Vrindavan: At a bi-weekly clinic for the elderly in Vrindavan, men and women over 60 walk in holding onto their relatives, leaning on walkers, or slowly limping forward. Seventy-five-year-old Nawal Singh struggled to make his way to a stool beside the doctor, helped by a fellow villager. Singh has been in chronic pain for the past five years, with swollen ankles and twisted knees, but this is the first time he is consulting a doctor. It’s thanks to a new wave of drives across India to reach out to the senior population.
“I am in a lot of pain,” he said, smiling and showing off his decaying, tobacco-stained teeth, “this is the first time I am going to see a doctor about it.”
Singh is among 50 senior citizens who had come to Vrindavan’s Aarogya hospital to seek treatment on 10 April. On the second and fourth Thursday of every month, the NGO Guild for Service runs a free-of-cost OPD for orthopaedic and eye treatment at their ashram, Ma Dham.
This OPD is one of the many small state and civil society initiatives to fill the gaps in public health infrastructure available for the elderly in India. Buried in the two-decade-old hype about India’s demographic youth bulge and Youngistan, the country’s senior citizens have silently suffered the lack of a targeted policy and medical attention. Making up more than 10 per cent of the population in India, and often suffering from multiple morbidities, the elderly require specialised care and find it more difficult to access due to mobility as well as medical literacy issues. Only now, India’s geriatric health infrastructure is slowly but determinedly expanding to include medical care for the silver population.
Countries such as Japan and China have raced ahead a long time ago in putting in place a healthcare infrastructure for its greying economy. Meanwhile, India’s National Programme for Healthcare of the Elderly (NPHCE) was only launched in 2010. It has been expanded under the Modi government, with two National Centres for Ageing, as well as 19 regional geriatric centres across 18 states set up in 2017-18. The ministry of Health and Family Welfare has also started weekly OPDs dedicated to geriatric patients at various Primary Health Centres across 722 districts of the country. Individual states have launched programmes to increase access to healthcare for the elderly. The new National Centre for Ageing at AIIMS Delhi is geared toward specialised geriatric care. With large waiting rooms, private wards and a day care centre, the NCA has become the go to destination for seniors seeking treatment in and around Delhi. But one centre is not enough to handle the load. According to Niti Aayog, one in every four Indians above the age of 60 report poor health, while 75 per cent of the elderly report a chronic illness.
At Vrindavan’s Ma Dham, senior citizens lined up to get medicine for diabetes and chronic pain. Pushpa Devi, 62, who has a compression in her backbone was prescribed short wave diathermy physiotherapy treatment, but she was restless to be in the fields.
“After getting this sikai my back will feel better, and I’ll work in the field tomorrow. My husband’s hand is fractured… someone needs to earn!” she said.
Access to healthcare, especially in rural areas remains a challenge, with only 28 per cent of the elderly population accessing OPD services, and just eight per cent opting for in-patient care. Climate change and extreme temperatures are further adding to senior morbidity.
The National Centre for Ageing
Sixty six and seventy year old Pushpavati and Mahendra Bansal had an early start from their home in Bahadurgarh to reach AIIMS Delhi’s Centre for Ageing by 10 am. They packed their lunch and brought it with them—this is their quarterly trip to AIIMS, and they know how time consuming the visit can be.
Mahendra is an AIIMS veteran. He knows the ins and outs of the hospital like the back of his hand. He knows how much time each doctor’s visit takes, and how to cross the bureaucratic hurdles to reach the right doctor. This visit was for a full body check up—to get eye tests, meet the orthopedician, as well as the general doctor. Each OPD would require them to wait for at least two hours, but the couple don’t mind the long wait time.
“This is the Supreme Court of medicine, one will have to wait here. It’s quite alright,” Mahendra said nonchalantly. He was sitting and dialling numbers in his contact list, catching up with relatives and old friends to kill the time. “I have so many people to talk to. I could never get bored,” he said.
Mahendra prefers AIIIMS, he said that private hospitals write unnecessary tests and prescribe expensive medicines that may not be required in the first place.
The geriatric department at AIIMS was started as a weekly clinic by Dr Vinod Kumar way back in 1993. It has now evolved into the NCA.
It is housed in a separate building, with shiny new operation theatres, dialysis centres, ICU, and multiple OPDs. Started in 2023, the walls still smell fresh. The centre is teeming with older patients with bent backs, or on wheelchairs, waiting for check ups.
It’s a one-stop shop for any person above 65 seeking treatment. The centre has a multitude of specialists—neurologists, cardiologists, gastroenterologists, orthopedists, ophthalmologists, endocrinologists. And if more specialised care is needed, then a patient is directed to another wing of the hospital.
