Introduction
The Government of India, led by NITI Aayog will present India's third Voluntary National Review (VNR) report on Sustainable Development Goals (SDGs) at the United Nations High-Level Political Forum (HLPF) on Sustainable Development in New York in July 2025. NITI Aayog is taking steps to ensure the process of preparing the VNR report is inclusive and representative in collaboration with the UN system in India. A key aspect of this process is the principle of Leaving No One Behind (LNOB), which recognises that sustainable development must benefit all sections of society.
The UN in partnership with NITI Aayog has identified 13 LNOB groups and is supporting consultation with them to help reflect their voices in the process and inclusion in the SDG agenda. Among the LNOB groups, older persons hold a significant place, constituting more than 10% of India's population.They are marginalised in terms of health, income, social support, care, skill and opportunities. The specific challenges and needs of older persons are shaped not only by these intersecting factors but also by the socio-economic and cultural contexts of different states, as well as the policies and programmes in place. Additionally, the proportion of older persons within the overall population varies across regions, influencing both societal perceptions and the government’s response to their evolving needs.
Within the UN system, UNFPA is the lead agency for the CSO consultation on older persons. UNFPA partnered with HelpAge India (HI) to organise CSO consultations in Lucknow and Hyderabad. This list includes CSOs, Senior Citizens Associations (SCAs), Regional Resource Training Centres (RRTCs) and think tanks.
Many Civil Society Organisations (CSOs) working on ground provide various services to the older persons, enhancing their well-being and dignity. While some CSOs focus exclusively on the ageing-related concerns, others integrate older persons into their broader efforts to uplift vulnerable communities. Additionally, there are associations formed and led by the older persons themselves, ensuring that their voices shape the discourse on ageing and development.
The SDGs identified for intensive discussion are:
Goal 1: End poverty in all its forms everywhere.
Goal 2: End hunger, achieve food security and improved nutrition, and promote sustainable agriculture.
Goal 3: Ensure healthy lives and promote well-being for all at all ages.
Goal 5: Achieve gender equality and empower all women and girls.
Goal 8: Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all.
Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable.
Goal 17: Strengthen the means of implementation and revitalize global partnership for sustainable development.
Agenda for Deliberation:
Reasons for vulnerability of older persons and challenges in responding to the concerns of an ageing population.
Recalibration of the approach adopted by the national and state governments to tackle the challenges of inclusion of older persons in the national development agenda: data as well as design.
National and state governments have introduced various policies and schemes to address the evolving needs of older persons, ensuring their well-being, dignity, and active participation in society. These initiatives focus on critical areas such as social and food security, income generation, healthcare, nutrition, employment, and the creation of age-friendly environments.
Focus on the most vulnerable among the older persons i.e. women, disabled, the oldest old persons from the LGBTQIA+ community.
Impact of mega trends like climate change, digital and technological development (inclusion and exclusion) on older persons.
Architecture of the financing system of schemes and programmes for older persons.
Efforts by civil society groups to raise the concern of older persons by identifying unmet needs, advocating for policy changes, and addressing challenges such as healthcare access, financial security, and social inclusion.
Good practices and lessons learnt in building an age friendly society. Case studies and recommendations for accelerating progress including international partnership.
Consultations
A one-day meeting for the participants from eight northern states (Uttar Pradesh, Madhya Pradesh, Bihar, Chhattisgarh, Rajasthan, Himachal Pradesh, Odisha and Delhi) was held on Monday 10th February 2025 in Lucknow. Similarly, in Hyderabad another one-day meeting was held for the participants of six southern states (Andhra Pradesh, Telangana, Tamil Nadu, Kerala, Karnataka and Maharashtra) on Wednesday, 19th February 2025.
In Lucknow 35 people participated whereas in Hyderabad 30 people participated in the consultations.
Key Issues and Opportunities for Action
Ageing is a natural and valuable stage of life, yet outdated perspectives often shape policies and programmes, limiting the support available to older persons. Recognising longer living spans, gender, and disability as integral aspects of ageing can help create more inclusive solutions. Addressing the unique needs of older persons from underserved groups, such as the poor, rural populations, women, persons with disabilities (PwDs), tribals, and unorganised sector workers, can strengthen the social fabric and ensure their continued contribution to society.
Key Considerations
Financial Security:
Rural elderly often face financial insecurity, due to agrarian stress and limited sources of earning alternative income. Many suffer from isolation, face apathy from local self-government bodies, deprivation of care due to out-migration of family members, and lack awareness about welfare schemes.
