Older Indians Research Articles

Aging in contemporary India: A qualitative inquiry

ABSTRACT India is aging. The growth of India’s older population has increased our concerns about their well-being. While it is critical to explore the diverse needs and aging experience of older Indians, their voices are largely missing in the aging literature. In this context, data was collected from 63 community-dwelling and OAH residing older men and women of Delhi NCR to understand their aging experience, views about old age and perceived need for government intervention in old age care and support. Reflexive thematic analysis of their aging experience and perception of old age generated five themes and six sub-themes: The aging body encompassing three sub-themes “the older we become the more diseases we have”, “the ointment called positive thinking”, “women’s quest for self-care”; Psychological gains and social losses; Affiliation, distraction and anticipation; The aging parent and the adult child comprising three sub-themes “filial relations—quality and quantity”, “children these days and their mobile phones”, “our daughter shows us more love and care”; and A time for religious and spiritual devotion. Lastly, the analysis of their perceived need for government support in old age care generated five sub-themes – Political cynicism, I was a private employee but am I not a part of this country? Government or Private Hospitals: A no-win situation, Everyday life and Reforms in OAHs. The present findings highlight the multidimensional and multidirectional experience of aging and the diverse needs of older persons in the Indian context.

The association between polluted fuel use and self-reported insomnia symptoms among middle-aged and elderly Indian adults: a cross-sectional study based on LASI, wave 1

BackgroundInsomnia predisposes the aging population to reduced quality of life and poor mental and physical health. Evidence of the association between polluted fuel use and insomnia symptoms is limited and is non-existent for the Indian population. Our study aimed to explore the link between polluted fuel use and insomnia symptoms in middle-aged and older (≥ 45 years) Indian populations.MethodsWe utilized data from nationally representative Longitudinal Aging Study in India (LASI) Wave 1. Participants with complete information on fuel use, insomnia symptoms, and covariates were included. Insomnia symptoms were indicated by the presence of at least one of three symptoms: difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), or early morning awakening (EMA), ≥ 5 times/week. Survey-weighted multivariable logistic regression analyses were conducted to evaluate the association between polluted fuel use and insomnia symptoms. We also assessed the interaction of association in subgroups of age, gender, BMI, drinking, and smoking status.ResultsSixty thousand five hundred fifteen participants met the eligibility criteria. Twenty-eight thousand two hundred thirty-six (weighted percentage 48.04%) used polluted fuel and 5461 (weighted percentage 9.90%) reported insomnia symptoms. After full adjustment, polluted fuel use was associated with insomnia symptoms (OR 1.16; 95%CI 1.08–1.24) and was linked with DIS, DMS, and EMA (OR 1.14; 95%CI 1.05–1.24, OR 1.12; 95%CI 1.03–1.22, and OR 1.15; 95%CI 1.06–1.25, respectively). No significant interactions for polluted fuel use and insomnia symptoms were observed for analyses stratified by age, sex, BMI, drinking, or smoking.ConclusionsPolluted fuel use was positively related to insomnia symptoms among middle-aged and older Indians. Suggestions are offered within this article for further studies to confirm our results, to explore underlying mechanisms, and to inform intervention strategies.

Socio-demographic and behavioral correlates of excess weight and its health consequences among older adults in India: Evidence from a cross-sectional study, 2017-18.

