Girija (name changed) spent years working as a domestic worker before her failing knees made it difficult for her to continue. Hoping to find a more manageable way to earn a living, the 60-year-old borrowed money from acquaintances and set up a roadside vegetable stall. But another health problem emerged, making it difficult to keep the business running.
“She learnt that she was suffering from urinary incontinence. Taking frequent loo breaks while managing the stall was not practical, and she eventually decided to shut shop, losing her source of income in the process,” says Gurajada Sobha Pernidevi, founder-president of Telangana Stree Seva Samstha, a voluntary organisation working for the welfare of women.
For older people with limited financial means, a health problem can do more than cause physical discomfort; it can take away their livelihood, independence and opportunities to socialise. Conditions that are difficult to discuss, such as urinary incontinence, are often endured in silence because of embarrassment and the cost of managing them.
Unlike ailments that call for joint replacement surgery or a cardiac stent, these less visible difficulties of ageing often receive scant attention, despite their potential to disrupt daily life. However, as Telangana’s share of elderly population grows, addressing such overlooked needs will become increasingly important.
Telangana’s population aged 60 and above is projected to rise from 12.5% in 2026 to 17.1% in 2036, according to the Reserve Bank of India’s report, ‘State Finances — A Study of Budgets of 2025-26: Demographic Transition in India — Implications for State Finances’.
The State is expected to join the category of ageing ones, where senior citizens account for at least 15% of the population. The projected demographic shift raises questions about how healthcare, caregiving and community support can keep pace with the needs of older people, particularly those who live alone or cannot afford private services.
Associations working with senior citizens say the challenges range from obtaining medicines and reaching hospitals to finding dependable caregivers and accessing mental health support.
P. Shyam Kumar, State project coordinator at HelpAge India, says doorstep medical services, including palliative care, could make healthcare more accessible. Nutritional supplements and the delivery of medicines through Accredited Social Health Activists could also help older people manage their health.
“Without adequate support, their condition may deteriorate, leading to more hospital visits, additional expenses and greater dependence on family members. So, supplying medicines through Accredited Social Health Activists may work in this direction,” he adds.
The pace mismatch
Access to healthcare is not simply a matter of getting an appointment or obtaining medicines. Older people who depend on younger family members for hospital visits may have to wait until someone can take time off work and accompany them.
Members of several associations say a family member’s availability often influences whether and when an older person seeks medical attention. Those with limited mobility may need transport, a wheelchair or stretcher. In a multi-storey building without a suitable lift, even getting someone downstairs can require additional assistance and planning. Hospital visits can involve long walks between departments, diagnostic tests and consultations, making them particularly difficult for those without someone to accompany them.
The problem does not end at the hospital gate. For older people who cannot leave home, finding a doctor willing to make a home visit can be equally difficult. “This is a crucial requirement of those who are unable to step out of their house,” says Sobha.
For older couples whose children have moved away for work, one partner falling ill can leave the other struggling to coordinate treatment, travel and follow-up visits. The absence of accessible transport and medical services at home can turn routine healthcare into an exhausting exercise.
Shanti, trustee and volunteer at Roshni Trust, which has organised mental health camps in bastis, says Hyderabad’s urban spaces do little to encourage inclusion and social interaction among older people. “The city is designed for isolation and does not promote inclusiveness,” she says.
Shanti calls for government centres at the basti level, on the lines of Anganwadis, where older people can access basic facilities, attend health camps and receive nutritious food. Such centres could also offer a place to meet others, reducing isolation among those who spend much of their time at home.
The search for dependable care
For older people who need help with daily activities, finding a caregiver presents its own difficulties. Volunteers point to the need for people who understand the physical and emotional needs of senior citizens, as well as concerns about safety when elderly couples live alone and their children live elsewhere. Sobha recalls the case of an elderly woman who sleeps during the day and stays awake at night to keep an eye on her caregiver, fearing for her safety.
“This fear weighs on many older people who live with hired help,” she adds.
Through Telangana Stree Seva Samstha, she along with 80-plus volunteers, distributes adult diapers, commode converter seats, walking sticks, books and other resources to those who need them.
