Ayurveda for comprehensive geriatric health management

The world is experiencing a demographic transformation marked by a significant increase in life expectancy for those aged 60 and above, necessitating a comprehensive reorganization of current socioeconomic frameworks and healthcare systems to address the needs of the aging population. Reports state that one in six people in the world will be 60 years of age or older by 2030, with a rise from 1 billion in 2020 to 1. 4 billion. The number of individuals over 60 will double to 2. 1 billion by 2050, and between 2020 and 2050, there will be 426 million people over 80, representing a threefold rise. 1 The world’s population is predicted to peak in the mid-2080s at about 10. 3 billion, with more persons aged 65 or older than under 18. In addition, life expectancy at birth reached 73. 3 years worldwide in 2024, and further mortality reductions are predicted to produce an average lifespan of around 77. 4 years worldwide in 2054. 2 Owing to the enormous improvements in public health, diet, personal hygiene, and medicine, the average human lifespan has significantly increased, which is one of the major accomplishments of social and economic progress. 2 According to the Technical Group on Population Projections for India and States 2011–2036, there are nearly 138 million elderly people in India in 2021, with 67 million males and 71 million females, representing nearly 34 million increase over the Population Census, 2011 and is expected to rise by around 56 million by 2031. Moreover, the life expectancy at birth in the country has increased in both rural and urban areas, where in rural population, it has risen from 48 years in 1970–75 to 68 years in 2014–18, and in urban areas, it has risen from 58. 9 to 72. 6 years. 3 According to the United Nations Population (2019) World Population Prospects, by 2050, India’s elderly population will reach 319 million (19. 5% of the total population), underscoring the growing socioeconomic ramifications of population aging in India. 4 India is undergoing a rapid demographic transition, with the elderly population (60 years and above) projected to more than double from 100 million in 2011 to 230 million by 2036, indicating nearly one in seven Indians will be aged 60 years or older in the year 2036. 5 CHALLENGES, ECONOMIC IMPACT, AND EXPENDITURE Global population aging trends are accelerating, profoundly impacting the social, economic, and political landscapes of nations worldwide, further necessitating strong policy, management, and planning initiatives in the health sector. The elderly population is influenced by factors including lifestyle and chronic diseases, along with a decline in physical and cognitive functioning. According to a study, the consequences of population aging can be understood in three primary areas, which include increasing prevalence of chronic conditions, comorbidities, and the overall disease burden; higher out-of-pocket costs and catastrophic expenditures, exacerbating financial inequalities and straining insurance funds; and the need for client-oriented approach to address the needs of nonmedical expectations and vulnerabilities of older adults. 6 Aging significantly impacts disability among elderly people, making them fragile and more susceptible to mental and physical illnesses, along with limitations in activities of daily living, posing significant pressure on the healthcare system. In many nations, healthcare spending has been steadily increasing over the past few decades, both in terms of per capita spending and as a share of Gross domestic product, and moreover, research has revealed that average healthcare costs are rising more rapidly for older people over time, posing new challenges. Elderly individuals consistently exhibit markedly elevated expenditure levels across outpatient hospital care, inpatient hospital care, prescription drugs, as well as expenditures to ambulatory care, i. e. primary care physicians and other medical specialists. Furthermore, as medical technology continues to advance, elderly people are living with chronic diseases, leading to prolonged healthcare needs. 7 According to reports, China’s healthcare spending increased by about 10. 47 times from 458. 66 billion Yuan in 2000 to 5259. 83 billion Yuan in 2017, outpacing the country’s GDP growth rate, of which almost 25% of all healthcare costs were related to senior citizen medical expenditures. Similarly, in 1978, the elderly population in the United States spent 2, 026 per capita on healthcare, a substantial amount more than young adults (286) and middle-aged persons (764). In India, households with older persons had higher catastrophic out-of-pocket spending than those without older adults, suggesting a higher geriatric care cost in the nation. 8, 9 As the proportion of the elderly population increases in society, there is an increasing need to guarantee that Long-term Care (LTC) services are available and affordable for everyone who needs them. Organization for Economic Co-operation and Development nations currently devote a sizeable portion of their economies to a variety of medical and nursing services, personal care, and support services for individuals who rely on others to perform everyday tasks. In 2018, all LTC services accounted for 1. 5% of GDP on average, amounting to about USD 760 per capita. 10 Data from the first wave of the nationally representative longitudinal aging study in India reported that frailty and functional impairment are significantly more common among older persons. According to the study, around 29. 2% of Indians 60 years of age and older were frail, and another 58. 8% were in the prefrail stage, with higher prevalence of frailty among women (37. 3%), illiterate (37%) and rural residents. 11 Furthermore, when evaluated on the cognitive abilities in five cognitive domains – memory, orientation, arithmetic function, executive function, and object naming – a greater proportion of adults 60 years of age and older (estimated at 15%) than adults 59 years of age or younger (estimated at 6%) fell in the lowest 10th percentile of composite cognition score. 12 According to earlier statistics, an average Indian elderly person spends about 17% of their consumption budget on health care services. Furthermore, the Out-Of-Pocket Health Spending (OOPHS) is comparatively high for the older population for both inpatient (17%) and outpatient (14%) care, with an average INR 23, 234 of OOPHS for hospitalization (inpatient) and INR 785 for reporting an illness during the previous 15 days (outpatient). 13 According to the 80th round of the National Sample Survey, by the Ministry of Statistics and Programme Implementation, conducted from January to December 2025, the age group 60 years and above had the highest morbidity rate with highest percentage of people reporting illness (43. 