Rapid population aging is expected to become one of the major demographic transitions in the twenty-first century due to the continued decline in fertility and rise in life expectancy. Such a rise in the aged population is associated with increasing non-communicable diseases. India has suffered from obesity epidemic, with morbid obesity affecting 5% of the population and continuing an upward trend in other developing countries. This study estimates the prevalence of excess weight among older adults in India, and examines the socio-demographic and behavioral factors and its health consequences. The study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 25,952 older adults (≥ 60 years) was selected for the study. Descriptive statistics, bivariate Chi-Square test, and logistic regression models were applied to accomplish the study objectives. Body mass index (BMI) has been computed for the study according to the classification of the World Health Organization, and "excess weight" refers to a score of BMI ≥ 25.0 kg/m2. Overall, 23% of older adults (≥ 60 years) were estimated with excess weight in India, which was higher among women irrespective of socioeconomic and health conditions. The higher levels of excess weight (than the national average of ≥22.7%) were observed among older adults in states like Haryana, Tamil Nadu, Telangana, Maharashtra, Gujarat, Manipur, Goa, Kerala, Karnataka, Himachal Pradesh, Punjab, Sikkim and some other states. After adjusting for selected covariates, the odds of excess weight were higher among females than males [OR: 2.21, 95% CI: 1.89, 2.60]. Similarly, the likelihood of excess weight was 2.18 times higher among older adults who were living in urban areas compared to their rural counterparts [OR: 2.18; 95% CI: 1.90, 2.49]. Higher level of education is significantly positively correlated with excess weight. Similarly, higher household wealth index was significantly positively correlated with excess weight [OR: 1.98, CI: 1.62, 2.41]. Having hypertension, diabetes and heart diseases were associated with excess weight among older adults. Regional variations were also observed in the prevalence of excess weight among older adults. The findings suggest that introducing measures that help to reduce the risk of non-communicable diseases, and campaigns to encourage physical activity, and community awareness may help reduce the high burden of excess weight and obesity among older Indians. The findings are important for identifying the at-risk sub-populations and for the better functioning of any public health programme and suitable intervention techniques to lower the prevalence and risk factors for excess weight in later life.

Gender and Generation: Landownership and Older Indians’ Autonomy

While increased access to household assets has been shown to improve older individuals’ autonomy and bargaining power at home, the role of gender hierarchy in shaping differential impacts of household assets has received far less attention. This article explores the gender asymmetry in the association of older people’s (age 60 years or more) decision-making power at home and survival probability with their ownership of and managerial control over agricultural land in rural India. Using data from the India Human Development Survey, results find that in multi-generational households, landownership at the household level is associated with higher decision-making power and survival probability for older men but not for older women. Among older women, the relationship between household landownership and decision-making power is positive when they have clearly established titles to the land or managerial control but negative when their names are not on the land title. HIGHLIGHTS Landownership is an important source of old age security in India. Agricultural land in India is typically controlled by the patriarch; women rarely own or control household land. The generational power conferred on older men with landownership does not apply to older women to the same degree. It is crucial to register household land under women’s names and recognize women as actual landowners.

Explaining the Urban-Rural Difference in Late-Life Depression in India: Evidence from a Multivariate Decomposition Analysis Based on Longitudinal Aging Study in India, Wave 2017-18

ABSTRACT Objectives The study explored the associated factors of depression among older Indian adults and the influences of individual and socio-environmental factors in explaining the rural-urban difference in the prevalence of late-life depression. Methods Data come from the Longitudinal Aging Study in India, with a sample of 30,637 older adults aged 60 and above. Multivariable logistic regression and nonlinear multivariate decomposition analyses were conducted to fulfill the objectives. Results About 6.2% older adults in urban areas and 9.5% in rural areas were depressed. Older adults in rural areas had significantly higher likelihood to be depressed than those in urban areas. Poor self-rated health, multiple chronic conditions, functional difficulty, low life satisfaction, social inactivity, low satisfaction with living arrangement, ill-treatment and being widowed increased the risk of depression. Additionally, work status similar to urban older adults, physical activity, living arrangement satisfaction, self-rated health and ill-treatment would decrease the urban-rural difference in depression. Conclusions The study showed significant rural-urban difference in late-life depression, with a rural disadvantage. Clinical implications The findings suggest the need for identifying at-risk populations and developing a framework of targeted policy interventions for mitigating the increased risk of late-life depression among older Indians and in rural areas in particular.

Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators.

While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment. Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions. The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment. Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.

Leisure as social engagement: does it moderate the association between subjective wellbeing and depression in later life?

