The Gerontologist

cite as: Gerontologist, 2015, Vol. 55, No. 6, 894–900

doi:10.1093/geront/gnv022

International Spotlight

Gerontology in India
Ramamurti V. Panruti, PhD,1 Phoebe S. Liebig, PhD,2 and

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Jamuna Duvvuru, PhD*,1 
Centre for Research on Ageing, Department of Psychology, Sri Venkateswara University, Tirupati, Andhra
1

Pradesh, India. 2Davis School of Gerontology, University of Southern California, Los Angeles.
*Address correspondence to Jamuna Duvvuru, PhD, Centre for Research on Ageing, Department of Psychology, Sri
Venkateswara University, Tirupati 517502, Andhra Pradesh, India. E-mail: [email protected]

Decision Editor: Rachel Pruchno, PhD

Abstract
India, with a population of 1.22 billion, has a predominantly agriculture-based economy.
Its 90 million elderly population heavily depend on their children for financial support
and caregiving. Research on aging in India today is focused on the medical, biological,
behavioral, and social sciences. Aging as an independent subject is only taught at a few
institutions. Several national and state agencies and many nongovernmental organiza-
tions offer housing, day care, and health care services. The 1999 National Policy on Older
Persons is being revised, 2 National Institutes on Aging have been designated, and a
pilot health program targeting seniors has been implemented. India’s greatest concern is
how to provide adequate health care and income security for its huge elderly population,
especially the uneducated rural poor.
Key Words:  Aging in India, Status of Indian elders, Research and education on aging

India derives its name from the Indus River that flows from the mainstay of the Indian economy (Registrar General of
the Himalayan Mountains. A  country of myriad subcul- India [hereafter, Registrar], 2011).
tures that constitute a unity in diversity, its ancient past Average per capita income is 54,000 Indian rupees or
reaches back to 2000 B.C. As the world’s largest democ- about US$1,000 annually; nearly one third of its popula-
racy, India based its parliamentary system of government tion lives below the poverty line, on less than $1.50 a day.
on that of the United Kingdom, from which gained its inde- The Gross Domestic Product in 2011 was $1.85 trillion.
pendence in 1947. As a federal union, it includes 29 states The overall literacy rate is 74%: 82% for men and 66%
and 7 Union Territories (UTs). for women (Registrar, 2011). This brief background sets
India’s constitution officially recognizes 23 of the many the stage for examining issues concerning India’s growing
languages spoken by its citizens. Hindi and English are elderly population.
the primary languages used in academia and in conduct-
ing business. Eighty percent are Hindus, 13% are Muslims,
and 3% are Christians. Sikhs, Jains, and Buddhists com- Demographics of Aging
prise the rest. Although India’s industrial sector and techni- Two national data sets, the Registrar’s Census of India and
cal prowess have grown rapidly, agriculture continues to be reports from the National Sample Survey Organization

© The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. 894
For permissions, please e-mail: [email protected].
The Gerontologist, 2015, Vol. 55, No. 6 895

(NSSO), provide most of the information about India’s younger years, with implications for accessing and address-
senior citizens. Statistics about the elderly population are ing their health care needs. Reported ailments are some-
drawn from the most recent NSSO survey of 2005 and pub- what higher in rural areas where health services are often in
lished in 2006; the next review will be conducted in 2015. short supply. However, urban older women are more likely
The 2011 national census projects that the current total to be immobile, with implications for greater familial care
Indian population of 1.22 billion—second only to China— responsibility. The absence of universal social security and
will exceed 1.4 billion by 2030. The elderly population of health programs contribute to the dependency of India’s
90 million may reach 130 million by 2030 (Registrar, 1996, elderly population (NSSO, 2006).
2011). India’s fertility rate of 2.5 live births may drop fur- Morbidity data are not available in the NSSO 2006
ther, increasing the current dependency ratio: 125 aged per report. However, in the 1996 report, arthritis was reported
1,000 of the general population ages 14–59. Average life by 34% of the elderly population; vision problems by 26%;
expectancy at birth is 69.8  years: 68  years for men and high blood pressure by 10%; diabetes by 9%; heart dis-
72 years for women. Life expectancy at age 60 is 18 years ease by 3%; and other conditions by 2% (NSSO, 1996).

