В Индии растет число операций у пациентов старше 90 лет

Pushing 90, why are more seniors choosing surgeries? As life expectancy rises and surgery becomes safer, India’s oldest patients are increasingly choosing to be active and independent rather than live with pain and disability When 86-year-old Vijaya Khare answers the door at her home in Dadar, Mumbai, there is little to suggest she had a knee replacement a year ago. She has just finished making savouries in her kitchen, is laying them out on the table, taking out the china and arranging the room to welcome guests. “As long as I can move, life will be good,” she says. She and her husband, 91-year-old Captain PR Khare, have spent decades building an independent life together, determined to remain as self-reliant as possible. Their three sons live separately but visit them regularly. That determination is increasingly reflected in hospitals across Mumbai and the country, where surgeons are seeing a growing number of patients in their 80s, 90s and even beyond 100 undergoing surgeries that were once considered too risky because of age. Knee and hip replacements, bypass and cancer surgeries, gastrointestinal procedures and cataract surgeries are becoming increasingly common among elderly patients who are medically fit, driven by longer life expectancy, advances in surgery and anaesthesia. This is a generation unwilling to accept pain and dependence as an inevitable part of ageing. My life, on my terms Vijaya started experiencing arthritis-related knee pain when she was around 70. “As I turned 80, I wanted a better quality of life free of pain. My baseline health was good, and because my son is a doctor, I had complete confidence in him, the hospital and the treating doctors. I wasn’t scared of the operation at all. Today I am 86 and my husband is 91. We live in our own home. With the help of domestic staff, I manage the household myself. Standing for long periods is no longer a problem,” she says. Vijaya is also the co-founder of Pragati Kendra and Meera Vidyalaya in Sion, a school for children with intellectual disabilities. The surgery has helped her go there regularly. Captain Khare himself underwent open-heart surgery when he was 76 and prostate surgery when he was 89. For the last 10 years, he has also been living with Parkinson’s Disease. “Just recently our children celebrated our 63rd wedding anniversary and without these surgeries I don’t think we would have been able to stay active, remain independent and enjoy the little moments of family and social celebrations with our loved ones,” says Vijaya. Their son, Dr Sanjay P Khare, chief consultant and director of the Apollo Institute of Clinical Obesity and Metabolism, says longevity, nuclear existence and effective therapies have rewired the mindset among the elderly. “Getting operated on at the age of 85 or 86 is no longer considered extraordinary because advances in medicine have made surgery safer and recovery easier for older adults. Improvements in minimally invasive surgical techniques, anaesthesia, pre-operative evaluation and post-operative care have significantly reduced the risks associated with surgery, while better management of chronic conditions means many people remain healthier and more active well into their 80s,” he says. With potential benefits outweighing risks, chronological age hardly matters. Like Vijaya, 90-year-old Kapaldev Singh, a retired scientist from the Bhabha Atomic Research Centre (BARC), had his first knee replacement surgery in 2017 and then again in 2025. “Usually, our concern is whether the muscles would be too weak to support the implant. But the muscle strength in fit and active seniors is fairly good to support a speedy recovery,” says his daughter, Dr Balvinder Sapra. In fact, Singh was able to walk on the second day after surgery. Within six weeks, he no longer required a walker. Today, he walks a kilometre or two every morning and evening with the support of a walking stick and spends nearly two hours each day exercising to maintain his muscle strength. “The surgery energised him. Before that, he had stopped going out because he feared falling, and the only alternative seemed to be a wheelchair. Today, he meets friends in his housing society, reads newspapers for hours every morning and continues to lead an active life,” says Sapra. Orthopaedic surgeries top the list Dr Rohan Sequeira, associate professor, Department of Geriatric Medicine at Sir JJ Group of Government Hospitals, says orthopaedic procedures account for the largest share of surgeries among older adults, followed by cardiovascular interventions. “We are seeing a large number of knee and hip replacements, spine and lower back surgeries, along with surgeries for neck-related issues. Angioplasties and bypass surgeries are also becoming increasingly common among the elderly,” he says. One of the reasons for increased bone and joint problems, he feels, is obesity, the triggers being a comfortable, sedentary lifestyle, limited physical activity and shrinking public spaces. “Obesity is contributing to osteoarthritis, chronic low back pain, cardiac diseases, poorly controlled diabetes and high cholesterol,” he says. India’s rapidly ageing population is also expected to increase the demand for surgery. “The younger generations of previous decades have now become senior citizens, and many are now facing the consequences of years of unhealthy lifestyles. As this population grows older, we are likely to see even more surgeries,” he says. Dr Sequeira attributes the rise in elderly surgeries to greater public confidence in modern medicine. “Families are better informed and now trust modern medicine after seeing results among their family members. Older adults now are regularly undergoing physiotherapy, strength training and structured exercise programmes,” he says. The spiral is in no small part aided