To investigate the role of leisure (as social engagement) in moderating the association between subjective wellbeing and depressive symptoms among older Indians. The sample included data from 39,538 older adults (aged 55-80) from the Longitudinal Aging Study in India (LASI, Wave-1), 2017-2018. Individual level questionnaire was used to examine the relationship among social engagement, subjective wellbeing, and depressive symptoms. Moderating effects of leisure activities were estimated through interaction analysis and linear multivariable modeling. Low participation in social engagement activities (or leisure) was associated with greater likelihood of depressive symptoms. Leisure activities positively and significantly moderated the subjective wellbeing among older adults with depressive symptoms. Results suggest a significant wealth gradient where affluent older Indians having a clear advantage in heightened levels of social engagement and subsequently lower likelihood of depressive symptoms. Additionally, being in an urban area, co-residence in a "joint" household and belonging to the dominant social groups in terms of caste and religious categories are associated with gains in wellbeing. The direct and indirect effects of social engagement suggest that depressive symptoms can be mitigated while enhancing overall wellbeing of older adults. This holds promise for social policy in redirecting efforts to develop age-friendly initiatives and social infrastructure that enhance the link between engagement and wellbeing.

Understanding depression in older Indians using diathesis-stress framework: The role of neighborhood safety and physical and functional health.

The interplay between an individual's vulnerability and related stressors, effectively termed as diathesis, is an important contributor towards depressive symptoms. Utilizing the diathesis-stress model, the present study examines the role of perceived neighborhood safety along with specific indicators of health such as activities of daily living (ADL) and self-rated health (SRH), and their associations with depressive symptoms among older Indian adults. A cross-sectional study has been conducted. Data were drawn from the Longitudinal Aging Study in India wave 1 that was collected during 2017-18. The present study is conducted on respondents aged 60years and above and the sample included 31,464 older adults. Depressive symptoms were assessed using the Short Form Composite International Diagnostic Interview (CIDI-SF). In this study, approximately 14.3% of the older participants reported perceiving their neighborhood as unsafe. A total of 23.77% and 24.21% of older adults reported at least one difficulty in ADL and poor SRH, respectively. Older adults who had perceived their neighborhood as unsafe had higher odds of reporting depressive symptoms [AOR: 1.758, CI: 1.497-2.066] than those with the perception of a safe neighborhood. Those with a perceived unsafe neighborhood and low ADL functioning had approximately 3.3 times higher odds of reporting depressive symptoms [AOR: 3.298, CI: 2.553-4.261] than those with a safe perceived neighborhood and high ADL functioning. Further, older adults with unsafe perceived neighborhood, low ADL functioning and poor SRH had much greater odds of reporting depressive symptoms [AOR: 7.725, CI: 5.443-10.960] than those with a safe perceived neighborhood, high ADL functioning and good SRH. Additionally, depressive symptoms were pronounced among older women and those who resided in rural areas with unsafe perceived neighborhood, low ADL functioning and poor SRH than their male peers. The findings suggest that older women and rural-dwelling older adults are more prone to have higher prevalence of depressive symptoms than their male and urban-dwelling peers, especially when they have an unsafe neighborhood and poor functional and physical health, and thus, they should be given focused care and attention by healthcare practitioners.

Biological risk factors for dementia in India

AbstractBackgroundMany clinical biomarkers have been associated with dementia. This paper uses a novel data set from an understudied population – a national sample of older Indians ‐ to assess the relative importance of 41 biomarkers using a variety of approaches. The value of these data is the extensiveness of the biomarker collection, the validated classification of dementia, and the uniqueness of the population with low average education. Many approaches to both summarizing and reducing data complexity have been suggested. Some of these are based on theory about biological mechanisms and some are agnostic and based on machine‐learning approaches. The results are informative for others collecting and analyzing biomarker data in population samples.MethodWe use 6 approaches to assessing the value of the biomarkers in explaining variance in dementia diagnosis and cognitive functioning – some traditional social science approaches and some based on machine learning. The aim of the different approaches is to determine how to best characterize the influence of biology as well as how to trim and combine the data. The five approaches to measuring biological risk: 41 individual biomarkers; identification of subsets of biomarkers with elastic net; support vector machine learning; factors developed with factor analysis; a principal components approach; and a factor classification based on a theoretical approach.ResultsResults indicate if the aim is explain variance in dementia, all the biomarkers or a reduced set of biomarkers identified by elastic net do the best job at explaining variability. However, biological markers chosen as most important do not fit well our understanding of biological mechanisms.ConclusionIf the aim is understanding the relative importance of biological systems, traditional social science approaches, e.g. the factor analysis and principal components approach, allow better understanding and interpretation of the biomarkers associated with cognitive performance.

