India is undergoing a profound demographic shift. The nation is aging, and a critical look reveals that women are at the forefront of this change. They are living longer, yet often facing a less healthy existence. This reality demands immediate attention and a re-evaluation of how society supports its senior **women**.
Recent data from the India Ageing Report 2023 paints a stark picture. Experts predict that by 2050, individuals aged 60 and above will constitute over 20% of India’s population. What’s more, women outlive men by an average of 2.7 years, leading to a noticeable increase in the number of elderly **women**. This longevity, however, comes with a caveat.
The McKinsey Health Institute estimates that women will likely spend 25% more time in poor health compared to men, particularly in their later years. This health gap is significant and highlights an urgent need for bridging. Despite these sobering statistics, the challenges faced by elderly **women** often remain undiscussed, pushed into the shadows. Society tends to view them as passive dependents, overlooking their distinct needs and the unique struggles they encounter daily.
When you factor in their ingrained caregiving and self-sacrificing instincts, you see a large demographic of grey-haired **women** quietly navigating public spaces. This article aims to bring these elderly **women** into the spotlight, exploring their health-seeking behaviors and the health conditions that disproportionately affect them. More importantly, it seeks to highlight potential strategies to empower them to live better, healthier lives as they age.
The social determinants of women’s health extend far beyond just medical considerations. Socio-cultural, economic, and structural factors all play a crucial role. Health-seeking behavior refers to the actions an individual takes to obtain medical attention, the type of care they seek, and how they manage their condition. This behavior is influenced by various elements, including access to information, perception of disease, demographics, economic status, availability of facilities, perceived quality of services, and socio-cultural beliefs. For **women**, additional layers like education, social conditioning, marital status, financial and digital dependency, and the lack of gender-sensitive care facilities further complicate matters.
The ‘Three Delays’ framework offers a useful lens through which to understand the barriers to health-seeking among older **women**. The first delay often originates within the household, where the needs of elderly **women** are sometimes de-prioritized. The second delay typically involves difficulties in accessing healthcare facilities and services, which can be a significant deterrent, especially for chronic conditions requiring frequent visits. The third delay concerns receiving adequate and timely care at the facility itself, encompassing everything from having gender-appropriate staff and capabilities to effective health financing mechanisms.
Indian **women** are often socialized to place their family’s well-being above their own. This often leads them to neglect their own health needs, even as they diligently care for spouses, children, and grandchildren. In many patriarchal households, decisions about when and if an elderly woman seeks care are often made by a spouse or adult children, adding an emotional layer that can delay crucial interventions. Furthermore, **women** may be psychologically conditioned to believe that the problem lies with them rather than the healthcare system, especially when facing difficulties like scheduling appointments. This internal bias can further inhibit them from seeking necessary care. The challenges for formerly married elderly **women** are particularly acute. Dealing with the loss of a spouse due to widowhood, divorce, or separation can significantly alter their living arrangements. While family has traditionally been a strong support system in Indian culture, the rise of job-related migrations and nuclear family structures is creating new norms for living, such as living alone or moving into senior citizen communities. This shift can either disrupt or improve their access to care, depending on individual circumstances.
Financial insecurity is another major vulnerability for older **women**. A 2011 UNFPA study alarmingly reported that nearly 60% of older **women** had no personal income, a figure that only increases with age. Few elderly **women** have health insurance coverage, which is often tied to higher education, financial autonomy, and mobility. Less than 20% of **women** can pay their own medical bills, a stark contrast to elderly men, where this number doubles. This high economic dependency severely limits access to timely and appropriate medical care.
The digital gender gap is also more pronounced among the elderly, with significantly fewer **women** having access to digital devices. This limited tech literacy hampers their ability to access vital health information and services. Other practical barriers include distance to healthcare facilities, lack of transportation, and the need for support from a family member typically a male to access care. A UNFPA study found that two-thirds of older **women** are accompanied by children or grandchildren to appointments, demonstrating a higher level of dependency compared to older men.
