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Depression is a major public health challenge linked with several poor health outcomes and disabilities among adults aged 45 years and older in India. We aimed to describe the prevalence of depression and its association with a variety of sociodemographic correlates and co-existing health conditions for this age group in India and its states.In this prospective cohort study, data from wave 1 (baseline) of the Longitudinal Ageing Study in India were used to estimate the national and subnational state level age-standardised prevalence of depression-major depressive episodes-using the internationally validated Composite International Diagnostic Interview-Short Form (CIDI-SF) scale. Hierarchical mixed effect multivariate logistic regression models were used to study the sociodemographic correlates and co-existing health conditions of major depressive episodes among the nationally representative sample of 72 250 adults aged 45 years and older from 35 states or union territories (except the state of Sikkim). Associations between depression and self-rated health, co-morbid conditions, functional health, and life satisfaction measures were also examined.A total of 40 335 (58·3%) females and 29 407 (41·7%) males aged 45 to 116 years (median age 58 years) participated. The overall age-standardised prevalence of depression based on CIDI-SF scale was 5·7% (95% CI 5·5-5·8) compared with 0·5% (0·5-0·6) self-reported prevalence of depression among adults aged 45 years and older in India. Wide sub-national variations were seen in depression prevalence, ranging from 0·8% (95% CI 0·3-1·3) in Mizoram state to 12·9% (11·6-14·2) in Madhya Pradesh. Prevalence was higher in females (6·3% [95% CI 6·1-6·6] vs 4·3% [4·1-4·6]) for India, and this higher prevalence was more pronounced in some of the northern states. The risk of depression was higher in those residing in rural areas, widowed, with no or low education, and in the poorest quintile. Depression showed a strong positive association with poor self-rated health (OR 2·39 [95% CI 2·21-2·59]; p0·0001), with one or more limitations in the activities of daily living (ADL; OR 1·60 [1·46-1·75]; p0·0001), instrumental ADL limitations (OR 1·51 [1·40-1·64]; p0·0001), and low cognitive judgment of life satisfaction (OR 1·94 [95% CI 1·78-2·10]; p0·0001).Despite the substantial burden, depression remains undiagnosed and strongly linked with poor health and wellbeing outcomes in adults aged 45 years and older in India. The ageing population of India and the subnational variations amplify the implications of this new evidence to address the substantial gaps in prevention and treatment of depression.LASI was funded by the Ministry of Health and Family Welfare, Government of India, the National Institute of Ageing, USA and the United Nations Population Fund, India.

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.

Fistula-in-ano is a common proctological condition that primarily affects younger people and leads to chronic morbidity. An anal fistula is divided into simple and complex fistulas. A complex fistula is a challenging problem due to higher recurrence rates and incontinence associated with surgery. Many new methods have been developed for the closure of complex fistula-in-ano, but there is no single best method. The aim of this study is to identify a superior surgical technique for treating complex/high cryptoglandular perianal fistulas (HCPFs). A literature search was done using PubMed and Google Scholar for the period of 2012-2021. Articles that contain surgical treatment for complex anal fistula in the English language published in the last 10 years were included. The types of studies included were randomized controlled trials (RCTs), meta-analyses, systematic reviews, cohort studies, and traditional reviews. Articles excluded were those done more than 10 years ago, in other languages, and containing simple fistula management only. Nine studies were included in the review; a systematic review and meta-analysis concluded that no single method is effective. The ligation of the intersphincteric fistula tract (LIFT) procedure seems to be a promising and effective technique as it has a low rate of fecal incontinence as compared to other methods. Biological techniques give variable success rates so does fistula plug (FP). Mucosal advancement flap (MAF) and rerouting seton give good results according to one study. Fistula plug gives variable results and is not a preferred method. Ligation of the intersphincteric fistula tract (LIFT) seems to be a promising new technique for complex anal fistulas, but the data available is not enough to determine the best method. More randomized trials are required to compare traditional techniques and emerging new biological methods to see the best technique available.

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

Very 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. Nationally 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. In 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. This 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.

Globally, elder abuse/mistreatment is a common form of violence against the elderly. This study examines the association between multimorbidity and abuse/mistreatment among the elderly population (60+) in India. Cross-sectional data from the United Nations Population Fund (UNFPA)’s “Building Knowledge Base on Population Aging in India” (BKPAI, 2011) was analyzed. We generated a multimorbidity variable by combining 20 self-reported diagnosed chronic diseases. Bivariate analysis was used to understand the sample distribution and prevalence estimation of elder abuse/mistreatment by multimorbidity and state. Furthermore, multilevel mixed-effect logistic regression was used to examine the association between multimorbidity and elder abuse/mistreatment. The overall prevalence of elder abuse/mistreatment in the study population is 11.4%. The prevalence of elder abuse/mistreatment among elderly with no chronic diseases is 6.01% which increases to 22.7% among elderly with four or more chronic diseases. Furthermore, the result from the multilevel mixed-effect logistic regression showed a close association between multimorbidity and elder abuse. Elderly with two, three, and four or more chronic diseases are 3.02 (CI = 2.33, 3.91, p < .000), 4.16 (CI = 3.02, 5.74, p < .000), and 5.06 (CI = 3.50, 7.31, p

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.