The association between loneliness and life satisfaction: examining spirituality, religiosity, and religious participation as moderators

BackgroundFuture cohort of older adults may have to rely on non-family sources and forms of support, religion being one of them. This may be especially so, considering the recent longitudinal evidence that individuals are inclined to become more religious with increasing age. Thus, the purpose of the present study was to assess the association between loneliness and life satisfaction among older adults in India, and the extent to which the association between loneliness and life satisfaction is moderated by spirituality, religiosity, and religious participation.MethodsData come from the Longitudinal Ageing Study in India, with a sample of 31,464 individuals aged 60 years and above. Multivariable logistic regression models were employed to examine the independent association of loneliness and life satisfaction. Further, an interaction analysis was conducted to examine the extent to which the association between perceived loneliness and life satisfaction is moderated by spirituality, religiosity and religious participation among older Indians.ResultsThe prevalence of low life satisfaction (LLS) was 30.84%; a total of 37.25% of participants reported feeling lonely, 12.54% reported a lack of spiritual experience, 21.24% reported not being religious, and 19.31% reported not participating in religious activities. Older adults who felt lonely had higher odds of LLS relative to peers who were not lonely. Further, the adverse impact of loneliness on LLS among older Indians is moderated by their spirituality, religiosity, and religious participation. Specifically, the adverse impact of loneliness on LLS was less negatively pronounced among older adults who were spiritual, religious, and engaged in religious activities.ConclusionsThe study found an independent association between loneliness and lower life satisfaction among older adults in India. It also revealed that religiosity, spirituality and religious participation moderate the association between loneliness and lower life satisfaction. These findings, which underscore the health promoting benefits of religiosity and religious engagement, may be used to build on the interaction between religious and faith-based groups and public health professionals.

“Day and night people run after money … where is the time to spend chit-chatting with parents?”: Challenges of, and coping strategies for, supporting older relatives in adults of varied socioeconomic backgrounds in Tamil Nadu, India

Fertility has declined significantly across the socioeconomic spectrum in the south Indian state of Tamil Nadu, which has the potential to increase the strains of support provision for family members and to limit support for dependent older people. We used a qualitative approach to explore the challenges that adults (N ​= ​113) from varying socioeconomic backgrounds (urban/rural and socioeconomic status) in Tamil Nadu experience when supporting their older relatives, and to understand how they cope with these challenges. While the broad challenges mirrored those seen elsewhere in India and globally (e.g., role conflict), some were particular to the context of contemporary Tamil Nadu (e.g., difficulties around supporting son/child-less or non-co-resident elders). The challenges experienced were qualitatively similar across socioeconomic groups but affluent families had more coping strategies available to limit the negative outcomes of support provision. We highlight the potential value of universal health coverage for promoting family-based support for older Indians, the urgent need for strategies to ease the challenges for lower socioeconomic status families, and the importance of wider socioeconomic policy to reduce the financial and time pressures that restrict the support that much of the population can provide each other.

Successful Aging in the Indian Socio-cultural Milieu.

There is a growing recognition of the importance of subjective definitions of successful aging from a clinical and policy perspective, and for their social and cultural relevance. However, the voices of older Indians remain largely underrepresented in the emerging body of qualitative literature on successful aging. Given this gap, and India's burgeoning older population, the present study set out to examine their subjective perception of successful aging. Using convenience sampling, data was collected from older men and women (N = 63, M Age = 71.21) living in the community, and in old age homes in Delhi NCR, through face-to-face interviews and focus group discussions. Reflexive thematic analysis resulted in four primary themes and eight sub-themes - Successful Aging as Personal Well-being, Tensions between Agency and Fatalism, comprising three sub-themes viz. the person as an active agent, co-existence of agency and fatalism, and negotiating with the invisible powers; Linked Lives comprising two sub-themes viz. the aging parent and the adult child, and spousal interrelationship; and The Social and Built Environment comprising three sub-themes, viz. complexity of social life: the health interface, social life in the neighborhood, and the good house. These findings provide a culture-specific view of successful aging in the Indian context, and reveals the multifaceted conceptualization of successful aging of older Indians - one that encompasses various biopsychosocial components.

