The rapid growth of India’s aging population, coupled with a rise in modifiable risk factors such as air pollution, hypertension, traumatic brain injury (TBI), and obesity, presents a significant challenge for the nation’s public health and social care systems. Dementia, or neurodegenerative disorder, a major cause of cognitive disability and dependency among the elderly, is expected to affect millions of Indian families over the next two decades.
The steady decline in India’s Total Fertility Rate (TFR) over the past several decades has led to an increase in the proportion of older adults in the population. As of 2019, India is home to over 139 million people aged 60 and above, accounting for more than 10% of the nation’s entire population. By 2050, the percentage of elderly people is projected to nearly double to 19.5%, with 319 million individuals over the age of 60. Consequently, it is anticipated that one in every five Indians will be a senior citizen. The TFR in India has witnessed a significant decline, dropping from 5.2 in 1971 to 2.0 in 2020, and it is now lower than 2.1, the replacement level.
TFR, which is the average number of children per woman, has further declined from 2.2 to 2.0 at the national level between National Family Health Survey (NFHS) 4 and 5. There are only five States in India that are above the replacement level of fertility which is 2.1. These are Bihar (3.0), Meghalaya (2.9), Uttar Pradesh (2.4), Jharkhand (2.3), and Manipur (2.2), according to NFHS-5, released by the Ministry of Health and Family Welfare. This shift has contributed to an aging population, as people are living longer and having fewer children.
Need for policy reforms
The Lancet Commission’s 2020 report on dementia prevention, intervention, and care, combined with findings from the National Family Health Survey (NFHS) 2020, highlights the urgent need for policy reforms and targeted interventions to tackle the growing dementia crisis in India. The country is confronting a growing challenge to manage age-related diseases such as Alzheimer’s, Parkinson’s, vascular dementia, and other neurodegenerative disorders. The demographic shift stands to exacerbate several risk factors for dementia identified in the Lancet Commission report, including hypertension, obesity, smoking, depression, social isolation, and physical inactivity.
Compared to NFHS-4, the prevalence of obesity has increased in most States in NFHS-5. At the national level, it increased from 21% to 24% among women and 19% to 23% among men. More than a third of women in Kerala, Andaman and Nicobar Islands, Andhra Pradesh, Goa, Sikkim, Manipur, Delhi, Tamil Nadu, Puducherry, Punjab, Chandigarh, and Lakshadweep (34–46%) are overweight or obese. With an aging population, the number of individuals at risk of Alzheimer’s and other forms of dementia will increase substantially in India. A research study conducted in India discovered that older individuals with disabilities were more prone to living alone, exacerbating their sense of social isolation and deprivation (Ugargol et al., 2016). A failure to address this growing health concern could result in significant social and economic consequences.
One of the key strategies to address the dementia challenge is to invest in early detection and timely intervention. The Lancet Commission report suggests that up to 40% of dementia cases may be preventable by addressing modifiable risk factors. Public health initiatives aimed at promoting healthier lifestyles, such as regular exercise, a balanced diet, and smoking cessation, can reduce the prevalence of these risk factors and curb the rise of Alzheimer’s disease. The Government of India must prioritise the development of a robust and comprehensive healthcare infrastructure to cater to its aging population. This includes training healthcare professionals in geriatric care, establishing specialised dementia care facilities, and promoting research to better understand the disease’s epidemiology and develop effective treatments.
Addressing risk factors
To confront the impending dementia crisis over the next two decades, India must take a proactive approach to addressing risk factors.
Firstly there is air pollution, which is a pervasive issue in India, with many cities experiencing hazardous levels of pollutants that pose severe health risks. Research suggests that long-term exposure to air pollution can lead to chronic inflammation, oxidative stress, and neuroinflammation, contributing to cognitive decline and an increased risk of dementia. As India’s population continues to age, the detrimental effects of air pollution on cognitive health cannot be ignored. Essential to managing these risks will be the adoption of stringent air quality regulations and sustainable urban planning strategies to reduce air pollution levels. Also essential are the adoption of cleaner transportation alternatives, the promotion of renewable energy, and investments in the monitoring and reporting of air quality data.
Secondly, addressing hypertension and obesity is critical. Governments must develop and implement nationwide campaigns to raise awareness about the importance of a healthy lifestyle, emphasising regular exercise, a balanced diet, and weight management. Strengthening primary healthcare services to facilitate early detection and treatment of hypertension, obesity, and related health issues is recommended.
Thirdly, in relation to traumatic brain injury, the state must implement public safety measures and regulations to reduce the incidence of TBI, focusing on road safety, occupational safety, and sports safety. Also critical is enhancing awareness about TBI and its potential long-term consequences, including the increased risk of dementia,.
There is no doubt that the underlying message is to greatly expand investment in healthcare infrastructure. The government must establish specialised dementia care facilities and train healthcare professionals in geriatric care, with a focus on early detection, intervention, and management of dementia and associated risk factors. Investments in research to understand the links between risk factors and dementia, paving the way for development of effective interventions and treatments are also important. Alongside, it is necessary to raise public awareness, and to increase public understanding of dementia and its risk factors, apart from encouraging individuals to take proactive measures to maintain cognitive health as they age and of course, fostering a supportive environment for those affected by dementia and their families.
Comprehensive response
The intersection of India’s growing elderly population and the increasing prevalence of modifiable dementia risk factors calls for an immediate and comprehensive response. To effectively address the impending dementia crisis and secure a healthier future for its aging population, India must adopt a multifaceted strategy focused on addressing risk factors, enhancing healthcare infrastructure, and raising public awareness. The National Programme for Health Care of the Elderly (NPHCE), Health and Wellness Centres (HWCs), under the Ayushman Bharat program, and the National Policy for Senior Citizens 2011 represent essential initiatives undertaken by the Indian Government to support the well-being of its aging citizens. These initiatives highlight the government’s commitment to meeting the evolving needs of the elderly and ensuring their welfare and social inclusion. To cultivate an environment where senior citizens can lead healthy, dignified, and rewarding lives, the government must diligently implement and monitor these programs and policies.
(Dr. Sunil K. Khokhar is a postdoctoral researcher at University of Pennsylvania, Philadelphia, specialising in neurodegenerative disorders. khokharsunil1@gmail.com)
