Inter-Relationships Between Depressive Symptoms and Cognition Among Older Adults in India: A Network Analysis of a Nationally Representative Sample.

BackgroundIndia is experiencing a rapid demographic transition with an ageing population increasingly burdened by cardiometabolic disease. Despite growing evidence from high-income countries linking cardiovascular risk factors with late-life cognitive decline, data from rural South Asia remain scarce. We examined the prevalence of cognitive impairment and its association with cardiometabolic and sociodemographic determinants among community-dwelling older adults in India, with a focus on rural residence.MethodsWe conducted a cross-sectional analysis using Wave 1 data (2017–18) of the Longitudinal Ageing Study in India (LASI), a nationally representative survey of adults aged 45 years and above (analytic sample: 31,464 individuals aged ≥ 60 years). Cognitive impairment was defined using the LASI composite cognitive index encompassing memory, orientation, arithmetic, executive function, and object naming domains. Cardiometabolic risk factors included self-reported hypertension, diabetes mellitus, tobacco use, and physical inactivity. Covariates included age, sex, education, rural–urban residence, and depressive symptoms. Binary logistic regression was used to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals.ResultsThe overall prevalence of cognitive impairment was 10.8% (rural 12.8% vs. urban 6.0%; p < 0.001). In adjusted models, rural residence (aOR 1.68; 95% CI 1.52–1.87), female sex (aOR 2.18; 95% CI 1.99–2.38), no formal education (aOR 3.87; 95% CI 3.35–4.47), hypertension (aOR 1.19; 95% CI 1.10–1.29), tobacco use (aOR 1.26; 95% CI 1.16–1.37), physical inactivity (aOR 1.28; 95% CI 1.18–1.38), and depression (aOR 1.83; 95% CI 1.68–1.99) were independently associated with cognitive impairment. Diabetes mellitus did not reach statistical significance after adjustment (aOR 1.11; 95% CI 0.99–1.24; p = 0.072).ConclusionsRural older adults in India face a substantially higher cognitive impairment burden driven by compounding cardiometabolic and sociodemographic vulnerabilities. Integrated community-based screening and cardiometabolic risk reduction strategies are urgently needed, particularly in rural settings. These findings have direct implications for the design of geriatric care programmes in primary health care settings.

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.

Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017–18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64–21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age.

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.

Given the rising older adult population and related increase in the prevalence of cognitive impairment in India, the present study aimed to examine the association between cognitive function and oral health measures among the middle-aged and older adults in India. Data for the study were selected from the Longitudinal Aging Study in India (LASI, 2017-2018) and 56,723 respondents&amp;gt;=45 years were included. Oral health was measured by self-reported oral health problems including number of oral diseases, edentulism (i.e., losing some or all natural teeth), and dental care utilization (e.g., dental visit in the past 12 months). Our outcome measure was a composite score of cognitive function measured across five broad domains, specifically memory, orientation, arithmetic function, executive function, and object naming. Negative binomial regression models were used to analyze the relationship between the oral health and cognitive function. Our results showed that complete edentulism was associated with 3% lower cognitive scores [IRR=0.97, 95% CI 0.96, 0.99], while dental care utilization was positively associated with cognitive function. Those who had visited a dentist in the past 12 months reported 6% [IRR=1.06, 95% CI 1.03, 1.08] higher cognition scores than those who had not visited a dentist. The unadjusted univariate regressions demonstrated a negative association between the number of oral diseases and cognitive function. Our findings suggest an urgency for improving the existing oral health infrastructure, including expanding access to dental care and promoting oral health education in India, especially for adults at higher risk for cognitive impairment.

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017–2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0–43) in the current sample was 19.43 [confidence interval (CI): 19.32–19.53] among men and 23.55 [CI: 23.44–23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16–0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: − 0.43, CI: − 0.61 to − 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: − 0.52, CI: − 0.69 to − 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging.

Interface of Law and Psychiatric Problems in the Elderly.

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

Cognitive impairment represents an emerging significant public health concern and a prominent risk factor for Alzheimer's disease and dementia among older adults. This study examines the association of substance use and lifestyle factors with cognitive impairment among older adults in India. Utilizing data from the Longitudinal Aging Study in India (LASI) wave 1 (2017–18). We performed bivariate analyses to show association between predictors and outcome variables. Binary logistic regression was employed to understand the impact of substances use, and life style factors controlling the effect of demographic, socio-economic, and health factors on cognitive impairment. In India, 10.76% of older adults exhibit cognitive impairment. The individual who consumed alcohol were 17% more likelihood to experience cognitive impairment (OR:1.17,95% CI:1.07,1.28). Similarly, those who smoked tobacco were 7% more likely to experience cognitive impairment (OR:1.06,95% CI:0.76,1.15). Life style also plays a significant role in determining cognitive impairment. Substance use and other lifestyle factors are significantly associated with cognitive impairment among the older adults in India. Therefore, encouraging older adults who use tobacco or alcohol to assess their cognitive function at an earlier stage that could prevent or mitigate cognitive impairment, thereby enhancing their quality of life. This contribute to achieve of Sustainable Development Goals, particularly Goal 3 that guaranteeing good health and wellbeing for all.