"I Don't Want to Have the Time When I Do Nothing": Aging and Reconfigured Leisure Practices During the Pandemic.

In this paper, we contend that urban middle-class older Indians engaged in "serious leisure" as a way to reimagine and reconfigure the structure of everyday life during the pandemic-led epochal downtime. In particular, we heuristically show that leisure activity patterns and constraint negotiation strategies among older Indians followed conceptual semblances with the dominant leisure-based typology of Serious Leisure Perspective. By thematically analysing household surveys (n = 71), time-use diaries and in-depth interviews (n = 15) of middle to upper middle-class individuals (55-80 years), we show how both men and women distinguished between serious leisure that is marked by motivation, agency and perseverance with that of unstructured, routinized free-time (or causal leisure). Time-use diaries suggested that despite the changed realities of heightened domestic time available to both genders due to the pandemic, women recorded higher proportion of their daily hours in household management and caregiving. Although women were governed by moral-cultural self-descriptions in their engagement with leisure, it was often associated with an enhanced sense of self-actualisation, self-management and identity. Overall, we show how the social codes of age and gender were inextricably linked with the practice of leisure during the pandemic.

Investigating the factors that explain white matter hyperintensity load in older Indians.

White matter hyperintensities are areas of hyperintense signal on MRI that typically represent cerebrovascular pathology. While focal white matter hyperintensities are common among older individuals, extensive white matter hyperintensities have been found to accelerate the progression of dementia. However, little is currently known about how various socioeconomic, health, lifestyle and environmental factors affect the severity of these lesions, particularly in low- and middle-income countries such as India. We investigated this question using cross-sectional MRI data (n = 126) from a pilot neuroimaging sub-study of an ongoing, nationally representative epidemiological study of late-life cognition in India. As a screening step, we estimated white matter hyperintensity load from fluid-attenuated inversion recovery MRI using a fully automated technique and tested for associations with each factor separately, controlling for age, sex and estimated total intracranial volume in each case. A combined model of white matter hyperintensity load included five factors which were significant after multiple comparisons correction: systolic blood pressure, body mass index, urbanicity status (urban versus rural living), daily chore hours and the frequency of store trips. This model explained an additional 27% of the variance in white matter hyperintensity load (54 versus 27% for the baseline model with only age, sex and estimated total intracranial volume). We accounted for the possibility of reverse causality by additionally controlling for concurrent markers of neurodegeneration and cognitive impairment, with no substantial change in our findings. Overall, our findings suggest that controlling high blood pressure and maintaining both a healthy body mass index and high levels of physical activity may reduce white matter hyperintensity load in older Indian adults, helping to prevent or delay dementia.

BIOLOGICAL RISK FACTORS FOR DEMENTIA AND COGNITIVE FUNCTION AMONG OLDER INDIANS: FINDINGS FROM LASIDAD

Abstract A number of clinical and exam-generated biomarkers have been associated with dementia. We assess the relative importance of 41 biomarkers using a novel dataset from an understudied population – a national sample of older Indians. The value of our data includes the biomarker extensiveness, the validated classification of dementia, and the relatively lower average education of the population. We use both traditional social science methods based on biological theories and agnostic machine learning algorithms to examine how biomarkers explain variance in dementia diagnosis and cognitive functioning. Comparing different approaches shows how to best characterize the influence of biology and how to trim and combine biomarkers. The six approaches used in our study include: (1) 41 individual biomarkers; (2) identification of subsets of biomarkers with elastic net; (3) support vector machine learning; (4) factor analysis; (5) principal component analysis; and (6) factor classification based on a theoretical approach. Preliminary results show that all the biomarkers or a reduced set of biomarkers identified by elastic net do the best job at explaining variability in dementia outcome, but the biomarkers chosen as most important by elastic net do not match well our understanding of biological mechanisms. Traditional social science approaches (e.g. factor analysis and principal components approach) provide better understanding and interpretation of the relative importance of biological systems as well as the association between biomarkers and cognition. These results are informative for others collecting and analyzing biomarker data in population samples.