Even when **women** reach a healthcare facility, insufficient access to female health providers and limited information or diagnostics for women’s health issues can cause further delays in care. Once inside the health system, **women** often require assistance navigating its complex processes, which can further deter them from seeking necessary services.
Beyond these access issues, **women** experience aging-driven chronic conditions differently. While cardiovascular diseases, cancers, and neurodegenerative diseases are commonly discussed, the nuances of how **women** experience these due to physiological transitions and caregiving burdens are often overlooked and under-researched. For healthy aging, **women** need access to affordable and adequate healthcare throughout their lives. In India, healthcare expenditure for **women** is significantly less than for men across all age and socio-economic groups, exacerbating conditions later in life that can severely impact their quality of life and cause disability.
Even in their 60s and 70s, many Indian **women** continue to bear the heavy burden of caregiving for spouses, children, grandchildren, and sometimes extended family. The hormonal shifts following menopause, coupled with muscle mass loss and nutritional deficiencies, mean that non-communicable diseases like hypertension, diabetes, and cardiovascular illnesses often have more severe outcomes and complications in **women**. The decline in bone health poses a substantial risk for osteoporosis and arthritis, which are far more common yet under-diagnosed in **women**. The heightened risk of fractures from falls can lead to disability or limited movement, deeply affecting their mental well-being. A lack of proper diagnostics, particularly in rural health systems, combined with limited knowledge among health workers, often leads to the normalization of musculoskeletal pain in **women**.
After their reproductive phase, the healthcare system often neglects **women**’s uro-gynaecological health. In lower-income settings, many **women** rarely receive gynecological examinations after childbirth. Conditions such as uterine prolapse, urinary incontinence, and pelvic floor dysfunction are widespread but often dismissed as embarrassing topics, leaving countless **women** to suffer in silence.
Certain cancers, like liver or colon cancers, affect **women** differently, often presenting in more severe forms. Cancers of the breast, cervix, ovaries, and uterus disproportionately affect older **women** and frequently go undiagnosed until advanced stages. Over 50% of breast cancer cases in India occur in post-menopausal **women**, yet screening awareness drops sharply with age. Studies show that appropriate therapies can significantly improve survival rates for elderly **women** with breast cancer.
While vaccines are helping reduce cervical cancer risk among younger **women**, older **women** remain susceptible, with limited access to and frequency of pap smears. Ovarian cancer, the most lethal gynecological cancer, often presents with vague symptoms like bloating and abdominal discomfort, which are frequently misattributed to normal aging. This delays diagnosis until advanced stages, leading to a grim five-year survival rate of 17 percent.
Neurodegenerative diseases, such as Alzheimer’s and other dementias, are more likely to develop in **women** due to both biological factors, like estrogen decline, and social conditions, such as longer lifespans and isolation after the loss of a spouse. The Longitudinal Aging Study in India LASI indicates that **women** over 70 report higher levels of cognitive impairment but are less diagnosed and treated compared to men.
Mental health among elderly **women** is significantly under-reported, under-diagnosed, and under-treated. Many **women** in their 60s and 70s continue to shoulder caregiving duties, often for multiple family members. With elderly **women** more likely to outlive their spouses, lose peer support systems, and internalize stress from years of emotional labor, they experience higher rates of depression and anxiety. However, according to HelpAge India, only 1 in 10 elderly **women** with depressive symptoms seek help, largely due to stigma and limited access to mental health services for the elderly.
Despite these systemic challenges, many elderly **women** in India proactively engage in activities to enhance their well-being. Socially, they often remain deeply connected to family and community networks, participating in religious activities, volunteering, and staying active in their grandchildren’s lives. These social engagements are powerful protective factors against loneliness and cognitive decline. LASI data shows that higher social engagement among elderly **women** can decrease the prevalence of poor health by 9 percentage points.
