Exploring Ageism and Age Norms among Older Adults in Urban India

IntroductionDiarrhoeal diseases are common among children and older adults. Yet, majority of the scientific studies deal with children, neglecting the other vulnerable and growing proportion of the population–the older adults. Therefore, the present study aims to find rural-urban differentials in the prevalence of diarrhoea among older adults in India and its states. Additionally, the study aims to find the correlates of diarrhoea among older adults in India. The study hypothesizes that there are no differences in the prevalence of diarrhoea in rural and urban areas.MethodsData for this study was utilized from the recent Longitudinal Ageing Study in India (2017–18). The present study included eligible respondents aged 60 years and above (N = 31,464). Descriptive statistics along with bivariate analysis was presented to reveal the preliminary results. In addition, binary logistic regression analysis was used to fulfil the study objectives.ResultsAbout 15% of older adults reported that they suffered from diarrhoea in the last two years. The prevalence of diarrhoea among older adults was found to be highest in Mizoram (33.5 per cent), followed by Chhattisgarh (30.7 per cent) and Bihar (30.2 per cent). There were significant rural-urban differences in the prevalence of diarrhoea among older adults in India (difference: 7.7 per cent). The highest rural-urban differences in the prevalence of diarrhoea were observed among older adults who were 80+ years old (difference: 13.6 per cent), used unimproved toilet facilities (difference: 12.7 per cent), lived in the kutcha house (difference: 10.2 per cent), and those who used unclean source of cooking fuel (difference: 9 per cent). Multivariate results show that the likelihood of diarrhoea was 17 per cent more among older adults who were 80+ years compared to those who belonged to 60–69 years’ age group [AOR: 1.17; CI: 1.04–1.32]. Similarly, the older female had higher odds of diarrhoea than their male counterparts [AOR: 1.19; CI: 1.09–1.30]. The risk of diarrhoea had declined with the increase in the educational level of older adults. The likelihood of diarrhoea was significantly 32 per cent more among older adults who used unimproved toilet facilities than those who used improved toilet facilities [AOR: 1.32; CI: 1.21–1.45]. Similarly, older adults who used unimproved drinking water sources had higher odds of diarrhoea than their counterparts [AOR: 1.45; CI: 1.25–1.69]. Moreover, older adults who belonged to urban areas were 22 per cent less likely to suffer from diarrhoea compared to those who belonged to rural areas [AOR: 0.88; CI: 0.80–0.96].ConclusionThe findings of this study reveal that diarrhoea is a major health problem among older adults in India. There is an immediate need to address this public health concern by raising awareness about poor sanitation and unhygienic practices. With the support of the findings of the present study, policy makers can design interventions for reducing the massive burden of diarrhoea among older adults in rural India.

Diarrhoeal diseases are common among children and older adults. Yet, majority of the scientific studies deal with children, neglecting the other vulnerable and growing proportion of the population-the older adults. Therefore, the present study aims to find rural-urban differentials in the prevalence of diarrhoea among older adults in India and its states. Additionally, the study aims to find the correlates of diarrhoea among older adults in India. The study hypothesizes that there are no differences in the prevalence of diarrhoea in rural and urban areas. Data for this study was utilized from the recent Longitudinal Ageing Study in India (2017-18). The present study included eligible respondents aged 60 years and above (N = 31,464). Descriptive statistics along with bivariate analysis was presented to reveal the preliminary results. In addition, binary logistic regression analysis was used to fulfil the study objectives. About 15% of older adults reported that they suffered from diarrhoea in the last two years. The prevalence of diarrhoea among older adults was found to be highest in Mizoram (33.5 per cent), followed by Chhattisgarh (30.7 per cent) and Bihar (30.2 per cent). There were significant rural-urban differences in the prevalence of diarrhoea among older adults in India (difference: 7.7 per cent). The highest rural-urban differences in the prevalence of diarrhoea were observed among older adults who were 80+ years old (difference: 13.6 per cent), used unimproved toilet facilities (difference: 12.7 per cent), lived in the kutcha house (difference: 10.2 per cent), and those who used unclean source of cooking fuel (difference: 9 per cent). Multivariate results show that the likelihood of diarrhoea was 17 per cent more among older adults who were 80+ years compared to those who belonged to 60-69 years' age group [AOR: 1.17; CI: 1.04-1.32]. Similarly, the older female had higher odds of diarrhoea than their male counterparts [AOR: 1.19; CI: 1.09-1.30]. The risk of diarrhoea had declined with the increase in the educational level of older adults. The likelihood of diarrhoea was significantly 32 per cent more among older adults who used unimproved toilet facilities than those who used improved toilet facilities [AOR: 1.32; CI: 1.21-1.45]. Similarly, older adults who used unimproved drinking water sources had higher odds of diarrhoea than their counterparts [AOR: 1.45; CI: 1.25-1.69]. Moreover, older adults who belonged to urban areas were 22 per cent less likely to suffer from diarrhoea compared to those who belonged to rural areas [AOR: 0.88; CI: 0.80-0.96]. The findings of this study reveal that diarrhoea is a major health problem among older adults in India. There is an immediate need to address this public health concern by raising awareness about poor sanitation and unhygienic practices. With the support of the findings of the present study, policy makers can design interventions for reducing the massive burden of diarrhoea among older adults in rural India.

