India’s demographic dividend—having more working-age than dependent population—provides for a significant opportunity for economic growth. The median age of the country stands at 28.4 years, which is significantly lower than countries like China, Japan, and the USA, which stand at 39.6, 49.4, and 38.3 years respectively (United Nations, n.d.). India’s current working age (15 to 64 years) population is approximately 67%, and is projected to peak in 2030, at 68.9% (EY, 2023). The population growth rate is declining—India’s Total Fertility Rate (TFR) fell from 2.2 in 2015-16 to 2.0 in 2019-21 (NFHS-5), indicating that India is transitioning towards population stabilization (NFHS-5 India Report, 2022). All this while, there is a significant increase in migration to the urban areas for employment opportunities. As per the Economic Survey 2023-24, more than 40% of India’s population will live in urban areas by 2030 (Ministry of Finance, 2023). As per the Periodic Labour Force Survey 2020-21, of the total migration, 18.9% was from the rural areas to the urban areas (PIB, 2024a).
These demographic shifts of declining fertility rate, increasing median age and rampant urban migration are deeply interconnected. Urban migration puts immense pressure on urban infrastructure, public services, and environmental sustainability, simultaneously creating questions for elderly care in the rural areas. While the pressures of rural-to-urban migration and rapid urbanisation dominate much of the current policy focus, an equally important yet less visible demographic transition is unfolding: the steady rise in India’s elderly population. As fertility rates decline and life expectancy rises, the country is gradually shifting from a youth-heavy society to one that must also prepare for aging. The challenges posed by this shift – from healthcare to social protection – demand urgent and forward-looking policy attention.
The Longitudinal Ageing Study of India (LASI), 2021 presents insight into the challenges faced by India’s elderly population. The report stated that 75% of them suffer from at least one chronic disease, while 24% have at least one Activity of Daily Living (ADL) limitation such as difficulty in bathing or dressing. Moreover, 48% reported limitations in Instrumental Activities of Daily Living (IADL) like managing finances or taking medications. Mental health indicators are also worrying, with one in three elderly experiencing depressive symptoms and 32% reporting low life satisfaction. On the social protection front, only 18% are covered by health insurance, 28% are even aware of existing concessions for senior citizens, and 24% faced problems in providing documentation to avail services. Alarmingly, 70% of the elderly are dependent on others for their daily maintenance, and 78% live without any pension coverage (Ministry of Health, 2020a). These figures underscore the urgent need for comprehensive, inclusive, and accessible systems of elderly care in India.
The Emerging Challenge of Elderly Care
The elderly in India currently comprises a little over 10% of the population, translating to about 104 million. The Population Projection Report projected that the elderly population in India will rise to more than 17% by 2036 (Ministry of Health, 2020b) and to 19.5% by 2050 (United Nations Population Fund, 2023). India’s average life expectancy in 1960 was 46 years. In 2023, India’s average life expectancy rose to 72 years (World Bank Group, 2023). As per UN estimates, it will further rise to 81.96 in the year 2100 – 75 years from now (Mukhopadhyay, 2022). Technological advancements and improved medical services, better access to healthcare, better diets, healthier lives due to comforts at disposal could have contributed to this improving trend.
The rising age, and the shrinking family size will have many elderly left to fend for themselves. They are generally faced with economic, physiological and housing related problems due to their age factor. While India is a young country by its median age, there are regional differences. E.g. Kerala’s elderly population for 2021 was projected to be 26.1%, while Tamil Nadu’s and Himachal Pradesh’s projections stood at 20.5% and 19.6% respectively (MoSPI, 2021). Hence, as the government works on policies that focus elderly care, it will have to keep in mind that ‘one size fits all’ approach wouldn’t work in this case as there is huge disparity in elderly population in different states of India. Another important indicator is the dependency ratio of the elderly population. Old age dependency ratio gives an idea about the number of persons aged 60+ per 100 persons in the age group 15-59. In 1961, the old age dependency ratio was 10.9%. By 2011, it had increased to 14.2%. However, the ratio is projected to increase to 20.1% in 2031 (ibid). The old age dependency ratio increased by 3.3 percent points in 50 years (1961 to 2011), but is projected to increase by 5.9 percent points in 20 years (2011 to 2031). This indicator makes the need of elderly care as a pressing policy point abundantly clear.
Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act, 2007
After signing the Madrid International Plan of Action on Ageing in 2002, India started to take substantial steps towards elderly care in the country. Later India legislated the Maintenance and Welfare of Parents and Senior Citizens Act, 2007. The Act legally obligates children – including adopted and stepchildren – and legal heirs to provide maintenance to senior citizens and parents, with a cap of ₹10,000 per month as determined by Maintenance Tribunals (Section 9). It also mandates state governments to establish at least one old-age home per district, with a minimum capacity of 150 residents. The act also provides for medical support for senior citizens including provision of beds in government hospitals, separate queues, and earmarked facilities for geriatric patients in every district hospital. The Act imposes penalties, including imprisonment and fines, on those who fail to comply with its This serves as a deterrent against neglect or mistreatment of senior citizens (Ministry of Law and Justice 2007).
However, the situation of implementation on ground is vastly different. It was found that only 12% of elderly were aware of the MWPSC Act 2007 even a decade after it was legislated (Issac et al., 2021). The mandate for the states to start at least one old-age home in each District appears to be a target not realized in the majority of the states, whereas some homes were in a dilapidated condition, without adequate facilities. The Supreme Court observed that “the Section 19 of the MWP Act is being complied with only in letter and certainly not in spirit” (Supreme Court of India, 2016). These gaps between policy intent and ground realities reveal the performative nature of the law: well-framed but poorly implemented. Without awareness, infrastructure, and institutional accountability, the Act risks remaining a symbolic gesture rather than a meaningful safeguard for India’s elderly.
Economic Problems
As per NSS 75th Round, about 70% of the elderly people depended on their family or others for their day-to-day upkeep. The situation of elderly females is even more concerning with only 10% and 11% economically independent elderly women in rural and urban areas respectively. On the other hand, males were in a better situation with 48% and 57% elderly males in rural and urban areas respectively were independent (MoSPI, 2021). While elderly being dependent on their families itself isn’t a problem, there does arise a concern considering the shrinking size of families, increased migration of working-age members, and the weakening of traditional caregiving structures.
To address such economic challenges, the Government of India introduced Indira Gandhi National Old Age Pension Scheme (IGNOAPS) in 2007. Under this scheme, a monthly pension of ₹200 is given to beneficiaries from 60 years up to 79 years and ₹500 thereafter (MoSPI, 2021). Considering that this scheme is for those who are below the poverty line, the pension of ₹200 and ₹500 is inadequate in today’s times. To strengthen India’s elderly support system, existing pension schemes like IGNOAPS need urgent revision in line with inflation and cost of living. A graded increase in pension amounts, linked to age bands and regional price indices, can help make the scheme more meaningful. Additionally, the eligibility criteria should be broadened to include economically vulnerable elderly above the poverty line, especially single and widowed women.
For middle-income senior citizens, Pradhan Mantri Vaya Vandana Yojana is a scheme where upon depositing a lumpsum amount of 1.6 lakhs or 15 lakhs, the senior citizens receive pension amount of Rs 1000 or Rs 9200 every month for the duration of 10 years (MoSPI, 2021). The PMVVY could be made more inclusive by reducing the minimum investment threshold and integrating it with a government-backed annuity option.
Health Concerns
As the age increases, so do the health concerns. India’s 75% of the elderly have one or more chronic diseases, whereas 40% of the elderly have one or other disabilities (NITI Aayog, 2024). In such cases, the expenses of medical treatment only go higher. To address this issue, the Government of India expanded the scope of Ayushman Bharat scheme in 2024 to provide free treatment benefits of up to ₹5 lakh per year to all senior citizens aged 70 years and above, irrespective of their socio-economic status including tribal communities. Senior citizens can avail the benefits of this scheme from over 30 thousand hospitals including 13 thousand private hospitals (Ministry of Health, 2025). Within two months of implementation of this scheme, more than 25 lakh senior citizens enrolled in, wherein treatment worth more than Rs. 40 crores was availed benefitting more than 22,000 senior citizens (PIB, 2024b).
