Old Age Homes to Branded Senior Care

Edition #14: Shifting the conversation around ageing, dignity and care.

Thanks for reading! The conventional ‘old-age home’ model is evolving into various senior living and care formats. In this newsletter, we look at key developments shaping this transition in the following two sections.



Now, let’s dive in!


The senior care ecosystem in India is undergoing a shift and so is the language around ageing and care. In this section, we look at how conventional ‘old age homes’ are likely to give way to regulated, branded, standarised and specialized formats of care.

HelpAge estimates that India has 1279 old age homes split between paid, free and mixed models, and also those that provide medical care and are exclusive to women.

Their 2019 report on homecare highlights the acute shortage of infrastructure, geriatric care facilities and trained manpower, and in particular number of beds per hospital at the district-level.

According to M H Dalal, Founder and Chairman of the Association of Senior Living in India (ASLI), the broader senior living market is split into eight different formats (illustration provided below). He also articulates the need for regulation to keep in mind the different formats of care as is the case in globally evolved markets, and that the same facility may offer more than one format.

In this LinkedIn post, Pankaj Mehrotra, a consultant on senior living and elder care services, identifies four broad formats and multiple sub-formats within the senior living space.

Our Take: The elder care and senior care market in largely urban areas, while still nascent, has the potential to in the next couple of years thanks likely to an enabling ecosystem. We could also see a rise in both government and private sector models (and likely PPP, similar to skill development) emerging in rural and peri-urban centres to fulfill the demand. States like Kerala with a larger proportion of older adults are already seeing a substantial increase in number of applications for old age homes.

In the short-term, the major challenges continue to be India’s low spend on senior citizen specific schemes and programs (estimated at 0.038% of GDP), lack of interest among philanthropy/CSR (vis-a-vis education, health, livelihood and other programs), limited research on ageing and data inadequecy, low awareness about ageing and implications of longer lifespans on society, and, limited availability of private and impact capital for market-driven models. With certain policy changes and enabling provisions, the government has shown its intention to reform this sector.

The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019 in PRS India website

Our Take: The bill, introduced in the Parliament in 2019, replaces the term ‘old age homes’ with more suitable language (senior citizens care homesmulti-service day care centres) along with provisions for minimum standards for food, infrastructure, medical facilities, recreation, staff, safety and security, and other aspects. Similarly, the bill also introduces requirement of registration and basic standards for home care services,makes it mandatory for healthcare facilities (hospitals) to provide relevant facilities for senior citizens and codifies police protection at a station-level. Given the low number of such government run homes (482 in 2019), the bill allows for care homes to be setup by the central or state government, or any other organization. With the passing of the bill and subsequent notification of the Act, it will bring existing and new elder and senior care service providers under the ambit of the law while ensuring basic standards and safeguards.

India to require 9 lakh beds for elderly by 2027 against 97,000 by Chittaranjan Tembhekar in Times of India

Our Take: A 2018 report prepared by Tata Trusts, UNPF and Samarth estimated that India would need 9 lakh beds by 2017, three times the availability, extended across both care homes and living facilities to meet the demands of elders. Basis a sample set of 480+ old-age homes and 60+ senior-living developments in India cutting across geographies, size, cost, facilities, ownership and management, the study identified 5 key result areas (infrastructure, management of facilities, dignity and respect, safety and security and physical needs) and 28 performance metrics to ensure comprehensive, measurable and practical standards. These and other recommendations could play a key role in shaping both infra-led and ageing-in-place care for elders.

Retirement home guidelines are finally here by Meera Siva in The Hindu

Our Take: A Moneylife-HDFC study in 2019 found that around 65% of senior citizens living in such facilities did not sign a contractual agreement on the services and their rights, and 100% of them wanted to see regulation of retirement homes. Considering these inputs, the government, in 2019 recognized retirement homes as a separate asset class thus making such developments subject to the Real Estate (Regulation and Development) Act, 2016. Further, the government also published a well put laid out model guidelines for development and regulation of retirement care homes including service standards for various facilities (medical, fitness, security, etc). The report has an excellent comparative of the two payment options (lease/deposit, ownership) prevelant in senior housing models, advantages and their disadvantages.


Emerging models, new initiatives and best practices that influence or drive the Silver Economy.