Treatment gap and care characteristics for mental disorders among older adults in India: Evidence from National Mental Health Survey 2015-16.

BackgroundCognitive functioning is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height with cognitive functioning among older adults (50+) in India and China. The age pattern of cognitive functioning with measures of life course socioeconomic status has also been examined.MethodsCross-sectional comparative analysis was conducted using the WHO’s Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect linear regression analysis was used to examine the association of life course socioeconomic status and adult height with cognitive functioning.ResultsIn both India and China, parental education as a measure of childhood socioeconomic status was positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and significant. Height was significantly and positively associated with improved cognitive functioning of older adults in India and China. Furthermore, the age-related decline in cognitive functioning score was higher among older adults whose parents had no schooling, particularly in China. The cognitive functioning score with age was much lower among less-educated older adults than those with higher levels of education in China. Wealthier older adults in India had higher cognitive functioning in middle ages, however, wealth differences narrowed with age.ConclusionsThe results of this study suggest a significant association of lifetime socioeconomic status and cumulative net nutrition on later-life cognitive functioning in middle-income settings.

BackgroundHealth at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above.MethodsUsing the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks.ResultsOur results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282—1.401) as compared to men among the older adults in India.ConclusionOur results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.

This study examined the associations between migrant status, social isolation, and loneliness among older adults in India, as well as whether these associations vary by sex, place of residence, wealth, and pension status. Data were obtained from wave 1 (2017-18) of the Longitudinal Aging Study in India (LASI), with a sample of 31,390 individuals aged 60 years and above. Multivariable logistic regression analysis was used to examine the association between social isolation, feelings of loneliness, and migrant status after adjusting for conceptually relevant covariates including sex, place of residence, and socioeconomic and demographic factors. Multiple stratified regression models were used to assess the role of sex and place of residence in the observed associations. A total of 11% of older adults reported social isolation and 37% reported loneliness. Migrants had a higher prevalence of social isolation (11.82%) and loneliness (39.95%). After adjusting for the selected covariates, older migrants had a higher likelihood of experiencing social isolation (AOR: 1.16; CI: 1.01–1.32) and loneliness (AOR: 1.19; CI: 1.06–1.34) than non-migrant older adults. Older adults residing in rural areas had higher odds of social isolation (AOR: 1.64; CI: 1.40–1.92) compared to those residing in urban areas. Older women were less likely to be socially isolated than their male peers were (AOR: 0.85; CI: 0.73–0.99). Moreover, older migrants residing in urban areas had a higher chance of social isolation (AOR: 1.76; CI: 1.33–2.31) and loneliness (AOR: 1.48; CI: 1.17–1.87) than non-migrant older adults residing in rural areas. Similarly, older male migrants were more likely to experience social isolation compared to male non-migrants (AOR: 1.23; CI: 1.03–1.47). Additionally, older migrants in rural areas were more likely to experience loneliness compared to non-migrant older adults in rural areas (AOR: 1.21; CI: 1.05–1.39). In addition, social isolation and loneliness were more pronounced among older migrants who did not receive pension in this study. These findings suggest that loneliness and social isolation among older adults, particularly migrants, are highly prevalent in older male and urban migrants. The findings also suggest that social health in older adults is determined by various factors, including sex, place of residence, work and marital status, education, health, wealth and pension status, and geographical location. Direct policy efforts are required to develop and implement healthcare and social welfare programs that specifically cater to the needs of older migrant adults in India.

