Study On Global AGEing And Adult Health Research Articles

Prevalence of Diabetes and the Relationship Between Wealth and Social Demographic Characteristics Across 6 Low-and-Middle Income Countries

BACKGROUND: As the global burden of diabetes persists, research is needed to understand the role of wealth and correlates of diabetes across regions of the world. The purpose of this study is to examine the prevalence and role of wealth and diabetes across 6 low- and middle- income countries while also accounting for independent correlates of diabetes by country. 
 
 METHODS: Data from the Study on Global Ageing and Adult Health (SAGE), SAGE Wave 1 was used. Self-reported diabetes status was the primary dependent variable and wealth quintile, number of dwelling characteristics and possession of a set of assets, was the independent variable. Logistic regression models examined the relationship between wealth and presence of diabetes across 6 countries with the highest wealth quintile, quintile 1, serving as the reference group. 
 
 RESULTS: Sample size by country included Ghana N = 5573, South Africa N = 4227, Russia N = 4947, Mexico N = 5448, India N = 12198, and China N = 15050. Average age across country ranged from 49 to 63 years of age. Prevalence of diabetes across country included 3.4% and 9.2% for Ghana and South Africa, respectively. In Russia, 8.3%; Mexico, 18.1%; India, 4.9%; and China, 5.9% of the sample reported having diabetes. In the adjusted logistic model, wealth was associated with higher odds of diabetes in Ghana (OR 2.26; CI 1.28; 4.13), South Africa (OR 4.57; CI 2.25; 10.32), Mexico (OR 2.00; CI 1.14; 3.60), India (OR 2.45; CI 1.60; 3.86), and China (OR 2.16; CI 1.62, 2.93). 
 
 CONCLUSIONS: These findings add to the growing body of evidence in our understanding between wealth and diabetes. As diabetes persists as a leading cause of death globally, future work should focus on mechanisms underlying the relationship between wealth and diabetes while also developing interventions to mitigate his burgeoning disease affecting communities across low- and middle-income countries.

Food insecurity and associated health and social determinants among older adults in Ghana: Analysis of the WHO’s study on global AGEing and adult health (SAGE), 2014–2015

This study was conducted to assess the prevalence and factors associated with Food Insecurity (FI) and further quantify its association with unmet need for health services and health-related outcomes among older adults aged 50 years and above in Ghana. The Ghana Study on Global AGEing and Adult Health was used. Body Mass Index (BMI), depressive episodes, functional difficulties (FD), low Quality of Life (QoL), memory decline, and Unmet Needs of Health Services (UNHS) are the the study outcomes. Ordinary Least Square, and Poisson regression analysis modified with Mahalanobis distance matching within propensity score caliper weights were employed. Stata 16.1 was used to perform analysis and a p-value < 0.05 was deemed significant. The prevalence of FI among older adults aged 50 years or older in Ghana was approximately 28 %(95 %CI = 24.5–31.7) and was strongly associated with lower educational attainment and social support. The prevalence ratio of depression, FD, low QoL and UNHS among older adults who experienced FI were; 3.43(95 %CI = 2.25–5.21), 1.18(95 %CI = 1.12–1.23), 2.01(95 %CI = 1.54–2.62), and 1.46(95 %CI = 1.01–2.11). Memory significantly decreased by 85 percentage points% among food insecure older adults [aβ(95 %CI) = −0.85(−1.62–−0.07)]. Older adults with relatively higher educational attainment and social support are less likely to suffer FI and associated limited health and poor social well-being. In the national quest to achieve SDG 2, these health and social determinants of FI among older adults should be considered in the implementation of the national ageing policy to improve the health and well-being of older adults in Ghana.

Associations between food insecurity and Sleep Duration, Quality, and Disturbance among older adults from six low- and middle-income countries.

