The Islamic Republic of Iran is confronting a demographic shift of startling velocity, one which even the government has struggled to predict with any clarity. 

The pace at which its population is ageing has doubled in recent years, transforming what was a young vibrant nation in the early 2000s into one grappling with the consequences of rapid greying on top of a myriad of other macro-economic and societal issues including the potential collapse of the state's welfare system due to falling revenues.

Mojgan Rezazadeh, head of the secretariat for the country's National Council for the Elderly, warned in a recent paper that the proportion of Iranians aged 65 and over has surged from single digits just decades ago to approximately 12% today — a figure projected to climb dramatically within the next one or two generations to above 30% of the population.

This demographic transition (or even transformation) is not uniform across the republic, with more expensive urban areas leading the dramatic shift. Central and northern provinces, particularly Gilan and Mazandaran, along with several regions including East Azerbaijan, Isfahan and Tehran, are experiencing the most pronounced ageing due to rapid urbanisation. These areas consistently report the highest proportions of elderly residents, with an increasing number of those being single-occupant dwellings. 

In contrast, provinces such as primarily impoverished Sistan and Baluchistan and ethnic Arab Hormozgan remain relatively youthful, which correlates with the worst performing economies historically in the country. Still, the bumper figures for the south must contend with the worsening economic malaise and the fall of the economy under the weight of US and now EU sanctions.  

"The regional crisis is most acute where both the elderly population share is high and the economic and medical infrastructure for their care is weak," Rezazadeh explains, without directly referring to the ongoing issues affecting the poorer provinces.

Feminisation of ageing

The phenomenon is also distinctly gendered. Like many countries, Iran faces the "feminisation of ageing", with women constituting more than half of the elderly population due to their longer life expectancy and higher male mortality rates in middle age. The poor quality of life many men lead in the country sees women being widowed by their 60s in many cases. 

This creates gender vulnerabilities, she noted, saying elderly women are more likely to face poverty, require gender-sensitive care services, and suffer from what Rezazadeh describes as "silent violence" and inadequate retirement provisions stemming from historically lower rates of economic participation.

Iran's ageing support infrastructure remains woefully unprepared for this demographic wave, as is the urban fabric in which many elderly people now find themselves. Whilst national policy documents exist — including a National Document on the Elderly — practical capacity lags by a country mile, according to multiple university studies reported to the country’s Ministry of Health.

Home care networks, day centres, skilled carers, sustainable financial coverage and inter-sectoral coordination all remain insufficient, with the vast majority of those mentioned having to be run in the private sector due to the lack of government funding. Government funding from the social services does not stretch to private clinics and palliative care, with Iranian families and those with children abroad now facing the arduous and costly task of long-term care. 

Of the estimated 9m to 10m pensioners, only a fraction receive direct support from the Social Welfare Organisation, with many vulnerable pensioners falling outside the formal safety net entirely.

The elderly require overlapping support across multiple dimensions: care services for those with disabilities or limited family support, preventive healthcare and chronic disease management, and social and psychological assistance to combat isolation.

Rezazadeh told Salamat News, “The needs are overlapping and multi-dimensional, and one cannot highlight just one alone. 

“Care needs such as home services, day centres and social work for elderly people with disabilities or limited support, health needs such as prevention and management of chronic diseases, multidisciplinary teams, access to medicine and rehabilitation; social and psychological needs including prevention of social isolation, mental health, economic and social support are amongst elderly needs,” she added. 

Private sector struggling

Speaking with bnm IntelliNews, care sector equipment provider KTMA director Akram Goli said the issue has become more acute in recent years. She mentioned that, as government resources remain stretched, the country has had to become more self-reliant to create its own care sector equipment, including "commodes, grab bars and hoists" for those with additional needs.

“We can make the physical infrastructure in-country, and we have been doing this for more than a decade in our company; however, there are some items which, due to the scale of production issues, we still need to import from East Asian manufacturers, including countries like China.”