Intraarticular stem cell therapy has become increasingly used to treat knee osteoarthritis (KOA) with minimal high-quality evidence to support its use. This study aims to see how well intra-articular injections of mesenchymal stem cells (MSCs) worked and how safe they were for individuals with KOA. A total of 10 studies were extracted using PubMed, Cochrane Library, and PMC from 2017 to 2021 in the English language. An assessment of the risk of bias was applied via the Cochrane Collaborative Bias Risk Tool and Newcastle-Ottawa Quality. Changes in pain and functional outcomes in patients with KOA were measured by a Knee injury and Osteoarthritis Outcome Score (KOOS) scores, Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline, and follow-up evaluation criteria. The magnetic resonance imaging (MRI) was evaluated using the whole-organ magnetic resonance imaging score (WORMS) and cartilage volume changes. A total of six randomized controlled trials (RCTs), three prospective retrospective clinical trials, and one retrospective clinical trial included 723 patients. They were diagnosed with unilateral or bilateral KOA with Kellgren-Lawrence (KL) grade 1-4 KOA and followed up for six, 12, and 24 months. The experimental groups received multipotent MSCs, mesenchymal progenitor cells (MPCs), adipose tissue progenitor stem cells (AD-MPCs), adipose tissue mesenchymal stem cells (AD-MSCs), bone marrow mesenchymal stem cells (BM-MSCs), bone marrow aspiration (BMA), bone marrow aspiration concentration (BMAC), or micro fragmented adipose tissue (MFAT) while the controlled groups received normal saline (NS), hyaluronic acid (HA), placebo, or went through conservative management. In conclusion, significant improvements were noticed in the MSCs groups via different outcome measuring tools like KOOS, VAS, WOMAC, and MRI. Furthermore, no significant adverse events (AEs) have been observed. Therefore, intra-articular injections of MSCs are effective and safe in relieving pain and improving motor function in individuals with KOA in the short term, contrary to earlier research findings.

In India, more than one third of older adults are underweight. The prevalence of edentulism is higher among older adults. Yet, the role of underweight in determining edentulism is remains unclear. This study examined the association between underweight and self-reported edentulism among older men and women in India. Nationally representative cross-sectional data from the first wave WHO’s Study on global AGEing and adult health (SAGE ) survey was used (n = 6366). The association between underweight and edentulism was examined using multivariable logistic regression analysis adjusting for age, residence, marital status, years of schooling, wealth quintile, tobacco use, self-rated health, chronic diseases, and state/province. The overall prevalence of underweight in the study population was 38%. The prevalence of edentulism was higher among women (16%) respondents compared to men (14%). Further, underweight women had a 51% higher risk of edentulism (OR = 1.51; CI: 1.12, 2.43; p

Background The number of persons who have survived cancer has been increasing in India as elsewhere due to advances in detection and treatment of this disease. However, evidence on the standardised number of cancer survivors, their characteristics and their complex health challenges on a national level does not exist due to data limitations. This study, therefore, examines the profile of cancer survivors and their health status using the recently released Longitudinal Ageing Study in India (LASI) survey data. Methods LASI wave 1 is a cross-sectional nationally representative survey of 65,562 middle and older adults aged 45 and above. We first calculated the socioeconomic, demographic and geographical characteristics of cancer survivors (per 100,000 population). We later estimated the adjusted odds of poor health, sleep problems, depressive symptoms, activities of living limitations (ADL and IADL), and hospitalisation of cancer survivors using multivariable logistic regression analysis. Results According to LASI estimates, there were 2.1 million cancer survivors in India (95% CI 1.8 million to 2.6 million) in 2017–18. Overall, 440 cancer survivors have been identified in this study, with considerable state variations. The number of cancer survivors per 1,00,000 population was relatively more in non-indigenous groups, people with a history of cancer in their families, those who worked earlier but currently not working and those in the richest quintile categories. As compared to those who never had cancer, the cancer survivors are at higher risk of hospitalisation (adjusted odds ratio (aOR) = 2.61 CI 1.86, 3.67), poor self-rated health (aOR = 3.77, CI 2.55, 5.54), depressive symptoms (aOR = 1.53, CI 1.41, 2.05) and sleep problems (aOR = 2.29, CI 1.50, 3.47). They also reported higher ADL (aOR = 1.61, CI 1.11, 2.34) and IADL (aOR = 1.49, CI 1.07, 2.07) limitations. Cancer survivors who had their cancer diagnosis in the past 2 years or a cancer-related treatment in the past 2 years have significantly higher odds of poor health status than middle-aged and older adults without a cancer history. Conclusion Middle-aged and older cancer survivors, particularly those who underwent cancer diagnosis or treatment in the past 2 years, are at a significantly higher risk of experiencing poor self-reported health and other health challenges, suggesting the need for an integrated healthcare approach.