Many **women** also find joy and purpose in routines that keep them physically and mentally active, such as walking groups, yoga classes, or pursuing new hobbies. Compared to their male counterparts, they tend to build deeper relationships, seeking emotional support and establishing new routines post-retirement. Educated **women** are also more likely to access better outpatient care in both public and private facilities, with education being a primary driver of choice. Wealth status, place of residence, and health insurance coverage are other significant enabling factors.
To truly support and empower elderly **women** in their health-seeking behaviors, India needs to transition to more inclusive, gender-sensitive health systems. Policies must acknowledge the unique path of Indian **women** significant unpaid caregiving, interrupted careers, lower financial autonomy, and distinct physiological life stages and how these factors shape their aging experience.
There is a scarcity of large-scale studies on the health behaviors of this rapidly growing elderly Indian population, including the burdens of access and affordability. Systematic gender-disaggregated data collection and analysis, potentially using AI/ML models to mitigate biases, can significantly improve understanding of biological and social barriers, leading to more nuanced interventions. Healthcare delivery needs to evolve, leveraging frontline workers, health volunteers, and mobile health units to increase access for **women** who may not seek help on their own.
Projects like Kerala’s Vayomithram Project, which provides mobile clinics staffed by medical professionals offering healthcare assistance and free medicines to the elderly, including **women**, serve as excellent models. Scaling up such programs with adequate funding, audit oversight, and healthcare training can greatly enhance accessibility for elderly **women**. Geriatric screening should be expanded to encompass conditions more prevalent or under-diagnosed in **women**, such as osteoporosis, Alzheimer’s, urinary incontinence, and gynaecological cancers.
The National Programme for Health Care of the Elderly aims to provide accessible, affordable, and high-quality long-term care for the aging population. Its effective planning, implementation, and monitoring require strong commitment and collaboration from various Ministries, States, and the Central government. While some states have demonstrated progress, implementation remains sporadic in most, plagued by low program expenditure and a lack of equipment or skilled health workers. A renewed commitment to this program’s original intent, through focused training and resources, is crucial to effectively address the unique health needs of the elderly and, specifically, **women**.
Pension reforms must also acknowledge and account for the informal work histories of **women**. Expanding eligibility for contributory schemes like the Atal Pension Yojana to include care credits or informal labor indexing for **women** not in formal employment is one potential approach. State-level pension schemes, such as the Indira Gandhi National Old Age Pension Scheme, could also be scaled up with gender-sensitive eligibility criteria, streamlined processes, improved efficiency, and increased payouts indexed to inflation and health needs.
Complementing financial assistance, the Rashtriya Vayoshri Yojana provides essential assistive devices to senior citizens from lower-economic households who suffer from age-related disabilities. While helpful, these schemes can be strengthened by integrating them with local health worker outreach or community groups, making them more accessible for elderly **women** who may be hesitant to navigate the process independently.
Health insurance, too, must evolve to reflect the realities of older **women**. Many **women** above 60 are not covered by employer-sponsored or private insurance plans. Government schemes often prioritize hospitalization but neglect outpatient care, preventive diagnostics, and long-term needs. Programs like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana AB PM-JAY could introduce add-on packages specifically for **women**-specific geriatric care, including mammograms, osteoporosis screening, mental health consultations, and home-based physiotherapy and regular diagnostic testing.
At the community level, investing in **women**-led social support groups can leverage their strengths in relationship-building and caregiving. Initiatives like Kerala’s Kudumbashree have established networks of women’s self-help groups, fostering social engagement and economic empowerment among elderly **women**. Similarly, the Smart Cities Mission is setting up senior citizen centers across Uttar Pradesh to address the emotional, social, and health needs of the elderly.
**Women** spend their lives holding families and communities together. As they age, it is our collective turn to support them with healthcare that truly listens, systems that are inclusive, and policies that genuinely understand their lifelong journeys. By centering elderly **women**, we build a stronger social fabric for everyone, laying a foundation crucial for the sustainable economic growth of a truly caring society. It is time to ensure that living longer also means living healthier for every elderly **women** in India.