INTRODUCTION: THE DEMOGRAPHIC IMPERATIVE AND SHIFTING SOCIAL LANDSCAPE
The world is going through a significant demographic shift marked by longer lifespans and falling birth rates, often called the “silent revolution.” In India, this situation is especially intense, leading to a quickly growing older population. (Shaik et al., 2024) (Annapuranam, 2025)(age 60 and above) projected to reach 14.9 per cent of the total population by 2036, and 324 million by 2050, (Yadav et al., 2024). As the home to the second-largest number of older people worldwide (Shaik et al. 2024). India faces immense challenges in adapting its social, economic, and health infrastructure to meet the complex needs of its senior citizens. (Elderly in India Report, 2021). This phenomenon, coupled with accelerating urbanisation and the shift towards nuclear families, has severely weakened traditional family support systems, leading to increased vulnerability and elderly abuse.
Historically, India’s traditional joint family system served as the primary safety net, built on cultural values emphasising filial piety and reverence for elders, “Matru Devo Bhav,” “Pitru Devo Bhav” (Kamal et al., 2020). However, rapid urbanisation, industrialisation, migration, and the prevalence of nuclear families are eroding these traditional structures, leaving many elderly vulnerable to financial, physical, and emotional insecurity. (Mathur, 2014). This shift mandates a robust state-led, community-supported welfare framework, shifting the burden of care from a solely private family matter to a public obligation. (Patel, 2024).
DEMOGRAPHIC REALITIES AND SOCIO-ECONOMIC VULNERABILITIES
India’s ageing population exhibits distinct characteristics that amplify vulnerability:
• Feminisation and Ruralization: Older women significantly outnumber older men, partly due to longer life expectancy, a phenomenon known as the feminisation of ageing (Kumar, 2017). The majority of the elderly population continues to reside in rural areas, 71 per cent in 2011 (Balamurugan, 2019).
• Economic Insecurity and Dependency: A major concern is the pervasive economic dependence of the elderly. As many as 65 per cent of senior citizens depend on others for their daily maintenance (Yadav et al., 2024), with this figure rising higher for elderly females. Many continue working out of economic compulsion, often in t(GOI, 2016). The unorganised sector, lacking formal social security or pension schemes (Ansari, 2021). This dependency creates a critical economic problem that underpins many other challenges. (GOI, 2021).
• Health and Functionality Burden: Ageing is accompanied by high morbidity, with over 52 per cent of older adults having one or more chronic conditions (Maurya et al., 2024). Chronic and degenerative conditions, such as arthritis, heart diseases, and sensory impairments (including hearing and vision loss), are highly prevalent. (Shaik et al., 2024). Crucially, the onset of these chronic non-communicable diseases often occurs earlier in India (around age 45 or older) than in developed countries. The progressive deterioration of the musculoskeletal system leads to common mobility restrictions and functional difficulties in performing Activities of Daily Living (ADL) (LASI, 2017).
• Elder Abuse: Elder abuse is a critical public health and human rights issue (Issac et al., 2021). The national prevalence is reported at 5.22 per cent. (Maurya et al., 2024), with vulnerability strongly linked to poor functional health (ADL limitations) and greater asset holdings. The most frequent perpetrators are immediate family members, such as sons and daughters-in-law, who often subject the elderly to verbal abuse, neglect, and emotional exploitation. (Maurya et al., 2024).
THE LEGAL AND POLICY FRAMEWORK IN INDIA
India’s policy response has been guided by international commitments, particularly the Madrid International Plan of Action on Ageing (MIPAA), 2002 (Issac et al., 2021). The core domestic policies include the National Policy on Older Persons (NPOP), 1999 (Shaik et al.,2024), and the landmark legislation that followed.
A. The Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act, 2007
The MWPSC Act, 2007, is the principal legal instrument designed to provide more effective provisions for maintenance and welfare. (Nagpal, 2024).
• Maintenance Obligation: The Act legally mandates adult children (and relatives who inherit property) to provide needs-based maintenance to parents and senior citizens who are unable to support themselves (Nagpal, 2024.). This obligation is enforceable through Maintenance Tribunals. (Bindu, 2021).
• Property Protection: The Act contains a controversial provision, Section 23, which allows the Tribunal to declare the transfer of property void if the transferor (parent/senior citizen) transfers property after the commencement of the Act under the condition that the transferee will provide basic amenities and care, but subsequently fails to do so (Yadav et al., 2024).