Urban elderly encounter challenges of neglect, abuse, and loneliness. They lack employment and volunteering opportunities, moreover above the poverty line households do not get access to government welfare schemes. Homelessness, destitution, and abandonment are other challenges faced by the urban elderly. Many migrants bring their mothers to towns and cities to look after the grandchildren, while their fathers live alone in the villages.
Social pensions are inadequate in terms of both amount and coverage. In states like Andhra Pradesh and Telangana, where higher pensions are provided compared to the national average, how families utilise this support remains unclear—those without any income struggle for basic survival.
Regional Resource and Training Centres (RRTCs) lack sufficient funding, limiting their ability to spread awareness and provide essential support.
Health:
Access to affordable and appropriate geriatric clinics remains a major gap. Medical treatment in old age is continuous and expensive, yet health insurance does not cover non-communicable disease (NCD) treatment.
The out-of-pocket expenses for outpatient care are a big concern, as no existing scheme covers such provisions.
Nutrition is a serious challenge for older persons due to multiple factors. Many of the older persons cannot afford nutritious food, while others consume inappropriate diets. Women, PWDs, and single individuals are the most affected in this regard.
There is a severe shortage of counselors who are equipped to deal with ageing and its challenges, especially emotional insecurity. Chronic illnesses receive little attention, and disorders such as Alzheimer’s and Dementia remain largely unaddressed.
The ageing needs of the LGBTQIA+ community are almost entirely overlooked.
Elderly persons in tribal communities are particularly under-served, often completely excluded from government welfare schemes.
Public infrastructure and transport facilities are not designed to their requirements, leaving many disconnected from essential services.
Digital exclusion remains a pressing issue, with digital literacy programmes often irrelevant to the realities of older persons, particularly in rural areas.
Gender Aspects:
Experience of isolation: Elderly women were reported to be more likely to be widowed and/or living alone.
Economic dependency: For a majority of women, isolation in old age led to economic insecurity, exacerbated by a lifetime of economic dependency, engagement in care-giving roles and lack of engagement in paid-work. Many elderly women lack pension benefits or savings.
Most vulnerable groups: Elderly women, transgender elderly persons, elderly persons with disability, elderly persons living with HIV, elderly persons living in prisons, were cited to be some of the most vulnerable groups
Intersectional discrimination: CSOs also reported how intersectional discrimination renders many elderly persons particularly vulnerable and marginalised. For e.g. transgender persons who are elderly and living with HIV experience severe isolation both from families and their own communities; sex workers experience severe economic insecurity after a certain age due to potential decline in income and increase in age-related challenges such as health concerns.
Key Considerations through SDG lens
SDG 1
Progress in ending poverty remains slow, as social pension allowances have remained unchanged for over a decade, with coverage stagnating despite the economic downturn caused by the pandemic and its aftermath. Women and other vulnerable groups continue to rely on family support, lacking sufficient opportunities to earn, and in many cases, even small savings.
SDG 2
Hunger affects a smaller segment of older persons—those who are extremely poor, destitute, or homeless. However, malnutrition is a far more widespread challenge, particularly for older women. Limited awareness and inadequate access to nutritious food remain the two biggest barriers to healthy ageing.
SDG 3
While healthcare has advanced in many ways, ageism remains a concern in the medical field, making access and affordability even more challenging for older persons. Geriatric wards are largely absent in hospitals, limiting specialised care for older persons.
Tribal communities experience ageing differently—harsh living conditions and inadequate nutrition often lead to premature ageing, with health issues that others face at 70 appearing as early as 45. Tribal older women face even greater hardships, with palliative care, especially for those who are abandoned, remaining largely unavailable.
The healthcare system has made strides with the National Program for Health Care of the Elderly now operational across the country. While an evaluation of its impact is yet to be conducted, monitoring data provides insights into its progress.
Financial protection for older persons has improved with health insurance coverage of up to ₹5,00,000 per year for poor elderly individuals, split into ₹2,50,000 per person for couples. Last year, a Universal Coverage scheme was announced, for those aged 70 and above, marking a positive step forward.
However, accessibility remains a challenge. Health facilities are often distant, particularly for poor and rural older persons, and emergency transport services need strengthening to ensure timely care. Managing and treating non-communicable diseases (NCDs) is another hurdle, as consultations, tests, and medicines remain costly. When hospitals lack essential medicines, older persons may not follow prescribed treatments, impacting their health outcomes.
