An ageing India, counted but not fully understood

India is ageing, and the most recent official figures show how quickly this is happening. The National Family Health Survey - 6 factsheets, released in August 2026, indicate that the proportion of Indians aged 60 years or older has reached 12.9%, up from 11.8% in NFHS-5, some four years earlier. This represents a small national increase, and while significant, is not the most interesting aspect of what the data reveal.The more important conclusion is that India is not ageing as one country. Keralam, which was already the oldest state, now has 20.7% of its population aged 60 and over; Goa is at 17.2%, Himachal Pradesh at 16.4%, and Tamil Nadu at 16.3%. On the other hand, Bihar and Uttar Pradesh had their proportions of elderly people increase by only 0.4 and 0.3 percentage points, respectively and remain young by any measure. There is also the case of Ladakh, where the percentage of people over 60 rose from 8.9% to 14.6% in four years, a 5.7 percentage-point increase, which is greater than the increase Kerala achieved over the same period.It is impossible to apply a single national template to such different populations. In States that are already ageing, there will be increases in the demand for care of chronic diseases, geriatric services and long-term care. Although younger States have more time ahead of them, that time is exactly when preparation should take place. Putting off action until the elderly population is large enough to be seen when looked at as a group, means responding to demographic change rather than predicting it.What the fact sheets cannot tell usThe NFHS-6 State and national fact sheets include 101 key indicators. The only one of these relating to older Indians is the proportion of the population aged 60 and over; all the other information that could tell us about their health is either included in age groups that are too broad to be of any use or is given in a form that does not allow linkage to individuals.When it comes to hypertension and high blood sugar, the two main indicators of India’s burden of non-communicable diseases, both conditions are recorded for adults aged 15 and over. Thus, a 25-year-old and an 85-year-old are placed in the same statistical category. Based on the available fact sheets, there is no way to know how common hypertension is among the elderly in India, how this prevalence differs from State to State, or whether the States ageing most rapidly are also experiencing the steepest increase in chronic disease among older adults.When it comes to nutrition, the gap is even more apparent. Body mass index is reported only for adults between the ages of 15 and 49, and not because older adults were measured and then left out of the tables. They were never weighed. Height and weight are recorded only for women up to 49 and men up to 54. The population whose nutritional and functional status matters most as a society ages does not appear in the data at all.With regard to health insurance and financing indicators, they are provided at the household level. These indicators tell us whether a household has coverage, but they tell us very little about whether the older person in that household is financially protected when their healthcare needs become intensive and long-term.There is a deeper design issue underneath this. NFHS interviews women up to 49 and men up to 54. Above that age, Indians appear in the survey only as a line in the household roster and, if selected, a blood pressure cuff and a glucose reading. So even where we have a measurement for a 70-year-old, we have very little to explain it with: nothing on their tobacco or alcohol use, whether they are on treatment, whether they sought care, whether they still work. The elderly are enumerated. They are not interviewed.This does not mean that NFHS-6 is a flawed survey; it is, in fact, one of the most valuable sources of information on population health available anywhere in the world, and it was intended to track overall population health rather than to answer all the questions raised by an ageing society. But as India’s age structure changes, so must the information system used to formulate health policy. The evidence is older than the policyThis is no longer just a theoretical issue: since the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has been extended to all citizens aged 70 and over, the government has now assumed responsibility for financing the health of a very large number of elderly people. To serve that population adequately we need to know more than simply how many people are eligible. How many live with chronic diseases? How many need help with everyday activities? How much are they paying out of pocket? Only on the basis of this information can we tell whether the money and the services are being directed towards the right needs in the right States.India possesses the necessary equipment to deal with these questions. The Longitudinal Ageing Study in India, conducted by the International Institute for Population Sciences, was designed precisely for this purpose. In its first phase, it included more than 73,000 adults aged 45 and over, gathering information on their health conditions, their use of and expenditure on healthcare, economic circumstances, social networks, functional health, and biomarkers. It is a major piece of infrastructure.The problem is that the first wave covers the period 2017 to 2018. For a policy programme being expanded this year, a baseline that is eight years old cannot be considered up-to-date evidence. Once data has been collected, it loses relevance over time, and this decline in value is most rapid in cases where the underlying population is changing quickly.Staying currentWhen a gap in data is identified, the reflex is to call for a new survey. That is the wrong instinct here. India already runs two surveys. The NFHS gives a regular, broad picture of population health across the country. The LASI does a deep dive into ageing and its social and economic consequences. They were built to do different jobs, and turning the NFHS into a second LASI would be expensive and would damage what it already does well.What is needed is more modest. Keep the ageing data current, rather than letting a decade pass between one wave and the next. Report the numbers by age where the NFHS already collects them, particularly for hypertension and blood sugar. And design the two surveys so they can be read against each other, instead of sitting in separate silos.An ageing India will have to do more than simply count its older population; it will also need to find out what their requirements are, where these needs are appearing first, and whether the health system is able to meet them. With regard to the first of these questions the data are now fairly good, but with respect to the others we are still making guesses.(Tanya Singla is a research student, tanyasingla.india@gmail.com, and Megha Jacob is an assistant professor in the department of economics at Jesus and Mary College, University of Delhi, mjacob@jmc.du.ac.in; Karan Babbar is an assistant professor of economics at XLRI Jamshedpur. phd17karanb@iima.ac.in)