A tale of two eldersAbdul Aziz, 72, from a remote village in Kupwara, has diabetes, hypertension, and severe osteoarthritis of both knees. He takes eight different pills every day – or rather, he tries to. Some days he forgets. Some days he runs out and cannot afford the 150 km round trip to the district hospital. Last winter, a minor foot ulcer turned into a diabetic foot infection because no one checked his feet at home. He spent three weeks in the hospital, lost a toe, and his family spent over ₹50,000 on travel and lost wages. “I became a burden,” he whispers. “My son had to borrow money.”

Fatima Begum, 68, lives alone in an old house in downtown Srinagar since her husband passed away. Her blood pressure is poorly controlled, but that is not her biggest complaint. “I don’t feel like eating. I don’t feel like talking. I just sit by the window,” she told me. She has classic depression – undiagnosed, untreated. Her children live in another city and call once a week. No health worker has ever visited her home. She stopped taking her blood pressure medicine six months ago. No one noticed.

These are not isolated cases. They are the faces of a silver tsunami that is silently sweeping across Jammu and Kashmir.By 2031, nearly one in six residents will be over 60 years old. Our hospitals are filling up with elderly patients suffering from a relentless epidemic of non-communicable diseases (NCDs): diabetes, hypertension, heart disease, chronic lung disease, kidney and liver failure, crippling osteoarthritis, and the silent epidemics of anxiety and depression.

The latest National Family Health Survey (NFHS-6, 2023-24) confirms that one in four women and one in five men in J&K already have elevated blood pressure. Diabetes is surging. But the numbers only tell part of the story. Behind every statistic is a grandfather struggling to walk due to arthritic knees, a grandmother forgetting her medicines because of depression, a family selling land to pay for repeated hospitalizations. These are not conditions that can be fixed with a single hospital visit; they require continuous, compassionate, community-based care. Yet our health system remains stubbornly hospital-centric – designed for emergencies, not for the daily, lifelong management of chronic illnesses and the complex web of vulnerabilities they create.

The hidden burden: Beyond just numbersThe elderly in J&K face a cascade of interconnected challenges that a hospital-centric model simply cannot address:The NCD epidemic: Hypertension, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), chronic liver disease (CLD), and osteoarthritis are rampant. An elderly person often has two or three of these at once, each complicating the others. Arthritis alone, especially osteoarthritis of the knees and hips, robs mobility and independence, turning a home into a prison.Mental health crisis: Anxiety and depression are nearly universal among the chronically ill elderly, yet they are almost never diagnosed or treated at the community level. A depressed senior is less likely to take their diabetes medication, more likely to neglect diet, and more prone to falls and fractures.Immunocompromise: Ageing and chronic diseases weaken the immune system. The elderly are more vulnerable to infections – from seasonal flu to COVID-19 to urinary tract infections that can spiral into sepsis. Without regular home-based monitoring, these infections are detected late, leading to avoidable hospital admissions.

Polypharmacy: An elderly patient with diabetes, hypertension, arthritis, and depression may take 10-15 pills a day. Managing this at home without a trained health worker’s supervision leads to missed doses,........

© Greater Kashmir