Author: Mahesh Venkateswaran

Edition #8: Results from a groundbreaking study among India’s 45+ population.

In the last newsletter, I shared the report Silver Economy: A case for market-based solutions, a self-authored report on my research into ageing, elder care and market-solutions available in India. In one of the sections, I highlighted early results from the Longitudinal Study on Ageing in India. Earlier this week, and amidst hectic preparations for the Covid-19 vaccine drive, the Minister for Health and Family Welfare (MoHFW) Dr Harsh Vardhan released results from the first wave of LASI data. This is a significant study for many reasons, for researchers, policy makers, health practitioners working on geriatric care, and for the general population.

Talking to Rajya Sabha TV, Prof T V Sekher, Principal Investigaror of LASI and Professor in IIPS, spoke about key aspects of the study results from the first wave data.

• 34% of surveyed have at least one chronic health condition.
  • Cardiovascular – 34%; hypertension – 32%; bone and joint diseases – 19%; diabetes – 14%; lung diseases – 8%; heart disease – 5%; anaemia – 5%; stroke – 3%; cancer – 0.7%
  • 3/4th of them that reported chronic conditions are getting treated for various chronic conditions. Diabetes – 83%; hypertension – 77%, etc.
• In the context of the pandemic, 23% have multi-morbidity health conditions. This was sponsored as part of the National Program on Healthcare for the Elderly.
• Mental illness (like depression) is seen among 8% of the population; among  the 75+ group, this increases to 10%. Most seen among rural residents, widows and elderly living alone.
• 11% of the elderly have physical impairment; locomotor – 6%; visual – 4%; others – mental, hearing.
• The study also captures information under “activities of daily living” of elderly (taking a bath, food intake, using toilets, etc.). 24% of elderly have at least one limitation; 14% have more than one limitation.

About LASI

The LASI study was launched in 2016 to generate scientific evidence and data about India’s growing elderly population.

First, and foremost, LASI is India’s first longitudinal study on ageing and the world’s largest longitudinal study.

The International Institute for Population Sciences (IIPS) based in Mumbai is carrying out this study. The first wave of the study was conducted in all states and UTs (except Sikkim) covering 72000 individuals from 43000 households across the country. This survey and study will go back to the same households over 25 years and every 2.5 years, the changes in their physical, health and economic conditions will be recorded.

The international partners on this study are Harvard and University of Southern California (USC) while the India project is financially supported by MoHFW, NIH (US) and UNPA. With this, India joins an elite club of health and retirement studies with 40 countries around the world. In particular, India joins other Asian countries like Korea, Japan, Indonesia and China in undertaking similar studies in their countries. By being part of an international grouping, researchers have access to standardized survey tools and protocols thus allowing for internationally comparable data.

The first wave survey results were released by the health minister on the 6th of Jan, 2021. The survey also captures various social security measures available for elderly, their level of awareness and use among the elderly.

The 2011 census estimated 100M Indians over the age of 60 and this population is expected to be approx. 320M by 2050, accounting for roughly 20% of the total population. While a lot of the focus of the goverment over the last decade has been on youth policies and programs, focused on the opportunities arising from the demographic dividend, this emerging area of research puts much needed focus on the other demographic – older adults – in a scientific manner.

What is a longitudinal study?

Source: BMJ

In a longitudinal study subjects are followed over time with continuous or repeated monitoring of risk factors or health outcomes, or both. Such investigations vary enormously in their size and complexity. At one extreme a large population may be studied over decades.  At the other extreme, some longitudinal studies follow up relatively small groups for a few days or weeks. 