As the population of older adults in India grows, research is needed to plan a sustainable future for India’s older adults. This article reports results from a Global Positioning System (GPS)–based pilot study that examined the mobility of middle-class, older adults living in Ahmedabad, Gujarat, India. Using mobility as a lens through which to examine the lives of older adults, we map potential research and identify policy areas of interest considering older adults in urban India. The study explores the role of life stage in mobility as well as the effects of gender and urban environment on mobility. Using this distinctive perspective on day-to-day life, we propose themes through which, using policy and planning tools, the living environments of older adults in Indian cities can be improved. These policy measures include focusing on walkability and pedestrian safety in residential areas and building on existing mixed land use to create high accessibility to goods and services in urban environments.

Interface of Law and Psychiatric Problems in the Elderly.

Using the Longitudinal Ageing Study in India 2010 pilot survey data, the present study examines the covariates and risk factors associated with functional limitations among older adults (45+ ages) in India. Functional limitation is defined as the difficultly in performing some basic activities of daily livings (ADLs) viz. bathing, eating, walking, dressing, toileting and getting in/out of bed. Result suggests that one in every seven older adults in India has at least one of the functional limitations. Among all the activities of daily livings, the most reported problem is difficulty in getting in and out of bed (7 %) followed by walking (6.6 %) and toileting (5.5 %). Age and physical functionality is inversely correlated; older adults aged 60 years report more functional limitations and this becomes more noticeable for older adults aged 75 years and above. We found inverse association between functional limitations and education level and positive association with wealth possession. The multivariate results also corroborate the findings of bivariate results that older adults at higher age, females and older adults with low education are more likely to have functional limitations than their counterpart groups. The likelihood of functional limitations increases significantly in the presence of chronic diseases and smoking tobacco. These finding calls for devising policy to ensure the social security and health care requirements of aged, uneducated, females, poor and those suffering from chronic diseases.

Epidemiology of cancers among older adults in India: findings from the National Cancer Registry Programme

The present study explores the leading environmental, socioeconomic, and behavioral factors that explain the prevalence gap in lifestyle diseases among older adults in rural and urban India, utilizing data from the recent Longitudinal Aging Study in India Wave-1 (2017–18). The study considers a total of 30,569 males and 41,681 females for the analysis. The analysis employs bivariate and multivariate techniques, including a complementary log-log regression model, to understand the adjusted effects of various correlates on disease patterns. Furthermore, a decomposition model is applied to identify factors contributing to the higher prevalence of lifestyle diseases in urban areas compared to rural areas. In urban settings, 39% of individuals suffer from obesity or overweight issues, and 37% from cardiovascular diseases. The regression results indicate that people who spent most of their adulthood in urban areas are significantly more likely to develop diabetes (β = 1.5), CVDs (β = 1.3), obesity or overweight (β = 1.5), and high cholesterol (β = 1.2), with p-values <0.001. The decomposition analysis reveals that lifestyle and behavioral factors, along with environmental elements such as pollution and lack of green spaces, contribute to the increased disease prevalence in urban areas. The urban lifestyle influences individuals by fostering unhealthy daily habits and promoting a sedentary lifestyle, which leads to various health problems, including chronic diseases.

