Senior citizens in India grapple with long distances to health facilities, study finds
Even within a universal healthcare system, there continue to remain marked disparities in access to care among older adults, with distance to healthcare facility posing a critical barrier, said a study published in The Lancet Regional Health Southeast Asia titled 'Miles to go before I seek: distance to the health facility and health care use among older adults in India'. It further noted that ensuring availability of health services within reach and reducing geographical barriers are paramount towards ensuring an equitable and inclusive healthcare system where no one is left behind.
The study points out that while a lot of research has explored financial constraints and health literacy as barriers to healthcare access, there is limited evidence on how physical distance impacts healthcare utilisation and health-seeking behaviours in older adults in India. For this paper, researchers used the nationally representative Longitudinal Ageing Study of India (LASI) (Wave-1, 2017–18) consisting of 31,902 older adults' data to analyse the average distance travelled by older adults for their routine and acute healthcare needs and concomitant healthcare utilisation through an equity lens.
Distances travelled
In India, access to healthcare is often restricted by factors including availability of local health services, financial constraints, low health literacy, and inadequate family or social support systems. India, home to 138 million older adults, is witnessing a rapid demographic transition, with the proportion of the population aged 60 and above increasing from 7.4% in 2001 to a projected 13.2% in 2031. Nearly half of these populations have multiple long-term or debilitating conditions that demand continuous and coordinated health care.
The study notes that older adults, on an average, travelled a distance of 14.54 km to seek outpatient services and 43.62 km for inpatient care respectively. For two-thirds (67%) of urban older adults, the availed outpatient facility was within 10 km of reach, while for their rural counterparts, it was 28.3 km, revealing a significant urban-rural disparity. This grew disproportionately for in-patient care, where the distance and time taken was two times higher for rural sexagenarians compared to their urban counterparts. For in-patient admission, 95 per cent arranged their own mode of transport, while 5 per cent used ambulance services, with no significant urban-rural difference.
Further both out-patient and in-patient care utilisation was high (73% and 40% respectively) when the facility distance was within 10 km. As the distance increased, a commensurate decline in the out-patient utilisation was observed, being 17% and 10% for facilities at 11–30 km and 30 km or more respectively. Additionally, for women, those living alone, and those with low education and income, this decline was more pronounced. Around 19% of rural older adults had to travel at least 60 km to avail of in-patient care. The situation was similar for urban dwellers with 10% travelling at least 60 km for in-patient care.
Risk of adverse outcomes
Long travel times and distant facilities act as a potential barrier to receiving timely and essential healthcare for this population which could posit high risk of adverse outcomes, warned the study adding that addressing transportation barriers could be a key strategy to improve access to care among the geriatric population, especially those residing in rural areas.
'Various studies have shown that interventions aimed at minimising transportation barriers among low-income, remote and older populations not only improves access to medical care but patient outcome as well, while being cost-efficient. Future research must develop and demonstrate how community-based transport service can be embedded within as a model for implementation for geriatric care. Given the rising number of ageing populations who are home-bound, a shift from clinic-based out-patient care to home-based primary care merits consideration through a mix of mobile medical van, digital healthcare and inclusive social support,'' recommends the study.
