Health, nutrition, and policy insights

India’s elderly population is growing rapidly, with the number of people aged 60 and above expected to reach 193.4 million by 2031. As this demographic expands, addressing the health and nutritional needs of older adults has become a pressing challenge. In South Asia, India is experiencing a moderate rate of aging, with the proportion of elderly individuals expected to reach 20 percent by 2050, and 36.1 percent by 2100 (figure below).

 

Percentage of elderly population in South Asian Countries (1950-2100)

 

A major health concern among the elderly in India is the high prevalence of chronic diseases. According to the National Programme for Health Care of the Elderly (NPHCE), these chronic conditions are among the leading causes of morbidity and mortality among seniors. Evidence shows that 17 percent of the elderly in rural areas and 29 percent in urban areas suffer from at least one chronic illness, making effective management of these diseases essential. In addition to chronic diseases, mobility limitations and physical disabilities are widespread in the elderly population. The Longitudinal Ageing Study in India (LASI) highlights the significant impact of physical decline on the elderly population, particularly in terms of the increased risks of falls and fractures. According to the study, as individuals age, they often experience a reduction in muscle strength, balance, and bone density, which heightens the likelihood of falls and related injuries. The LASI study underscores the need for targeted interventions, including improved physical rehabilitation, fall prevention programmes, and better healthcare access for the elderly, to mitigate risks and enhance their well-being. According to a study, a significant number of elderly individuals suffer from osteoporosis, particularly women, making them more susceptible to bone fractures and other injuries. The study found that osteoporosis affects about 35-40 percent of postmenopausal women and 20-30 percent of older men in India, contributing to an increased risk of fractures, particularly in the spine, hip, and wrist.

The nutritional health of elderly people is also a concern in India, particularly in rural areas, where many face malnutrition due to limited access to nutrient-dense foods.

Mental health is a significant area of concern for the elderly in India, with depression, anxiety, and cognitive decline being common. According to the National Mental Health Survey (2015-16), 13.7 percent of the elderly population suffers from mental health disorders, with depression being the most prevalent. The Survey also revealed that elderly individuals with mental health issues often do not seek help due to stigma, a lack of awareness, and insufficient healthcare infrastructure. Additionally, a study found a high prevalence of depressive symptoms (75.6 percent) among the elderly in rural central India, with factors such as female gender, age over 70 years, lower educational attainment, financial dependency, and comorbidities being significantly associated with depression. A study utilising LASI data reported that the age-standardised prevalence of depression among adults aged 45 and above in India is 5.7 percent, with higher rates observed in females (6.3 percent) compared to males (4.3 percent). It was seen that depression in elderly individuals was significantly associated with factors such as rural residence, widowhood, low education, and low income. An analysis estimated the national prevalence of dementia among older adults in India to be 7.4 percent, highlighting the significant burden of cognitive impairments in this population.

The nutritional health of elderly people is also a concern in India, particularly in rural areas, where many face malnutrition due to limited access to nutrient-dense foods. Financial constraints often prevent the elderly from purchasing fresh produce and nutrient-rich meals, leading to poor dietary intake. A study conducted in rural Kerala found that 14.3 percent of elderly individuals were malnourished, with 44.1 percent at risk of malnutrition, highlighting the significant nutritional vulnerabilities in these populations. Similarly, research in rural Puducherry reported that 17.9 percent of older adults were malnourished, with nearly 60 percent at risk. Factors such as a lack of formal education, unemployment, and physical limitations due to aging contribute to poor nutritional status. Moreover, a study indicated that about 45 percent of elderly individuals in rural areas were food insecure, with a substantial portion suffering from malnutrition, including being underweight or overweight. Inadequate knowledge about specific dietary needs and challenges in food preparation, particularly among those with limited mobility or cognitive impairments, further exacerbate the problem.

The National Nutrition Monitoring Bureau (NNMB) report revealed that a significant number of elderly individuals fail to meet recommended dietary allowances, leading to deficiencies in essential nutrients such as calcium, vitamin D, and vitamin B12. These deficiencies contribute to serious health complications, including bone fractures, cognitive decline and other chronic conditions. A study titled “Burden of Vitamin D, Vitamin B12 and Folic Acid Deficiencies in an Aging Rural Indian Community” reported that 75.7 percent of older adults had low vitamin D levels, 39.1 percent had a vitamin D deficiency, 42.3 percent had a vitamin B12 deficiency, and 11.1 percent had a folic acid deficiency. These deficiencies are concerning given their potential negative consequences on cognition, immunity, and frailty in the aging population. A systematic review and meta-analysis, which estimated the pooled age-wise prevalence of six preventable micronutrient deficiencies, highlighted the need for micronutrient fortification in geriatric foods to address deficiencies prevalent among the elderly population.

In India, the nutritional health of the elderly is often compromised due to a lack of awareness, limited accessibility, and the lack of affordability of nutritious foods.

Evidence from rural areas highlights their vulnerability to malnutrition due to limited access to fresh produce and affordability issues. There is a greater need to focus on enhancing the affordability of nutritious food groups to ensure equitable access for all, particularly in vulnerable populations. As of 2022, about 56 percent of Indians could not afford a nutritious diet, due to food prices, income levels, and economic disparities. Incorporating micronutrient-rich and fortified foods into government feeding programs has proven effective in addressing nutritional deficiencies in India. Additionally, a case study on the Mid-Day Meal Scheme (Pradhan Mantri Poshan Shakti Nirman) has demonstrated that fortifying meals with essential micronutrients significantly improved the nutritional quality of the food provided to children. A review of the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies has found a high potential to benefit the elderly.

In India, the nutritional health of the elderly is often compromised due to a lack of awareness, limited accessibility, and the lack of affordability of nutritious foods. Data from the National Nutrition Monitoring Bureau (NNMB) shows that many elderly individuals fail to meet recommended dietary allowances. The Indian Council of Medical Research, in its revised dietary guidelines for Indians, emphasises the need to “include nutrient-rich foods in the diets of elderly for health and wellness”. The Government of India has implemented a range of programs through various ministries and departments to address the health, welfare, financial, and nutritional needs, and also digital inclusion for the elderly. However, increasing awareness, improving accessibility, and ensuring the sustainability of these programs, especially in rural areas, will be critical in addressing the growing needs of India’s aging population.

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Shoba Suri is a Senior Fellow with the Health Initiative at the Observer Research Foundation.

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