Senior Housing search tool by Samarth

Goto and look for a senior living facility or old age home for you or your family. It is a easy-to-use tool and they advise users to make personal enquiries upon locating a facility.

Sukh Dukh Helpline by Pallium India in partnership with MIND India, Caregiver Saathi and Edjacklegs.


HUL and Portea partner to drive Mission Hope in Delhi and Bengaluru


All of us likely read about the unfortunate death of a 30-year old woman from Kerala, in Israel recently. Here are four stories picked up from mainstream newspapers and magazines, and the parts marked in yellow refer to her occupation in these articles.

This difference in reference also highlights the general lack of awareness of the differences between various jobs (domestic help, caretaker, caregiver, nursing attendant, etc) and activities involved in providing (elder) care.

Stay Safe.

Thoughts, feedback, questions?

Want to share your work or interesting articles? Feel free to reach out at any time via email:

Silver Angels is an independent platform tracking the Silver Economy in India. No advertising or sponsorship.


Rise in Teleconsultation and Digital Adoption Among Elders

Edition #13: Hybrid care models, active ageing programs and silver superstars

Thanks for reading! In this newsletter, we will focus on how elder care organizations and programs have adapted to the needs of elders as a result of the pandemic. It has three sections.




And a special section, Silver Super Stars! Now, let’s dive in!


Articles from mainstream newspapers and magazines that touch upon the Silver Economy in India, and our short take.

Reinventing healthcare delivery with telemedicine, by Practo and the Telemedicine Society of India (TSI)

Our Take: The report captures only those people that used Practo’s service between the first wave (March to Nov 2020), and noticed an over 500% rise in consultations among people over 50, making them a significant customer base. The same report also identified a rise in online mental health consultations and queries. You can also read this article about the potential role of telemedicine in the broader ehealth space, triggered by the Telemedicine Practice Guidelines issues by the Government in March 2020.

Training and help are now virtual for dementia caregivers by Swati Sanyal Tarafdar in the Hindu Business Line

Our Take: This article reaches out to caregivers of dementia patients, and how online videos and programs are substituting physical meetings. It also highlights a set of online resources from NIMHANS and Alzheimer’s and Related Disorders Society of India (ARDSI) and others, that may be useful for those seeking more information and training. A large part of the last newsletter was focused on caregiving and caregivers, in case that is of interest.

How this senior care organisation is catering to the physical and mental health of the elderly living at home by Anju Ann Mathew in YourStory

Our Take: Having been setup in 2013, Samvedna Senior Care, a women-led social enterprise in the NCR, today offers 360-degree holistic care management including dementia care. Apart from support in making medication available on time, Samvedna has seen a rise in teleconsultation and mental health support, and is building various programs to support elders and their families.


People and models that influence or drive the Silver Economy, and their journeys.

We highlight three interesting models that have emerged in the recent past.

Post Covid Rehab Program in Bangalore, by Kites Senior Care

Dedicated Covid Care Centre (CCC) in Gurgaon by Emoha Eldercare

Counselling Helpline by Samvedna Senior Care

Organizations like Elders FirstAge Ventures and Vardaan provide a range of services and care for elders. For example, Vardaan Senior Care offers both short- and long-term rehabilitation options for elders in their facility.


We highlight some active ageing programs – online learning, social clubs, discussion forums and much more – focused on older adults.

Silver Talkies is hosting this free online event on the secret of Japanese longevity. You can register by clicking here.

Silver Talkies is an online magazine and social engagement platform for 55+. For more information, visit

Seenage.Life is hosting this interesting session on living a medicine-free and disease-free life. You can register by clicking here.

Card image

Seenage Life is a platform for senior citizens to engage with each other, the community and businesses and enables them to lead productive and fulfilled lives. For more information, visit

GetSetUp India is hosting a course on Zoom for Beginners scheduled on May 10th may be quite useful for a lot of them to connect, interact and join online events.

GetSetUp India is an online community of seniors who want to keep learning, connecting and explore. For a day-wuse course schedule, visit

Seniors Today has a webinar section where one can access recorded sessions, largely around health & wellness.

Seniors Today will contain feature-length articles and columns on topics such as travel, entertainment, shopping, dining, health and wellness, and much more. For more information, visit


As a parting note, here is an amazing story by Zubeda Hamid in The Hindu on the rise in older adults in the media and entertainment industry

Saroja. Janaki. Naresh. Micky Singh. Dr Verma. Dinesh Mohan. SN Bhatt.