The UN General Assembly declared 2021-30 the Decade of Healthy Ageing, where we seek to reduce health inequities and improve the lives of older people, their families and communities through collective action (World Health Organisation, 2024). In the same line, the government should adopt a holistic approach to ageing that goes beyond physical health to include mental well-being, social inclusion, and economic security. Mental health awareness among the elderly remains low, and age-related isolation, dementia, and depression often go undiagnosed and untreated. Community-level outreach programs, geriatric counselling services, and integration of mental health in primary healthcare can go a long way in improving quality of life. Moreover, initiatives that promote intergenerational engagement, digital literacy, and active ageing, such as senior volunteering, recreation hubs can help combat loneliness and keep the elderly socially and mentally engaged.
Long-term Care
India’s long-term care infrastructure for the elderly remains sparse and poorly equipped to meet the needs of a rapidly ageing population. According to the Longitudinal Ageing Study in India, over 20% of individuals aged 60 and above reported limitations in activities of daily living (ADLs), indicating a substantial need for long-term care and assistance (Ministry of Health, 2020a). However, institutional care options such as old-age homes and assisted living facilities are limited and largely concentrated in urban areas (NITI Aayog, 2024). Most of these are privately operated and financially inaccessible to low-income and rural elderly populations. As per the National Health Profile 2017, there were only 43 physicians per 100,000 population in rural areas, compared to 118 physicians per 100,000 population in urban areas.
Traditionally, family members were expected to care for ageing parents, but this model is increasingly strained. The rise in nuclear families, increased out-migration of working-age adults, and longer life expectancy have weakened intergenerational support systems. As per NCRB’s Crime in India Report 2022, crime against the senior citizens has only seen a steady uptick over the past few years. In 2020, more than 24,700 cases were registered for crime against senior citizens. The number of cases rose to over 26,000 in 2021 and over 28,500 in 2022 (National Crime Records Bureau, 2022). With rising cases of abuse and neglect against senior citizens, there is a need to strengthen the enforcement of the Maintenance and Welfare of Parents and Senior Citizens Act 2007, ensure faster grievance redressal, and expand awareness campaigns about elder rights. Community policing models should be introduced in all states. A national registry or tracking mechanism for elder abuse cases can also help monitor and address this growing issue effectively.
If India is to provide dignified ageing, the development of an affordable, accessible, and regionally distributed LTC system must become a policy priority. This includes both community-based home care services and institutional care models that are supported by public-private partnerships and trained human resources.
Conclusion
As India faces the challenge of elderly care – posed by both demographic shifts and changing family dynamics – it will need a multi-pronged strategy to protect the elderly and prevent abuse. The enforcement of the Maintenance and Welfare of Parents and Senior Citizens Act (2007) should be strengthened. Senior citizens should be made aware of their legal rights. Expansion of digital and offline awareness campaigns about elder abuse, reporting channels, and rights under Indian law is essential. Fast-track tribunals dedicated to elderly grievances should be functional in every district, with timely resolution of complaints.
Community policing models, where police work with local community members to address local issues, enhance safety and build trust, can be used effectively for this. This will include local police regularly checking in on elderly persons living alone, maintaining registries of vulnerable seniors, and offering helplines with trained responders.
India should also consider introducing a National Registry for Elderly Abuse, similar to child abuse or domestic violence tracking systems, to enable better surveillance, reporting, and targeted policy intervention. Moving forward, a rights-based approach to elderly care is essential. With the UN Decade of Healthy Ageing (2021 – 2030) as a guiding framework, India must transition from viewing elderly care as a family responsibility to recognizing it as a public policy imperative.