Here is one such example on a comparable study at IISC. The Srinivasapura Ageing Senescence and Cognition (SANSCOG) is an initiative by CBR in collaboration with NIMHANS, Sri Devaraj Urs Medical College, Kolar and other departments of IISc. The project by the Centre for Brain Research at IISC Bangalore is envisioned as a prospective community based cohort study with long term follow-up over many years for comprehensive evaluation of the risk and protective factors associated with cognitive changes due to normal ageing, Alzheimer’s disease and other related disorders. The Srinivaspura taluk in Kolar district of the state of Karnataka is the site of the study. The study cohort (n=10,000) comprising of cognitively healthy individuals without dementia in the age group of 45 years and above will undergo detailed assessments comprising of clinical, neurocognitive, lifestyle, anthropometric,biochemical, genetic and multi-modal neuroimaging measures at baseline and periodic follow up. 

This 2017 archived article by FactorDaily delves deeper into the SANSCOG project but here is an interesting bit of information about how the private sector has contributed to establishing a largely under-funded but important research work.“CBR’s Vijaylakshmi says she got pulled into the project when Kris (Gopalakrishnan) walked into the then IISc director Padmanabhan Balaram’s office in October 2014. He wanted to “do something in neuroscience, particularly ageing”.

She had already raised funding to start brain-related research at IISc with Ratan Tata, an early donor, writing out a cheque for Rs 75 crore in 2014. And then, Kris ponied up Rs 225 crore right after that with just one ask: set up a dedicated brain research centre on the sylvan IISc campus.”

Kris Gopalakrishnan is the co-founder of Infosys, philanthropist and investor.

Why is th LASI study unique and also different?

Most surveys capture secondary and primary information through surveys. The LASI study captures physical, reported (survey) and measured (biomarkers) health conditions of the elderly.

For example, a large number of biomarkers (dry blood spot samples for diabetes and haemoglobin levels, vision test, memory test, grit strength, lung function using spirometry, anthropometric (measurement of human individuals) have been used to study specific health conditions. Here is a quick reference guide to understanding the importance of capturing biomarkers of the population group.

• Dry blood spot tests: The test analyzes specific biochemistry parameters – uric acid, cholesterol, triglycerides, glucose, creatinine – in dried blood samples, using standard laboratory equipment. Source: WHO
• Spirometry tests: Test used to assess how well your lungs work by measuring how much air you inhale, how much you exhale and how quickly you exhale. Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing. Source: Mayo Clinic
• Anthropometric measurements: Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness. These measurements are important because they represent diagnostic criteria for obesity, which significantly increases the risk for conditions such as cardiovascular disease, hypertension, diabetes mellitus, and many more. There is further utility as a measure of nutritional status in children and pregnant women. Additionally, anthropometric measurements can be used as a baseline for physical fitness and to measure the progress of fitness. Source: NCBI

Prof Sekher also mentioned how LASI results can be used by policy makers to make evidence- and data-based decisions on some critical issues (few mentioned below).

• 1/4th of the elderly in BPL receive pensions; 1/4th of widows are also pensioners.
• 1/5th of older adults (45+) are covered by health insurance
• 6% of elderly in India live alone, 9% among women. More people living alone or forced to live alone.
• Increase in ill-treatment and abuse by family members. While the Maintenance and Welfare of Parents and Senior Citizens Act, 2007 (with amendments made in 2019), provides protection to elderly under the law, the awareness of such an Act is very low (20%). You can read more about this Act here – PRS India and MoSJE.

You can see the full 25-min discussion on the topic here.

The study has been covered by various media publications during the course of the week, and links to these articles (along with the headline), are highlighted below.

The Hindu (“Number of India’s elderly to triple by 2050”)

Times of India (“75m Indians above 60 suffer from chronic disease: Survey”)

Hindustan Times (“About 75 million elderly in India suffer from some chronic disease: Health ministry survey”)

Economic Times (“55 per cent Indians above the age of 60 suffer from a chronic disease, shows study”)

India CSR (“Care for India’s Elderly”)

DownToEarth (“Almost 70% senior citizens in India have a chronic illness”)

If you are a researcher with interest in this area, you can also access datasets here with a simple registration.

Edition #7: “Silver Economy: A case for market-based solutions”

Early this year, I planned to compile my research on ageing, and share it publicly. Little did we know how 2020 would turn out but here we are in December, possibly with the worst behind us and hopeful of a less restricted 2021.

