Debarati Dhar
India’s elderly population stood at about 153 million in 2020 and is projected to more than double to 347 million by 2050, nearly one in five Indians. India added around 25% dedicated senior living facilities in five years (Dsouza et al., 2023) . Research studies (Dsouza et al., 2023) document directly how this shift has led to a substantial decline in intergenerational communication, with older adults increasingly experiencing isolation and health issues.
Because families do not care, not. Because it was legally structured but rather because it was rich in communication, with generations living under one roof continuously and informally negotiating ageing, disease, dependency, and death, india’s primary care system for centuries was the joint family, which functioned not. As a result, the first serious discussion about care often takes place in a hospital corridor or when a parent reveals a decision that has already been made.
American-style advance care planning directives, typically signed in a lawyer’s office, are not suitable for a society where care is based on relationships, family, and context.
Parents reassure with “Don’t worry,” while children interpret it as “Something’s wrong. A 2026 guide for NRI families, published by Samarth , which describes itself as “India’s leading elder care organization, serving over 30,000 senior citizens nationwide,” highlights the issue with disturbing precision: ageing parents frequently neglect their medications, hide falls, and dismiss loneliness as “just part of ageing” to avoid burdening their children. The primary obstacle is the belief that “it is not yet time” (Lee & Ng, 2020) . More than a quarter of the urban elderly population does not have assistance from their children or other family members, a number that is expected to continue to rise, according to the Longitudinal Ageing Study of India (LASI) . The conversation should not begin with “what happens when you die,” but rather with “what would make your days enjoyable?”
For majority of them, the most important choices on how and where they will spend their later years will be made in the back of a car following a medical emergency, in a hospital corridor, or when a parent makes an unexpected announcement that shocks everyone, including themselves. However, they never discussed it. The real crisis in Indian elder care is not a shortage of beds or facilities; it is a shortage of conversations. Yet there is no equivalent count of families that sat down and asked an ageing parent what they actually wanted. One of these things is measurable. The other, perhaps more imperative one, is not, and that invisibility is itself the problem. The framework has been dismantled as and when the society transitioned to a nuclear family structure, but unfortunately, the conversation has not been replaced. What can possibly fill that emptiness? Mostly silence, a unique kind of silence that Indians have perfected. Everyone avoids direct communication. Meanwhile, adult children living in Mumbai, Bengaluru, or abroad steer clear of conversations about ageing, as culturally it feels like wishing decline upon their parents. By the time this conversation happens, it has shifted from a dialogue to a mere reaction. the country faces distinct challenges that worsen it Although this problem is not limited to India. Studies conducted in Singapore, which has a family culture similar to that of urban India, reveal that both elderly parents and their adult children rarely engage in conversations about end-of-life care preferences, even when the parents have privately made their decisions clear. However, there is no equivalent Indian study that assesses how many of these individuals have had meaningful conversations with their families about their desires. We do not even quantify this gap, and that itself is a major issue. The solution does not come from Western influences. What is required is a more natural approach: integrating discussions about ageing into relationship conversations rather than framing them as medical or legal issues. Research on ‘communication non-accommodation in family’ , shows that adapting our communication style in family interactions, focusing on how we speak, not just the content, significantly enhances constant engagement in health-related talks. This skill can be taught.