Future of Ageing: An Indian Perspective

This essay captures the evolution of Indian policies towards improving quality of life of older adults (since the 1990s), impact of these policies on the perception around ageing, and key themes and trends shaping the emerging Silver Economy in India.

27 June, 2021
Mahesh Venkateswaran


Background

The wellbeing of senior citizens is captured in the Constitution of India, under Article 41. India came up with its first ever policy centred around well-being of older persons in 1999, also declared the year of older persons by the UN. This policy laid out strategies to improve the quality of life of senior citizens through interventions in areas of financial security, healthcare and nutrition, shelter, continuous education, protection of life and property, and welfare programs focused on the most vulnerable among the older persons. In 2011, a national policy on senior citizens that integrated various services and benefits (pension, travel concession, etc.) to improve access and provisions for seniors was published. Drawing from active international efforts in the space, the policy advocated for dignified life for older adults through ageing-in-place services, financial support for assisted living facilities (old age homes), protection against abuse and neglect, and much more. This triggered a host of different intervenions, largely focused on the poor and vulnerable among the elderly.

In a significant gesture, the UN declared 2021-2030 as a decade for healthy ageing and gave it a broad definition – the process of developing and maintaining the functional ability that enables wellbeing in older age. It identified four areas for action – age-friendly environments, combatting ageism, integrated care, and long-term care – and this was followed by the WHO’s 2016 global strategy, which lays out an action plan to meet these goals centred around ageing and health. These and many other developments around the world have helped evolve the language around ageing over the past two decades – positive ageing, productive ageing, healthy ageing, happy ageing, active ageing, better ageing are a few phrases that reflect a more nuanced approach.

It is fair to infer that the language around ageing and context of usage helps shape the perception around ageing, and how we frame a problem, challenge or an opportunity in this space.

Generational changes also alter the perception around ageing, and strengthen the movement away from the binary of working and retired lives, which is largely a creation of formal workforce arrangements. In the Indian context, a senior citizen is somebody over the age of 60 and thus acquires special rights under law, is eligible to avail certain entitlements and concessions, and gets credits in the Indian government tax system. A senior citizen-dependent is also a tax-saver for a family, as highlighted in the article. Simply put, the definition of a senior citizen influences the financial and non-financial aspects of the elderly in India, and it is all the more relevant in the case of those dependent on the government for basic needs and protection. It is estimated that old age pension covered 28 million individuals across the country in 2019-20, the largest of the three major disbursements under the National Social Assistance Protection (NSAP).

Impact of Longevity on Quality of Life of Older Adults

As of 2019, India was home to approximately 106Mn adults over the age of 60 years, and this demographic group is growing at 2X the rate of general population (higher among 80+) and is forecast that 20% of India’s population by 2050 will constitute this population group. Further, the average lifespan of general population in India (longevity) has increased from 62 years in 2000 to almost 70 years in 2018, a rise of 8 years in less than two decades. In short, what we have is a single standard cut-off age for a moving average for a population demographic with multiple indices around general wellbeing, and this could lead to negative or detrimental effects on their quality of life, particularly in later stages.

Countries around the world have adopted varying standards to define senior citizens, and also the broader ageing journeys of older adults. Senior citizens in South Korea are those with a chronological age of 65 years while in the US, it could vary for different provisions and benefits. The federal health insurance (Medicare) kicks in at the age of 65 while getting policies around driving licenses vary from one state to the other, between 64 and 80. Taking a completely different view, Denmark categorizes people between 60 and 80 years into the third age group and those over 80 years into the fourth age group. The paper Think Tank – The 3rd Age from a reputed Danish think tank articulates 7 key challenges and 33 recommendations to develop what it terms as a good life for the third age group. A joint committee of the Japanese geriatrics and gerontology societies proposed to increase the age of elderly to 75 years and above considering those between 65 and 75 years continue to be active and feel uncomfortable being treated as elderly. Driven by these realities, they frame policies to proactively tackle the challenges arising from this rising population group and meeting the needs of shifting demographics.

  • Germany, one of the five super-aged societies of the world, has a comprehensive policy that involves leveraging digital technology, better community and social infrastructure, retirement reforms and creation of productive opportunities, and focus on healthcare and wellness.
  • The UK and many countries in Europe use public health services to build awareness about healthy ageing, and also provide support and care for elders at the community level.
  • Japan, which is considered a super-ageing society, has formulated the smart ageing strategy to push forward active ageing among its old.
  • Countries like Taiwan and Singapore have innovated on technology-enabled tools and inter-generational communities while helping retain their workers in the labor workforce for longer durations. Many of these countries also have highly active public and private institutions that support research, innovation and discussions among the larger public, around ageing and elder care.
  • The United States has a federal administrative division for Ageing working closely with the American Association for Retired Persons (AARP), an independent and private sector initiative, to formulates policy and support for this demographic.

It is well established that a lot of factors contribute to increased life expectancy among general populations including sustained investment in health, education and so on. A developing and emerging country like India measures its progress over time by the improvement in access to basic and essential needs (food, shelter and clothing) of a larger population and improvement in overall standard of living (rights, life expectancy, safety, income equality, environment conditions, etc.). While standard of living comparisons help benchmark globally, they do not necessarily reveal the quality of life among those living longer.

