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Underweight defined as body mass index (BMI) < 18.5 is associated with negative health and quality of life outcomes including mortality. Yet, little is known about the socioeconomic differentials in underweight and its association with health and well-being among older adults in India. This study examined the socioeconomic differentials in underweight among respondents aged ≥50 in India. Consequently, three outcomes of the association of underweight were studied. These are poor self-rated health, cognition and quality of life. Cross-sectional data on 6,372 older adults derived from the first wave of the WHO's Study on global AGEing and adult health (SAGE), a nationally representative survey conducted in six states of India during 2007-8, were used. Bivariate and multivariate regression analyses were applied to fulfil the objectives. The overall prevalence of underweight was 38 percent in the study population. Further, socioeconomic status showed a significant and negative association with underweight. The association of underweight with poor self-rated health (OR = 1.60; p < .001), cognition (β = -0.95; p < .001) and quality of life (β = -1.90; p < .001) were remained statistically significant after adjusting for age, sex, place of residence, marital status, years of schooling, wealth quintile, sleep problems, chronic diseases, low back pain and state/province. The results indicated significant socioeconomic differentials in underweight and its association with poor self-rated health, cognition and quality of life outcomes. Interventions focussing on underweight older adults are important to enhance the overall wellbeing of the growing older population in India.

AimFood insecurity is a global public health concern; however, there is limited knowledge about its health impacts in India. We examined the associations of food insecurity with socioeconomic conditions, chronic disease and various domains of health and well-being in a community sample of middle-aged and older adults (45+ years) in India.MethodsCross-sectional nationally representative data were collected in wave 1 (2017–2018) of the Longitudinal Ageing Study in India. Food insecurity was measured by questions of access and availability of food. We used logistic regression analyses to examine associations of food insecurity with poor self-rated health, limitations in activities of daily living (ADLs), instrumental ADLs, low life satisfaction, depression, sleep problems and low body mass.ResultsFood insecurity related to all seven indicators of poor health and well-being, even after controlling for material wealth and the presence of multimorbidity (which food insecurity also predicted). Associations with mental health were stronger for those for physical health. For instance, food insecurity related to a threefold increase in probable depression (OR=2.9, 95% CI=2.4 to 3.4) and low life satisfaction (OR=3.4, 95% CI=2.9 to 3.8).ConclusionsFood insecurity is a powerful social determinant of poor health among older adults in India. Policy measures to improve population health and well-being should closely follow trends in food insecurity, particularly among those living in poverty and with multiple health conditions.

Background Childhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people’s life remains still unclear and needs to generate more evidence, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms amongst middle- aged and older adults in India. Methods The data for the study was drawn from national representative survey “Longitudinal Ageing Study in India (LASI)” Wave I, 2017–2018 in order to conduct cross-sectional study. Multivariable regression analysis was used to examine the association of childhood socioeconomic status and health with depressive symptoms in the older population. Results Poor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.56, CI: 1.19, 2.04). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.16 CI: 1.01, 1.34). In addition to this, the odds of having depressive symptoms increased significantly among the average (AoR: 1.28 CI: 1.08, 1.51) and poor childhood socioeconomic status group (AoR: 1.31 CI: 1.11, 1.55) as compared to the higher socioeconomic category. Conclusions Childhood socioeconomic status and health have a significant role in determining mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.