“We started geriatrics as a separate department in 2012, it was a 24-bed facility with a private ward. National Centre for Ageing began in March 2023 with just OPD services. On 13 December 2023. we started in-patient services,” Dr Avinash Chakravarty, head of geriatric medicine at AIIMS Delhi, told ThePrint.
The centre also has a six-bed dialysis centre, 18 ICU beds as well as a 10-bed facility for patients receiving short term treatment like chemotherapy. It also has a memory clinic.
AIIMS Delhi also has three to four seats for MD in Geriatric medicine, and in the past three years it has opened 32 seats in total.
“When India got Independence, our average life span was just 32, now it is 70. The population of elderly people is growing year by year,” Dr Chakravarty said, while explaining the need for geriatric medicine. “People come here with multiple morbidities, they need specialised drugs, and trained doctors who understand how a cocktail of drugs could adversely affect a patient with multiple diseases,” he added.
The AIIMS Centre for Ageing is a superhit among patients seeking care, their beds have 100% occupancy, and it is full of younger doctors seeking specialisation in geriatric medicine.
This (AIIMS, Delhi) is the Supreme Court of medicine, one will have to wait here. It’s quite alright
Mahendra Bansal, 70
The only other National Centre for Ageing is in Chennai’s Guindy, and is a part of Madras Medical College. It opened in February 2024, and had 1,000 patients visiting its OPD from all over Tamil Nadu within a month of inauguration. The government has also established regional geriatric centres across the country, under the National Programme for Health Care of the Elderly.
Also read: How India’s seniors are fighting loneliness—Love, loss, and logins
Setting up geriatric specialties
Dr Mangala Borkar of Government Medical College, Chattrapati Sambhaji Nagar had bucked the need for specialised geriatric care at hospitals in the 2010s. Since then, she has worked with her hospital’s administration to offer an MD in geriatric medicine, fellowships and training programmes in the speciality, and also spearheaded a WhatsApp group to encourage other hospitals to open geriatric departments. She has been working to get her hospital recognised as a regional geriatric centre, but the process has proven to be slow so far.
Even with a burgeoning elderly population, projected to reach 319 million by 2050, India has an acute dearth of geriatric medicine doctors. India reportedly produces only 20 geriatricians per year, according to a 2022 study by KEM hospital Mumbai. According to the National Medical Commission list for courses available for the year 2024-2025, there are only 31 seats across nine medical colleges for an MD in geriatric medicine.
But now there’s a push for opening specialised departments all over the country. Eighteen 30-bed regional geriatric centres have been opened across the country since 2011, along with two National Centres for Ageing—both 200-bed facilities. A third NCA is to come up in BHU, Varanasi.
“The National Centres for Ageing are supposed to have six geriatric MDs per year, while regional centres are supposed to have two to three seats, but not all centres are functioning at full capacity right now and are still setting up. It is a work in progress,” Abhijeet Jose, a consultant with Directorate General of Healthcare Services, said.
Hospitals are lining up for training and assistance in setting up regional centres. AIIMS Rishikesh has taken training from AIIMS Delhi to set up a geriatric ward and department.
Also read: India’s silver economy is booming—app, startups, part-time ‘daughters’, dementia centres
Increasing accessibility
Public health infrastructure is also expanding beyond hospitals. Through training and state-specific schemes, there is increasing accessibility to healthcare within people’s homes and the opening of spaces for senior citizens to interact.
Under the NPHCE OPDs across 722 districts in India at Community Health Centres have been started for senior patients.
According to data provided by the Directorate General of Health Services, 7.31 crore people availed government OPD services for the elderly between April 2024 and January 2025, and 78 lakh people above 60 years of age sought inpatient treatment.
In the present scenario, Indian rural health care faces a crisis unmatched to any other social sector.
Meera Khanna, President, Guild of Service
Primary care services come under the National Health Mission, under which the government has set up Aarogya mandirs for AYUSH medicine, in addition to weekly OPDs at primary health centres, and bi-weekly OPDs and physiotherapy at Community Health Centres.
“We are also conducting repeated training sessions for doctors as well as nurses so they can give proper care to the seniors. This includes information on the multi-morbidity factors among the seniors, as well as nutrition,” Dr Alok Mathur, director, DGHS, told ThePrint.
To increase accessibility, the centre has also recognised best practices in states, and seeks to emulate it.
These include Makkalai Thedi Marutuvam (MTM), a scheme by the Tamil Nadu government under which 463 vehicles have been hired by the government, one at every block, along with teams to operate them. They provide auxiliary nurse support and physiotherapy to elderly at their homes.