Although food insecurity has been associated with poor sleep outcomes in young and middle-aged adults, few studies have examined this relationship in older adults. This study aimed to examine the relationship between food insecurity and sleep duration, quality, and disturbance among older adults in six low-income countries (LMICs). We analyzed nationally representative cross-sectional data from 33,460 adults (≥50 years) from the Study on global AGEing and adult health (SAGE). Food insecurity (FI) was assessed using two questions regarding the frequency of eating less and hunger caused by a lack of food. Sleep outcomes included self-reported sleep duration, sleep quality, and sleep disturbances (difficulty falling asleep, frequent sleep interruptions, and early awakening) assessed based on self-reports over two nights. Multivariable logistic regression was used to assess country-specific relationships between food insecurity and sleep outcomes, and random-effects models were used to estimate pooled associations. The prevalence of FI among older adults in the overall population was 16.2%. In pooled analyses, FI was significantly associated with long sleep duration ≥ 9 h (OR=1.58, 95% CI: 1.30 to 1.93; P=0.001). There were also significant pooled associations between FI and poor sleep quality (OR=1.34, 95% CI: 1.14 to 1.56; P < 0.001) and sleep disturbances (OR=1.44, 95% CI: 1.08 to 1.91; P = 0.014). In conclusion, the current study found that FI is adversely associated with sleep duration, quality and disturbances in older adults, with some heterogeneity by country. The findings suggest food policies and intervention programs are needed for vulnerable households.

Prospective changes in anemia are associated with the incidence and persistence of sarcopenia among older Mexican adults.

Low hemoglobin levels are a significant biomarker in the prognosis of sarcopenia. Anemia and sarcopenia are frequent and disabling conditions in the older adult population, but little is known about the role of anemia in the onset and progression of sarcopenia. This study aimed to determine whether prospective changes in anemia are associated with the incidence and persistence of sarcopenia. Data come from the second and third waves (2014, 2017) of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) in Mexico. SAGE-Mexico is a dynamic cohort with national representativeness, including a follow-up sample and new enrollments. For this study, 1,500 older adults (aged 50 or above) with measurements in both waves were included. Sarcopenia was defined as having low muscle quantity and either/both slow gait speed and weak handgrip strength. Anemia was defined according to hemoglobin concentrations, adjusted for altitude, as recommended by the WHO, <120 g/L for women and <130 g/L for men. Multinomial logistic regression was used to estimate the association between anemia and prospective changes in sarcopenia. The baseline prevalence of anemia was 17.4%, and that of sarcopenia was 12.1%. The incidence and persistence of anemia were 10.6% (95% CI: 7.3-15.0%) and 6.9% (95% CI: 4.7-9.8%), respectively, and for sarcopenia, they were 5.3% (95% CI: 3.7-7.7%) and 9.2% (95% CI: 6.4-13.0%), respectively. Incident anemia was associated with incident (RRR = 3.64, 95% CI: 1.18-11.19) but not with persistent (RRR = 0.75, 95% CI: 0.18-3.20) sarcopenia. Persistent anemia was significantly associated with persistent (RRR = 3.59, 95% CI: 1.14-11.27) but not incident (RRR = 1.17, 95% CI: 0.30-4.54) sarcopenia. Changes in anemia are significantly associated with incident and persistent sarcopenia. Primary actions to promote a healthy diet rich in antioxidants, high-quality proteins, and micronutrients, as well as moderate physical activity and maintaining a healthy weight, are crucial for the aging population to delay the deleterious effects of anemia and sarcopenia.

Exploring the Intersectionality of Place and Gender Among Older Adults in Ghana: An Examination of Women's Disability Disadvantage.

Ghana's older adult population is growing rapidly and is projected to double by 2050. It is well-documented that social, health, and housing factors influence segmented aging trajectories that lead to disparate rates of disability. However, little is known about how the intersection of place (i.e., urban and rural) and gender (i.e., woman and man) inform rates of disability among older Ghanaians. We seek to examine this gap in the literature through an intersectional approach. Using logistic regression with Wave 1 (2007/2008) data from the World Health Organization's Study on global AGEing and adult health (SAGE) Ghana, we investigate the prevalence of reporting activities of daily living (ADL) disability among respondents ages 50+ (n = 4,106). To document gender differences by place, we compute separate adjusted odds ratio models among urban and rural respondents. We also control for health, social, and housing factors that might explain gender differences. Compared to urban men, urban women's ADL disability disadvantage was explained by marital status, particularly widowhood. In contrast, rural women consistently reported an ADL disability disadvantage when compared to rural men. Additionally, we found that the morbidity profiles of those who reported ADL disability differed by place and that certain ADL difficulties (i.e., bed transferring and toileting) were especially common among women respondents. Women, regardless of urban or rural residence, were especially vulnerable to ADL disability. Marital status, particularly widows, explained the difference in disability risk between urban men and urban women. This finding suggests that urban women's risk of ADL disability is attenuated during the partnership. Also, we speculate that varied morbidity associations with ADL disability are due to different stressors in urban versus rural environments. These findings also generate further interest in about rural women's disability disadvantage.

