Ageing in India: Care, Support and Emerging Challenges for Older Adults: A Critical Narrative Review
Irin Das *
Department of Human Development and Family Studies, College of Community Science, Odisha University of Agriculture and Technology, Bhubaneswar, India.
Nilotpal Saikia
Department of Community Medicine, Jorhat Medical College and Hospital, Jorhat, Assam, India.
Nirja Saikia
Department of Food and Nutrition, College of Community Science, Punjab Agricultural University, Ludhiana, India.
*Author to whom correspondence should be addressed.
Abstract
India is ageing rapidly and unevenly. The number of people aged 60 years and above is projected to grow substantially over the coming decades, with marked differences between states, between women and men, and between rural and urban populations. The arrival of nationally representative ageing surveys has transformed the evidence base, yet the resulting literature is fragmented across epidemiology, health economics, gerontology, demography and social policy. This critical narrative review examines what is known about care and support for older adults in India and evaluates the strength, consistency and policy relevance of that knowledge. Peer-reviewed studies, methodological papers and authoritative institutional reports were identified through structured searches of multidisciplinary, biomedical and social-science indexes, supplemented by citation tracking and official sources, and were appraised for design adequacy, representativeness, measurement validity and analytical transparency. The synthesis is organised around six themes: the changing burden of health and functional need; the family as the principal care institution; health-system responses and financial risk protection; income security and work in later life; social connectedness and psychological well-being; and emerging challenges, including dementia, climatic hazards, pandemic shocks, digitalisation of services and the feminisation of later-life disadvantage. The evidence is strongest for the high prevalence of multimorbidity, functional limitation and undiagnosed chronic disease, for the dominance of family-based care and for the persistent financial vulnerability of households containing older members. Findings are contested or instrument-dependent for depression, loneliness, elder abuse and food insecurity, and for the protective value of publicly funded health insurance and social pensions. Much of the recent literature consists of cross-sectional secondary analyses of a single survey wave, which limits causal inference, while older adults in institutions, the oldest old and several marginalised groups remain poorly represented. The review concludes that India is moving from implicit reliance on family care towards a mixed but under-specified care regime, and that longitudinal, quasi-experimental and implementation research is now needed to determine which forms of public support most effectively protect function, dignity and economic security in later life.
Keywords: Population ageing, older persons, longitudinal ageing study in India, family caregiving, long-term care, social protection, financial risk protection, healthy ageing