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for women and 16 for men. About 3.5% of the total popu- A  recent comparison of elder health status in 91 nations
lation is more than 80  years of age, with women in the ranked Indian seniors near the bottom, at 85 (Global Age
majority (Registrar, 2011). Watch Index, 2013).
India’s rural population constitutes two thirds of its
total population; three fourths of Indian elders live in
Developments in Research, Education, and
rural areas (NSSO, 2006). Rural/urban differences are
Training
important for examining elders’ income, support, and
health issues. Research
Table  1 shows that most Indian elders reside with Since the earliest studies in the late 1950s and early
their adult children, a traditional practice. A  majority of 1960s that concentrated on the behavioral and social sci-
rural (66%) and urban (63%) dwellers are dependent on ences (see Amesur, 1959; Ramamurti, 1956; Ramamurti
their children, who are expected to provide financial and & Parameswaran, 1963, 1964), the pace and breadth of
social support and personal care (NSSO, 2006). In 2007, research on aging in India increased during the 1980s and
the Maintenance and Welfare Act of Parents and Senior continues today. Approximately 3,000 articles on vari-
Citizens was enacted to enforce family elder care and pre- ous aspects of aging in India have appeared in a variety of
vent elder abuse. Indian and international journals (see Karkal, 1999, 2000;
In terms of education and health status, 74% of rural Ramamurti & Jamuna, 2010a, 2010b; Ruprail, 2002).
and 40% of urban elders lacked formal schooling in their Research output now falls into several major categories:

Table 1.  Selected Social and Economic Indicators and Health Status of the Aged (60+) Population in India (2001–2005)

Indicators Percent

Rural Urban

Living arrangements
  Living alone 5.3 4.3
  Living with spouse only 12.5 10.4
  Living with spouse and family 44.2 44.0
  Living with adult children 32.0 32.0
  Living with others 4.2 4.9
Economic dependency on children
  Not dependent 32.8 35.9
  Partly dependent (supplemented by personal sources) 13.9 11.4
  Fully dependent (no self-income) 51.9 51.6
Education status
  No formal education 74 40

Male Female Male Female

Health status
  Reporting ailments 29 28 25 26
  Immobile/confined to home/bed 6.7 8.8 6.8 10.0

Source: NSSO (2006).

896 The Gerontologist, 2015, Vol. 55, No. 6

medical, biological, behavioral, and the social investiga- gene expressions and their impact on aging (Kanungo,
tions (Ramamurti & Jamuna, 2010b), as shown in Figure 1. 2004a, 2004b). Dr. Kanungo also founded the nationwide
Association of Gerontology (India) in 1981.
Medical/Geriatric Research This research emphasis has been continued by Thakur
Initially, medical research on morbidity in the elderly and associates, at BHU, by developing an amnesic mouse
population was hospital-based, beginning with the work model and examining the effects of Aswagandha plant leaf
of Pathak (1978) at Bombay Hospitals. Followed by the extract and the role of estrogen coregulator molecules on
sustained work of Venkoba Rao (Rao, 1979, 1987, 1991; brain function, including memory (Thakur, 2003, 2004).
Rao & Madhavan, 1983) of Rajaji Hospital in Madurai, Other researchers across India, notably Subbarao (1997),
research focused on physical and psychological morbid- conduct studies in several areas, such as telomere repair in
ity, especially mental health, depression, and suicide in the brain cells.
aged. During this pioneering period, Rao also directed the
first Task Force on Aging of the Indian Council of Medical Social and Behavioral Gerontology

