In the West, retirement can mean a bucket list. In India, it often means a sort of cheerful resignation to ageing, say health experts. Photo: iStock
The World Health Organization’s latest Global Health Estimates, released last month, puts India’s average life expectancy at birth to be 71 years in 2023. Significantly, however, India’s healthy life expectancy is only 60.6 years. Part of it comes from our social conditioning where age is seen to be synonymous with declining health.
Ravindra Kumar, a retired Canadian embassy employee in his late sixties, has progressively seen his world shrink in recent years. Living with age-related hearing loss, the Ghaziabad resident has been withdrawing from conversations that he struggles to follow. He avoids going out and rarely calls relatives; even at home, his is often a silent presence. His family — wife, children, their spouses — would like him to be more involved. “They want me to use a hearing aid, but I don’t want to be dependent on a device,” he says, by way of explaining his reluctance.
And so, he has become increasingly withdrawn, inhabiting an inner world that admits not even those closest to him. “I play with my granddaughter once she returns from school; the rest of the time I just sit and ponder on life.”
The World Health Organization’s latest Global Health Estimates, released last month, puts India’s average life expectancy at birth at 71 years in 2023. Significantly, however, there is a gap between living and living healthy; one which the WHO report acknowledges. In case of India that gap is a decade; the Global Health Estimate puts India’s healthy life expectancy at 60.6 years. Globally, non-communicable diseases (NCDs) accounted for 74 per cent of deaths in 2023, up from 58 per cent in 2000, and WHO noted rising diabetes mortality risk in South-East Asia.
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Delhi-based palliative care physician Sneha Rooh counts hypertension, diabetes, osteoporosis (the weakening of bones, which leads to increased risk of fractures in women), heart disease in men and dementia, as the most common complaints she encounters in patients past 60 (the threshold of senior citizens in India).
For Dr Hardik Patel, a consultant physiotherapist at Fortis Hospitals in Mulund and Vashi (both neighbourhoods in Mumbai), the central distinction is between ageing and disability. Some loss of muscle, bone density and reaction time is expected. Recurrent falls, trouble rising from a chair and dependence on others for daily tasks are not, and should not be shrugged off as old age. His proposed test is simple. Ask not "How old is the patient?" but "What can the patient still do independently, and what has changed?" Someone who now pushes off with both hands to stand up, avoids stairs or stops going out is a candidate for assessment.
Part of the gap between life expectancy and healthy life expectancy can explained by real issues — problems of access to healthcare, or limited personal and family funds in old age.
As in the case of 62-year-old Delhi resident Yashoda Devi, who can no longer negotiate the stairs without struggling with knee pain. “Achi sehat ka taluq seedha aapke khaate mein jo raashi hai, usse hai (Good health is directly linked to how much money you have in your account),” she says sagely. “We are a lower-middle-class family. My children are busy earning their bread and butter. They have their own responsibilities. I don't want to disturb them every couple of days to take me to the doctor,” she says, rubbing a pain relaxing gel onto her knees. She accepts the pain “as a natural part of ageing".
According to a 2024 Forbes report, about 70 per cent of Indians were covered under public health insurance or voluntary private insurance in 2021. The remaining 30 per cent, reportedly left without any insurance cover, then numbered around 40 crore. The Indian government has introduced schemes like the Jan Arogya Yojana and Ayushman Bharat, to help improve access to healthcare, but often the benefits get lost in lack of awareness, paperwork issues or delays in payment.
Even where families are able to afford medical care, social conditioning often plays a part in the elderly ignoring “minor health inconveniences”, which however can go a long way in interfering with a full, active life. Indians are taught to earn for their children and expect care in return, which makes spending on one's own health feel indulgent, notes Rooh.
Then there is the old resignation to ageing and what old age should look like.
In the 1968 comedy Padosan, starring Sunil Dutt, Saira Bano, Kishore Kumar and Mehmood, Dutt’s character is seen reading from old text that lists that till the age of 25 one should maintain Brahmacharya (discipline), while 25 to 50 years for Grihastha or family life. While he doesn’t get a chance to go beyond 50 in the film, traditional Indian philosophy earmarked 50-75 as the period of vanaprastha or retirement from household life and post 75 to be a period of sanyasa, or detachment from material and worldly life and a seeking of moksha or release.
While not many would probably follow this structured life today, the conditioning that beyond an age one is to withdraw and surrender to the years is a belief that continues to condition many Indians.
That attitude explains a lot about ageing and ageing well to Dr Sujatha Rajamani, a consultant psychotherapist at KIMS Hospital in Hyderabad. In the West, she says, retirement can mean a bucket list. In India, it often means a sort of cheerful resignation. The children are married, the grandchildren have arrived, and what else is there? "Ab toh kabhi bhi bhagwan bulae, hum toh tayyaar hai. (Death can come any time now and we are prepared).” Women, she says, are assumed to be healthy as long as they are cooking. Men, whose friendships often lived entirely at the office, find the circle gone the day the routine ends.
That attitude can be frustrating for the family.
“My father, 80, is a COPD [compulsive obstructive pulmonary disorder] patient, but refuses to undergo regular check-ups, depending instead on inhalers. In recent months, he has been wheezing more, has lost weight, and refuses to step out of the house to ensure he doesn’t struggle more to breathe. But whenever my mother and I try to talk him into a doctor’s visit or to motivate him to take better care of his health so that he can lead a more full life, his standard answer is that at his age he can’t be expected to be any different,” says Preyashi Chatterjee, 50, a communication professional based in New Delhi.
She adds: “It is now taking a toll on my mother. She is 75, active and independent and doesn’t believe in depending on hired help. With my father hardly able to do anything around the house, there is no division of work.”
Often though, the family can help mould the attitude towards age. Love, in an Indian family, often expresses itself as taking things out of people's hands, point out medical practitioners. Fetch the water. Carry the bag… encouraging senior people to stop being active.
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Where age brings in conditions like dementia, care is essential.
As in the case of 38-year-old Delhi resident Majid Hussain, much of whose daily routine revolves around his 68-year-old father, who has been living with dementia for the past three years. Hussain, who runs a business in manufacturing paper carry-bags, brings his father to the factory daily, keeping him close while trying to keep the business running. “It's tough. Just now, he asked me for a cup of tea, even though he had already had his evening tea. He doesn't remember the way back home either,” Hussain says. The smallest routines, it seems, can become the hardest to hold on to.
But wherever possible, doctors advise families to encourage senior people to exercise, to be independent and to follow interests and passions.
A slow change is already becoming visible, especially in urban areas. Senior people are travelling more, pursuing a second career or an interest which the rigour of a professional life had made difficult to keep up with. Retirement communities are coming up, where the company of contemporaries is ensuring a more active social life, while ensuring there is practical and medical help available when needed. It is being reflected in films like Unchai (starring Amitabh Bachchan) and 102 Not Out (again Bachchan), which show the elderly reclaiming life.
All this can not guarantee that a longer life will be a healthier one. But the desire to participate and live life to the fullest, can go a long away in being more mindful of health, in seeking out medical help where required and that in turn might help bring down the gap between life expectancy and healthy life expectancy.
