Ageing and ailing: The rising cost of growing old

A 68-year-old Mirriam Adamba has been battling diabetes and hypertension. The conditions have gradually taken a toll on her, significantly changing her way of life.

What initially began as occasional hospital visits has turned into weekly medical check-ups, with at least a day or two of admission whenever her blood sugar levels become difficult to control.

Adamba, from Busali in Vihiga County, says she regrets that ageing has come with a cost she never anticipated.

Although she recently enrolled in the Social Health Authority (SHA), she still spends about Sh20,000 every month on medication, laboratory tests and specialised care not covered under the scheme.

“I go for check-ups every week, and most of the time I am admitted for two days to have my sugar levels managed,” she told The Standard in an interview.

In the same neighbourhood, 70-year-old Beatrice Ingasiani is recovering after surgery following complications linked to a goitre condition and high blood pressure, which caused her to lose her voice.

The emergency surgery saved her life but left her family with a hospital bill of Sh180,000.

At the time, she had not registered with SHA due to financial constraints.

Relatives, friends and members of her church organised a fundraiser to settle the bill. “I heavily rely on my children for my medication and upkeep,” she said.

“I was depending on small-scale farming, mostly rearing chickens, an economic activity that I am no longer actively engaged in due to my health complications. I am often weak.”

Such cases are increasingly common as the country’s ageing population grapples with rising healthcare costs and chronic illnesses.

Even as Kenya pushes towards universal health coverage, many senior citizens continue to shoulder a significant portion of their medical expenses, often forcing families into debt, fundraisers and difficult financial decisions.

According to the Kenya National Bureau of Statistics, there are about 2.7 million people aged 60 years and above, a number projected to rise steadily.

While Kenyans are living longer, healthcare systems and insurance products have struggled to keep pace with the needs of an ageing population.

A recent HeriAfya study by Liberty Life Kenya found that fewer than three per cent of Kenyans aged 60 and above have formal health insurance coverage.

The study notes that although older persons account for some of the highest healthcare needs, many remain insufficiently protected.

The findings paint a worrying picture at a time when non-communicable diseases such as diabetes, hypertension, cancer, kidney disease and cardiovascular conditions are becoming increasingly common among older people.

Financial struggle

For many families, a diagnosis of chronic illness among ageing parents often marks the beginning of a financial struggle that can last for years.

Data from the Kenya National Health Accounts shows that out-of-pocket spending accounts for about 27 per cent of total health expenditure in Kenya. For many uninsured senior citizens, however, healthcare costs are borne almost entirely by patients and their families.

The HeriAfya study further reveals that healthcare costs increase significantly with age.

Internal analysis of more than 7,400 cases involving members aged above 60 showed total claims amounting to Sh169.5 million, with an average inpatient cost of more than Sh318,000 per case. Circulatory diseases alone accounted for more than Sh33 million in claims, highlighting the growing burden of chronic illness among the elderly.

Experts warn that unless deliberate measures are taken to improve prevention, insurance coverage and long-term care planning, Kenya could face an even greater healthcare challenge as its elderly population expands.

SHA data shows that 1.5 million indigent and vulnerable people have been identified and registered, with premiums fully paid for by the government.

“Unlike private insurance, SHA is not discriminatory and is not limited only to the working class, as is the case with private insurance,” says Digital Health Agency Chief Executive Officer Anthony Lenaiyara.

However, according to Beatrice Kairu, a health economist and public policy expert, although senior citizens are eligible for coverage under the national health insurance framework (SHA), the majority are not covered.

She says a large proportion of elderly Kenyans face challenges such as lack of national identification documents or updated records required for registration, limited digital literacy, and inability to afford contributions where applicable.

In addition, most live in remote areas with poor access to registration services, coupled with limited awareness of benefits and enrolment procedures.

Private insurance coverage among elderly Kenyans is also low because premiums rise significantly with age. “Many insurers impose age limits, despite the rising costs of chronic conditions,” she adds.

Accomodative insurance

Kairu recommends that Kenya adopt an “Elderly Health Security Guarantee” policy, which would include automatic SHA enrolment for all citizens aged 60 and above.

She further notes that retired individuals often lose employer-sponsored medical cover. 