by the laparoscopic and robotic surgeries, the gold standard for many procedures. As Dr Prashanth Rao, director of Surgical Gastroenterology and Minimal Access Surgery at Gleneagles Hospital, Parel, says, “Complex cancer surgeries are now routinely performed through keyhole techniques, resulting in less pain, reduced blood loss, smaller scars and much faster recovery. These benefits are particularly significant for older adults, who are the age group most commonly affected by cancer.” Who is eligible for surgery Dr Siddharth Yadav, senior consultant, Orthopaedics and Joint Replacement Surgery, Apollo Hospitals, Navi Mumbai, says surgery is recommended only after a thorough evaluation, including assessment of the heart, lungs and kidneys. “Those classified as ASA Grade I or Grade II, meaning they have either no major medical illness or only well-controlled conditions such as diabetes or hypertension, are generally suitable candidates. Patients with higher anaesthetic risk, such as ASA Grade III, are usually not advised elective joint replacement because our aim is to improve their quality of life, not expose them to unnecessary complications,” he explains. Having performed knee replacements on 90-year-old patients, he has seen that recovery following planned surgery is often quicker than many families expect. “The skin heals within about two weeks, while muscles and tissues continue healing over eight to 12 weeks. By around three months, most post-operative inflammation settles and patients are able to enjoy the full benefits of the surgery,” he explains. Dr Sandeep Wasnik, consultant, Joint Replacement and Orthopaedic Surgery at Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, has operated on a 106-year-old, too. “He had suffered a hip fracture after a fall, and we did a hip replacement. Today, we have advanced regional anaesthesia techniques such as a sacral plexus block, which numbs only the leg being operated on instead of the entire body, making surgery much safer for the elderly. Better tissue handling has also made a significant difference,” he says. Dr Rao recalls how a 94-year-old freedom fighter underwent laparoscopic hernia surgery and two patients, aged 89 and 84, adjusted to Whipple’s procedure, a complex surgery to remove cancerous tumours in the head of the pancreas, the gallbladder, the bile duct, and the upper part of the small intestine. One of those who benefited from advances in minimally invasive surgery is 92-year-old Ramesh Kulkarni*, a retired bank manager from Mumbai. Living with his wife and son in a middle-class household, he spent nearly six months coping with recurrent bleeding, weight loss and altered bowel habits caused by colorectal cancer. Although initially fearful, he steadily recovered over six to eight weeks by following medical advice, taking regular walks, practising breathing exercises and maintaining a healthy diet. Today, he remains independent in his daily activities, regularly attends social and religious gatherings, and believes staying physically active is essential for maintaining both physical and mental well-being. Sharing figures from his own practice, Dr Wasnik says his team now performs surgeries on at least 10 to 15 patients aged over 80 every month. Between 2018 and 2020, that number stood at only three to five patients a month. Dr Rao has seen a 30 per cent increase over the past decade. Kulkarni’s surgery cost around Rs 5 lakh and was largely covered by health insurance, significantly reducing the financial burden on the family. Even so, many families consider the expense worthwhile if it helps an older relative remain mobile, independent and free from chronic pain. “At least, I am not a dependent and I am not carrying a burden of guilt,” says Vijaya. The cost of surgery Most health insurance policies now cover medically necessary surgeries in patients above 80 years, subject to policy terms, coverage limits and pre-existing disease clauses. “Wider insurance coverage has become one of the key factors encouraging families to proceed with surgery rather than delay treatment,” says Dr Roy Patankar, Director, gastrointestinal surgeon at Zen Multispeciality Hospital, Mumbai. The cost of surgery varies widely depending on the procedure and hospital. Knee and hip replacements typically cost between Rs 2.5 lakh and Rs 5 lakh, while complex cardiac, gastrointestinal and cancer surgeries can cost considerably more. In addition to the operation itself, families also need to budget for rehabilitation, physiotherapy, medicines and follow-up consultations, all of which are essential for recovery. Doctors point out that while health insurance has improved access to surgery for many older adults, it is not a complete solution. Senior citizen health insurance policies often come with significantly higher premiums than those for younger people, and may include waiting periods, co-payments, sub-limits or exclusions for pre-existing illnesses, particularly when purchased later in life. Those who have maintained insurance coverage over many years or are covered under employer or family floater policies are generally better protected against the financial burden of major surgery. Dr Prasun Chatterjee, former group clinical lead, Geriatric Medicine and Longevity Science, Apollo Hospitals, India, has seen that even when patients have health insurance, many families struggle with reimbursement or do not receive financial support from insurers at the time they need it most. “This often means arranging large sums of money upfront and waiting for claims to be processed, which can delay treatment or place considerable stress on families,” he says. “While schemes such as Ayushman Bharat have expanded access to healthcare, India needs dedicated healthcare and insurance policies that address specific needs of people over 80,” he adds. (Name changed to protect privacy)