Determinants of semantic and episodic memory decline among older adults in Ghana: Evidence from the WHO study on global AGEing and adult health Ghana wave 2.

Determined factors associated with semantic (SM) and episodic memory (EM) among older adults aged 50years and older in Ghana. Data from WHO Study on Global AGEing and Adult Health (SAGE) Ghana Wave 2 was used for this study. Semantic memory (SM) and Episodic memory (EM) were the main study outcomes separately. The study employed Nested Ordinary Least Square regression analysis by sequentially adding 6 blocks of variables and comparison tests between the nested models. The study involved 3575 adult Ghanaians aged 50years and older with a mean±standard deviation of 62.6±18.4years. The overall mean±SD of EM and SM were 5.86±2.51 and 11.69±8.59 respectively. Overall, analysis from block 6 showed a significant variation in SM by approximately 16.9%(ΔR2=1.17%) where increasing age, never married (β=-1.55; 95% CI=-2.41-0.69), being resident in Greater Accra (regional disparity) (β=-3.45; 95% CI=-4.73-2.20), underweight (β=-0.81;95% CI=-1.34-0.27), and moderate self-rated health (SRH) (β=-0.98; 95% CI=-1.52-0.45) significantly decreased SM. Similarly, increasing age, separated/divorced (β=-0.22; 95% CI=-0.35-0.87), being resident in Greater Accra (β=-0.53; 95% CI=-0.80-0.26), and moderate SRH (β=-0.20; 95% CI=-0.36--0.04) significantly decrease EM with an overall significant variation of approximately 22.9%(ΔR2=2.7%). Increasing age, sex, marital status, regional disparity, and poor SRH significantly decreased both Semantic memory and Episodic memory. Higher educational attainment and life satisfaction significantly influenced SM and EM. These provide pointers to important socio-demographic determinants of SM and EM with implications for the implementation of the Ghana national ageing policy 2010, 'ageing with security and dignity', and as a key consideration for healthy ageing towards 2030.

Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2.

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.

Health, wealth, and medical expenditures among the elderly in rural Tanzania: experiences from Nzega and Igunga districts

BackgroundThe per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. The gap between health needs and available resources for elderly healthcare is widening in many developing countries, like Tanzania, leaving the elderly in poor health. These conditions lead to catastrophic HEs for the elderly. This study aimed to analyse the association between measures of health, wealth, and medical expenditure in rural residents aged 60 years and above in Tanzania.MethodsThe data of this study were collected through a cross-sectional household survey to residents aged 60 years and above living in Nzega and Igunga districts using a standardised World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) and European Quality of Life Five Dimension (EQ-5D) questionnaires. The quality of life (QoL) was estimated using EQ-5D weights. The wealth index was generated from principal component analysis (PCA). The linear regression analyses (outpatient/inpatient) were performed to analyse the association between measures of health, wealth, medical expenditure, and socio-demographic variables.ResultsThis study found a negative and statistically significant association between QoL and HE, whereby HE increases with the decrease of QoL. We could not find any significant relationship between HE and social gradients. In addition, age influences HE such that as age increases, the HE for both outpatient and inpatient care also increases.ConclusionThe health system in these districts allocate resources mainly according to needs, and social position is not important. We thus conclude that the elderly of lower socio-economic status (SES) was subjected to similar health expenditure as those of higher socio-economic status. Health, not wealth, determines the use of medical expenditures.

Longitudinal data resource from the Wellbeing of Older People cohort of people aged >50 years in Uganda and South Africa from 2009 to 2019.