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Research (ICMR; Rao, 1987). In 1988, a separate in- Gerontological research in this area has expanded since its
patient ward for elders was created by Natarajan at the beginning to include welfare, economics, and demography.
Government General Hospital in Madras. An outpatient An extended description of these developments, especially
clinic for the aged was established in 1996 by Vinod Kumar in the behavioral sciences, was conducted by Ramamurti
at the All India Institute of Medical Sciences, New Delhi, to and Jamuna (2010b). A major development was the found-
conduct a series of morbidity studies (Kumar, 1996, 2003). ing, in 1983, of the first research center on aging in India.
A 1997 landmark issue of the Indian Journal of Medical The Centre for Research on Ageing (CEFRA) was estab-
Research focused on the prevalence of chronic conditions lished in the Department of Psychology of Sri Venkateswara
and their management, including diabetes, hypertension, University (S.V. University) and has been supported by the
and arthritis, as well as disabilities. These issues have University Grants Commission’s Departmental Special
continued to be addressed by Sharma (1999), Rosenblatt Assistance Program (UGC/SAP) since 1990 (CEFRA, 2014).
and Natarajan (2002), Dey (2003), and Rao (2004). More than 20 major research projects conducted by
Since 2009–2010, increased ICMR funding for individual Ramamurti, Jamuna, and associates have covered a variety
research projects in geriatrics and geropsychology has of topics including: markers of successful aging; disability
expanded these areas of inquiry. Nutrition also has become assessment and coping; characteristics of centenarians; and
another significant area of research. Recommended Daily development of a conceptual model of aging (Ramamurti
Allowances of nutrients for Indian elders have been com- & Jamuna, 2010a, 2010b). The current focus is on a pro-
piled by the National Institute of Nutrition at Hyderabad. spective cross-sequential study of health and aging. Besides
Research programs conducted by Bagchi (2000), Natarajan its teaching, training, and research, outreach activities
(1995), Puri and Khanna (1999), Shah (2004), and Sujatha include distributing useful handouts for seniors and their
(2004) have identified the nutritional status of different families, for example, fall prevention, improving memory,
groups of the elderly population and the effect of specific and nutritional tips for healthy aging.
supplements on their health status. A major surge of social and behavioral research has
occurred since 1990, including major contributions on
Biological Gerontology gender aging, mental health, and empowerment of women
Biological research in aging was initiated in the late 1960s (Prakash, 2003, 2004); on health and aging of urban elders
by Kanungo and associates at Banaras Hindu University (Sivaraju, 2002a, 2002b); advocacy and rights of the elderly
(BHU) in Varanasi. This work centered on enzymes as population (Nayar, 2003); and sociological perspectives on
modulators of the aging process and on the role of chro- and awareness of elder abuse (Shankardas, 2003).
mosomal histones and genetic interventions in modulating Other major areas of inquiry have included rural
aging, loneliness (Prafulla, 2009); anthropometry of the
elderly population, female aging, and health (Bagga, 1994,
2013); pensions, old age homes, and coping with disasters
(Anupama & Sonali, 2012); and the demographics of aging
and social security (Rajan & Matthew, 2008).
Much of this research has been published in major
Indian journals dedicated to aging. They include the Indian
Journal of Gerontology (Indian Gerontological Society);
Research and Development Journal (HelpAge India);
Aging and Society: The Journal of Gerontology (Calcutta
Metropolitan Institute of Gerontology); and the Indian
Figure 1.  Research output in different areas of aging. Source: Ramamurti Journal of Geriatrics (Indian Association of Geriatrics).
and Jamuna (2010b). Research findings also appear in periodical reviews
The Gerontologist, 2015, Vol. 55, No. 6 897

and annotated bibliographies (see Karkal, 1999, 2000; Census data of the general population are collected every
Ramamurti & Jamuna, 2010a, 2010b; Ruprail, 2002). 10 years, followed by reports from the Registrar. However,
these surveys lack detailed information about persons aged
80+. Efforts are under way to generate separate data on
Education and Training this age group from the 2011 census.
Higher Education Roles A new resource, the Longitudinal Aging Study in India
In contrast to the development of research, the trajectory (LASI), was created in 2009 by the International Institute
of gerontological education has been less robust. The first of Population Science of Mumbai, the Harvard School of
graduate course in gerontology was introduced in 1976 by Public Health; the School of Medical Sciences, University
the Department of Psychology, S.V. University, as an applied of California, Los Angeles; and the RAND Corporation. Its
branch of psychology at the master’s and doctoral levels. It objective is to provide reliable information on the health,
was followed by a master’s specialization and a multiyear health care, and social and economic aspects of the Indian
diploma course in 1990, supported by the UGC/SAP. population, aged 45 and older. Its first phase (2013–2015)