You know what is common among them all?

They are all professional actors and models in their own right, be it television commercials, movies or print ads. Some of them like Micky Singh, homemaker turned actor at 59, have explored new careers, while others, like Dr Raja Ravi Verma, doctor turned actor and singer at 60, have rekindled their life-long passion. For 78-year-old Janaki Jayaraman, an actor in commercial ads and somebody that lost her husband in 2010, this second career has also given her financial independence.

While silver generation as leads in advertising is (re)emerging, marketers are also capturing mindshare of this important segment for their purchasing power.

Age is just a number.

Stay Safe.

Thoughts, feedback, questions?

Want to share your work or interesting articles? Feel free to reach out at any time via email:

Silver Angels is an independent platform tracking the Silver Economy in India. No advertising or sponsorship.


The Elder+Care Market in India

Edition #12: Caregiving, Caregivers and the Sandwich Generation

Thanks for reading! In this newsletter, we will focus on various aspects of the eldercare economy, and in particular, the rise in caregiving triggered by the pandemic. This newsletter has three sections.




Now, let’s dive in!


Articles from mainstream newspapers and magazines that touch upon the Silver Economy in India, and our short take.

How Eldercare Market Is Evolving In 2021 by Aditya Rangroo & Smita Mehta in The Entrepreneur

Our Take: The (urban) eldercare market has broadly two kinds of customers – older adults and younger family members. Older adults are mostly 55 and above, and depending on their individualized needs, the support sought could be very basic (to support daily living needs) to one that is more holistic, integrated and specialized. Younger members are largely folks that have at least one older adult in the house or family that needs support.

  • Member subscriptions and custom plans are usually the way such services are offered by companies in this space.
    Fixed Plans: Flexible and transparent membership plans that offer a clear rate card and services. Examples are ElderAid in Bengaluru, Ahmedabad and Kochi, Alserv in Chennai, Emoha Eldercare in Delhi NCR (and pan-India), Anvayaa in Hyderabad (and multiple locations) and Samarth Eldercare in Delhi (and multiple locations). Additional services, where sought, are charged additionally provided they are able to deliver such services in the locations.
    Custom Plans: Larger organizations like PorteaCare24HCAH and Nightingale Eldercare provide toll free numbers to setup consultations as a way to structure more personalized plans given the range of services offered by them is fairly extensive.
  • The common delivery model is to assign a care manager/service executive to assist with customer needs, and layer it by integrating technology solutions (website, app, etc).
  • While some of the large organizations have in-house training and employees on roll, most of them use an extended network of care providers (hospitals, labs, grocery chains, etc) and skilled personnel (caregivers, house safety and repair technicians, etc) to deliver care.

Time to Care: Unpaid Care Work in India, Oxfam Report (India Supplement)

Our Take: Care work covers a broad-spectrum (including childcare, eldercare, familycare, etc) and much of it is unpaid or low wage, and exists in informal systems. Given that women are the majority primary caregivers across the care spectrum, there is a disproportional impact on the quality of their lives reinforcing gender inequality in care work. Oxfam’s India-specific supplement captures this reality, and also highlights how time forms a conceptual point of assessing impacts of unpaid care work and stresses the importance of capturing time-use data, which is not part of national statistical systems anymore. You may also refer to these articles for more insights.

Why India’s middle-aged are the new sandwich generation? by Chandrika Radhakrishnan in Silver Talkies

Our Take: The article focuses on the sandwich generation, and how middle-aged folks and mostly women are playing a dual role as primary caregivers, managing the needs of the young and the old in their families, in addition to their professional lives. The article highlights the importance of sharing the load of caregiving among other members of the family. You may also read this linked article on caregiver burnout on how continuous caregiving may also result in both physical and emotional strain on the caregivers.

Covid19: Increased demand for 24*7 caregivers by Subhankar Chowdhury in The Telegraph and Atal Vayo Abhyuday Yojana: Government to create pool of caregivers for elderly citizens in New Indian Express

Our Take: As mentioned, in the last newsletter, ageing-in-place services are seeing a fair bit of traction with existing players expanding to new locations and new organizations emerging in non-metropolitan areas, likely attributed to demand for such services due to the impact of the pandemic on elderly. Given rural areas account for over 70% of population over 60, programs by Government and non-profits will continue to fill this gap until business models evolve to cater to this largely underserved populations.