Rural‐urban and gender differences in the prevalence of metabolic syndrome among older Indians

AbstractBackgroundThe clinical significance of metabolic syndrome (MetS) as a risk factor for cardiovascular disease, cerebrovascular disease, and dementia is becoming increasingly prominent. However, there is a dearth of studies from India on the prevalence of MetS, especially in the aging population. We aimed to estimate MetS prevalence and associated comorbidities in two prospective, aging cohorts from rural and urban India.MethodOur study sample includes aging (≥ 45 years) individuals – 2171 from the rural (SANSCOG) cohort and 332 from the urban (TLSA) cohort. These older Indian adults have contrasting population characteristics, which echo the stark rural‐urban divide in the country. Data from baseline clinical and biochemical assessments were used to calculate the prevalence of MetS in both the above cohorts using two well‐established criteria, namely consensus criteria and NCEP‐ATP III criteria. Further, we compare rural‐urban, gender‐ and age‐wise differences in the prevalence of MetS as per the consensus criteria.ResultPrevalence of MetS was 46.2% and 54.8% as per consensus criteria in rural and urban subjects, respectively; corresponding numbers using NCEP‐ATP III criteria were 40.3% and 45.1%. Rural‐dwelling older adults had a significantly lesser prevalence of all individual MetS parameters except impaired triglycerides and high‐density lipoprotein levels. Rural women had a significantly higher prevalence than rural men, whereas there was no significant difference among urban subjects. We did not observe any consistent age‐wise trend when comparing both these cohorts. There was a high burden of comorbidities among both groups, mostly undiagnosed in rural subjects.ConclusionRoughly 1 in 2 older Indians have MetS, urban significantly more than rural, reaching an alarming 63.1% among urban subjects aged 65‐74 years. The very high prevalence of undiagnosed co‐morbidities in rural Indians is extremely concerning, calling for urgent public health measures including ramping up the primary health care system in this marginalized and health disparate population.

Moderation of marital status and living arrangements in the relationship between social participation and life satisfaction among older Indian adults

Social participation is considered one of the central components of successful and healthy aging. This study aimed to examine the moderating role of marital status and living arrangement with social participation and its association with life satisfaction of older Indian adults. Samples of 31,464 individuals aged ≥ 60 years were extracted from the Longitudinal Ageing Study in India, wave-1. Descriptive statistics, bivariate analysis, and multivariable linear regression were performed for the analysis. The moderation effect of marital status and living arrangements on the relationship between social participation and level of life satisfaction among Indian older adults were also analyzed. Overall, life satisfaction among older men was relatively higher than older women in this study. Older adults’ involvement in social participation [β = 0.39, p < 0.05], being in marital union [β = 0.68, p < 0.001] and co-residing either with spouse [β = 1.73, p < 0.001] or with other family members [β = 2.18, p < 0.001] were positively related to their greater life satisfaction. Interaction of social participation with marital status showed that participating in social activities can boost life satisfaction only among married older people. Further, moderation effect of social participation with living arrangements showed that older adults who were not involved in social participation but living with a spouse or any other household members had higher life satisfaction, and again participation in social activities increased their life satisfaction to a greater level. The establishment of social clubs and advocating social policies oriented toward meaningful social connections are highly needed, especially for older Indians living alone or currently not in a marital union, which will help to enhance their overall life satisfaction.

Cross-Sectional Observational Study on Association of Polypharmacy With Health-Related Quality of Life in Patients With Hypertension