The population of people aged ≥60 years continues to increase globally, and has been projected by the United Nations Population Division to increase to 21% of the total population by 2050. In addition, the number of older people living with HIV has continued to increase owing to the introduction of antiretroviral therapy as a treatment for HIV-infected people. Most of the older people living with HIV are in sub-Saharan Africa, an area that faces the biggest burden of HIV globally. Despite the high burden, there are limited reliable data on how HIV directly and indirectly affects the health and wellbeing of older people within this region. To showcase the availability of data on how HIV directly and indirectly affects the health and wellbeing of older people in Uganda and South Africa (SA). The World Health Organization Study on global AGEing and adult health (SAGE), in collaboration with Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit and the Africa Health Research Institute (AHRI) in SA, started the SAGE Wellbeing of Older People Study (WOPS) in Uganda and SA in 2009. Since initiation, respondents have been surveyed every 2 years, with four waves of surveys conducted in Uganda and three waves in South Africa. The available datasets consist of two cohorts of people, aged >50 years, who were surveyed every 2 years between 2009 and 2018. The prevalence of HIV positivity over this period increased from 39% to 54% in Uganda and 48% to 62% in SA. The datasets provide comparisons of variables at a household level and at an individual level. At the individual level, the following measures can be compared longitudinally for a 10-year period for the following variables: sociodemographic characteristics; work history and benefits; health states and descriptions; anthropometrics performance tests and biomarkers; risk factors and preventive health behaviours; chronic conditions and health services coverage; healthcare utilisation; social cohesion; subjective wellbeing and quality of life; and impact of caregiving. This article describes the WOPS in Uganda and SA, the population coverage of this study, and the survey frequency of WOPS, survey measures, data resources available, the data resource access and the strengths and weaknesses of the study. The article invites interested researchers to further analyse the data and answer research questions of interest to enhance the impact of these data.

Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana.

Understanding the patterns of multimorbidity, defined as the co-occurrence of more than one chronic condition, is important for planning health system capacity and response. This study assessed the association of different cardiometabolic multimorbidity combinations with healthcare utilization and quality of life (QoL). Data were from the World Health Organization (WHO) study on global AGEing and adult health Wave 2 (2015) conducted in Ghana. We analysed the clustering of cardiometabolic diseases including angina, stroke, type 2 diabetes, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataract and depression. The clusters of adults with cardiometabolic multimorbidity were identified using latent class analysis and agglomerative hierarchical clustering algorithms. We used negative binomial regression to determine the association of multimorbidity combinations with outpatient visits. The association of multimorbidity clusters with hospitalization and QoL were assessed using multivariable logistic and linear regressions. Data from 3,128 adults aged over 50 years were analysed. We identified four distinct classes of multimorbidity: relatively "healthy class" with no multimorbidity (47.9%): abdominal obesity only (40.7%): cardiometabolic and arthritis class comprising participants with hypertension, type 2 diabetes, stroke, abdominal and general obesity, arthritis and cataract (5.7%); and cardiopulmonary and depression class including participants with angina, chronic lung disease, asthma, and depression (5.7%). Relative to the class with no multimorbidity, the cardiopulmonary and depression class was associated with a higher frequency of outpatient visits [β = 0.3; 95% CI 0.1 to 0.6] and higher odds of hospitalization [aOR = 1.9; 95% CI 1.0 to 3.7]. However, cardiometabolic and arthritis class was associated with a higher frequency of outpatient visits [β = 0.8; 95% CI 0.3 to 1.2] and not hospitalization [aOR = 1.1; 95% CI 0.5 to 2.9]. The mean QoL scores was lowest among participants in the cardiopulmonary and depression class [β = -4.8; 95% CI -7.3 to -2.3] followed by the cardiometabolic and arthritis class [β = -3.9; 95% CI -6.4 to -1.4]. Our findings show that cardiometabolic multimorbidity among older persons in Ghana cluster together in distinct patterns that differ in healthcare utilization. This evidence may be used in healthcare planning to optimize treatment and care.