Background The mental health burden and associated costs are considerable, which is posing challenges for public health delivery systems because of the increased treatment gap, especially in low- and middle-income countries. It is therefore important to investigate the factors influencing access to mental health care from the perspectives of different stakeholders to gain meaningful insights. This study was conducted to assess the existing barriers and facilitators using a socioecological model. Methods A qualitative study involving in-depth interviews (IDIs) and focus group discussions (FGDs) at health care facilities was conducted with 24 service users (diagnosed with depression and anxiety) and 21 health care professionals. Thematic analysis was performed and presented using a socioecological model to enhance clarity and impart recommendations. Results The results suggest that there are four levels of persisting impediments and facilitators while accessing mental health care in Sudurpaschim Province: (1) Individual level- education, exposure to mass media and women’s empowerment (facilitators) but unawareness and side effects of medication (barriers); (2) Community level: community involvement and awareness (facilitators) while stigma, discrimination, misconceptions, and adverse environments (barriers); (3) Organizational level: psychosocial counselling and effective communication (facilitators) while limited accessibility and availability of MHS (barriers); and (4) Policy level: existing policy and strategies (facilitators) while political indifference, implementation gap and low budget allocation (barriers). Conclusions This qualitative study presents a complex, interconnected set of multi-layered barriers and facilitators influencing access to mental health care in Sudurpaschim, Nepal. From the socioecological view, the findings suggest that a comprehensive approach that integrates efforts across all levels are equally essential to effectively address these barriers and facilitators.

Handgrip strength, a measure of muscular strength is a powerful predictor of declines in intrinsic capacity, functional abilities, the onset of morbidity and mortality among older adults. This study documents socioeconomic (SES) differences in handgrip strength among older adults aged 50 years and over in six middle-income countries and investigates the association of handgrip strength with measures of intrinsic capacity—a composite of all the physical and mental capacities of an individual. Secondary data analysis of cross-sectional population-based data from six countries from the WHO’s Study on global AGEing and adult health (SAGE) Wave 1 were conducted. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength. Regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; and multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Wealth quintiles are positively associated with handgrip strength among men across all countries except South Africa while the differences by education were notable for China and India. Work and nutritional status are positively associated with handgrip strength. Our findings provide new evidence of robust association between handgrip strength and other measures of intrinsic capacity and confirms that handgrip strength is a single most important measure of capacity among older persons.

Body pain, sleep problems and falls are commonly reported among the elderly population. This study aimed to explore the mediating role of pain in the association of sleep problems with fall-outcomes (falls, fall-injury, and multiple falls) among older adults. Cross-sectional data from the baseline survey of Longitudinal Aging Study in India (LASI), 2017–18 were used. The total sample size for the study was 28,285 older adults aged 60 years and above. Falls and fall-related injuries among older adults in the last two years were self-reported. The Jenkins Sleep Scale (JSS-4) was used to assess sleep problems while pain was assessed using questions on whether respondents reported that they were troubled by pain and they required some form of medication or treatment for the relief of pain. Multivariable logistic regression and mediation analyses were conducted to fulfill the study objectives. While 13% older adults suffered from sleep problems, 38.83% were troubled with pain. Additionally, 12.63%, 5.64% and 5.76% older adults reported falls, fall-injury and multiple falls respectively. Older adults who suffered from sleep problems had higher odds of falls [adjusted odds ratio (aOR): 1.43, confidence interval (CI): 1.30–1.58], fall-injuries, [aOR:1.50,CI:1.30–1.73] and multiple falls [aOR:1.41,CI:1.24–1.62]. Similarly, older adults who were troubled with pain were more likely to report falls [aOR:1.80, CI:1.67–1.95], fall-injuries [aOR:1.66, CI:1.48–1.87] and multiple falls [aOR:1.90,CI:1.69–2.12]. The percent of the mediated effect of pain when examining the association between sleep problems and fall outcomes were reported to be 17.10%, 13.56% and 18.78% in case of falls, fall-injuries and multiple falls respectively. The current study finds evidence that pain mediates the association of sleep problems and falls, fall-injuries, and multiple falls among older Indian adults. Both sleep problems and pain are modifiable risk factors that need attention for fall prevention strategies.

Background Cognitive 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. Methods Cross-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. Results In 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. Conclusions The 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.