S. Bhooma Reddy (78), editor of Voice of Senior Citizens magazine, says the demand for caregivers is substantial, with some families hiring them even when their children live in the same building. “The caregivers are paid a monthly salary of around ₹25,000, apart from being provided food and accommodation,” he adds.
Such arrangements, however, remain beyond the reach of many households. Families from financially disadvantaged backgrounds often live in cramped homes and juggle work, household responsibilities and the care of parents or in-laws with limited resources.
V. Manjula, president of Gruha Karmikula Union-Telangana, says opening community halls where older people are provided regular meals and medicines would be a significant source of support for those from poor backgrounds.
The consequences of inadequate family support can be more severe than the absence of daily assistance. Associations report cases of older people being abandoned at hospitals, railway stations and bus stops. They also cite instances of elderly parents being neglected after transferring property to their children. Physical ailments are not the only problems that can go unnoticed as people grow older. Depression and dementia, too, may remain undiagnosed because their early signs are mistaken for normal aspects of ageing.
K. Chandra Sekhar, 70, founder-director of ASHA Hospitals, says families often seek specialist help only after symptoms have worsened. Forgetfulness, which can be an early sign of dementia, is frequently dismissed as a natural consequence of growing old. Such assumptions can delay diagnosis and prevent older people and their families from accessing appropriate support.
“Early diagnosis can improve quality of life and help caregivers prepare for the support that may be required as a condition progresses,” he says.
A loss of interest in activities once enjoyed, reduced appetite and weight loss, less social interaction and multiple physical complaints can be signs of depression, Dr. Chandra Sekhar points out. Older people experiencing forgetfulness can consult neurologists or psychiatrists.
While health camps often screen for physical illnesses, camps focused on identifying mental health problems are rarely organised, he says.
Aarathi Bellary, consultant physician and co-founder of Aayu Geriatrics, says some older people overlook age-related health problems even when symptoms become apparent.
“While physiological issues get attention, mental health issues in old age are barely discussed. One should not dismiss every problem as an inevitable part of ageing. It is important to consult the relevant medical specialists,” she says.
Dr. Bellary also encourages older people to pursue hobbies, maintain an active social life and take part in activities that allow them to share their knowledge and experience. Such engagement can help them remain socially connected rather than being defined solely by their health needs.
Planning for assisted living
For those who need more sustained support, assisted living and other residential care options could fill a gap between hospital treatment and independent living. Hyderabad, however, has only a few such facilities.
Ambati Rampapa Rao, chairman of PACCS Healthcare Pvt Ltd, which has a subsidiary, Ucchvas Transitional Care Centres, says longer life expectancy has made it necessary to plan for the changing needs of older people, particularly when their children move out of their hometown.
Ageing can bring a range of difficulties, including reduced physical strength, tremors, weight loss, malnutrition and emotional or psychological problems, affecting one’s ability to carry out everyday activities.
Dr. Rao outlines three broad categories of elderly care. Transitional care provides support immediately after hospital discharge, ranging from a few weeks to several years, with some degree of medical supervision; assisted living caters to those whose age and medical history call for monitoring and preventive care; and elderly living facilities serve people who remain mobile but have minor health problems.
“Social and aspirational security has to be factored in while designing spaces for the elderly, to meet their emotional and intellectual aspirations. This has to be planned for people of all financial segments,” he says.
With corporates exploring investments in the sector, the number of facilities could increase. But affordability remains central to whether these services can reach those who need them the most.
Care beyond the family
The Telangana government has sanctioned 37 multi-service daycare centres for senior citizens, of which 32 are operational. Run by non-governmental organisations with full financial support and monitoring from the government, the centres encourage social interaction and provide nutritious food, indoor games and basic medical check-ups once a week.
For older people who depend on regular meals or monitoring of health conditions, however, the reliability of these services matters as much as their availability. One elderly woman says she worries that health problems could jeopardise her access to the centre.
“My sugar levels shoot up if I don’t have food on time. Someone else may develop other health problems. If we fall ill at the centre, our children may consider taking us there a hassle and ask us to stop going,” she says.
Her concern points to a larger dilemma: services intended to support older people may not be enough if families view the time and effort involved in accessing them as a burden.
As Telangana’s elderly population grows, the challenge will be to make care accessible not only to those who can afford paid assistance, but also to people whose health problems, limited mobility or financial circumstances threaten their independence.