I took the second half of the year to further my understanding of the ageing process, eldercare solutions available and in the process, spoke to many elders and their families, and also with entrepreneurs and experts working in the space.

The report – Silver Generation: A case for market-based solutions – captures my learning over the last 18 months.

You can read it here for free: Read Silver Angels Report

If you have any comments or thoughts, you can drop me a line on mahesh@silverangels.in. Feel free to share with your friends and family. Thank you.

Edition #6: “Individuality is a feature, not a bug.”

Sorry for the radio silence. Managing a full-time gig and a passion are difficult. I have moved the newsletter from Mailchimp to Substack as it is seems like a nicer interface.

“I want to retire early and settle into a simpler life.”

“I want to rekindle my passion for writing and also learn to grow my own vegetables.”

You have likely thought about something like this or discussed something to this effect with your partner or friends in the recent past. If yes, this one’s for you.

Most people like to have a career that pays their bills, follow their passion and like to learn new things. For many that make a career out of their passion in creative pursuits like photography, there is also the additional challenge of balancing it with economic gain while continuing to be independent.

The ability to build a career that secures one financially and ability to follow a passion for something fundamentally different is top-of-the-mind for many. I see this equally among peers that are both working professionals and entrepreneurs. A lucky few seem to have figured this out and balance work and passion quite well.

An extended conversation interestingly and always leads to financial security and planning. This may manifest differently for different people and may take the form of financial goals – savings to retire early, money to buy a home, capital to start a business, surplus funds to support causes, medical cover for parents, kids’ education and so on.

A quick and informal survey among a few friends identified a number between 40 and 63 as the age when they are likely to care less about financial goals.

This is quite remarkable considering that multiple generations before had identified 60 to be that magic number to retire and settle into a life of peaceful existence. Here is an interesting read in a previous blog, ‘How old is old?’ by Dr Gita Mathai, a family care expert. It touches upon the perceptions and realities of ageing and how you can understand ageing from the lens of an older person.

Something has changed over the last decade. Many folks do not want to retire and some find the word ‘retirement’ obnoxious.

They however want to be in position to not work for money and stay committed to the pursuit of something more elevated than a job or career. The pursuit of passion lowers its age bar with every new generation, whatever the label you give the latest one. A large measure of pursuit discovery can also be attributed to financial stability of the parents and opportunities available to express oneself in today’s technology-first world. This article by Li Jin about the ‘passion economy’ is a wonderful read and has a line I like the most,

Individuality is a feature, not a bug.

The passion for pursuit and the willingness to contribute to society is also very high among people that have retired after a long career of work. I am yet to meet a person in this artificial category of ‘senior citizens’ that doesn’t have a plan for life, things to do for the day and the desire to explore more of life.

These conversations made me realize my own age-bias, recognize their individuality and also appreciate how the process of ageing affects physical mobility and mental agility.

Maybe the more pertinent question to ask ourselves is our view of age as a number, and decadal indulgence with it.

That brings me to an audience that I call the “in-betweens”.

This generation that saw faster wealth creation, had access to better education, benefited from an open market, curated their professional experiences and likely earn more in a year than the entire pension of their parents. They broadly fall between 35 and 45 years, plus or minus a few years. I belong to it.

At this point, you are likely thinking if am moving towards some solution of sorts. Well, not really. I feel many of us are feeling up the elephant of life blindly without knowing it is an elephant. Digging deeper turned out to be more complex than I thought so I jumped further in.

Thanks to a nudge from a friend, I decided to compile what I learnt, heard or saw. It started by writing/compiling a few pages every week including rough notes, research papers and everything from two years ago. I parked this well organized 250MB data and information gorilla in a folder called ‘Age Report’.