Companies help men get back to work after break by Namrata Singh in Times of India

Our Take: Beyond the clickbaity headline, it captures a more positive development among corporates to recognize the importance of care work through specialized programs. Deutsche Bank’s ‘Return to Work’, UBS India’s ‘Career Comeback Program’ and John Deere’s REAP programs have seen increased participation of women coming back to work after career breaks although the number of men is less than ten across these programs. This re-emphasizes the gender disparity inherent in all sections of society and the need for corporates to do much more to create equal opportunities and career pathways. On a much broader note, India’s female labour workforce participation rate has worryingly dropped over the past decade.


People that influence or drive the Silver Economy, and their journeys.

Bhavana Issar: Breaking barriers for Family Caregivers on the NASDAQ website. Bhavana is the founder of Caregiver Saathi™, a social enterprise that is building a unique model centred around the primary caregiver and the care-receiver/patient. You can read more about her journey and the challeges along the way.


Stories of startups, growth plans and new launches/initiatives.

This agetech startup from India wants to be synonymous with ‘khyaal’ or holistic care for the elderly by Tenzin Pema & Shreya Ganguly in Yourstory

SenCiCare a startup for senior citizens now in Rourkela in India CSR Network

🎃 Pill Box

While pill boxes today are not on the endangered species list, they are less common for one reason: People tend to forget to take, or forget whether they have already taken, their daily meds. Drug companies were quick to notice this and came up with pill counters and weekly “SMTWTFS” pill schedulers, which are good not only for patients but also for drug companies. A pill not taken is a pill not sold. And no one has ever bothered to make these plastic counters works of art.

This History of Pill Boxes:

Anybody up for a Pill Box Design Challenge?

Stay Safe.

Thoughts, feedback, questions?

Want to share your work? Feel free to reach out at any time via email:

Silver Angels is an independent platform tracking the Silver Economy in India. No advertising or sponsorship.


Senior Care Start-up Fund in India

Edition #11: Ageism, care infrastructure, entrepreneurship, advertising and jobs

Thanks for reading and subscribing to the Silver Angels Newsletter. I cover news focused on the Silver Economy spanning research, media, entrepreneurship and impact. This newsletter has three sections.


·         NOTICED

·         IMPACT

And an EXTRA! JOBS! section highlighting a few jobs in this emerging sector.

Now, let’s dive in!


In this section, we will present articles from mainstream newspapers and magazines that touch upon the Silver Economy in India, and our short take.

Senior Care Ageing Growth Engine (SAGE) start-up fund in India

Our Take: The Ministry of Social Justice and Empowerment, through an empowered expert committee, organized a consultation with prominent investors and practitioners in the eldercare space, on the 12th of April, 2021. The fund, estimated to be around INR 100 Crores initially, is the first-of-its kind in India, and has the potential to catalyze entrepreneurial activity and bring much needed capital and support. This initiative also opens up two potential opportunities – (a) more private capital for businesses with growth plans, and, (b) a supportive and enabling ecosystem that includes mentoring, incubation and business support for early-stage businesses.

It would also be interesting to see efforts towards creating and supporting older entrepreneuers, and if one were to go by inspirational stories from India, here is one about Captain C P Krishnan Nair starting Leela hotels in his 60s, and turning it into a world class luxury chain.

Making the world more elderly friendly by Harish Bijoor in the New Indian Express

Our Take: Harish Bijoor is a brand specialist and makes a case for India to be a leader in eldercare management, and goes on to propose an elderly audit on businesses, infrastructure and societal attitude (ageism) to address the deficiencies in the way we engage with the elderly. Branding specialists and advertisers can massively shift the narrative (and language) around older adults, and in particular elders, given the influence their work has on the general population. For example, this article by a communications consultant identifies advertising campaigns that have seniors as actors in them.

Senior Living is a Young Market by Rishi Ranjan Kala in Financial Express

Our Take: This article provides a glimpse into the opportunities in the senior living market with inputs from key players like Columbia Pacific, Antara, Ashiana and Anarock Consultants. For those that are not aware, the Association for Senior Living in India (ASLI) is an independent entity founded in 2011, to create a model for self-regulation and work with government to ensure minimum standards for operational excellence. With active regulation, guidelines and universal care standards, this sector can bring more high-quality players to meet the rising demand for senior, assisted and care facilities.