• Welfare and Health Provisions: The Act mandates State Governments to establish old age homes, penalise abandonment (Kalavar et al., 2020), and ensure medical facilities, specialised geriatric wards, and research promotion in elderly health care (Balamurugan, 2019).
B. Critiques and Implementation Gaps
Despite its noble intentions, the MWPSC Act faces significant practical and conceptual challenges:
• Low Awareness and Cultural Resistance: Implementation is hampered by a lack of awareness; only 12 per cent of the elderly reported knowledge of the Act, even a decade after its enactment (Nagpal, 2024). Furthermore, many elderly prefer not to take legal recourse against their own children, viewing the Act as attacking the traditional Indian value system. (Mathur, 2014).
• Judicial Inconsistency (Section 23): The legal landscape around property protection under Section 23 is unstable due to conflicting judicial interpretations (Yadav et al., 2024). A major debate revolves around whether the conditionality of care must be explicitly written in the transfer deed (the strict, literal view affirmed by the Supreme Court in Sudesh Chhikara) or whether the Tribunal can implicitly infer the expectation of care from the relationship (the broader, goal-based view favoured by some High Courts) (Yadav et al., 2024). This instability undercuts the security that the law intended to provide. (Yadav et al., 2024).
• Inadequate Health System Alignment: The National Programme for Health Care for the Elderly (NPHCE), 2010, aims to provide comprehensive geriatric care (Kumar, 2017). However, implementation suffers from insufficient infrastructure, a lack of specialised manpower, and limited geriatric services, meaning these health goals often remain “on paper” rather than reaching the grassroots level effectively. (Shaik et al., 2024.).
THE PATH FORWARD: TOWARDS INTEGRATED AND HEALTHY AGEING
The future demands a multi-pronged strategy that moves beyond inadequate legal measures and fragmented service delivery. This strategy must integrate principles of public health, social protection, and human rights.
A. Embracing the Healthy Ageing Framework
The World Health Organisation (WHO) advocates for “Healthy Ageing,” defined as the process of developing and maintaining the functional ability that enables well-being in older age(WHO,2020). Functional ability encompasses a person’s capacity to meet basic needs, be mobile, learn, build relationships, and contribute to society. (WHO,2020).
The WHO mandates concerted action in four priority areas:
• Changing Ageist Attitudes: Addressing pervasive ageism in society, media, and healthcare settings is crucial (Shaik et al., 2024).
• Fostering Supportive Communities: Ensuring that environments (physical, social, and policy) are age-friendly and supportive of the elderly’s capabilities (World Report on Ageing and Health, 2015).
• Delivering Integrated Care: Implementing person-centred integrated care services, such as the WHO ICOPE (Integrated Care for Older People) model, which focuses on optimising functional ability rather than merely managing disease (World Report on Ageing and Health, 2015).
• Providing Long-Term Care Access: Developing sustainable systems for long-term care, especially given that long-term care needs are projected to increase drastically, requiring formal systems alongside family support (Annapuranam, 2025).
B. Policy and Research Priorities
To achieve this vision, specific institutional and research reforms are necessary:
• Economic Reform: There is an urgent need to launch self-employment and re-skilling initiatives tailored to retired older persons to tap into their accumulated knowledge and experience, offering them gainful engagement opportunities (Agewell Foundation, 2021). Policies must enhance income security, increase the adequacy of social pensions (which are currently meagre), and explore health insurance models that cover chronic conditions. (Ansari, 2021).
• Integrated Care Models: Successful models like Kerala’s palliative care system, which utilises community-based organisations (CBOs) and volunteers alongside local governance, demonstrate effective mechanisms for managing chronic disease burden and dependency(Kumar,2017). Furthermore, resources should be mobilised to implement community services like mobile medical units (MMUs) for rural areas, hospice care, and day care centres. (Kumar,2017).
• Data and Research: Currently, three-quarters of the world’s countries, including India, lack comparable longitudinal data on healthy ageing (WHO,2020). The launch of the Longitudinal Ageing Study in India (LASI), the largest study in the HRS family, is a landmark achievement, providing vital data on health, economic status, and vulnerability. Future research must leverage this data to understand complex intergenerational relationships, the economic contributions of the elderly, and the efficacy of interventions. (LASI,2017).
CONCLUSION
The conclusion of this comprehensive review synthesises the escalating challenges posed by India’s demographic shift and evaluates the efficacy of current governmental and social responses, charting a necessary course toward an integrated and sustainable elder care framework.