She added, “Another growing concern we have is the lack of development in government and social services support, which currently can only be met by the Iranian Red Crescent Society,” she noted. “We can support physical products, but the country has a major problem with the growth in long term diseases like dementia."

The UN's Zero Project representative, Leila Daneshvar, said that the burden is now entirely on children of the elderly to cover the basics, and in most cases, become full-time care providers for those with complex social and medical needs, as outside care is now out of reach for many families due to the collapse in quality of care and burdensome cost. 

"Families with those in need of social care are under enormous pressure due to the ongoing fiscal constraints, that, along with poorly designed homes for people with mobility needs, has become a growing concern," she told bnm IntelliNews.  

She added that countries like Iran have the added burden of sanctions affecting their ability to participate in international programmes, with regular payment channels often entirely disconnected and foreign agencies unwilling to engage with the demographic changes. 

"We are often forgotten by international agencies dealing with the issue, despite our country producing competent tertiary sector reports and analyses mostly down to the sanctions," she noted. 

How the government responds to the growing charity sector involvement in the elderly care sector is another long-term challenge, as caregivers in the country are often not regulated or on registers, leading to issues including malpractice in a limited number of reported cases. 

Societal response

Daughters also appear to be taking the brunt of the caring and work duties for parents, as happens elsewhere, bnm IntelliNews was told when speaking with people in Tehran about the ongoing care needs of the growing retired class in the country. 

A Tehran resident, Haniyeh, speaking with bnm IntelliNews, said that she was now in charge of her mother's day-to-day activities, despite being one of several children. The caring burden had become a central part of her life in recent years, as she had to support her family due to the emigration of her siblings. 

 "I certainly know that the next generation does not act as I did for my parents, so it bothers me," she said, when talking about caring for her mother and whether she would have children

Mostafa, 45, echoes the previous commenters' points, noting that the issue with the elderly in Iran is coming to a head in the next few years. "The people with the money used to be the elderly 30 years back," he said, "they had the money, the villas, the nice cars, but in recent years families have had to sell many of their assets to get by." 

The accountant from central Tehran said that the fiscal crisis in the country has made the issues of elderly people all the more acute due to the ongoing shortage in funds. 

"There have been several dozen protests in recent years, of retirees demanding their pensions outside parliament or government offices around the country," he said, adding that it was not a good long-term sign. 

The government is attempting to shift its targeting of care for the elderly sector, as part of the move; however, with the Iranian rial at the weakest point in history against the US dollar, currently at IRR1.1mn against the greenback, it is now struggling to deal with payouts.

The situation for successive governments has only gotten worse in recent years, as a substantial proportion of the young working-age population has either become officially economically inactive or emigrated to Western countries, including Canada and the United Kingdom.

The compounding problem for the government’s coffers means an impending fiscal crisis already beginning to appear.

If things weren’t bad enough, the birth rate in the country continues to collapse, with a recent report by the University of Mashhad reporting a collapse in the country’s birth rate, which means fewer people are propping up the system in the future.

Earlier in May, the director of population studies at Mashhad, Dr Ahmadian, warned that the World Health Organisation predicts Iran's fertility rate will fall below 1.36, with 26% of the population becoming elderly by 2051, Shahara News reported on May 14. 

Speaking at a press conference marking Population Week in May, Ahmadian explained that when discussing population studies, two key factors are typically addressed: declining birth rates and an ageing population.

According to the latest statistics published by the WHO in 2023, the global ageing rate is predicted to be around 24%. In this report, Iran, with a population of about 81mn, ranks 18th globally, ninth in Asia, and third regionally."

Discussing the Total Fertility Rate (TFR), which shows the average number of children born to a woman during her reproductive years, Ahmadian noted: "This indicator is the Achilles heel and key component of all population analyses. In 1990, this rate in Iran was about 3.95, but in 2020-2025, it has decreased to about 1.36."