Care economy: Why India must recognise and invest in care work by Mitali Nikore in the Indian Express

Our Take: While the care economy is an all-encompassing definition of all types of care (childcare, eldercare, specialized care, etc.), the article refers to provisions in the American Jobs Plan towards investments (and not as expenditure) in developing a care economy infrastructure. The formalization of the care economy through systematic investments could not just result in more jobs but also more gender-inclusive growth given much of the care work (informal, semi-formal and formal) is performed by women.

Healthy ageing was never so attractive by Vibha Varshney in Down to Earth magazine

Our Take: The article touches upon the vaccination drive underway and the challenges faced by elderly, and why a door-to-door vaccination drive may be more effective.


In this section we will cover the people that influence or drive the Silver Economy, and their achievements.

Ambi Parameswaran, a senior marketing and advertising executive, is now a brand coach, author and thought leader. He was also one of the earliest to write about the silver generation, and the opportunities for brands and businesses to tap into this population segment.

Check out his conversation (audio-only) with Rutu Mody-Kamdar on HT Smartcast:

Also check out this article about brands using seniors as leads in their advertisements.


In the impact series, we will profile entrepreneurs, organizations, innovative solutions, and their impact.

Seniors Have Talent – Season 4 by Seniors Today, a digital community for seniors.

You can register here if you are over 60 years of age:

The first episode (Round 1, Group A) of ‘Seniors Today Seniors Have Talent Season 4’ will commence on May 9, 2021, and will be aired on Zoom and Facebook Live.


Some open positions in this sector.

  • Sales Manager at Elder Aid Wellness, LinkedIn.
  • Interior Designer at Aaji Care. For the new Elder Care Centre in Andheri, Mumbai. Reach out to Prasad Bhide on LinkedIn.
  • Sales and Marketing Specialist at Elders First, LinkedIn.

Thoughts, feedback, questions?

Want to share your work?

Feel free to reach out or share your work via email:

Disclaimer: Silver Angels is an independent platform tracking the Silver Economy in India. No advertising or sponsorship involved.


Ageing in Place services are gaining traction

Edition #10: Doubling down on vaccination drives to understand mental health and wellbeing of elderly

Thanks for reading and subscribing to the Silver Angels Newsletter. I cover news focused on the Silver Economy, with a focus on research, media, entrepreneurship and impact. This newsletter has three sections.


·         NOTICED

·         IMPACT

And an EXTRA! SOCIAL! Section. Now, let’s dive in!


In this section, we will present articles from mainstream newspapers and magazines that touch upon the Silver Economy in India, and our short take.

How Covid-19 has changed the lives of the elderly by Sandipan Roy in the Mint (HT)

Our Take: The Covid-19 pandemic has affected elderly disproportionately as it has created both social isolation and disconnectedness, and impacted their daily routines and mental health. The researchers of this longitutindal study by the Government of Tamil Nadu and J-PAL reached out to ~5000 adults over 55 years of age, to generate insights on the impact of the pandemic on the elderly, and observed that feelings of loneliness and depression rose between the months of April and July 2020. The vaccination drives, which bring the elderly out at least twice to a medical facility, is a good opportunity for eldercare organizations to directly engage with the elderly in understanding more substantive issues.

Market trends and challenges associated with senior care, an interview with Atul Jagadish of Alserv in the ET World.

Our Take: While a lot of focus in the eldercare space has been towards senior housing and other infra-related projects, older adults and their families today are more open to exploring secondary support systems for at-home or ageing-in-place. With Chennai as the pilot market, Alserv has identified five broad categories to focus in their efforts to provide holistic support for seniors.

Genesis Rehabilitation partners Healthcare at Home to boost eldercare services in the Mint (HT)

Our Take: The professionalization of home care services is expanding to include more clinical care services, including for specific ailments and conditions (stroke rehabilitation, diabetes, post-operative care, drug administration, etc), and this partnership promises more holistic care with a combination of virtual wellness and home care efforts.