The recent LASI India report on India identifies subjective wellbeing to be crucial for later life satisfaction and is an important determinant of quality of life.

Aside from meeting basic needs, it has been proven that financial security, continuing participation in societal activities, better geriatric care, availability of supportive and assistive devices, better living arrangements and general life satisfaction play a crucial role in enhancing the quality of life among older adults.

Silver Economy – Opportunity Matrix

The silver economy, in broad terms, refers to products and services focused on addressing the present and future needs of an ageing population. The addressable market is largely need-based and dependent on the demographic trajectory at a country-level, and driven by ageing policies focused on older adults. Countries adopt different strategies in addressing these needs and hence it is important to understand the context at the country level. Largely driven by the demographic transitions and associated factors (urbanization, modernization, education, etc), the silver economy in India offers a host of opportunities.

The Silver Angels report published in January 2021 touched upon many aspects of the evolving eldercare ecosystem in India, in particular, the need for a multistakeholder approach and the role of market-based solutions in addressing some of these challenges. The continuing impact of Covid-19 on elderly has brought up the systemic weaknesses and thus accelerated the need to address them with utmost urgency.

The categorization of ‘senior citizens’ by chronological age severely limits our ability to understand the many sub-groups (by age, medical conditions, mobility, family support structure, financial security, living arrangements, etc.), and thus acts as a poor proxy to understand their quality of life. This is also likely to result in designing a one-size-fits-all approach to address the needs of this heterogeneous group and lose out on the opportunity to cater to uniquely addressable groups within them.

The Government’s recently launched SAGE scheme is an effort in this direction, and offers equity of up to INR 1 Cr for credible startups working in this space. While there is data available around demographic shifts and ageing in India, the data is static in nature and mostly part of government surveys conducted over longer time periods. In specific areas (like senior housing, geriatric services, insurance, etc.), there is industry data but again very specific and focused on the target group for products and services. This also highlights the need to gather and build on credible data and research to understand population sub-groups better.

Further, private sector initiatives that support and foster innovation, entrepreneurship and financing for this emerging sector would open up hidden market opportunities and also add to the improvement in the quality of life among a wider population group. The business opportunities in this space could emerge from new and established businesses, and with the right ecosystem, likely to accelerate this journey. Looking at the eldercare market from the perspective of quality-of-life improvements can help build a vibrant silver economy and a marketplace of reliable services spread across various needs. Affordability and access of such services are going to be key to ensure such improvements reach the next half billion. Listed below are four such opportunity areas that have been covered recently in the Silver Angels newsletter.

  • Opportunities arise out of transitions from one-size-fits all approach of old age homes to various formats for senior care and living arrangements, and the growing ageing-in-place services in India.
  • While the shortage of doctors and nurses in India is well covered, the estimates around demand for caregivers for an ageing population is not fully understood. With global shortage of caregivers for elders, investments in this space can result in disproportionate improvements in quality of life. According to official estimates, Israel, a country of around 9 million, is home to 15000 Indians out of which 13500 are registered caregivers. While the Government, through industry partnerships, has developed certain standards for this industry, this is an area with immense opportunity to create both jobs and globally acceptable standards for care.
  • The Alzheimer’s and Related Disorders Society of India (ARDSI)’s 2018 Dementia India Strategy Report estimates 14.3 million Indians with dementia by 2030 and the cost of care to touch 0.5% of the GDP. Given elderly are particularly vulnerable for dementia and other chronic conditions, this space needs better attention given its impact on the quality of life.
  • Mid- and later-life planning and transitions are also an important aspect of ensuring the well-being of general populations. This is particularly relevant when it comes to health security, financial independence, access to specialized care services and products. For example, grandparenting can act as a lens to older adult development.

Silver venture is a start-up or business entity serving the 55+ consumer segment AND building on a long-term opportunity in the space. Such entities design, develop, build and/or adopt solutions to various target groups within the broader consumer segment.

The opportunity matrix for the silver economy can traverse various sectors (housing, finance, tourism, healthcare, etc) and the size of the opportunity is likely shaped by sector-agnostic trends (longevity, internet penetration, mobility, per-capita-income, localization, etc).

Basis independent research and tracking 50+ companies over the last two years, Silver Angels has identified the following themes to drive the growth of the silver economy in India.

  • Rise in ageing-in-place services (daily needs, nursing, incident response systems, etc)
  • Emergence of new formats of senior living (housing, assisted living, co-living, intergenerational facilities, etc)
  • Financial planning and banking services to meet longevity needs (retirement planning, social assistance, pension planning and diversification, etc)
  • Long-term health planning solutions (geriatric care, health insurance, emergency care, etc)
  • Specialized care facilities, services and use of skilled manpower (dementia, mental health, home-aide workers, etc)
  • Active ageing solutions (events, online programs, entertainment, social clubs, etc.)
  • Increase in options of consumer products (adult diapers, clothing, elder-friendly tools and devices, etc.)
  • Technology solutions (home-care platforms, teleconsultations, etc) and assistive aids (wearables, mobility aids, etc)

While these themes are in no way definitive, they help frame the conversation around future of ageing and evolve a much richer thesis around the many moving parts, each significant in its own way.

Feel free to drop me a line at mahesh@silverangels.in, with your feedback and comments.


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