I intend to share it with you shortly. You can call it a white paper or an unscientific research paper or maybe even a market landscape study! In reality, these will be my first-hand experiences, honest conversations with a diverse set of people on the topic, quick surveys among friends, information compiled from media articles, etc. I am solo on this one and have a lot of people to thank but nobody to really apologize, if I screw up!

Signal your interest in the Age Report with a like or a comment. Thank you for reading and appreciate that you have joined this Journey.

Edition #5: Guest post by Dr Gita Mathai and a fun video

People have varying perceptions about ageing.

Speaking to people about ageing, you realize it is very much a personal journey, and so are the views. Some prepare ahead in time and others wait till they feel the first symptoms of feeling old. This 1-minute video by the Center for Ageing Better in the UK does a great job of capturing responses to this simple question among people of different ages.

Over 92% of respondents in the Silver Angels Ageing Survey mentioned they had limited or inadequate information about ageing and response systems for care.

Dr Gita Mathai has been running a family care centre in Vellore for over three decades, is author of the book “Staying Healthy in Modern India” and contributing health columnist in The Telegraph. Outside her professional achievements, she is also a black belt 3rd dan in Karate, a national level swimmer, hammer throw athlete and a regular on the half marathon circuit.

In this guest post, she writes about basic at-home signals you can incorporate in caring for seniors at home.

The Indian population has crossed the 1.1 billion mark and 8% of the population is over the age of 60. People now live longer as they have access to health care, enjoy better nutrition and education. Our average life expectancy is expected to increase from 67.5 years in 2015 to 75.9 years in 2050. To look at this differently, between now and 2050, the 60-plus population will increase by over 300% and by 700% for the 80-plus age group.

The retirement age has remained unchanged and people stop working even though they have healthy and productive years left.

They are ‘active’ yet ’retired’

On the contrary, being a young country, 30% of our population is below the age of 30 years. In this scenario, writing about old age may seem inappropriate as it apparently affects only a minority!

Family and society have a role in caring for the 8% of the population financially, physically and emotionally although

the care economy in India is largely defined by parental care

i.e., time and resources spent towards children. It excludes the time spent by family members in providing care for their ageing dependents. Given that women are looked at as ‘primary caregivers’ in Indian families, it impacts them adversely and, in many cases, limits their continuing pursuit of economic opportunities. Corporate policies towards well-being largely exclude care for parents and other older dependents.

How do I know somebody in my family is ‘getting old’?

Simple cues of everyday activities can be early signals in detecting how the body and mind age over time. Here is a basic checklist to refer at home.

Physical appearance

provides invaluable cues. Older adults should appear clean and well groomed. Failure to bathe, brush teeth or wear clean clothes indicates an inability to keep up with daily routine. This may be due to physical weakness, dementia or just depression.

Fixed routine

If you carefully watch the way they do things around the house, you might find inexplicable illogical changes in the routine. The house may be dirty and housework neglected. Also, they may be absent minded, like leaving things on the stove and forgetting about it. These are danger signals indicating that care is required.

Lighting in the house

It should be bright especially in hallways and bathrooms. Narrow staircases and slippery front steps are also difficult to navigate. Bannisters are essential. Indian style toilets are difficult to use if there is arthritis. Supporting bars need to be embedded near the toilet and bathing areas. Otherwise the chances of accidental falls and fractures are greater.

Good nutrition

It is essential for immunity (to prevent diseases), muscle mass (for strength to prevent falls). A balanced diet boosts immunity and helps withstand disease and recover rapidly if illness strikes. Older adults often suffer from malnutrition even when they can financially afford an adequate diet. They may be unable to go to the market and purchase the materials required. Fresh fruits and vegetables may be difficult to obtain regularly. Cooking may be troublesome, time consuming or they may be physically unable to do it. Medications, illness or a recent hospitalization may dull taste and reduce the appetite. Diet restrictions due to diseases (salt, sugar, oil, fluid and spice) may make the food unpalatable, unappetizing and inadvertently limit intake. Social isolation and depression can also make people eat less. Nutrition can be monitored by keeping an eye an eye on the weight, the turgor and quality of the skin, hair and nails. Meals (at least once a day), if necessary, now can be arranged from outside.