In a culturally different and low-resource setting, where lifestyle habits, including dietary pattern and physical activities differ from those in high-income countries, the association between physical activity and cognition is expected to differ. We aimed to investigate the association between physical activity and cognitive functioning after controlling for potential confounders among older adults in India. Furthermore, gender differences in this relationship were analyzed. Using a national-level data from the Longitudinal Ageing Study in India (2017–2018), this paper employed propensity score matching (PSM) approach to examine the association between physical activities and cognitive functioning among Indian older adults. Cognitive impairment was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming). We limit our sample to older adults aged 60 + years, and our final dataset contains 31,464 participants (men = 16,366, and women = 15,098). The results indicated that older adults who engaged in frequent physical activity have greater cognitive functioning than older adults without physical activity after adjusting for various individual, health, lifestyle, and household factors. This association holds true for both older men and older women. The results from the PSM revealed that the cognitive function score was increased by 0.98 and 1.32 points for the frequently physically active older men and women population, respectively. The results demonstrate the possible beneficial effects of frequent physical activity on cognitive functioning among older adults. Thus, regular physical activity can be considered as an effective lifestyle factor to promote healthy cognitive aging.

This study examined the gender differences in sleep problems among older adults in India. We also examined the role of socioeconomic status in determining the gender differences in sleep. Individuals aged 50 years and above (N = 6560) from the first wave of WHO’s Study on global Ageing and Adult Health (SAGE) – 2007 were studied using bivariate analysis and multivariate logistic regression. In the fully adjusted regression model, older women in India were 46% more likely to report sleep problems than men. Educated and wealthier older adults had fewer sleep problems compared to their counterparts. Further, the gender difference in sleep problems is largely driven by lower socioeconomic status. There are no gender differences in sleep problems among older adults in 6–9 and 10+ years of schooling as well as middle, fourth and fifth wealth quintile (richest) categories. Gender differences could be explained further with women’s mental health (cognitive function, depressive symptoms, stress etc.) and managing their overall physical health and multiple roles demands at the household level in India. Interventions focusing on women in lower socioeconomic strata will be beneficial to reduce the sleep problems in the context of the population ageing in India.

Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs). To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants' responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment. A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking. The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.

BackgroundGiven the unique socioeconomic structures, and the rural/urban differentials in the prevalence of mental illnesses in the country, this study aimed to explore the associations of childhood, adulthood and late-life rural/urban place of residence with mental health outcomes, namely depressive symptoms and cognitive impairment, among older adults in India. The study also examined the relationship between older individuals’ life-course rural/urban place of residence and late-life mental and cognitive health.MethodsUtilizing data from the Longitudinal Aging Study in India (n = 28,027 older adults age 60 years and above), the study employed multivariable logistic and linear regression models to examine the association between urban/rural residential status, life-course residence, depressive symptoms and cognitive impairment among older adults.ResultsChildhood and adulthood place of residence was not associated with depressive symptoms in older men and women. Current rural place of residence was positively associated with depressive symptoms in older women [adjusted odds ratio (aOR): 1.37, confidence interval (CI): 1.05–1.80] but not men. Childhood [aOR: 1.88, CI: 1.16–3.04], adulthood [aOR: 2.00, CI: 1.26–3.16] and current rural residence [aOR: 1.93, CI: 1.27–2.91] was positively associated with cognitive impairment in men. Only current rural residence [aOR: 1.71, CI: 1.29–2.27] was associated with cognitive impairment in women. There was no significant association between life-course place of residence and depressive symptoms except in case of lifetime rural residence Respondents with urban-urban-urban (childhood-adulthood-current) place of residence were less likely to have depressive symptoms [adjusted coefficient (aCoef.): -0.14, CI: -0.21- -0.07] compared to those with rural-rural-rural place of residence. There were significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants, showing an urban advantage in cognitive function among older adults.ConclusionsThis study showed significant associations between life-course residence and depressive symptoms among permanent rural/urban residents. The study also showed significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants. Considering the rural disadvantage in mental and cognitive health among older adults, the government should continue to support policies that can improve access to education and healthcare among people residing in rural areas and women, in particular. The findings also urge social scientists and gerontologists in particular, to consider the importance of lifetime historical context while evaluating mental and cognitive health of older persons.

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.