National Centre for Ageing, Chennai is also providing a three-month certificate course to provide primary care giver skills to senior care assistants. Such courses are currently running in 19 government medical colleges in the state. The programme was started in September 2024 and more than 200 students have already enrolled.
Kerala government is running Ormathoni, which are dementia clinics as well as Mandahasam project, which provides free of cost dentures to elderly under the Below Poverty Line category.
And in places where the state is falling short, civil society groups fill the gap—like the Guild of Service in Vrindavan.
Easily available doctors
Concerned villagers and relatives helped 75-year-old Nawal Singh into a mini yellow van bound for Vrindavan on Thursday morning. The NGO Guild of Service has been campaigning in villages within 10 kilometres of Vrindavan to increase awareness about the free OPD available at the clinic. They even provide transport for the elderly to make access even easier.
Dressed in a striped blue shirt and grey pants, Singh said that he picked out his best outfit for his day at the clinic.
He used to work in construction and in agricultural fields but had to quit five years ago when the pain in his knees became unbearable. Slowly, his knee became disjointed and he developed a limp. Bound to a bed, he tried local quacks and massage oils to no avail.
“The hakim gave me oils to massage on my knees but it hasn’t helped. I also visited local doctors who gave me injections for the pain but it always comes back,” he said.
For the past three years, Singh has been lying in bed, unable to do most things. His mobility is severely affected and walking even a short distance is excruciating for the old man. While his son has taken him to the district hospital for check ups, no doctors have given him a proper diagnosis. “Mujhe lakwa maar gaya hai, aisa bohot hota hai (I am paralysed, it’s a common ailment),” he said confidently.
Singh travelled 15 kilometres with other elderly persons in the village to reach this free OPD. His co-villagers had back pain, weakening eyesight, cataract, and pre-scheduled physiotherapy appointments. Carrying their past reports in polythene bags, villagers lined up in front of the physiotherapy, orthopedics and ophthalmology OPD. Once they were given prescriptions, members of the Guild of Service distributed free medicine to them.
This was Singh’s first time at the Aarogya Mission, he had not heard of this free OPD, which has been running for eight months before his visit in April, and his fellow villagers have been visiting the OPD for the last four months.
To be able to walk, Singh has fashioned a makeshift walking stick with the iron rod from an umbrella and two water pipes.
“In the present scenario, Indian rural health care faces a crisis unmatched to any other social sector. Though the existing infrastructural setup is on a right track, the qualitative and quantitative availability of primary health care facilities is far less than the defined norms by the World Health Organization,” Meera Khanna, President of the Guild of Service, said. The Aarogya clinic was started on World Elder’s Day on 1 October 2024.
The doctor checks Singh’s knees and legs for pain and asks him about his symptoms. But Singh looks confused, his eyes foggy. He is unable to fully understand the doctor’s instructions.
“Aapke ghutne ki grease khatam ho rahi hai (the fuel in your knees is over),” the doctor said, in an attempt to explain the illness. Singh has osteoarthritis, a degenerative joint disease. He would ideally require knee replacement, but for now, the doctor has prescribed physiotherapy, gel, massages, a heat pad as well as an injection to relieve him of the pain.
“This is a very common problem that is reported here daily,” Dr Amrit Kumar, who is the visiting orthopedician at the clinic, told ThePrint. “These areas also have a common recurrence of chikungunya, which further deteriorates joint health. We give free medicines, injections and physiotherapy to our patients here. Since the patients from the villages coming here are mostly farm labourers or construction workers, they come with back and knee complaints. If they have Aayushman cards, we will also try to conduct knee replacement surgeries,” he said.
The doctor regularly comes across older patients who either neglect their ailments or visit quacks before coming to a hospital, once pain becomes unbearable.
“There’s a common practice of sutwana here, which is going to local masseuses to seek pain relief. Even well-educated people go to them first. The average senior in villages is not well-versed with the concept of physiotherapy,” the doctor said.
Most patients turn up at Dr Kumar’s doors only after their illness worsens after seeking treatment from quacks. “This is a trend that I see not just here but even at bigger hospitals, among the educated folks too. Even if patients fracture their hands, they first try to fix the problem through home remedies and come to us once the injury worsens,” he said.
As the day ends, the patients hop back on to the yellow mini van—eager to go home. Singh hopes to come back soon.
“I thought only death will be the end of my pain. Today I have been proven wrong,” he said as the van drives off.
This article is part of Grey World, a series on India’s senior communities. Read all articles here.
(Edited by Theres Sudeep)
NMC’s policies made in cahoots with medical-college-owning politicians are stifling the growth of emergency medicine in the country. Let’s see what it does to geriatric medicine.