Memory lapses

We all have memory lapses and with age these are greater and more frequent. Glasses and keys may be constantly misplaced. Memory loss is abnormal if it extends to names of close relatives (children, grandchildren, nieces and nephews), the route to the neighbourhood shop or involves dosages of regular medications. At that point medical evaluation is required.

Lifestyle, chronic diseases occur with aging. It is important that all medical details and prescriptions be neatly filed chronologically. This should then be placed in an accessible place. Medical check-ups and doctor visits should be regular and scheduled. Medical containers should be neatly labelled. If tablets are in strips, the person should be able to distinguish one medicine from another. Some look very alike (calcium tablets and metformin) and it is possible to make disastrous life-threatening mistakes.

Hearing and eyesight

should be checked regularly and timely corrective measures taken. Hearing loss and partial loss of eyesight leads to dependency, feelings of social isolation accidents and falls. Cataract surgery and hearing aids (if required) often are lifesavers.

Sleep disturbances

are common in older adults. In some it may be because of Alzheimer’s, or dementia when the sleep-wake cycle is disturbed leading to daytime drowsiness and night-time restlessness. In many it may be a side effect of medications, snoring (obstructive sleep apnea), restless legs or just depression.

Good sleep can be promoted with

• Exposure to a few hours of bright sunlight in the morning
• Not taking caffeine (tea coffee) after 1 pm.
• Adjusting medication with the help of the doctor so that any tablets with a stimulatory effect are taken in the morning.
• Avoid sleeping tablets as they are habit forming and cause confusion.
• Daytime sleep should be avoided at all costs. No one can sleep for more than 6-7 hours a day. If this quota is used up during the day, night sleep will be affected.
• Medically treat any diseases that might interfere with good restful sleep.
• Immunizations should be up-to-date. At the age of 60 years, people need a dose of pneumococcal vaccine to prevent development of silent and often fatal pneumococcal pneumonia. Flu vaccine should be given every year.
• Physical activity for at least an hour a day should be encouraged. Walking will help with appetite, lifestyle diseases, balance coordination, depression, dementia and sleep disturbances. It will also entail some social interaction as they will meet other walkers.

A little extra effort on the part of children and caretakers will pay off in the long run to make old age hassle free for everyone, both the elderly person and the younger adult.

Edition #4: How safety decides the place we live

How many of you have thought about safety as an important factor in deciding your place of living?

Is the city safe?

Is the neighbourhood safe?

Is it safe for my kids?

Is it safe for my parents?

Is it safe at night?

Is it worth relocating to an unsafe city?

These are questions we ask for ourselves and our families that live away from us.

In most cases, the eventual decision of your place of residence is made basis word-of-mouth experiences, convenience, anecdotal data and how well you are convinced by the builder or the broker. And, of course the budget and affordability. While finding a place has become easier with online sites and social media groups (like “flats with no brokers”), there is very little information to actually know if the place is ‘safe’. Much of this is also due to lack of accessible information at a neighbourhood level.

At a global level, the Economist publishes the annual Safe Cities Index that ranks 60 countries worldwide on multi-faced indicators like digital, infrastructure, health and personal security. If you are curious, New Delhi and Mumbai were ranked 45 and 51 while Tokyo and Singapore topped the global rankings. I am sure many are thinking, this is an American magazine, and they do not understand India. Be that as it may, this is one way to think of it, and moreover, we love rankings in this country.

The Annual Survey of India’s City Systems (ASICS) by Janaagraha, a Bangalore-based non-profit, provides independent benchmarking of Indian cities with a focus on quality of living. Smaller initiatives like Safecity were started with a focus on ‘making cities safer by encouraging equal access to public spaces for everyone especially women’, due to increasing sexual violence against women.