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

The population aged 60 years and older in India constitutes over 7 per cent of the total population (1.21 billion) and is projected to triple in the next four decades, from 92 million to 316 million (James, 2011). Improved access to health care and better living conditions have resulted in this increased longevity. However, this does not readily translate into greater well-being for older adults in India. The implications of a rapidly ageing population means there is little or no time to develop the infrastructures required to meet the demands of an older population. Yet, in a country where very few pay taxes, India has not acquired the resources to develop state-funded care or housing for older people. One of the most prevailing assumptions in the context of older people’s care in India, is that families provide care and support to older people. While this has been the been the norm for centuries, contemporary India represents a climate where rapid demographic shifts have impacted on families, which means many older people are no longer guaranteed traditional family-based care in later life, especially from low-income adult children. Hence, the current generation of older adults in India are caught between different cultural norms of co-residence. They were born and socialised in multi-generational co-residential households and now find themselves often living with a married son and his family or increasingly on their own. Widowhood and deteriorating health conditions acts as push factors to renegotiate living arrangements based on the accessibility to caregivers. Moreover, large-scale internal and international migration of the younger age groups has left many households with fewer family caregivers. Care for Older Adults in India: Living Arrangements and Quality of Life brings together an interdisciplinary set of authors to examine the different patterns of living arrangements across India and how they impact on the provision of care and quality of life for older adults. The narrative that emerges across these chapters is one that challenges the assumed wisdom about the demographic, industrial and social change on older adults. The chapters in this book tell us a much more complex story about living arrangements and care for older adults in India. Rather than being a single, linear narrative, it is a story about the heterogeneity of families, care and migration experiences.

Research has been conducted on the prevalence of health consequences of falls among older adults (aged ≥60 years) in India, and our systematic review and meta-analysis aimed to synthe-size the existing evidence on this topic. The JBI guideline was followed for conducting this review work. Several databases were searched, and eight studies were included. The critical appraisal scores (“yes” responses) for the included studies ranged from 56% to 78%. Among older adults in India who fell, the pooled prevalence of injuries was 65.63% (95% confidence interval [38.89, 87.96]). Similarly, head and/or neck injuries was 7.55% (4.26, 11.62), upper extremity injuries was 19.42% (16.06, 23.02), trunk injuries was 9.98% (2.01, 22.47), lower extremity injuries was 34.36% (24.07, 45.44), cuts, lacerations, abrasions, grazes, bruises and/or contusions was 37.95% (22.15, 55.16), fractures was 12.50% (7.65, 18.30), dislocations and/or sprains was 14.31% (6.03, 25.26), loss of consciousness was 5.96% (0.75, 15.08), disabilities was 10.79% (7.16, 15.02), and hospital admissions was 19.68% (15.54, 24.16). Some of the high figures indicate the need for prioritizing and addressing the problem. Furthermore, high-quality studies on this topic should be conducted, including on psychological health consequences, health-related quality of life, length of hospital stay, and death. PROSPERO registration: CRD42022332903.

Our objective was to test whether food insecurity mediates cross-sectional associations between social disadvantage and body composition among older adults (aged 50+) in India (n = 6556). Adjusting for key sociodemographic and dietary variables, we examined whether markers of social disadvantage (lower educational attainment, lower household wealth, belonging to a disadvantaged caste/tribe, and belonging to a minority religion) were associated with food insecurity. We then examined whether food insecurity, in turn, was associated with anthropometric measures of body composition, body mass index (BMI), and waist circumference (WC). We also tested whether food insecurity mediated the relationship between social disadvantage and body composition. In adjusted models, lower household wealth [lowest quintile (Q5) vs highest quintile (Q1): odds ratio (OR) = 13.57, P < .001], having less than a high-school education (OR = 2.12. P < .005), being Muslim (OR = 1.82, P < .001), and being in a scheduled caste (historically marginalized) (OR = 1.49, P < .005) were associated with greater food insecurity. Those who were severely food insecure had greater odds of being underweight (OR = 1.36, P < .01) and lower odds of high WC (OR = 0.70, P < .01). Mediation analyses estimated that food insecurity explained 4.7%-29.7% of the relationship between social disadvantage and body composition, depending on the variables considered. Our results are consistent with the hypothesis that food insecurity is a mechanism linking social disadvantage and body composition among older adults in India. These analyses contribute to a better understanding of processes leading to variation in body composition, which may help enhance the design of interventions aimed at improving population nutritional status.