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The Centre for Molecular Biology of Aging at BHU has will cover two waves of data and be made accessible to all,
offered doctoral programs in molecular biology of aging including other researchers and policy makers (http://www.
since 1980. A  postgraduate course in geriatrics was initi- iipsindia.org/research_lasi.htm).
ated by the Madras Medical College in 1996.
Despite these initial developments, gerontology as a spe- Nongovernmental Organizations
cial course of study in higher education has grown slowly. With GOI and other funding, NGOs have played major
In 2000, the Government of India (GOI) recommended roles in implementing national policy by conducting stud-
that universities and other educational institutions intro- ies and offering various services to seniors. The largest—
duce courses in aging as part of implementing the National HelpAge India—established in 1978 (www.helpageindia.
Policy on Older Persons (NPOP). Several institutions now org). With branches nationwide, it collects data and offers
offer courses as part of master’s and doctoral-level pro- different kinds of programs (e.g., old age homes, day care
grams in psychology, social work, anthropology, and home centers, health clinics) and education. Information about
science. research and its programs is published in its Research and
Development Journal.
Other Organizations Engaged in Research and The Alzheimer’s and Related Disorders Society of India
Professional Training (ARDSI, 2013), founded in 1991, now include many local
The National Institute of Social Defence, as part of the chapters. ARDSI has focused on various aspects of demen-
GOI’s aging initiatives, collaborates with nongovernmental tia awareness and care (www.alzheimerindia.org) and pro-
organizations (NGOs) and educational institutions to train vides data on the prevalence of dementia in India. A recent
individuals in geriatric and other elder care services and to study reported that one in every 20 Indian elders aged 60+
raise public awareness about aging. The gradual expansion and one in five aged 80+ suffers from this disease (Roy,
of biomedical research has led to development of training 2010).
modules in geriatric clinical care for a variety of health pro- Other NGOs providing education and care are located
fessionals. At the National Institute of Health and Family in several major cities. They include the Centre for
Welfare of the Ministry of Health, Khan has initiated pro- Gerontological Studies in Trivandrum that organizes semi-
grams on training health care professionals in aging and nars and conferences on aging and rights of the elderly pop-
promoting doctoral research (Khan, 2011). ulation (www.cgsindia.org). The Calcutta Metropolitan
In 2011, the National Programme for Health Care of the Institute of Gerontology, established in 1988, provides
Elderly (NPHCE) was established to develop a multilevel, research, training, and care services (www.cmig.org.in).
intergovernmental structure that delivers care dedicated to The Heritage Hospitals and Foundation, established in
specific needs of seniors. It also builds the capacity of medi- 1994 at Hyderabad, was India’s first private sector geriatric
cal and paramedical providers through training programs. care service (www.heritagehealthcareindia.com). In 2004,
the International Longevity Center at Pune was created to
conduct research and training and advocate for the aged
Other Resources for Aging
(www.ilcindia.org).
National Data Sets Several NGOs are advocacy organizations. The All
The NSSO reports and the national census data are impor- India Senior Citizens Confederation (www.aisccon.org)
tant resources for both Indian and international research- represents seniors nationwide. It publishes a newsletter
ers. Beginning in 1985–1987, the NSSO undertook a and a magazine, The Twilight Years. The SSS-Global is a
nationwide sample survey on rural and urban elders to leading web-based discussion group of senior citizens (sss-
assess their socioeconomic status. Similar surveys were [email protected]). Some foundations in Mumbai
conducted in 1995 and 2005, with results published in sub- provide services and advocate for the elderly population.
sequent years (NSSO, 1996, 2006). They include the Dignity Foundation (1995); the Harmony
898 The Gerontologist, 2015, Vol. 55, No. 6

Foundation (2004); and the Silver Inning Foundation (Hendricks & Yoon, 2006). These circumstances have put
(2008). Each publishes a magazine for seniors. Additionally, considerable stresses and strains on India’s economy.
a large number of local NGOs serve elders by organizing A basic issue for current and future Indian elders centers
programs on their rights, health care, and legal aid. None of on government versus family responsibility for their sup-
these organizations, however, has achieved the same levels port. Given a trend toward nuclear families (Khan, 2004),
of influence on public policy as the AARP in the United to what extent can the traditional multigenerational fam-
States, the Senior Citizen’s Forum in Canada, or the United ily be expected to provide necessary care and support for
Kingdom’s Age Concern (Nayar, 2003). seniors, two thirds of whom live below the poverty line?
Viable public–private options are needed for management
and maintenance of huge numbers of elders, particularly
Government Policy the oldest old.
The GOI, after extended deliberations and consultations A second issue centers on adequate health care for
with aging experts, established India’s first national aging escalating numbers of elders, many with chronic diseases

