India Is Ageing, Says NITI Aayog. It’s Time to Rethink Healthy Ageing.

New Delhi, Delhi, 7th of October, 2026 : India Is Ageing. Are We Ready to Hear, Move and Live Well?

As India prepares for an older population, hearing and balance care must move beyond devices to rehabilitation, safety, brain health and human connection

India is ageing. The question before us is no longer simply how long Indians will live, but how well they will live those additional years.

The NITI Aayog’s Reimagining Care: Strategies for Empowering Caregivers in Viksit Bharat@2047, released in August 2026, highlights India’s changing demographics, changing family structures and growing need for long-term care. The report projects that India’s elderly population could reach 347 million by 2050 and calls for a stronger, more organised caregiving ecosystem.

This conversation about ageing must include something that is often overlooked: hearing and balance.

We speak extensively about diabetes, hypertension, cancer and cardiovascular disease in older adults. But the ability to hear a conversation, understand a doctor, recognise a warning sound, maintain relationships and walk safely is equally important to living independently.

When children are no longer at home

India has traditionally relied heavily on families for elder care. But migration, urbanisation and nuclear families are changing this model.

The first wave of the Longitudinal Ageing Study in India found that about 5.9% of older adults lived alone. Living alone does not necessarily mean having no children; many have children living in another city or country. But physical distance can matter when hearing, balance or cognitive abilities begin to change.

Who notices that an older person has stopped hearing the doorbell? Who realises they are no longer following conversations? Who takes them for a hearing assessment? Who notices that they are struggling with dizziness or have become afraid to walk outside?

These are not merely medical questions. They are caregiving questions.

Hearing loss is more than hearing less

The World Health Organization estimates that more than 1.5 billion people globally live with some degree of hearing loss, with more than 430 million requiring rehabilitation for disabling hearing loss. Among people over 60, more than one in four has disabling hearing loss.

Hearing loss can affect communication, social participation, emotional wellbeing and independence. WHO also recognises an association between unaddressed hearing loss, cognitive decline and increased risk of dementia.

The relationship between hearing loss and dementia is complex, and hearing loss should not be described as directly causing dementia. However, hearing impairment is increasingly recognised as an important potentially modifiable risk factor in the broader conversation about brain health.

This means hearing cannot remain outside discussions about healthy ageing and dementia prevention.

The patients who changed how I see hearing care

As an audiologist, some patients stay with you long after they leave the clinic.

I remember a patient who repeatedly said, “If I cannot hear, I will die.” She was experiencing severe emotional distress and suicidal tendencies.

At that moment, the problem was no longer simply an audiological diagnosis. There was a person behind the hearing loss who felt that life had become unbearable.

It reminded me that we cannot measure the impact of hearing loss only in decibels. When a patient expresses hopelessness or suicidal thoughts, it must be taken seriously, with appropriate mental-health support and coordinated care.

Another patient taught me about the importance of hearing as a safety issue.

He had a hearing aid but, on one particular day, forgot to wear it before going for his routine walk. While he was walking, somebody honked from behind. He did not hear it. He was involved in an accident and lost his life.

A hearing aid cannot guarantee safety, and no hearing intervention can prevent every accident. But for someone with significant hearing loss, being without their hearing support can reduce access to important environmental sounds — a vehicle, a horn, an alarm or someone calling from behind.

That case has stayed with me.

Then there are patients who simply forget to use their hearing devices. One of my patients repeatedly does so. It is easy to call this “non-compliance”, but we should ask why. Is the device uncomfortable? Does the sound feel unfamiliar? Is the technology difficult to manage? Does the person need more rehabilitation or caregiver support?

A device sitting in a drawer is not successful treatment.

My father’s experience made this personal

My understanding of hearing loss also became more personal through my father’s experience.

As clinicians, we spend years learning the science and counselling families. But when hearing loss affects someone in your own family, you experience another side of the problem.

Families adapt. They repeat themselves. They speak louder. They answer questions for the older person. Eventually everyone may feel they are “managing”.

But managing is not the same as living well.

Hearing and balance go together in healthy ageing

Hearing is only part of the story.

Dizziness, imbalance and falls are also common among older adults and should not automatically be dismissed as “old age”. Indian data have shown significant levels of dizziness and injurious falls among older adults.

The causes of dizziness are varied and can include vestibular disorders, medication effects, cardiovascular and neurological conditions, vision problems and musculoskeletal issues.

An older person with recurrent dizziness deserves proper assessment. Where indicated, vestibular evaluation and balance rehabilitation can be an important part of care.

A fall can lead to a fracture, hospitalisation, loss of mobility and eventually loss of independence.

What needs to change?

First, hearing and balance screening should become part of elderly care. Existing programmes such as the National Programme for Health Care of the Elderly should incorporate routine hearing and balance checks for older adults, including at primary healthcare centres and during regular health assessments.

Second, we need to fund rehabilitation, not just devices. Hearing aids and cochlear implants are important interventions for appropriate patients, but the treatment does not end with fitting or surgery. Auditory rehabilitation, communication training, counselling and follow-up are essential if people are to benefit from these interventions.

Third, we need to train the frontline. Doctors, nurses, community health workers and family caregivers should recognise warning signs such as repeatedly asking others to repeat themselves, withdrawing from gatherings, difficulty communicating, unsteadiness and fear of walking outdoors.

Fourth, we need clear referral pathways for dizziness and falls. An older person with recurrent dizziness should receive appropriate assessment rather than simply being told it is part of ageing.

Fifth, hearing should become part of the brain-health conversation. Public-health campaigns around healthy ageing and dementia prevention should encourage people to check their hearing and seek timely intervention.

Finally, we need to support families. Check hearing early. Encourage appropriate daily use of hearing technology. Learn how to communicate effectively. Do not simply adapt around the problem.

Because managing is not the same as living well.

A bigger role for the audiologist

An audiologist is not simply someone who conducts a hearing test or fits a hearing aid.

Audiologists assess hearing and balance disorders, provide or coordinate appropriate interventions, support cochlear implant pathways, provide auditory rehabilitation, communication strategies and counselling, conduct vestibular assessments and contribute to balance rehabilitation.

They also work with ENT specialists, physicians, speech-language pathologists, physiotherapists, psychologists and other professionals.

For one person, treatment may mean a hearing aid. For another, a cochlear implant. Someone else may need auditory rehabilitation, vestibular therapy, assistive technology or psychological support.

There is no single solution.

There is a continuum of care.

World Audiologist Day: a chance to listen differently

World Audiologist Day, on October 10, is a chance to rethink what hearing care means in an ageing society.

It is not about selling or fitting devices.

It is about helping an older person stay connected to family and community, communicate with their doctor, move safely and remain independent.

As India moves towards Viksit Bharat@2047, we must prepare not only for people to live longer, but to live well.

When hearing fades, we can lose conversations, confidence, connection and safety. A healthy ageing strategy that ignores hearing and balance is incomplete.

The real measure of hearing care should therefore not be:

“Did we fit the device?”

It should be: “Did we help the person continue to live, communicate, participate and belong?”

That is the hearing and balance care India will need as it ages.