Ageing India: population change and care

India is still young, but it is ageing fast. Life expectancy rose from 58.6 years in 1990 to 72 years in 2023, according to the Human Development Report 2025, and fertility has fallen below replacement level in most states. The result is a slow, certain shift: the share of older people will grow steadily in the coming decades, and the number of very old people — those over 80 — will grow fastest. The demographic dividend discussed earlier is therefore the first half of a longer story, and ageing is the second half.

Ageing brings three linked challenges. The first is income: most older Indians worked informally and have no pension, and the old-age pension under the National Social Assistance Programme is small. The National Pension System, opened to all citizens in 2009 after starting for government employees in 2004, and the Atal Pension Yojana, launched in 2015 for unorganised workers, extend coverage, but enrolment and benefit levels remain limited, and many older people depend on family support. The second is health: older people need long-term, chronic and palliative care, which the health system, built around episodic treatment, is poorly equipped to provide. The third is care itself: as families shrink, urbanise and see more women in paid work, the traditional model of daughters and daughters-in-law providing full-time care is under strain.

Kerala shows the future first: it has the oldest population profile in India, with high life expectancy, low fertility and large out-migration of the young, and it has experimented with palliative care networks and community-based support. Other states will follow its path at different speeds. The policy agenda includes pension adequacy, geriatric training, home-based and community care, age-friendly housing and transport, and protection against elder abuse, which the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, addresses by requiring children to maintain their parents.

Ageing is sometimes framed as a burden, but that framing is incomplete. Older people work, care for grandchildren, volunteer and vote, and their experience is a resource. The real question is whether institutions adapt in time: pension systems designed when lives were shorter, health systems designed for acute illness, and families designed around joint households all need rethinking before the age wave arrives, not after.