Mental health support for the elderly, including care for depression, anxiety, and dementia, requires greater attention within the system. Strengthening these services can significantly enhance the well-being of older persons, ensuring they receive the care they deserve.
SDG 5
A life-course approach should be adopted in SDG-5, to ensure that older women are included in policies and programmes that address gender equality at every stage of life.
Elderly women face a higher risk of osteoporosis, arthritis, and cognitive decline, challenges that are further intensified by menopause. However, strengthening their health-seeking behavior by addressing barriers such as distance and cost will enable more women to continue treatment for non-communicable diseases (NCDs). Access to essential assistive devices, particularly those above the poverty line who currently fall outside government support, can greatly improve their quality of life.
Older widowed women face heightened economic and social insecurity. As elderly women are more likely to be widowed or living alone, fostering stronger social networks and community engagement can help reduce isolation and enhance their overall well-being.
Additionally for a majority of women, isolation in old age led to economic insecurity, exacerbated by a lifetime of economic dependency, engagement in care-giving roles and lack of engagement in paid-work. As elderly women are more likely to be widowed or living alone, fostering stronger social networks, community engagement, and targeted support programmes can help reduce isolation and enhance their overall well-being.
Most of the CSOs reported that there is high prevalence of GBV among elderly women, and most of it is either unreported or under-reported. Violence includes economic exploitation, physical and psychological abuse and neglect.
Elderly women, transgender elderly persons, elderly persons with disability, elderly persons living with HIV, elderly persons living in prisons, were cited to be some of the most vulnerable groups
CSOs also report a high prevalence of gender-based violence (GBV) among elderly women, most of which goes unreported or underreported.
Elderly transgender individuals living with HIV often experience severe isolation, while older sex workers face economic insecurity due to declining income and age-related health challenges.
SDG 8
There are no provisions or schemes to include older persons in re-skilling or continued employment programmes. Many other countries have devised new, innovative schemes to utilise the skills of older people.
SDG 11
Older persons, particularly those from marginalised communities, face digital exclusion. Mobility challenges due to poor road conditions, inadequate public transport, and weak last-mile connectivity—especially in metro cities—further limit their access. Rapid and unplanned urban development, overcrowding, petty crime, and insufficient civic amenities make independent living increasingly difficult.
Good Practices
Economic Security:
Elders Self Help Groups under the AGRASAR programme of the Ministry of Social Justice and Empowerment (MoSJE) and National Livelihoods Mission (NHM) are commendable initiatives..
They empower older persons by enhancing their financial credibility, enabling participation in micro-income generation activities, and fostering peer support networks. In Himachal Pradesh, the State Rural Livelihoods Mission (SRLM) is supporting farmers and small enterprises from elderly self help groups, by providing financial assistance of ₹15,000, to establish outlets for producing pickles, jams, and other products made from locally grown apples and tomatoes.
Krishi Vigyan Kendra (KVK) Training for Elder Self-Help Groups (ESHGs) in Andhra Pradesh: A valuable initiative that equips older persons with knowledge of good agricultural practices, enabling them to enhance productivity and sustain livelihoods.
Doorstep Distribution of Social Pensions in Andhra Pradesh: This is a significant step towards ensuring financial security for older persons, reducing their dependency on travel and intermediaries to access their rightful benefits.
Urban Infrastructure and Accessibility:
Universal design principles are being incorporated into public buildings, ensuring accessibility for all. Mega cities now feature low-floor public buses, making public transport more accessible for older persons.
Ramps and public toilets have been introduced in urban areas, while rural regions benefit from improved sanitation through the Swachh Bharat Mission.
Public gyms in various cities provide older persons with spaces for exercise and social engagement.
State-Level Initiatives for Elderly-Friendly Infrastructure
State governments have begun incorporating elderly-friendly features into building codes, including:
Daycare and residential facilities
Stretcher lifts in multi-story buildings
Panic buttons for emergency alerts
Maharashtra's landmark regulation mandates that housing projects with over 100 units must include old age homes and day care centers. High-rise buildings are required to have stretcher lifts, escalators, and panic buttons, ensuring safety and convenience for seniors.
Pune’s innovative panic button system alerts a central team in case of an accident, fall, or emergency, offering swift response mechanisms.