Introduction Hypertension is one of the major co-morbidities affecting older Indians, though current trends show that it is increasingly being diagnosed in younger adults as well. In elderly members of the population, it has been shown to be associated with other co-morbidities, making its management difficult. Among the issues that have arisen with its treatment is the increased prevalence of polypharmacy.Thus, there is a need to identify the issues arising from this increase in medications. In particular, the patient's health-related quality of life (HRQoL) can be assessed and interpreted to ensure only appropriate polypharmacy is practiced. Methods The adjusted Research and Development (RAND) 36-Item Health Survey 1.0 for health-related quality of life was sent to a consecutive sampling of 100 hypertensive patients at a rural tertiary care hospital in Wardha District. They were all clinically diagnosed with hypertension and had been prescribed allopathic medication for the same. They were instructed to answer all the questions to the best of their abilities, and each question was then scored from 0 to 100. In addition, they were given questions regarding their age, sociodemographic details, number of medications and frequency of dosage, and additional co-morbidities. The independent variable, i.e., the number of medications (polypharmacy), was then compared to the physical and mental scores they received on the 36-Item Short Form survey (SF-36) to see if there was an association between the two. Result The patients with hypertension that satisfied the criteria for polypharmacy scored lower in the Physical Component Score (PCS) of the HRQoL with a mean difference of 10.4 points. This is a significant value, and when studied in a multivariate linear regression model, controlling for the covariates mentioned above, indicated a statistically significant and negative association between the number of medications and adjusted PCS scores (β = -5.437, p<0.05, 95% CI -8.392 to -2.482). In regards to the Mental Component Score (MCS) of the HRQoL, a difference of 3.72 points was observed unadjusted and, upon controlling for covariates, it was found to be statistically significant (β = -2.825, p<0.05, 95% CI -5.300 to -0.351). Conclusion There is a negative correlation between HRQoL and polypharmacy in hypertensive patients. This is especially evident in the physical aspect, as can be inferred from the Physical Component Scores attained in the study. A smaller but still significant negative correlation is seen in the mental component as well. Hence, a change of policy is indicated to idealize prescriptions and physicians must be vigilant about inappropriate polypharmacy.

Leisure as self-care in the times of the pandemic: Insights from a time-use diary study in India

ABSTRACT In this research note, we discuss how the pandemic forged a renewed interest in self-care among urban older Indians. A reflexive thematic analysis of time-use diaries (N = 15) allows us to examine leisure patterns and everyday subjectivities of middle-class older Indians. In particular, time-diaries reveal a heightened focus on leisure-based enacted self-care practices including meditation, online activity/learning, and socialising. Consistent with previous scholarship of an unequivocal gender inequality in leisure as self-care, we observe distinct differences among men and women in their engagement with self-care. Specifically, while men engaged in outdoor activities as a way to cope with the stress and uncertainties of the pandemic, women’s everyday lives continued to be defined by domesticity and household management. Additionally, we show that while immediately uplifting, the ethics of self-care embodies the neoliberal logic of the entrepreneurial subject that makes self-reliance a necessity to practice responsible citizenship in times of the pandemic. Overall, by shifting the logics of care to the self, we depart from the more commonly held notion of older adults being recipients of care to the crafting of autonomous subjects through the pandemic-led public health practices of committed citizenship and civic virtue.

The Association Between Grip Strength and Depression Among Adults Aged 60 Years and Older: A Large-Scaled Population-Based Study From the Longitudinal Aging Study in India.

BackgroundThe association between grip strength and depression in elderly individuals in low- and middle-income countries (LMICs) has rarely been studied. This study aims to explore the relevance of grip strength and depression in the elderly population using data from a national large-scale population.MethodsThis study was conducted using data from seniors over 60 years old in wave 1 of the Longitudinal Aging Study in India (LASI). Grip strength is the maximum of three measurements by the dynamometer. Depression symptoms were assessed using 10 items on the Center for Epidemiologic Studies Depression Scale (CESD-10) with a 10-point boundary. Multivariate linear regression analysis, non-linear analysis, subgroup analysis, interaction tests and sensitivity analysis were performed.ResultsThere were 27,343 participants in this study, including 19,861 participants with low grip strength and 7,482 participants with normal grip strength. The results revealed that grip strength and depression were negatively correlated in elderly individuals after adequate adjustment for confounding factors [odds ratio (OR) = 1.237, 95% confidence interval (CI) 1.172–1.305, p < 0.00001]. The results remained stable after adjusting for all confounding factors (OR = 1.090, 95% CI 1.030–1.155, p = 0.00307). Regression analysis showed that physical activity (PA), comorbidities and cognition may have an impact on the correlation between grip strength and depression symptoms. Smooth curve fit suggested that grip strength and depressive symptoms were linearly related. The interaction test results of gender in the relationship between grip strength and depression were significant (p for interaction < 0.05).ConclusionGrip strength and depression were negatively correlated in older Indians, and larger prospective studies are needed in the future to determine this association.