It adds that there is a need to design and formulate strategies on how existing Ayushman Arogya Mandir (community-based primary care centres) can be strengthened to meet the comprehensive healthcare needs of growing geriatric population.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Hindustan Times
15-06-2025
- Hindustan Times
Elderly-focussed health care is a demographic imperative
India stands at a critical demographic crossroads — by 2050, the share of the elderly in the national population will double from 10.1% (2021) to 20.8%, fundamentally reshaping our social fabric and health care needs. This shift will disproportionately affect women and the oldest-old as they form increasingly larger proportions of this population. Our elderly already navigate a health care landscape filled with formidable barriers: Limited access to health care services, shortage of experts in geriatric care, fragmented delivery, inadequate elder-friendly systems, lack of independent financial reserves, and low health-seeking behaviours. For rural seniors, these challenges intensify dramatically. The Longitudinal Age Survey of India (LASI) data reveal that 31% must travel more than 30 kilometres simply to access basic medical attention — an arduous journey for those with limited mobility and resources. One can't ignore the gender dynamics wherein women over 49 find themselves virtually invisible in medical care planning. India must create a comprehensive, dignity-centred, integrated health care ecosystem for the elderly. Over 70% of India's seniors struggle with chronic diseases, with nearly a quarter navigating the complexity of multiple conditions. In the absence of a health care delivery system that is designed to facilitate easy availability, accessibility of treatment and management, the result is a cascade of preventable complications that diminish independence and dignity, while straining already limited health care resources. India's elderly face a health care ecosystem marked by structural gaps. A majority of the health care services are scattered and disjointed, leading to lack of coordination, duplication of services, and poor outcomes. The specialised care gap is particularly indefensible. Rural India faces an even more dire reality, with over 70% of community health centres missing essential specialists. Meanwhile, financial vulnerability transforms health care gaps from challenging to catastrophic. Over 40% of our elderly fall within the poorest wealth quintile, while nearly one-fifth survive without any income whatsoever. A HelpAge India report highlights that approximately 75% of elderly women have no personal financial reserves — a finding that exposes a gendered dimension of ageing. With more than half of these women never having participated in formal employment, we are witnessing the compounded effects of lifetime economic exclusion. This economic precarity directly impacts health outcomes, as regular treatment for non-communicable diseases — often excluded from special schemes or individual insurance coverage — becomes financially unsustainable. Perhaps most troubling is our collective neglect of elderly mental health. The LASI report found that depression rates are 10 times higher than self-reported. The diagnosed cases signify not just an unattended medical need but a profound social one. We have normalised the suffering of our elders, accepting their isolation and despair as inevitable byproducts of ageing rather than addressable health concerns. How can we reconcile our cultural reverence for elders with the harsh realities they face? Our current approach indicates two misconceptions. First, we have cast our elderly as passive recipients of care rather than potential contributors. Second, we have failed to conceptualise a longevity dividend that could benefit both seniors and society. Our policy frameworks — including the National Policy on Older Persons and the Maintenance and Welfare of Parents and Senior Citizens Act — articulate high aspirations, yet millions of seniors go without regular treatment and essential medicines. Initiatives like Ayushman Bharat and the National Insurance Scheme for Senior Citizens above 70 represent meaningful steps forward, offering annual health insurance coverage of ₹5 lakh to 4.5 crore families regardless of the senior citizen's socio-economic status. However, expanding this coverage to encompass India's diverse elderly population in its entirety, constitutes an urgent policy imperative as the demographic transition accelerates. The stark reality that only 18% among those over 60 have health insurance reveals the vulnerability of our elderly. This coverage gap calls for immediate, comprehensive action. We must prioritise developing multi-tiered health care delivery systems that recognise the unique needs of the ageing population. This means establishing comprehensive networks that integrate specialised care including mental wellbeing with robust preventive and functional-ability-maintaining initiatives. The current reactive approach must give way to a proactive and preventive approach. For rural seniors especially, establishing district-level help desks for the elderly can provide crucial navigation assistance for those with limited mobility, resources, and digital literacy. Enabling telehealth utilisation, online appointment management, and virtual consultations for the elderly can also transform health care for the elderly. Many organisations in India have already piloted successful hybrid approaches that combine digital technology with human support systems. These changes should go hand-in-hand with elevating elderly voices from the margins to the centre of policy discussions. Anupama Datta is head (policy research & advocacy), and Ritu Rana is mission head (health care), HelpAge India. The views expressed are personal
