India requires a strong policy framework for financing geriatric care

Rajit Mehta, MD & CEO, Antara Senior Care in an interaction with Express Healthcare talks about the status of geriatric care in India and highlights the key learnings from Antara’s State of Senior Survey

India is a young country, with an ageing population. Do you think India is equipped to handle this change?

India is a young country with elaborate socio-cultural intricacies and an ageing population. According to a study by WHO, between 2000 and 2050, the proportion of the world’s population over 60 years will double from about 11 per cent to 22 per cent. The country is on a downward trend with respect to ageing, and some projections indicate that the population of Indians above the age of 55 may increase by more than double in 2050. A recent report showed that India’s elderly population is projected to touch 194 million in 2031 from 138 million in 2021, a 41 per cent increase over a decade, according to the National Statistical Office (NSO)’s Elderly in India 2021 report.

Seniors have special healthcare needs that increase stress on the existing healthcare systems. We, as a country, need to start buttressing the healthcare ecosystem right now so that it will be ready to take care of this population as it grows. Though there has been an increased focus from the government on the changing needs of seniors, such as initiation of Longitudinal Ageing Studies across all states to collect data on senior citizens, which will help to establish a range of preventive and health care programmes for the older population, we still have a long way to go. We need to proactively look at the measures and create a conducive ecosystem for seniors. It is necessary to bring a new service sector with professional and specialised services to ensure a healthy and happy ageing experience for seniors. This thus calls for a structured senior care sector – one that is currently in its nascent stage yet is rich with opportunities and growth prospects. India needs to identify the changing norms and values, which will influence how much support older people will receive from their families – a major trend in India, and therefore how much help they will need from the government and other organisations.

What is the State of Seniors Survey? What are some of the key learnings that you took from the responses?

Antara’s State of Senior Survey, a first-of-its-kind, attempts to bring out insights on the lives, aspirations, preferences, opinions, and consumer behaviour traits of seniors in India. The survey aims to bring out insights into lives, preferences, opinions, and consumer behaviour traits of senior citizens in urban India.

Antara’s State of Senior Survey has conducted an in-depth and comprehensive analysis of the needs, and behaviours of seniors in India. The study has been conducted over three regions – North, South and West, covering 2,000 middle and upper -class elders aged 60 and above. The Study was conducted across urban India and specifically in the North (Delhi-NCR & Jaipur), West (Mumbai & Pune), and South (Bengaluru & Hyderabad). The target sample size of the Study was 2000, divided equitably between the three regions. The Study has collected 2092 responses. Given the population of seniors in these cities, this sample size should provide a confidence level of 96 per cent, with a confidence interval of +/- 5 per cent.

The SoSS second edition findings came at a significant time when India is beginning to experience major demographic shifts with a growing senior population. It is critical to understand this demographic cohort better to offer them professional and specialised services, in line with their evolving needs, enabling a healthy and happy ageing experience.

Listing a few key learnings from the report below:

The findings from the report revealed that India requires a strong policy framework for financing geriatric care and a strategy to create a welfare ecosystem for seniors. Increased life expectancy, improved affordability and changing family structures are some of the driving factors to enhance elderly care in India. The fact that over 50 per cent of the respondents said that they faced mental health issues, 70 per cent faced difficulty in accessing healthcare, and about 53 per cent felt that India is ill prepared to deal with COVID-19, is a reminder to increase efforts in geriatric care.

The survey brought us face-to-face with the fundamentals of seniors’ lives during the pandemic. It is essential we understand these needs to appropriately address them. Studies like these can help us understand the new, nuanced senior cohort emerging in India. The crucial insights recorded in the report tell us that we urgently need a strong policy framework including mechanisms for financing of care and a strategy to create an elder welfare ecosystem that would help the elderly Indians to live a healthy and enriching life in their silver years. This growing elderly population with increasing life expectancy, improved affordability, shifting disease burden and changing family structures are becoming the driving factors to enhance senior care in India. There will be an increase in demand for care and resources, both medical & non-medical, so it is imperative we act now towards building and implementing such a robust policy framework. With the findings from the report we can also foresee a future that withholds an independent lifestyle for seniors, increased demand for at-home and assisted living facilities and proper access to healthcare, so seniors could spend their silver years in a hassle free, easing environment.

The growing elderly population and the concerns that they are dealing with, will eventually increase demand for care and resources, both medical and non-medical. Thus, building and implementing a robust policy framework is necessary.

According to the survey report, what are some of the key concerns seniors experienced during COVID-19?

