An Ageing Society: Initiatives Addressing Greying Population in Smaller Cities

Trends & Projections of India’s Ageing Population

In 2022, India’s share of those aged 60 and older was 10.5% of the total population. According to the India Ageing Report 2023, this demographic is projected to double by 2050. Based on the data from various organisations, this report estimates that 1 in 5 person will become a senior citizen by the next two decades. With a fertility rate under 2.0 and life expectancy reaching above 70+ years, India is witnessing an exponential growth in the number and proportion of elderly people. Improved healthcare facilities, better access to medical treatment, and advancements in technology have led to increased life expectancy across the country. Additionally, changing societal norms, urbanisation, and migration patterns have altered traditional family structures, resulting in a shift towards nuclear families and reduced familial support for the elderly.

Implications of a Greying Population
This greying population will have numerous implications for smaller cities, with changes in the housing market, shifting disease burden, and evolving healthcare services. Currently, there are 18,000 units of senior living facilities in India, with southern cities like Chennai, Coimbatore, Kochi, and Bengaluru contributing 62% to the overall supply. Housing.com's research predicts a substantial growth in demand for senior living housing, especially post-COVID19. However, a study by Kumar et al. (2024) revealed that advanced health facilities were more concentrated in metropolitan cities, while smaller cities lacked good health facilities which were not easily accessible. Nevertheless, such gaps have triggered the growth of the Home-based healthcare sector which are gaining significance in catering to the healthcare needs of the elderly.

Greying Towns in India
A small town in Kerala, Kumbanad is grappling with the consequences of an ageing society. While the local schools face shortage of students, migration of the younger generations for better opportunities has left behind a largely elderly population. Kumbanad is a microcosm of the challenges of the growing greying population in other states like Nagaland and Tamil Nadu as well. These states have the highest percentage of elderly living alone, attributed to out-migration for education and lack of employment opportunities in their home states. However, community engagement is creating awareness regarding the need for elderly in Nagaland. In September 2023, Kohima celebrated the 2nd anniversary of “The Elder Line – 14567,” a national helpline for senior citizens. This helpline centre in Nagaland has also been successful in creating separate counters for seniors at banks and providing free travel in NST buses.

Community Champions for the Elderly
Some Individuals have also taken an innovative path in addressing the needs of the ageing population and to foster well-being. In Maharashtra’s small town – Wai, Madhav Damle pioneered the matchmaking initiative “Happy Seniors” in 2012 to provide companionship, while breaking taboos around relationships among older adults. The Goodfellows initiative, spearheaded by Shantanu Naidu, is fostering intergenerational bonds between elderly individuals (referred to as “grandpals”) and young volunteers or “good fellows”. Meanwhile, Pranav Shukla began Anandi Old Age Home in Faridabad where the elderly are kept engaged in productive activities like dairy production, which contributes to the self-funding of their home.

Kochi has become the 1st city in India to be a member of the WHO Global Network for Age-friendly Cities and Communities (WHO-GNAFCC), to work alongside older people in fostering age-friendly environments for healthy and active ageing. Meanwhile, in Pimpri Chinchwad, an unauthorised parking space in Sudharshan Chowk has been reclaimed through placemaking to create an “8 to 80” Park. Transformed through community action, this open space now provides space to exercise, cycle, and socialise for the young and the old alike. Likewise, Malappuram recently inaugurated “Badai Bazaar,” a community centre free of cost for the elderly to socialise. Based on a survey conducted by the municipality, plans are underway to establish 28 more such centers, which will remain open from 6 am to 7 pm.

Public Initiatives to address India’s Greying Population
NIMHANS has collaborated with HelpAge India to train 10,000 workers and volunteers to provide geriatric mental health care through ‘Sarthak’, a community-based initiative. Likewise, Ivory Health - an age-tech startup is focusing on addressing cognitive decline among the elderly through cutting-edge technology and personalised interventions. Meanwhile, the Uttar Pradesh government to planning to develop old age homes called “Garima Grahs” in 18 districts around the state. These homes will provide boarding, food, entertainment, clothes, and medical treatment to the elderly trans community. In Ranchi, plans are underway to establish children-cum-old age home in single campus on pilot basis with an aim to provide congenial environment to both orphaned children and abandoned elderly at these facilities. These homes are also being planned for Dumka, Palamu, and Latehar.

The government's efforts to address the needs of India's elderly population have been outlined in various policies and schemes, such as National Policy on Senior Citizens 2011, National Programme for Healthcare of Elderly and the Geriatric package at Ayushman Arogya Mandirs, among others. The National Policy for Older Persons (1999) has encouraged familial care for the elderly while also providing support through pension schemes and NGOs. However, LASI data suggests that only about one-fourth of the elderly are aware of their legal entitlements and as less as 12% know about the law on welfare of parents and senior citizens. The overall access to social security also remains inadequate, particularly in terms of health insurance coverage, exacerbating the vulnerability of elderly individuals.

Mental Health Issues among the Elderly
Within the health landscape, the aspect of growing mental health problems, especially for the older population, is becoming crucial. According to the Longitudinal Ageing Study in India (LASI), around 20% of the elderly in India have mental health issues and almost one-third of the elderly population exhibits depressive symptoms. While India’s life expectancy has improved, cognitive impairments have also increased. According to WHO, India has an estimated 4 million people who are living with dementia, and this number is projected to increase to 13.4 million by 2050. Experts cite social isolation and pollution as few of the major factors which have impacted the onset of degenerative diseases among the urban elderly. Furthermore, increasing elderly abuse has also had adverse impacts on their mental health. HelpAge India's survey had indicated an alarming trend of elderly abuse in smaller cities, where Madurai had recorded the highest rate at 63.25%. While disrespect was cited as the most prevalent in tier-I cities at 76%, tier-II cities reported high incidence of verbal abuse at 72%.

The Way Forward
A recent McKinsey Health Institute (MHI) survey found that “having purpose in life and meaningful connections with others” has a positive impact on the overall health of elders around the world. The shift away from community-based family structures has left many elderly individuals isolated in India. However, Gujarat’s Chandanki village near Mehsana, is combating such loneliness by eating together at their community kitchen. With the elderly villagers gathering in the solar-powered AC hall to share meals together, they are showing the way to cities in creating spaces for India’s greying population.

India faces a pressing need for comprehensive policies and community-driven initiatives to address the evolving needs of its ageing population. Age-friendly environments like community kitchens and public parks, along with enhanced awareness of and access to healthcare support services, are the need of the hour. By ensuring the well-being of its elderly, India can harness their wisdom and resilience for a brighter future.

How is your city supporting its ageing population? Are there initiatives in your city that are helping the elderly battle loneliness? Let us know in the comments section below!