Dementia And Ageing: Why India May Face A Bigger Home-Care Burden

India’s rapidly ageing population could face a growing dementia challenge in the years ahead, with a larger share of people with the condition likely to depend on families and home-based care, as has been indicated by a new study from the University of Helsinki.

It has highlighted how a rise in dementia cases, coupled with limited long-term care facilities, can increasingly shift the responsibility of care from institutions to households.

The Finnish study projects that the number of people with dementia could rise from around 1.24 lakh in 2018 to nearly 2.16 lakh by 2040, mainly because people are living longer and the population is ageing. More strikingly, depending on the availability of institutional care, the number of people with dementia living at home could more than double.

While the figures are from Finland and cannot be directly applied to India, the underlying concern has clear relevance for the country, where families remain the primary source of support for older people and formal long-term care is still limited.

India is also ageing rapidly. As life expectancy rises and the proportion of older people increases, dementia is expected to become an increasingly important public-health and social-care challenge.

The issue is not only how many people develop dementia but also who will care for them, where that care will be provided and how families will cope with the long-term demands.

The Helsinki study is among the first to separately project the number of people with dementia living at home and those receiving long-term care. Researchers analysed national registry data on dementia diagnoses and long-term care among people aged 65 years and above between 2000 and 2018.

They then examined different scenarios based on possible changes in dementia incidence, mortality and the availability of institutional and residential services.

The findings showed that care infrastructure can significantly influence where people with dementia eventually receive support.

If long-term care provision remained at its 2018 level, the number of people with dementia living at home was projected to reach around 1.26 lakh by 2040. But if the decline in institutional and residential services continued at the same rate seen before 2018, the number living at home could rise from about 71,000 to as many as 1.7 lakh.

The researchers said this would not necessarily mean that the need for care had disappeared. Instead, a substantial part of that care would shift to homes.

“No matter how many care places are available, the population’s need for care will grow. Many people with dementia living at home also need a great deal of support and care,” said Kaarina Korhonen, postdoctoral researcher at the University of Helsinki.

She also cautioned against assuming that home-based care would automatically reduce the cost to society.

“Home care for those with substantial care needs is not necessarily cheaper for society than 24-hour care,” she said.

For India, this is particularly relevant because dementia care often depends heavily on spouses, children and other relatives. A person with advanced dementia may need assistance with eating, bathing, dressing, taking medicines and moving around, apart from supervision to prevent falls, wandering and other risks.

The burden can become especially difficult when caregivers have to balance employment and other family responsibilities with round-the-clock care.

Dementia often develops over many years before diagnosis. Therefore, any reduction in new cases reflects the impact of prevention and healthier lifestyles over earlier decades rather than producing an immediate fall in the overall number of patients.

“International research findings on dementia incidence trends are nevertheless contradictory, making the realisation of such developments uncertain,” said Maria Guzman-Castillo, a researcher at the University of Helsinki.

For India, the findings underline the need to prepare for dementia as both a medical and social-care issue. Expanding diagnosis and treatment services will be important, but equally critical will be strengthening geriatric care, community-based services, caregiver support, respite care and trained home-care workers.

Awareness will also matter. Dementia is often mistaken for a normal part of ageing, delaying diagnosis and support. Early recognition can help families plan care, manage associated health problems and understand what to expect as the condition progresses.

The study was published in the Scandinavian Journal of Public Health as part of the LIFECON project examining the life-course and economic implications of demographic change.