India, like most other nations, was caught in the eye of the storm when the COVID-19 pandemic hit the country in 2020. The state of the senior survey asked seniors questions concerning their health during the pandemic and recorded the various complications that the elderly in India went through.

The report findings show that most of the elderly population in India faced major issues when it came to accessing healthcare during the pandemic. The survey recorded that more than 2/3rd i.e 70 per cent of seniors surveyed faced difficulties having no direct way to basic healthcare facilities. Access to proper healthcare was a big concern during COVID. Hundreds of thousands of infections and deaths on a daily basis brought the crumbling Indian healthcare infrastructure to light during the second COVID wave. It was also found that the seniors most affected with the situation were from metropolitan cities like Delhi (84 per cent) and Bangalore (80 per cent). This gives us a deep insight about India’s underlying healthcare infrastructure and how we further need to step up in our working in order to not only provide better healthcare facilities but also make way for seniors to live a fulfilled, independent life.

Other key concerns seniors experienced during COVID-19 were

Over 57 per cent seniors faced mental health issues during COVID

• The survey reveals that 57 per cent of seniors in India experienced some mental health problems over the course of the pandemic.
• The number (81 per cent) being highest in seniors from Mumbai followed by Bangalore (70 per cent), Pune (70 per cent), Delhi (64 per cent) and Jaipur (51 per cent).
• Hyderabad being an exception, recorded the lowest cases accounting to 94 per cent of seniors who did not face any mental health issues.

Over 59 per cent seniors only partly satisfied by Indian government’s handling of the pandemic

• Commenting on the Indian government’s management of COVID, majority of the seniors leading to a large 59 per cent said only some aspects were managed well by the government
• About 33 per cent seniors found that the self-precautionary measures provided by the government were inadequate.
• 8 per cent seniors thought the handling was mismanaged on most fronts.
• In the past, Antara State of the Senior survey, a significant 32 per cent had applauded the government’s effort while the number was reduced straight down to 0 this year when asked if the government did well in handling the pandemic situation, given some limitations.

What are some of the most interesting insights you got from the survey?

The COVID-19 pandemic has played a crucial role in the faster adoption of electronics among the senior population. Seniors are increasingly defying the stereotype of older individuals being uncomfortable with technology. They are now acquainting themselves with smartphones at a faster pace to stay connected with their loved ones. The findings indicate a large majority of seniors surveyed used their phones to stay connected. Over 69 per cent of seniors surveyed, used their phones for video calling, and 40 per cent for chatting. Contrary to popular belief, seniors showed that using smartphones is no longer a concern for them and apart from just using it for socialising, a large chunk of seniors used their phones for entertainment purposes like watching videos and listening to audio clips. Smartphones also helped seniors beat the COVID induced social isolation, especially through social media. WhatsApp, facebook and instagram were the top 3 mediums seniors used with whatsApp leading adoption by a huge margin.

Another interesting insight recorded was that over 56 per cent of seniors surveyed wanted to retire early. The report showed that most of the seniors wanted to retire and live a peaceful life at the earliest, whereas 23 per cent wanted to experience a complete work life and retire only after 60 years of age and the rest wanted to continue working even after passing the set retirement age.

When asked about the motivating factors to continue working post-retirement age, seniors mentioned that working to stay active and healthy (66 per cent), followed by financial independence (52 per cent) were the biggest motivators and 45 per cent seniors wanted to do it for their personal satisfaction. Considering 56 per cent of seniors want to retire peacefully and enjoy their silver years, and only 33 per cent are in control of their finances, there is an increased need for policy-level interventions. A major global response has been to progressively increase the retirement age. This provides seniors wanting to continue working (21 per cent) with an opportunity, and others who are in control of their finances and want to retire early, an option to do so without hesitation.

The pandemic had most people struggling in isolation, how have seniors fared in this regard?

Seniors have been established as one of the most vulnerable populations, during the pandemic, especially physically. We have, however, discounted the psychosocial aspects of the after-effects of a global pandemic on seniors. The pandemic and resultant lockdown had the world struggling to keep up with the new normal, adding strain to the already vulnerable senior population. While advisories were issued to curb the rising mental health issues among seniors, the survey reveals that 57 per cent of seniors in India experienced some mental health problems over the course of the pandemic. In addition to the worries about their safety, access to basic healthcare facilities, groceries, medicines, etc. was strained especially during the second wave, it was recorded that over 2/3rd of the senior population experienced mental health issues such as anxiety, social isolation and depression during the pandemic.