Substance Abuse Among Elderly in India: Evidence Based on Study on Global Ageing and Adult Health (SAGE) Wave 1

Substance Abuse Among Elderly in India: Evidence Based on Study on Global Ageing and Adult Health (SAGE) Wave 1

Food insecurity and subjective cognitive complaints among adults aged ≥ 65 years from low- and middle-income countries

PurposeTo date, no study has investigated the association between food insecurity and subjective cognitive complaints (SCC). Thus, the aims of the present study were to examine this association among older adults in low- and middle-income countries (LMICs), and to identify the potential mediators in this association, given the importance of SCC in dementia risk among older people, and the projected particularly large increase in dementia in this setting.MethodsCross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and Adult Health (SAGE) collected between 2007 and 2010 were analyzed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable linear regression and mediation (Karlson–Holm–Breen method) analyses were conducted to assess associations.ResultsData on 14,585 individuals aged ≥ 65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Severe food insecurity (vs. no food insecurity) was associated with 9.16 (95% CI = 6.95–11.37) points higher mean SCC score. Sleep/energy (mediated% 37.9%; P < 0.001), perceived stress (37.2%; P = 0.001), and depression (13.7%; P = 0.008) partially explained the association between severe food insecurity and SCC.ConclusionFood insecurity was associated with SCC among older adults in LMICs. Future studies should assess whether addressing food insecurity among older adults in LMICs can improve cognitive health.

Physical Activity, Sedentary Behavior, Fruit and Vegetable Consumption, and Sarcopenia in Older Chinese Adults: A Cross-Sectional Study.

The purpose of this study was to investigate the association between moderate to vigorous physical activity (MVPA), sedentary behavior, fruit and vegetable intake, and the risk of sarcopenia among older Chinese adults. This cross-sectional study enrolled 5418 older Chinese adults who participated in the Study on Global Aging and Adult Health (SAGE). Participants reported information about their physical activity, sedentary behavior, and dietary habits (fruit and vegetable intake). Sarcopenia was defined as the presence of low skeletal muscle mass and either a slow gait speed or weak handgrip strength. A multiple logistic regression model was employed to determine the relationship between MVPA, sedentary behavior, fruit and vegetable intake, and the risk of sarcopenia. Only 32.63% of participants met all three recommendations (for MVPA, sedentary behavior, and fruit and vegetable intake). Compared with meeting none of the recommendations, meeting all three recommendations was associated with a lower risk of sarcopenia (OR = 0.63, 95% CI = 0.41-0.98). Moreover, meeting the recommendation for sufficient fruit and vegetable intake (OR = 0.69, 95% CI = 0.58-0.83), MVPA and fruit/vegetable intake (OR = 0.67, 95% CI = 0.52-0.86), and sedentary behavior and fruit/vegetable intake (OR = 0.69, 95% CI = 0.48-0.98) was associated with a lower risk of sarcopenia. Our findings indicate that in this large representative sample of older Chinese adults, meeting lifestyle recommendations for MVPA, sedentary behavior, and fruit and vegetable intake protected against sarcopenia.

The Relationship Between Social Capital and Sleep Duration Among Older Adults in Ghana: A Cross-Sectional Study.

Objective: This study aims to investigate the connection between social capital and sleep duration among older adults in Ghana, as limited research has been conducted to explore this relationship. Methods: This study utilized Wave 2 data from a sample of Ghanaian older adults from the World Health Organization Study on Global AGEing and Adult Health (SAGE). Self-reported data on social capital and sleep duration were compiled. Using ordered logistic regression, the relationship between social capital and sleep duration was examined. Results: Older adults who did not participate in social activities showed the strongest association with the risk of short sleep (p < 0.05). Our study found that older adults who sleep for shorter periods tend to report better sleep quality. There was no correlation between medium and long sleep durations and social capital. Conclusion: This study underscores the importance of more research to truly understand the complex connections between older adults' social participation, sleep, and health. It also has important implications for the promotion of good sleep in aging populations.

Higher frailty levels are associated with lower cognitive test scores in a multi-country study: evidence from the study on global ageing and adult health.

Frailty has been recognized as a growing issue in older adults, with recent evidence showing that this condition heralds several health-related problems, including cognitive decline. The objective of this work is to determine if frailty is associated with cognitive decline among older adults from different countries. We analyzed the baseline the Study on Global Ageing and Adult Health (SAGE), that includes six countries (Ghana, South Africa, Mexico, China, Russia, and India). A cross-section analysis was used to assess how Frailty was related with the Clinical Frailty Scale decision tree, while cognitive decline was evaluated using standardized scores of tests used in SAGE. A total of 30,674 participants aged 50 years or older were included. There was an association between frailty levels and cognitive performance. For example, women had an inverse relationship between frailty levels and cognitive scores, even when comparing robust category with frailty level 2 (RRR = 0.85; p = 0.41), although the relative risks decrease significantly at level 3 (RRR = 0.66; p = 0.03). When controlling for age, the relative risks between frailty levels 4 to 7 significantly decreased as cognitive performance increased (RRR = 0.46, RRR = 0.52, RRR = 0.44, RRR = 0.32; p < 0.001). Our results show an association between frailty levels measured in a novel way, and cognitive decline across different cultural settings.