9%). Moreover, the survey indicated that about 8. 1% of elderly population needed hospitalization, indicating a considerable need for geriatric care services and a rise in noncommunicable diseases. 14 CONCEPT OF HEALTHY AGING AND AYURVEDA Population aging is emerging as a defining demographic trend worldwide, posing significant challenges to healthcare systems. The World Health Organization (WHO) defines healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age. ”14 This definition marks a paradigm shift from disease-centric care toward a more holistic focus on preserving functional capacity, autonomy, and quality of life. Healthy aging is influenced not only by intrinsic capacity but also by environmental and social determinants, highlighting the need for integrated and person-centered approaches to geriatric care. 15 WHO conceptualizes healthy aging as a universal goal shaped by two key dimensions – diversity and inequity among older populations. In alignment with the Sustainable Development Goals, the WHO, its Member States, and partners developed the Global Strategy and Action Plan on Aging and Health (2016–2020) with a vision of a world where every individual has the opportunity to live a long and healthy life. 16 The 2020 evaluation of the strategy by WHO demonstrated notable progress, particularly in raising global awareness and strengthening collaboration among key stakeholders, including governments, academic bodies, and civil society organizations. At the same time, it brought attention to enduring challenges, such as the need to reinforce multisectoral partnerships, enhance implementation at local and national levels, and establish more effective accountability mechanisms. Drawing on these achievements and identified gaps, the strategy provided a foundation for the Decade of Healthy Aging (2020–2030). This global initiative aims to intensify efforts across four priority domains: reshaping societal perceptions of Aging, promoting access to age-friendly environments, ensuring the delivery of integrated and person-centered health services tailored to older populations, and strengthening LTC systems for those in need. Together, these actions strive to support the expanding older population in leading lives that are not only longer but also characterized by dignity, active participation, and optimal well-being. 17 These priorities closely align with traditional systems such as Ayurveda, which emphasize a preventive, promotive, and holistic approach to health throughout the lifespan. Ayurveda conceptualizes life in three stages (Vaya): Balavastha (~childhood), Madhyavastha (~adulthood), and Vriddhavastha (~old age). Aging (~Jara) is considered a natural and inevitable process characterized by progressive degeneration of Dhatus (~major structural components of the body), Indriya (~cognitive organs), Bala (~immunity/strength/physical endurance), Virya (~potency), Utsaha (~enthusiasm), Paurusha (~masculinity), Parakrama (~courage), Grahana (~reception), Dharana (~retention), Smarana (~memory), and Vachana (~speech). 18 This stage is predominantly governed by Vata dosha (~Dosha responsible for movement and cognition), which manifests clinically as dryness, weakness, and functional decline. Importantly, Ayurveda does not view aging merely as a pathological condition but as a manageable phase where decline can be delayed and quality of life enhanced through appropriate interventions. The branch of Jara chikitsa (~geriatrics and rejuvenation therapy) or Rasayana chikitsa (~rejuvenation therapy) is one of the eight branches of Ayurveda that focuses on maintaining good cognitive and intellectual function, and delaying the effects of aging. Rasayana therapy encompasses a comprehensive spectrum of interventions, including herbal formulations, dietary regulation, lifestyle modifications, and behavioral practices or Achara rasayana (~rejuvenation through the right code of conduct), to promote longevity, enhance immunity, improve cognitive function, and maintain physical and mental vitality. Classical texts describe Rasayana as having Vayasthapana (~prolonging younger age) properties, capable of delaying senescence and promoting overall well-being. Beyond pharmacological interventions, Ayurveda emphasizes the importance of Dinacharya and Ritucharya (~daily and seasonal regimens), Sadvritta (~ethical conduct), and mind-body practices such as Yoga and meditation. These collectively contribute to maintaining the integrity of body tissues and optimizing physiological function. Contemporary research increasingly supports the antioxidant, immunomodulatory, and adaptogenic properties of Rasayana therapies, suggesting their relevance in addressing multisystem age-related disorders. 19, 20 In India, the growing elderly population is placing considerable strain on the healthcare system. Government initiatives such as the National Programme for Health Care of the Elderly, National Policy on Older Persons, and various Ayush-based programs reflect efforts to address this challenge. 21 Integrating Ayurveda into public health frameworks offers a promising avenue to enhance geriatric care through cost-effective, culturally acceptable, and preventive strategies. Under the aegis of the Ministry of Ayush, several initiatives have been undertaken to strengthen geriatric health care. These include dedicated Outpatient Departments for the elderly and the National Campaign on Geriatric Health Care through Ayurveda and Siddha, launched in 2008 by the Department of Ayush, which focuses on improving quality of life through preventive, promotive, and therapeutic interventions using traditional medicine. In addition, services such as “VAYO MITRA” under the National Ayush Mission, along with nationwide geriatric health camps – benefiting over 2000 individuals in 2024 – underscore the emphasis on Rasayana therapies for promoting healthy aging. 22, 23 As global health discourse increasingly recognizes the importance of adding “life to years” rather than merely “years to life, ” Ayurveda provides a time-tested framework for achieving this goal. Its emphasis on harmony between the individual, environment, and lifestyle aligns closely with contemporary models of healthy aging. Moving forward, a collaborative approach that integrates Ayurvedic principles with modern geriatric medicine could help address the complex and multidimensional needs of the aging population. Policymakers and healthcare providers must adopt a multilevel strategy encompassing policy support, age-friendly environments, and individualized clinical care. Such an integrative approach has the potential to not only reduce disease burden but also enhance functional independence, dignity, and overall well-being in older age.