India ageing before getting rich, nearly 70% of elderly to live in rural areas by 2050: Study

Nearly one in five Indians will be aged 60 years or above by 2050, with almost 70% of the country's elderly expected to live in rural areas, highlighting the growing need to overhaul India's care ecosystem, according to a white paper released by Transform Rural India (TRI) on Friday.

The report, titled Demographic Transition, Evolving Families and the Future of the Care Ecosystem in Rural India, warns that India is ageing before it becomes affluent, unlike many developed countries that grew wealthy before their populations began to age.

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"By 2050, one in five Indians -- around 347 million people -- will be over the age of 60, with nearly seven in 10 older adults living in rural India. Unlike many developed nations that became wealthy before their populations aged, India is undergoing this demographic transition at much lower income levels," the study said.

Released ahead of TRI's India Rural Colloquy (IRC), the white paper draws on data from the National Family Health Survey (NFHS), Longitudinal Ageing Study in India, Census projections, Time Use Surveys and other national datasets.

It projects that the number of working-age adults available to support every older person will decline sharply from 8.4 in 2001 to an average of 5.2 by 2026, increasing pressure on families and communities.

According to the study, India's traditional family-based caregiving model is coming under strain as families become smaller, younger members migrate for work and life expectancy continues to rise.

"Yet nearly 94% of care for older people is still provided within households, leaving fewer family members to meet growing and increasingly complex care needs," it said.

The report also highlights the unequal burden of unpaid care work, with women spending an average of 305 minutes a day on caregiving compared with just 56 minutes by men. It says this imbalance remains one of the biggest obstacles to improving women's participation in the workforce.

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Climate change is further intensifying the challenge, with heatwaves and floods significantly increasing the amount of unpaid care work undertaken by women, the study added.

The white paper also points to a shift in India's disease profile, noting that nearly two-thirds of all deaths are now caused by non-communicable diseases (NCDs), including diabetes, cardiovascular diseases and cancer. At the same time, an increasing share of the disease burden stems from years lived with disability rather than premature death.

It argues that India's healthcare system was primarily designed to address episodic healthcare needs such as childbirth, immunisation and acute illnesses, and is ill-equipped to deal with the demands of an ageing population living with chronic conditions.

"The next phase of healthcare is about supporting people living with chronic illnesses, disabilities and the challenges of ageing -- something hospitals alone cannot do," the report said.

To address the challenge, TRI has proposed a "neighbourhood of care" model that would integrate existing rural institutions, including Gram Panchayats, self-help groups, ASHAs, Anganwadi centres and Ayushman Arogya Mandirs, into a community-based care network.

Rather than creating new infrastructure, the model seeks to connect existing institutions to make integrated care accessible within walking distance of every household.

The white paper also presents caregiving as a major economic opportunity, estimating that investing 2% of India's GDP in the care economy could create around 11 million jobs, largely for rural women.

"India has made remarkable progress in helping people survive. The next challenge is ensuring they can live well for longer. Our demographic transition requires us to redesign care delivery itself -- beyond facility-based care, it will require to facilitate as shared community function and improving sustainable living conditions," said Shyamal Santra, practice director, Transform Rural India.

"The institutions needed to make this possible already exist across rural India. By connecting them through a common care mandate, an eco-system needs to be built that supports families, caregivers, strengthens local governance and prepares villages for the decades ahead," Santra added.