Pain and mild cognitive impairment among adults aged 50 years and above residing in low- and middle-income countries

BackgroundPrevious studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship.MethodsData analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?” was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis.ResultsData on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18–1.55), 2.15 (95% CI = 1.77–2.62), and 3.01 (95% CI = 2.36–3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI.ConclusionsAmong middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI.

Association between food insecurity and quality of life among older adults (60+) in six low and middle-income countries

Food insecurity is a key social determinant of health and nutrition. However, very few studies have examined the association of food insecurity and quality of life outcomes among older adults in low and middle-income settings. In this study, we examine the association of food insecurity with self-rated poor quality of life, low life satisfaction, and WHO quality of life (WHOQol). Nationally representative data from WHO's Study on global AGEing and adult health (SAGE) consisting of 20,026 older adults were analyzed. The association of food insecurity with self-rated poor quality of life and low life satisfaction was assessed using bivariate and multivariate logistic regression analysis. Multivariate linear regression models examine the association between food insecurity and WHOQol score. Pooled data analysis of six countries showed older adults with severe food insecurity were two times more likely to report poor quality of life (OR = 2.49, CI 2.10, 2.96; p < 0.001) and low life satisfaction (OR = 2.36, CI 1.94, 2.87; p < 0.001), respectively. Similarly, older adults with severe food insecurity had 3.60 (CI-4.25, −2.95; p < 0.001) points lower WHO-QoL score than those who are food secure. These results show that the association of food insecurity is statistically significant with all three outcomes of quality of life in all six countries adjusting for sociodemographic and health measures. Public health and social security interventions are important to prevent food insecurity to promote overall wellbeing of the growing older population in low and middle-income countries.

Frailty and risk of adverse outcomes among community-dwelling older adults in China: a comparison of four different frailty scales.

Data on which frailty scales are most suitable for estimating risk in Chinese community populations remain limited. Herein we examined and compared four commonly used frailty scales in predicting adverse outcomes in a large population-based cohort of Chinese older adults. A total of 5402 subjects (mean age 66.3 ± 9.6 years, 46.6% male) from the WHO Study on global AGEing and adult health (SAGE) in Shanghai were studied. Frailty was measured using a 35-item frailty index (FI), the frailty phenotype (FP), FRAIL, and Tilburg Frailty Indicator (TFI). Multivariate logistic regression models were performed to evaluate the independent association between frailty and outcomes including 4-year disability, hospitalization, and 4- and 7-year all-cause mortality. The accuracy for predicting these outcomes was determined by evaluating the area under the curve (AUC). The prevalence of frailty, sensitivity, and specificity were calculated using our proposed cut-off points and other different values. Prevalence of frailty ranged from 4.2% (FRAIL) to 16.9% (FI). FI, FRAIL and TFI were comparably associated with 4-year hospitalization, and 4- and 7-year mortality (adjusted odds ratios [aORs] 1.44-1.69, 1.91-2.22 and 1.85-2.88, respectively). FRAIL conferred the greatest risk of 4-year disability, followed by FI and TFI (aOR 5.55, 3.50, and 1.91, respectively). FP only independently predicted 4- and 7-year mortality (aOR 1.57 and 2.21, respectively). AUC comparisons showed that FI, followed by TFI and FRAIL, exhibited acceptable predictive accuracy for 4-year disability, 4- and 7-year mortality (AUCs 0.76-0.78, 0.71-0.71, 0.65-0.72, respectively), whereas all scales poorly predicted 4-year hospitalization (AUCs 0.53-0.57). For each scale, while specificity estimates (85.3-97.3%) were high and similar across all outcomes, their sensitivity estimates (6.3-56.8%) were not sufficient yet. Prevalence of frailty, sensitivity, and specificity varied considerably when different cut-off points were used. Frailty defined using any of the four scales was associated with an increased risk of adverse outcomes. Although FI, FRAIL and TFI exhibited fair-to-moderate predictive accuracy and high specificity estimates, their sensitivity estimates were not sufficient yet. Overall, FI performed best in estimating risk, while TFI and FRAIL were additionally useful, the latter perhaps being more applicable to Chinese community-dwelling older adults.