In Karnataka, residents of old age homes encourage donors to purchase handmade products made by them, rather than offering direct financial aid– promoting economic independence and dignity.
Community Support and Social Security:
Kerala's decentralized model prioritizes older persons' welfare through the Panchayat Act of 1994, which mandates a 5% budget allocation for elderly welfare. While earlier funds were used for ad hoc distributions (e.g., blankets, medicines), they are now directed towards sustainable initiatives like daycare centers. The Kerala Institute of Local Administration (KILA) supports panchayats in designing and implementing appropriate programmes.
Maharashtra’s Latur Zilla Parishad enforces a parental maintenance rule—if a government employee neglects their parents, one-third of their salary is deducted and transferred directly to the parent.
Meet and Greet Program in Andhra Pradesh brings older persons together in community centers, where they receive information on legal rights, government schemes, and enjoy recreational activities like singing, dancing, and poetry performances.
Healthcare and Specialised Support:
The National Program for Health Care of Elderly is a good practice for geriatric health care facilities for older persons. Universal coverage of 70+ in the health insurance scheme of the government PM Jan Aarogya Yojana (PMJAY) that ensures up to Rs 5 Lakh benefit to the elderly per annum.
Kerala is pioneering dementia and Alzheimer’s care with two dedicated centers under construction in Thrissur and Ernakulam.
Multi-facility centers in SMART cities like Lucknow house government departments that assist older persons with service-related grievances, alongside cafés and recreational spaces.
Policy and Legal Frameworks:
Kerala’s State Policy for Older Persons is undergoing a second review, with plans to establish a Commission on Older Persons, reinforcing the state's commitment to elderly welfare.
These initiatives reflect a growing recognition of the diverse needs of older persons and a shift towards dignified, inclusive, and empowering ageing policies. By embedding elderly-friendly infrastructure, financial security mechanisms, and social support systems, these best practices set a precedent for holistic ageing solutions nationwide.
The Role of Civil Society Organisations:
CSOs play a crucial role in raising awareness and facilitating access to essential services for older persons. They address procedural barriers by setting up helplines, and help desks in tertiary hospitals, and assisting with identity documentation like Aadhar enrollment etc. More specifically, following are the support which are provided by various organizations:
Policy Advocacy and Systematic Change:
CSOs actively engage with policymakers by highlighting challenges, and advocating for systematic and institutional changes: Organising Multi-stakeholder Integrated Solutions.
Developing dedicated facilities for abandoned older persons, in collaboration with local police, to ensure their rehabilitation and well-being, while encouraging CSR initiatives to provide financial support.
In Uttar Pradesh, the Uttar Pradesh Varish Mahasabha for Elderly initiative empowers retired older persons by engaging them in educating children from slum areas who are out of formal education. This initiative also includes young women, offering them a minimum salary, thereby fostering financial empowerment and social inclusion.
Environmental Sustainability and Green Energy Initiatives:
In the villages of Uttar Pradesh, older persons are being engaged in a green energy project under CSR initiatives, thereby generating community resources while contributing to environmental sustainability.
GRAVIS in Rajasthan helps older persons tackle water scarcity by constructing eco-friendly water storage and filtration tanks for agriculture and daily use.
Accessibility and Universal Design:
CECOEDECON in Rajasthan has advocated for the adoption of universal design in panchayat buildings, ensuring access to the elderly and PwDs to attend the meetings and programmes.
Capacity Building and Skill Development:
The Centre for Gerontological Studies,Kerala, in association with Sree Narayana College, offers a skill-based certificate course in Counselling and Guidance for Geriatric Care, equipping professionals to assist older persons in hospitals, palliative care centers, old age homes, and residential care.
Addressing Homelessness and Destitution:
RVM Homes in Bengaluru identified 55,000 homeless persons through a detailed survey, coordinating with local police and hospitals to provide shelter and rehabilitative care for destitute older persons.
Healthcare Access and CSR in Elderly Care:
HelpAge India has established helpdesks in government hospitals, such as SGPGI Lucknow, ensuring elderly patients receive guidance on government schemes, treatment processes, and medical support.
Expanding Outreach and Service Delivery: CSOs mobilise government and corporate support for outreach programmes, ensuring older persons benefit from essential services like:
COVID-19 vaccination drives.
PMJAY health insurance enrollment and biometric scans.
Community-based healthcare initiatives.