The HelpAge report, “Ageing and the city: making urban spaces work for older people” is a highly recommended read. It highlights systematic social, economic and spatial marginalisation and exclusion of older persons in cities, and how this is impacting their lives. HelpAge India, setup in India in 1978, offers a suite of welfare and development programs catering to elders in multiple states in India.

For many of us that live in an urban environment, safety of the family is largely associated with controlled spaces and secondary support structures like good neighbours and reliable services.

Real estate players have captured this need and today offer safe gated communities with a suite of accessible services for all age groups. Senior housing and assisted living communities are on the rise however, these affect only a few due to the nature of these projects (controlled spaces, away from cities and expensive) whereas the majority of seniors reside and navigate cities independently, and with the support of family. A lot of elders that I speak to mention how they wish to live in the same house till their last years as there is

a certain familiarity and routine associated with it, something they are unwilling to trade for higher quality of living unless it is the only option.

They like to live safely within a city.

Regardless of where they chose to live, we could make it dignified, joyful and fun for them. That is exactly what a bunch of people are doing across India.

The Senior Citizens’ Group of Besant Nagar in Chennai is an informal network of elders that share Gandhian values. They organize among themselves to make the society better for everybody.

The Silver Surfers Club in Bangalore has a created an array of programs for people over 55 to live an active, fulfilling and dignified life. This bunch loves to party and travel.

The Adhata Trust based started by Arun Nanda of the Mahindra Group, launched its 10th community center in Mumbai with a focus on ensuring psychosocial welfare of senior citizens.

The Samarth community based in Delhi has a mission to bring peace of mind to elderly and their families in India.

You may have also read this news article about how five high school girls won a global contest for developing a mobile app to connect senior citizens and their children.

These are just some initiatives that give you a glimpse of the work that is happening around you. With a little effort, you will find many more of these in your own neighborhoods and parks.

Edition #3: Age as a number, Whipple index and age heaping among the old

What happens when you are 90 years old?

People in their 90s tend to give their age in rounded figures, usually the closest multiple of five, i.e., 95 or 100. There is even a term for it – age heaping – adding more years to your age. The 2011 Indian census identified 6 lakh centenarians but less than a lakh that were 95. The Whipple’s Index is used by the UN to account for age heaping.

I recall a visit to a village in Jharkhand where I met a very old woman, and when I asked folks her age, one guy said she was 125 and everybody around nodded. On my next visit, I asked the same question. Another guy said she was around 80. I doubt the old lady was counting or aware of this conversation.

Perception of age starts with the first birthday when your family celebrates you, and you really aren’t aware. You then celebrate the many wonderful years with your friends in school, college and work. In the process of growing up (not ageing yet), you also become eligible to do responsible adult things.

You can seek employment at 14.

You can vote and drive at 18.

You can drink in Andhra Pradesh at 18. If you are in Delhi, you will have to wait 7 more years.

You can be an elected Member of the Parliament at 25. But you need to be 35 and wiser to be the President.

Over time, age becomes a number that we love to indulge and more so when it comes with decadal tones. Life gets benchmarked to 100 and we race towards it grudgingly.

Thirty and officially old.

Big four-O.

Fifty. The half-way mark.

Silver sixty.

Golden eighty.

Centenarian.

When you dig deeper, something interesting emerges.

I read this 2014 article, “Why I Hope to Die at 75” by Ezekiel J. Emanuel in The Atlantic, early this week. Ezekiel is a successful oncologist and a controversial figure, and this article is provocative if nothing else. I discussed this article with my dad who had just come back from spending time with my grandmother who is 95 (or thereabouts), is severely limited by mobility, lost much of her memory, and supported by her sons in their early to late 70s and a hired care worker. We discussed human mortality, perceptions of death among his peer group, life after death and even euthanasia. Any conversation about death (=expected end number of ageing),

somehow turns philosophical and spiritual.

What amazed me is the ease with which he had an open conversation about it.