The Hindu
30-05-2025
- The Hindu
8 per cent infectious disease outbreaks during 2018-2023 spread from animals to humans, study says
Zoonotic outbreaks consistently peaked during June, July, and August, researchers from the Indian Council of Medical Research-National Institute of Epidemiology, Chennai said. Typically, about seven zoonotic outbreaks -- also sometimes called 'spillover events' -- occurred in a month, and such instances significantly increased over the years, specifically, post-pandemic, the study published in The Lancet Regional Health Southeast Asia journal found. Study highlights The team analysed a total of 6,948 outbreaks reported under the Integrated Disease Surveillance Program (IDSP) to identify trends. Of these, 583 (8.3 per cent) were zoonotic -- Japanese encephalitis was found to account for 29.5 per cent of zoonotic outbreaks, followed by leptospirosis (18.7 per cent) and scrub typhus (13.9 per cent). Region-wise, the northeast part of the country contributed 35.8 per cent of zoonotic disease outbreaks, followed by the southern (31.7 per cent) and western regions (15.4 per cent), the researchers found. They added that late reporting of disease outbreaks has declined over the years -- 52.6 per cent in 2019, 40.9 per cent in 2021, and 5.2 per cent in 2023. Overall, a third of the outbreaks during the study period were reported late, the team said. "Of the 6948 outbreaks reported in IDSP, 583 (8.3 per cent) were zoonotic, with a median of seven monthly zoonotic outbreaks. Outbreaks significantly increased over the years," the authors wrote. Further research required The researchers said that while outbreaks of measles, chickenpox, and dengue have been individually analysed, zoonotic events from the national-level infectious disease surveillance system have not been comprehensively examined. A lack of analysis of geographical patterns and documentation of reporting delays hindered evidence-based decision-making and targeted interventions, the team said. "Critical gaps in weekly outbreak reports were identified, particularly the lack of follow-up documentation. To address these gaps, we recommend strengthening disease-specific surveillance systems in hotspot regions," the authors concluded.
Time of India
30-05-2025
- Time of India
8 per cent infectious disease outbreaks during 2018-2023 spread from animals to humans, study says
New Delhi: Over eight per cent of outbreaks reported under India's infectious disease surveillance system between 2018 and 2023 were zoonotic -- spread from animals to humans, such as the COVID-19 pandemic, according to an analysis. Zoonotic outbreaks consistently peaked during June, July, and August, researchers from the Indian Council of Medical Research-National Institute of Epidemiology, Chennai said. Typically, about seven zoonotic outbreaks -- also sometimes called 'spillover events' -- occurred in a month, and such instances significantly increased over the years, specifically, post-pandemic, the study published in The Lancet Regional Health Southeast Asia journal found. The team analysed a total of 6,948 outbreaks reported under the Integrated Disease Surveillance Program (IDSP) to identify trends. Of these, 583 (8.3 per cent) were zoonotic -- Japanese encephalitis was found to account for 29.5 per cent of zoonotic outbreaks, followed by leptospirosis (18.7 per cent) and scrub typhus (13.9 per cent). Region-wise, the northeast part of the country contributed 35.8 per cent of zoonotic disease outbreaks, followed by the southern (31.7 per cent) and western regions (15.4 per cent), the researchers found. They added that late reporting of disease outbreaks has declined over the years -- 52.6 per cent in 2019, 40.9 per cent in 2021, and 5.2 per cent in 2023. Overall, a third of the outbreaks during the study period were reported late, the team said. "Of the 6948 outbreaks reported in IDSP, 583 (8.3 per cent) were zoonotic, with a median of seven monthly zoonotic outbreaks. Outbreaks significantly increased over the years," the authors wrote. The researchers said that while outbreaks of measles, chickenpox, and dengue have been individually analysed, zoonotic events from the national-level infectious disease surveillance system have not been comprehensively examined. A lack of analysis of geographical patterns and documentation of reporting delays hindered evidence-based decision-making and targeted interventions, the team said. "Critical gaps in weekly outbreak reports were identified, particularly the lack of follow-up documentation. To address these gaps, we recommend strengthening disease-specific surveillance systems in hotspot regions," the authors concluded. PTI
