, housing, transportation, digital inclusion and community participation. Traditional family-based support systems are weakening because of urbanization, migration and the rise of nuclear families. Therefore, the real challenge is not simply supporting a larger elderly population but creating conditions that enable older adults to remain healthy, independent, socially connected and productive for as long as possible. Healthy ageing is a lifelong process that begins well before old age and requires sustained investments in disease prevention, health promotion and quality of life throughout the life course.

Q. What experiences shaped your understanding of ageing-related issues, and what is your vision for healthy and dignified ageing in India?

A. My experience in public health administration has shown me that ageing is shaped by an interlinked set of health, economic and social factors. Older adults often face multiple chronic illnesses, disabilities and functional limitations, but these challenges are closely linked to socioeconomic realities such as education levels, household wealth, income security and social support systems.

Rural elderly populations are particularly vulnerable, often struggling with limited access to specialist healthcare, diagnostic facilities, rehabilitation services and geriatric care. Transportation barriers and financial constraints further restrict access to essential services. Older women face additional disadvantages because of lower lifetime earnings, limited asset ownership and greater social marginalization.

One of the most significant lessons from my public health experience is that healthy ageing cannot be viewed solely as a medical issue. It is influenced by education, nutrition, employment opportunities, social inclusion, community support and lifelong health behaviours. Healthcare systems must move beyond disease treatment and adopt integrated care models that support physical, mental and social well-being simultaneously.

A major area that deserves greater attention is prevention. Healthy ageing begins decades before a person turns sixty, and investments in preventive healthcare, physical activity, mental health and chronic disease management throughout adulthood can significantly reduce disability and dependency in later life. The Longitudinal Ageing Study in India (LASI) is an important initiative that is helping policymakers better understand ageing patterns, health risks and regional variations among Indians aged 45 and above.

My vision is for India to view older adults not as a burden but as a valuable resource. We need to build age-friendly communities where seniors continue to participate actively in society and where ageing is measured not merely by longevity but by the ability to live independently, with dignity and purpose.

Q. Are there any initiatives that stand out as meaningful responses to ageing-related challenges?

A. The National Programme for Health Care of the Elderly (NPHCE) stands out as one of the most significant policy interventions in this area. Before the programme’s launch, India lacked a structured framework for geriatric healthcare and had limited institutional capacity in the field.

The programme seeks to address these gaps by strengthening geriatric services at multiple levels of the healthcare system. Important achievements include the establishment of Regional Geriatric Centres (RGCs), development of geriatric wards in district hospitals, introduction of MD programmes in Geriatric Medicine, and the creation of specialized infrastructure and training mechanisms for healthcare professionals. The programme also established two National Centres for Ageing — one at All India Institute of Medical Sciences (AIIMS), New Delhi and another at Madras Medical College, Chennai — conceived as centres of excellence for geriatric healthcare, training, research and capacity building.

Caregiver support is another area that deserves much greater attention. It has traditionally depended on families but remains under-recognized. Caregivers frequently face emotional, physical and financial strain, yet support systems for them remain limited. Mental health services for both older adults and caregivers also require substantial strengthening.

Ageing policy must be rooted in convergence. The National Policy on Older Persons, the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, and the role of the Ministry of Social Justice and Empowerment in elder welfare are all important parts of this landscape. Stronger collaboration among ministries, healthcare systems, social welfare departments, community institutions, civil society organisations and technology providers is essential. Ageing requires a comprehensive “360-degree approach” that addresses every aspect of an individual’s well-being.

Q. Is the CSR and development sector giving enough attention to India’s ageing population?

A. Awareness of ageing issues has increased over time, but older adults still receive insufficient attention within development priorities. Historically, philanthropic efforts have focused largely on old-age homes, while modern CSR initiatives tend to prioritize education, livelihoods, maternal and child health, poverty alleviation and infrastructure development.

While these areas remain important, ageing can no longer be treated as a peripheral issue. Given the scale of India’s demographic transition, programmes specifically designed for older adults deserve significantly greater attention and resources.

CSR investments often favour visible infrastructure projects that generate immediate and measurable outcomes. As a result, critical but less visible issues affecting older adults remain underfunded. Dementia care, mental health services, palliative care, rehabilitation services and caregiver support are some of the most neglected areas. Dementia, in particular, remains severely under-resourced despite its growing prevalence.

There is also a need for greater investment in age-friendly communities, assistive technologies, digital inclusion and digital literacy. Many older adults, particularly in rural areas, remain excluded from digital services, financial systems and government benefits because they lack the skills needed to navigate increasingly digital environments.

Another major gap is the absence of an integrated ecosystem approach. Healthcare, housing, transportation, social welfare and community services often function in silos. These sectors must work together through a coordinated framework for healthy ageing.

Q. What should India prioritize to ensure dignified ageing in the future?

A. India must adopt a multidisciplinary and multisectoral approach to ageing. We need to move beyond care-oriented models and focus on enabling healthy ageing through prevention, rehabilitation, mental health support and long-term care services.

Social protection systems need to be strengthened, particularly for elderly individuals in rural areas and the informal sector who often lack pensions or retirement savings. Geriatric care should be integrated into primary healthcare, with trained professionals, rehabilitation services and age-friendly facilities available at the district level. Home-based care models, telemedicine and mobile health units can play an important role in reaching underserved populations. There is also a need for greater investment in dementia care, palliative care, mental health and rehabilitation, areas where significant gaps remain. Beyond healthcare, we need age-friendly infrastructure, accessible public spaces, safe housing, inclusive transportation systems and digital literacy initiatives for older adults.

It is equally important to create opportunities for older adults to remain productive and engaged. With increasing life expectancy, many individuals can continue contributing to society for 10 to 20 years after retirement. Communities and institutions should therefore encourage intergenerational engagement, mentorship and meaningful participation.

Healthy ageing is a lifelong process requiring a “womb-to-tomb” approach. Health outcomes in old age are shaped by conditions throughout life, beginning even before birth. Therefore, ageing policy cannot be separated from broader social, economic and environmental determinants of health. Ultimately, a society that prepares well for ageing creates a better future for every generation, ensuring dignity, independence and well-being across the life course.