On the other hand, my mom turns 70 in a few days. She never really cared about her birthday, and said, we remind her of her age by wishing her every year and then she forgets it. Until her retirement from a full-time job, she only counted her age by the years left to retire so she can get a pension. She is very good with numbers and has quite a memory.

She has always counted years pegged to a milestone

– my brother’s graduation, a family trip, the wedding of my dad’s last sister and so on – almost to the precise date and details leading up to it. In many ways, she is disengaged from the broader conversation around ageing, and the number game.

The third conversation with an academic was around quality of life (QoL)

among general population. I was told researchers studying ageing generally look at four broad domains – physical, psychological, social and environment – when looking at QoL standards. Various studies have been conducted on this, and across various cross-sections and demographic groups (adults, adolescents, elderly, women, etc.) to understand perceptions using structured surveys. For example, a study by Indian researchers points to education, wealth and family support as good predictors of higher QoL among the elderly.

Across these studies, and in general literature, you would notice adjectives like happy, joyful and successful associated with ‘ageing’.

Edition #2: Emergence of the older adult population

Jobs. Youth. Growth.

You cannot possibly miss these words in today’s India. Everything else (health, education, skills, investments, innovation, technology) folds into this meta narrative. Elections are likely won, and lost, on these promises.

Here is an April 2019 post from Dr Shamika Ravi, a member of the Economic Advisory Council to the Prime Minister of India.

The article is about jobs in the context of ease of business environment in states, pre-demonetization and GST rollout.

• Dynamic states are defined by ease of business environment -> They tend to have lower unemployment.
• Progressive states are defined by better human development indicators -> This doesn’t necessarily mean they are job creators.

A recent article in India Spend, a platform that analyses open data to inform policy and governance, talks about India’s demographic dividend and how the national narrative varies when it comes to states. Let us look at this a bit closely.

67 out of 100 persons in India are currently in the working age population (15 to 59 years). The rest are considered dependents.

Right now, India has a low dependency ratio and this positively correlates to higher economic growth. The working age population will continue to increase till 2031, and stay stable until 2041.

All else given, a higher working age population is suitable for high economic growth and allows us as a nation to reap (economic) benefit from the (demographic) dividend.

This is only half the story. Why?

The fertility rates are falling in Tamil Nadu, New Delhi, Andhra Pradesh, Telangana, Gujarat, Punjab and West Bengal. Moreover, in these states, the fertility rates are lower than replacement rates. Their window of opportunity from the demographic dividend will close by 2021.

For a second group of states that include Karnataka, Odisha, Himachal Pradesh, Maharashtra, Assam, J&K, Uttarakhand, Haryana, it will start closing in 2031.

States where the window of opportunity is closing have to prepare themselves for an emerging demographic – people over 60 years – commonly referred as ‘senior citizens’.

Ageing India

The number of senior citizens stands at 100 million plus today, and expected to rise to rise to 350 million by 2050. Southern states (along with Punjab and HP) show faster growth of this demographic. These are also states with human development indicators above the national average.

Longevity, i.e., average life of general population, is expected to rise from 67.5 years in 2015 to 75.9 years in 2050, and this is a key reason why the ‘ageing population bulge’ is inevitable.

Looking back into the census 2011 household data, one can see early warning signals from the changing family patterns.

What does this mean?

• Joint family systems are breaking down due to economic migration (rural-urban, urban-urban) and other factors.
• Seniors are increasingly living by themselves, and dependent on secondary support structures.
• Loneliness and lack of companionship are aspects that come out strongly from multiple studies by UNFPA, HelpAge, AgeWell and other non-profits working on senior care.
• The country is under-prepared to meet the needs of this hidden demographic. Meeting healthcare needs is only one aspect.
• The senior care ecosystem in itself presents an area of opportunity for investment, jobs and innovation.

Edition #1: Launch on Substack

The newsletter captures news and stories from Silver Economy in India, with particular focus on the longevity economy, ageing journeys and senior care ecosystem in India. Businesses, brands, startups, researchers and analysts following this space are likely to find it interesting.

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