Ashok Soota to invest ₹200 crore in research on ageing, neuro health in The Hindu

Our Take: Split equally for partner and in-house projects under the newly formed SKAN Trust, this is one of the largest grants in the broader ageing space in India. The other significant contribution being the Rs 220-crore research grant by Kris Gopalakrishnan, towards brain research and ageing-related studies. While both are research-centric, there continues to be limited philanthropic and impact capital available for #SilverEconomy entrepreneurs in India.

Technology, Ageing and Longevity by Sofiat Akinola of the World Economic Forum

Our Take: While the article provides a global outlook, it is insightful and touches upon some key areas where technology could play a positive role for seniors. Of particular interest was the idea of precision care, which combines the skill of caretakers and the power of data for the well-being of elderly citizens who need care. While technology use, and particularly data privacy, is a contentious topic, it cannot be wished away given the ubiquitousness of smart phones in all our lives.


In this section we will cover the people that drive the Silver Economy, and their achievements.

HelpAge India is the winner of the 2020 United Nations Population Award in the Institutional category, a prestigious global recognition for an organization that has been a pioneer in serving the elderly for over four decades now. The award was announced in Nov’ 2020.


In the impact series, we will profile entrepreneurs, organizations, innovative solutions, and their impact.

Elder First launches a senior co-living space in Gurgaon.


Social media engagement will play a critical role in learning, collaborating and building general awareness about the #SilverEconomy.

Check out this LinkedIn thread started by Ankur Gupta, JMD at Ashiana Housing, and responses on how we can differentiate senior living facilities from care homes.

You can also notice emergence of quick polls on social media, and while it helps to gain insights, you may want to be aware of the role of confirmation bias in such polls.

Thoughts, feedback, questions?

Want to share your work?

Feel free to reach out at any time via email:

Disclaimer: Silver Angels is an independent platform tracking the Silver Economy in India. No advertising or sponsorship involved.


Silver Angels Newsletter gets a facelift

Edition #9: Capturing news, events, celebrations from across India.

Welcome to April 2021! I am attempting a new format this week, with three sections.


·         NOTICED

·         IMPACT

And now, let’s dive in!


In this section we share articles from mainstream newspapers and magazines that touch upon the Silver Economy in India.

‘Second innings’: India’s new-age seniors splurge on themselves, drive growth of silver economy by Smitha Verma at the New Indian Express

Our Take: One of the most comprehensive coverage on the emerging #SilverEconomy, this article covers a lot of ground, from ventures in agetech to companionship services to care facilities and senior-friendly forums and e-commerce websites.

Old Money by Lhendup G Bhatia at the Open Magazine.

Our Take: An interesting take on how businesses, startups and advertisers are recognizing the purchasing power of a ‘largely ignored demography’, elders, particularly accelerated by the pandemic.

Exorbitant health insurance premiums take a toll on senior citizens by Mahavir Chopra in Money Control.

Our Take: The author, Mahavir Chopra, is also the founder of, an independent consumer awareness platform for insurance. His insights of being a senior executive and leader in the insurance space, are both insightful and enriching. Check out the new ratings feature on their website and they even have a forum for you to ask questions to experts.

Do the right thing by Neha Sinha in the Daily Pioneer.

Our Take: A dementia specialist and Founder-CEO of Epoch Elder Care, Neha Sinha brings a first-hand understanding of the eldercare space. In this article, she writes about the various formats of elder care facilities. A must read if you are looking at options for yourself or your family members.


In this section we will cover the people that drive the Silver Economy, and their achievements.

Kites Elder Care wins the Centre of Excellence Award for 2021 in the Deccan Herald Healing Hands initiative. As many as 44 doctors and hospitals were felicitated for their efforts to help Covid patients during the pandemic.

Elder Aid is a winner of the 2020 DBS Foundation Social Enterprise Grant Programme. Being one among 14 global winners, and one of only two Indian winners, it is a recognition of the perseverance of the team and the importance of this space.


In the impact series, we will profile entrepreneurs, organizations, innovative solutions, and their impact.

Aaji Care launches first-of-its-kind home geriatric counseling in Mumbai.

Thoughts, feedback, questions?

Want to share your work?

Feel free to reach out at any time via email:

Disclaimer: Silver Angels is an independent platform tracking the Silver Economy in India. No advertising or sponsorship involved.


Longitudinal Study on Ageing in India (LASI)

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.


[Announcement] Launch of Silver Angels Report

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 Feel free to share with your friends and family. Thank you.


Age Report

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.


How old is old?

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.
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.