In Rajasthan, private corporate hospitals are providing free specialized healthcare to the elderly through their CSR initiatives. However, these initiatives remain limited to very small geographical areas.
In Rajasthan, private corporate hospitals provide free specialized healthcare to elderly persons under CSR initiatives, though these efforts remain geographically limited.
Maharashtra Regional Resource and Training Centre (RRTC) successfully advocated for Aadhar registration camps for older persons by engaging the District Information Officer to run newspaper advertisements, ensuring their inclusion in government welfare schemes.
VI. Recommendations for Strengthening Elderly Care and Support
1. Sabka Vikas: Fostering Financial Security
Ensure reasonable and adequate social pensions for poor older persons, linked to a minimum standard to cover basic needs.
Introduce a special allowance for older persons taking care of disabled family members to ease their financial burden.
Revise the quota system for pension and welfare schemes at the village or Gram Panchayat level, ensuring universal coverage for all eligible elderly persons.
Issue ATM cards to older persons for pension withdrawals, bypassing biometric authentication challenges that often delay payments.
Assign dedicated bank staff to assist older persons and reduce financial frauds.
2. Enabling-Last Mile Inclusion
Encourage multi-segment Self-Help Groups (SHGs) that bring together older women, PwDs, bed-ridden individuals, and youth, fostering intergenerational solidarity and mutual support.
Establish outreach services through Common Service Centres for Aadhar cards/ identity cards to help the linkage of homeless and destitute older persons into relevant welfare schemes of the government.
Provide special identity cards for LGBTQIA+ older persons to ensure their inclusion in government programmes.
3. Health and Emergency Services
Prioritise geriatric care by investing in geriatric centers, trained doctors, and specialised staff to address non-communicable diseases (NCDs) and provide comprehensive healthcare for the elderly.
Maintain dedicated geriatric wards in hospitals for the older patients.
Introduce and strengthen special ambulance services to transport older persons from rural areas to healthcare facilities.
Improve affordability and availability of medicines under Jan Aushadhi Yojana with more number of outlets.
Provide tax exemptions on health insurance for older persons.
Establish palliative care facilities for abandoned older persons, especially women.
Set up first-aid centres in rural areas for emergencies such as snake bites and sudden health crises.
Special attention should be given to mental health support, including information, awareness, screening and treatment of Alzheimer’s and dementia patients.
Support caregivers by offering training, counseling, and stress management resources to prevent burnout.
4. Creating Elderly-Friendly Cities, Villages and Communities
Ensure age-friendly cities with accessible public transport and elder-friendly infrastructure.
Centre for ageing in universities to focus on research on ageing are needed. Cross sectional analysis of ageing experience required.
Establish support groups for older persons, particularly those living alone or in isolation.
Attach public transport facility to day care centres or build day centres in the locality at walking distance
Focus on the most vulnerable elderly populations, including tribals, women, Persons with Disabilities, and the “oldest old”, recognising the intersectionality of their challenges.
Establish support groups for older person especially those living alone or isolated
Integrate age friendly features in designing public spaces where older persons live or visit frequently like parks, courts, tribunals, banks, religious places, recreation centres, buses, metro and cabs/rickshaws.
5. Senior Citizens' Welfare and Legal Literacy
Involve social workers and NGOs at Tribunal Level (under the DM) to facilitate justice under the Maintenance and Welfare of Parents and Senior Citizens Act.
Encourage CSR investment in small, community-driven elderly care projects..
Elder care to be included in Schedule 7 under Sec 135 of Companies Act so that the companies are legally bound.
Launch awareness campaigns to educate older persons about social schemes and legal entitlements, ensuring they can access the benefits they deserve.
6. Gender Considerations
Some of the recommendations that were suggested for gender-sensitive elderly care policies and programmes:
Large Scale Service Provider Sensitisation: Orient service providers, particularly health care professionals, One Stop Centre (OSC) staff, police and prison officials on the specific needs and concerns of elderly persons. Service providers must also be trained on communicating effectively and sensitively with elderly persons.
Screening for Violence: Health workers attending to elderly persons must screen for potential violence when they come across some common symptoms such as injuries, changes in clients’ behaviour, or care-giver stress.
Support for Care-Givers: Care-giving for the elderly can involve fatigue arising from intensive physical and mental exertion. Support services (health, protection) should incorporate outreach to care-givers to enable adequate sensitisation, ensuring the needs of elderly persons and care-givers are appropriately identified and addressed.