Association of Perceived Health, Happiness, and Quality of Life With Morbid Thoughts and Suicide Ideation: Evidence From the Study on Global AGEing and Adult Health

Background and aims: This study aimed to determine the prevalence of morbid thoughts and suicide attempts as well as their relationship with perceived health status, quality of life, and happiness in five low-middle-income countries. Methods: Data on 3373 men and women aged 40 years and above were collected from the World Health Organization’s (WHO’s) study on global AGEing and adult health (SAGE) survey on five countries: China (830), Ghana (438), India (1602), Russia (175), and South Africa (830). Outcome variables were morbid thoughts and suicide attempts, and the main explanatory variables were health status, quality of life, and happiness. Results: The findings indicated that among the five countries, India had the highest prevalence of both morbid thoughts 79.5% (95% CI: 73.4-84.5) and suicide attempts 75.4% (95% CI: 61.0-85.7), while Ghana had the lowest prevalence of both morbid thoughts 1.9% (95% CI: 1.3-2.7) and suicide attempts 2.5% (95% CI: 1.1-5.5). Furthermore, regression analysis revealed a significant association between perceived health, quality of life, and happiness with morbid thoughts and suicide attempts. However, the association between perceived health and happiness was significant only among women. Men and women reporting dissatisfaction with the quality of life had 1.521 times (95% CI: 1.126-2.056) and 1.762 times (95% CI: 1.406-2.209) higher odds of morbid thoughts compared with those who reported satisfaction with the quality of life. Conclusion: Perceived poor health, quality of life, and happiness are significantly associated with higher odds of morbid thoughts of suicidal ideation, especially among women. In line with the past findings, these findings support the importance of focusing on these perceived constructs of health and life for mental health promotion and suicide prevention programs.

Cardiometabolic Multimorbidity Associated with Moderate and Severe Disabilities: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana and South Africa.

Integrated management of cardiometabolic diseases is crucial in improving the quality of life of older persons. The objective of the study was to identify clusters of cardiometabolic multimorbidity associated with moderate and severe disabilities in Ghana and South Africa. Data were from the World Health Organization (WHO) study on global AGEing and adult health (SAGE) Wave-2 (2015) conducted in Ghana and South Africa. We analysed the clustering of cardiometabolic diseases including angina, stroke, diabetes, obesity, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataracts, and depression. The WHO Disability Assessment Instrument version 2.0 was used to assess functional disability. We used latent class analysis to calculate the multimorbidity classes and disability severity levels. Ordinal logistic regression was used to identify the clusters of multimorbidity associated with moderate and severe disabilities. Data from 4,190 adults aged over 50 years were analysed. The prevalence of moderate and severe disabilities was 27.0% and 8.9% respectively. Four latent classes of multimorbidity were identified. These included a relatively healthy group with minimal cardiometabolic multimorbidity (63.5%), general and abdominal obesity (20.5%), hypertension, abdominal obesity, diabetes, cataracts, and arthritis (10.0%), and angina, chronic lung disease, asthma, and depression (6.0%). Compared to the participants with minimal cardiometabolic multimorbidity, the odds of moderate and severe disabilities were higher among participants with multimorbidity comprising hypertension, abdominal obesity, diabetes, cataract and arthritis [aOR = 3.0; 95% CI 1.6 to 5.6], and those with angina, chronic lung disease, asthma and depression [aOR = 2.7; 95% CI 1.6 to 4.5]. Cardiometabolic diseases among older persons in Ghana and South Africa cluster in distinct multimorbidity patterns that are significant predictors of functional disabilities. This evidence may be useful for defining disability prevention strategies and long-term care for older persons living with or at risk of cardiometabolic multimorbidity in sub-Saharan Africa.