Background To examine the prevalence of toileting disability among older adults in India and its association with broad aspects of the physical and social environment. Methods We use data from the inaugural wave of the Longitudinal Ageing Study in India and focus on adults aged 65 and older ( N  = 20,789). We draw on the disablement process model and existing frameworks to identify environmental factors and other risk factors that may be associated with toileting disability. Hierarchical logistic regressions are implemented to analyze the health impacts from physical and social environment characteristics. Results One in five older Indian adults had difficulties with toileting, and the prevalence rate of this functional disability varied across sub-national regions. We find that low neighborhood trust was associated with an increased likelihood of toileting disability, as was the use of assistive mobility devices. The negative effects of these social and external environment characteristics hold when we stratified the sample by rural and urban residency. Also, older adults in urban areas without access to toilets and using shared latrines had higher odds of being disabled in terms of toileting. Other factors important in explaining toileting disability among older adults included poor self-rated health, arthritis, currently working, living in the East or West region, and having functional limitations. Conclusions Poor person-environment fit can compromise older adults’ ability to perform self-care tasks. Policymakers need to look beyond the physical environment (e.g., dedicating resources to construct toilet facilities) to adopt a more holistic, multi-faceted approach in their sanitation policies. Improving the safety of neighborhood surroundings in which shared latrines are located and the availability of accessible toilets that cater to those with mobility impairments can help improve independence in toileting among older adults.

Household air pollution (HAP) presents numerous health challenges. The association between HAP and sleep problems has not been extensively studied. This paper examined the effect of HAP due to solid fuel use on sleep problems among older adults in India. Data from the initial phase of the Longitudinal Aging Study in India, which included 51,060 individuals aged 50 years and older, was utilised. Sleep problems were defined as experiencing difficulty falling asleep, waking up during the night, or waking up too early at least five times per week and were classified as a binary variable. Exposure to HAP was defined as the use of solid fuel for household purposes. Multivariate logistic regression was employed to assess the association, and additionally, interaction analysis was conducted to explore the potential moderating effects of age, gender, and residence on this association. The prevalence of sleep problems among older adults was around 12.7%. Sleep problems were higher among older adults who used solid fuel for cooking (OR = 1.25; 95% CI: 1.17, 1.33) and other purposes (OR = 1.13; 95% CI: 1.06, 1.20) in the adjusted model. The place of cooking, ventilation, and type of stove played a significant role in the association between solid fuel use and sleep problems. Individuals over 65, females, and those residing in rural areas were particularly vulnerable to sleep problems due to HAP exposure. The findings highlight the importance of reducing HAP exposure by transitioning to clean fuels as a public health priority within initiatives aimed at promoting healthy aging.

BackgroundVery little is known about the association of back pain with subjective health and well-being and sleep problems among the older population in middle-income countries. In this study, we examine the association of back pain with four health outcomes — poor self-rated health, impairments in activities of daily living (1+ADL), sleep problems and World Health Organization Quality of Life score (WHOQOL) — and to study what extent the association differs by age group.MethodsNationally representative data from World Health Organization’s Study on global AGEing and adult health (WHO-SAGE) consisting of 33,878 older adults aged 50 or above were analyzed. The linkages of back pain with poor self-rated health, impairments in activities of daily living (1+ADL), and sleep problems were examined using multivariate logistic regression analysis. Multivariate linear regression was used to assess the association between back pain and quality of life.ResultsIn the pooled analysis, the association of back pain with four health outcomes were significant. Older adults who reported low back pain were more likely to report poor self-rated health (OR=1.91; p < .001), impairments in activities of dailiy living (ADL) (OR=2.06; p < .001), and sleep problems (OR=2.04; p < .001), and had lower quality of life score (β = −3.23, p < .001). Furthermore, the association of back pain and poor self-rated health, impairments in ADL, and sleep problems was stronger for the 50–59 age group than the 80 or above age group, suggesting significant age interaction in the association.ConclusionThis study suggested the significant role of back pain in determining subjective health, wellbeing, and sleep problems. Measures to prevent back pain, particularly among those in the 50–59 age group, are important to enhance overall wellbeing of the growing older population in low- and middle-income countries.