A. The Policy and Implementation Chasm
• India has proactively responded to global ageing challenges by becoming a signatory to the Madrid International Plan of Action on Ageing (MIPAA) and endorsing the Sustainable Development Goals (SDGs), which mandate inclusion and well-being across all ages (Issac et al., 2021). Domestically, landmark policies like the National Policy on Older Persons (NPOP) and the National Programme for Health Care of the Elderly (NPHCE) aim to provide dedicated services. (Issac et al., 2021).
• However, the core challenge remains a significant implementation gap. The Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act, 2007, designed as a fundamental legal safeguard, is hampered by low utilisation and limited visibility; the Longitudinal Ageing Study in India (LASI) found that only 11.7 per cent of the elderly were aware of the Act, even a decade after its enactment (Nagpal, 2024). Furthermore, the Act contains an inherent flaw with the arbitrary maximum monthly maintenance cap of ₹10,000, which hinders securing adequate financial support, particularly for those with high health needs or residing in high-cost urban areas. (Nagpal, 2024).
• Critically, the implementation of Section 23 (annulment of property transfer) has been undermined by inconsistent judicial interpretations. While the Supreme Court requires the obligation of care to be explicitly stipulated in the transfer deed, several High Courts have adopted broader, implicit interpretations, creating legal uncertainty and instability in property rights essential for third parties(Yadav et al., 2024). This demonstrates that the MWPSC Act, though pivotal, is a weak enactment that often fails to deliver substantive justice due to these legislative loopholes and uneven enforcement. (Banerjee, 2021).
B. The Shift to Integrated, Functional Care
• The traditional familial support system is rapidly eroding due to urbanisation, migration, and the decline of the joint family, increasing the economic dependency of the elderly, reported up to 70 per cent dependent on others for maintenance (AgeWell Foundation, 2021). This vulnerability is compounded by the high prevalence of chronic diseases and functional disabilities, ADL/IADL limitations. (Issac et al., 2021).
• The fundamental policy imperative must be a comprehensive shift toward the Healthy Ageing framework advocated by the WHO, which focuses on optimising functional ability rather than merely managing disease(WHO,2020. This means fostering the abilities of older people to meet basic needs, maintain mobility, and participate meaningfully in society. Research suggests that improving health conditions, a modifiable factor, is critical, as functional limitations significantly increase the likelihood of elder abuse and require focused intervention. (Maurya et al., 2024).
C. Directions for Accelerated Action and Reform
• Sustaining the welfare of India’s rapidly growing senior population requires concerted action across legislative, administrative, and social domains:
• Legislative Reform: The proposed amendments to the MWPSC Act must address key inadequacies, notably by removing the arbitrary cap on maintenance amounts and providing clearer, unified enforcement guidelines (Banerjee,2021). This must be accompanied by strengthening police mechanisms and institutional accountability to safeguard the property and dignity of the elderly. (Banerjee, 2021.).
• Integrated Health Systems: Resources must be dedicated to strengthening geriatric infrastructure, moving the NPHCE from a supply-oriented approach to a demand-driven, integrated service model (such as the WHO’s ICOPE model), and increasing the availability of trained, specialised geriatric staff and informal caregivers (Balamurugan, 2019).
• Data and Research Mobilisation: The LASI remains the foundation for evidence-based policymaking; continued investment is required to close critical data gaps on health trajectories, socioeconomic inequality, and the precise effectiveness of intervention models. This research should focus on promoting active ageing, recognising the elderly as an asset rather than a burden, and leveraging community-based successes (like Kerala’s palliative care model) for wider replication (LASI, 2017).
• Social Change: Efforts must intensify to combat ageism and foster intergenerational solidarity, essential steps to ensure older persons are valued members of society, mitigating the social isolation and disrespect often leading to neglect and abuse (WHO,2020)
In conclusion, addressing India’s ageing challenge requires political will to accelerate implementation of existing laws, rectify legal ambiguities (like Section 23) to ensure equitable enforcement, and implement the Healthy Ageing framework to pivot care from a disease-centric approach toward a person-centred, integrated system focused on maintaining dignity and functional ability.(2017). This transformative process demands sustained effort and resource allocation from all stakeholders: government, civil society, and older persons themselves. (Kamal et al., 2020). Ultimately, ensuring a dignified life for senior citizens requires policymakers to regard elderly welfare not as a marginal social service, but as a central component of national development and human rights, underpinned by political will and integrated societal commitment. (Issac et al., 2021). The successful model of elderly welfare will therefore be built not just through legislation, but through the continuous, collaborative effort of the family, community, and the state, focused unequivocally on enhancing the functional capacity and agency of every older person.