Globally, health insurance is moving away from one-size-fits-all medical cover towards more life-stage and needs-based solutions, observes Anthony Mwangi, General Manager for Health Business at Heritage Insurance.

There is also increasing demand for health cover among senior citizens, particularly for non-communicable diseases such as cancer, diabetes and cardiovascular disease.

These conditions account for a significant share of claims.

Mental health is also increasingly part of core benefit considerations, including post-discharge care and home-based recovery.

“In Kenya, insurers must design around how families actually seek, use and pay for care, not only around traditional corporate medical schemes,” says Mwangi.

However, despite high demand for healthcare, there are barriers in affordability, trust, awareness and product relevance.

Many households have irregular incomes, so insurance can feel like a cost they can postpone until illness strikes. Others have experienced exclusions, complicated processes or unclear benefits.

Culturally, many families rely on savings, relatives, harambees or mobile money appeals during medical emergencies. The challenge is that out-of-pocket payment is not cheaper; it is simply delayed risk.

When serious illness occurs, the bill arrives immediately and can destabilise the entire household.

To improve enrolment among senior citizens, Mwangi says the government must provide a universal foundation covering registration, primary healthcare access, risk pooling, clear tariffs, regulation, fraud control and protection for vulnerable households.

Private insurers, he adds, should complement this foundation through top-up cover, group schemes, innovation, digital enrolment and tailored products for segments such as SACCOs, cooperatives and community groups.

“Private insurers should not compete with the public system; we should complement it through additional cover and specialised solutions for families and institutions whose needs go beyond the basic package,” says Mwangi. 

Experts advise that early symptoms should not be ignored to mitigate age-related complications.

Dr Jemimah Kamano, a lecturer at Moi University School of Medicine, hormone specialist and chronic disease researcher, says most diseases do not appear suddenly but develop gradually from conception, childhood, adolescence and through lifestyle choices.

For instance, malnourished children are predisposed to diseases that may manifest even before the age of 40.

“If mothers continue feeding children junk food instead of a balanced diet and fail to encourage exercise, we are likely to have a future generation that will end up in wheelchairs,” warns Dr Kamano.

Dr Jairus Maling, an internal medicine specialist, attributes many age-related diseases to lifestyle factors, including diabetes, hypertension, obesity, kidney failure, cardiovascular disease and stroke.

Other conditions include perimenopausal symptoms, erectile dysfunction, osteoarthritis, urinary tract infections and prostate diseases. 

He notes that from around 40 years of age, the body begins to struggle to keep up as organs experience fatigue. For example, the heart continues pumping against high blood pressure, and while the body initially compensates, these mechanisms eventually fail, leading to conditions such as kidney failure, diabetes, stroke and heart attacks.

However, he notes that women tend to experience fewer severe complications at 40 compared to men.

Common conditions

Common conditions among women include breast and cervical cancers, hypertension and menopause-related symptoms, which become more pronounced between 55 and 60 years, including sleep disturbances, irritability and restlessness.

Men, on the other hand, are more prone to genitourinary infections, prostate enlargement, prostate cancer and lung cancer, particularly among long-term smokers.

Both genders, however, experience depression linked to midlife pressures and crises.

“Exercise is important as it helps burn excess calories and reduce salt and alcohol intake,” he advises.

For cancer prevention, he recommends regular screening for early diagnosis and treatment. 

“Men above 40 should undergo prostate screening. If detected early at stage one or two, it can be managed medically, but at stage three outcomes become more guarded,” says Dr Maling.

He further recommends medical check-ups every three months for blood sugar levels to enable early diagnosis and proper management of conditions such as hypertension and diabetes.

Experts also caution that families should plan early for old age. Dr Geoffrey Wango, a senior lecturer in counselling psychology at the University of Nairobi, notes that loneliness often increases after retirement as individuals lose friends and colleagues, making them vulnerable.

As this happens, older people may be left without attention, while children are often busy, leading to emotional distress. “At an advanced age between 60 and 70, most individuals have no friends to talk to, nowhere to go, and those they depend on are often too busy. This leads to disappointment and loneliness,” says Dr Wango.

He suggests maintaining a balance between work and social life, including hobbies and simple exercises, which help rejuvenate memory and prevent dementia.