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policy—the NPOP—in 1999. The Ministry of Social that can exacerbate dependency and lead to considerable
Justice and Empowerment (hereafter, MOSJE), charged expenditures. Current national health programs, as well as
with implementing this policy, had no budget for this proposed expansions in health and mental health policies,
new responsibility. Instead, it was expected to coordinate cover all citizens, including seniors, but they rarely address
implementation through budgets of other ministries iden- geriatric care needs.
tified as relevant to NPOP goals. Major goals include: However, important changes are under way. Recently,
provide financial security through savings plans, pensions states have received NPHCE funding to develop regional
for the needy and workers in the nonindustrial sector, geriatric centers and local clinics. Implementation will
special tax deductions, and discounts in travel and hos- probably take some time before it is widespread (K.
pital services; promote affordable shelter and subsidize R.  Gangadharan, personal communication, April 18,
basic necessities (e.g., food); advance and improve pri- 2014). Additionally, two National Institutes on Aging, to
mary health care and health insurance for elders; accentu- be funded by the GOI, have been designated, one in the
ate research and training in geriatrics and gerontology; north (Delhi), the other in the south (Chennai). NGOs also
strengthen the family as the primary eldercare provider; play important roles, as exemplified by a recent telemedi-
and value seniors as human resource partners in national cine/hospital-based dementia care management system in
economic development. The MOSJE disseminates infor- Bangalore (www.nightingaleseldercare.com).
mation about senior programs. Finally, the LASI study is expected to generate significant
NPOP goals and objectives often raise implementa- data on health issues of middle-aged and older adults as a
tion issues. For example, to hold adult children legally basis for future health care provision. Policy makers and
responsible for their aging parents, Parliament enacted the NGOs at all levels also must familiarize themselves with
Maintenance and Welfare of Parents and Senior Citizens effective policies and programs within India and elsewhere.
Act in 2007. Although the law required state and UT help, A third issue concerns income security of the elderly
their involvement has been uneven. Their ability to imple- population. National means-tested monthly old age pen-
ment national policies is often dependent on their priorities sions are paid to poor, widowed, or single elders aged 60+,
and budget capacity (Rajan & Matthew, 2008). Six years lacking family support. States administer this program and
later, only 15 states and 6 UTs had initiated enforcement can opt to provide monthly supplements, ranging from 50
(http://socialjustice.nic.in/oldageact.php). to 1,000 rupees, depending on the extent of their welfare
This issue and other NPOP problems led to proposals budgets and other concerns.
for amending the national policy. An advisory committee Currently, there are two other kinds of pensions: a life-
was convened in 2010 that subsequently issued its recom- time monthly retirement benefit, predominantly for govern-
mendations in 2011. Various stakeholders have continued ment workers, and lump-sum “provident funds” for some
providing input. The 2014 elections brought in a new gov- private sector retirees. Critical long-range solutions involve
ernment that immediately appointed a new MOSJE min- expanding the availability of lifetime savings and pension
ister, who is expected to provide leadership for the new plans for those who work in nonindustrial and casual occu-
policy on aging. pations, and developing a universal social security program,
particularly for the oldest old.
Developing national programs for India’s elders will
Emerging Issues on Aging in India increase the demand for more research and education about
Today, India is challenged by several major transitions aging, including effective social policies for the growing
(demographic, health, sociotechnological) since it achieved numbers of seniors (Birren, 2006). Strategies for enhanc-
its independence. As a developing nation, these changes ing gerontological education programs include increased
have been quite rapid, compared with experiences of more research funding; faculty development and continuing
developed nations undergoing similar changes in their past education of existing faculty; widespread professional
The Gerontologist, 2015, Vol. 55, No. 6 899

education, training and certification; expanded graduate Government of India, Ministry of Social Justice. Role in the welfare
and undergraduate degree education; and practical educa- of elderly. (2014). Retrieved from http://www.socialjustice.nic.
tion for elders and their families, especially those who live policies.in
in rural areas (Liebig & Kunkel, 2014). Government of India, Care provisions and legal supports. (2014).
Retrieved from http://socialjustice.nic.in/oldage act.php
HelpAge India. (2013). Retrieved from http://www.helpageindia.org
Hendricks, J., & Yoon, H. (2006). The sweeping change of Asian
Conclusions
aging: Changing mores, changing policies. In J. Hendricks & H.
India is not alone in grappling with these issues. The most Yoon (Eds.), Handbook of Asian aging (pp. 1–21). Amityville,
pressing global challenges to older persons’ welfare are NY: Bayworth.
poverty; malnutrition; unattended chronic disease; lack of Heritage Hospitals and Foundation. (2014). Retrieved from www.
access to safe drinking water and sanitation; and income heritagehealthcareindia.com
security (International Association of Gerontology and International Association of Gerontology and Geriatrics. (2014,
Geriatrics [IAGG], 2014). In developing nations like India, March). Report. Seoul, Korea: International Association of

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the task to develop, initiate, and expand programs for the Gerontology and Geriatrics-IAGG.
elderly population is more difficult due to growing num- International Longevity Center. (2013). Retrieved from http://www.
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Indian National Science Academy. New Delhi, India: Indian
and other challenges through appropriate and viable long-
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