In this study, we assess the relationship between food insecurity andperceived stress among older adults (50+) in six low- and middle-income countries of China, Ghana, India, Mexico, Russia and, South Africa.Cross-sectional comparative analysis was conducted using nationally representative data from the WHO's Study on global AGEing and adult health survey. Bivariate and multivariate regression analyses examine if food insecurity was associated with perceived stress. We also examined the mediating role of health conditions on the association between food insecurity and perceived stress.Across countries, the mean perceived stress score was higher among the older population with food insecurity. Regression analysis showed significant and positive association between food insecurity and perceived stress. Findings from the pooled data of six countries showed, older adults who experienced severe food insecurity (Food insecurity showed significant adverse impact on perceived stress among the older population in low- and middle-income countries. Policy measures to reduce household food insecurity are important for improving both mental and physical health conditions of the growing older population in low- and middle-income countries.

Back pain is one of the leading causes of disability and decreased quality of life. In this study, we examined the association between back pain and major depressive disorder (MDD) in six low- and middle-income countries. We also examined the association of back pain duration and severity with MDD among middle-aged and older adults in these countries.Nationally representative data from the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) consisting of 33,878 middle-aged and older adults aged 50 years or above were analysed. The linkages of back pain, pain duration and severity with MDD were examined using multivariable logistic regression analyses.Across six countries, the prevalence of MDD was higher among middle-aged and older adults who reported back pain than those who did not report back pain (14.5 % vs 4.5 %). In the pooled data, middle-aged and older adults who suffered from back pain had higher odds of depression [adjusted odds ratio (aOR): 2.41, confidence interval (CI): 2.19-2.64] compared to those with no back pain. Particularly, the association was stronger in Ghana [aOR: 4.78] and South Africa [aOR: 2.42]. Further, the association was stronger for those who experienced back pain for2 weeks as well as those who reported severe and extreme back pain than those with no back pain across all the countries.In this study, the association of back pain and its duration and severity with MDD is consistent and significant among middle-aged and older adults in six countries. Government policies should consider the role of back pain in improving the mental health of middle-aged and older adults.

This study examines gender differences in sleep problems among older adults in India, China, Ghana, Mexico, Russia, and South Africa. We used data on 33,929 individuals (50+ years) from the WHO-SAGE. Results showed significant gender differences in the prevalence of sleep problems with the largest difference in Russia followed by India. Regression results showed higher odds of sleep problems among women in India, China, Russia, and South Africa. Age, low back pain, depression, and poor self-rated health were significantly associated with sleep problems. This research confirms significant gender differences in sleep problems among the older population in middle-income countries.

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.

Little is known about the prevalence and association between visual impairment, low vision acuity, and sleep indicators (sleep duration and sleep problem) in the Indian context. We investigate this association for Indian older adults (50+ ages). Using cross-sectional data from WHO-Study on global AGEing and adult health (WHO-SAGE) 2007–2008, a sample of 6560 ( Mage = 61.81, SD = 9.00) was selected for analysis. Self-reported visual impairment and performance-based low vision acuity were used as outcome variables, whereas sleep duration, problem in sleep, and medical condition with socio-demographic were used as covariates. Multivariate logistic regression analyses were conducted. In a fully adjusted model (including all covariates), vision impairment was associated with short sleep duration (

Cognitive functioning is an important factor in determining overall well-being in adults. The research conducted in this area has mainly focused on dementia and gender differentials in cognitive ability. Using data from WHO’s Study on global AGEing and adult health (SAGE), this study examines the association of individual, household, contextual socioeconomic status, and chronic morbidities with cognitive abilities of younger (18-49) and older adults (50+) in India. Multilevel linear hierarchical model was used to examine this association. Results show that the years of schooling and household income were positively and significantly associated with cognitive abilities in younger and older adults. Community level socioeconomic status was positively associated with cognition in adults. Females had significantly lower cognitive abilities than male counterparts. Further, chronic morbidites and edentulism were negatively associated with cognition, especially the association of chronic morbidities was stronger in younger adults (β = −0.11; p

Background The rise in life expectancy and the share of older population represents the most significant demographic transformation in the twenty-first century. Increasing longevity with the coexistence of chronic multimorbidity makes the elderly population vulnerable to functional limitation, disability and more frequent hospitalization, resulting deterioration in QoL. The present study aims to investigate the association between non-communicable disease (NCD) multimorbidity and QoL among the older population in Varanasi, India. Methods A cross-sectional data of 500 individuals in the Varanasi district aged 50 + years were collected, using a multistage simple random sampling procedure from November 2017 to May 2018. WHOQOL-BREF was utilised to assess the quality of life of the study participants, and the important covariates used in the analysis are; age, sex, marital status, place of residence, health factors, socioeconomic status, and behavioral risk factors. Descriptive analysis was performed to assess the mean QoL score pattern, whereas multivariate linear regression analysis examines the association between multimorbidity and QoL. Results The QoL scores decreased with age and was higher among females. Regression results show that demographic and lifestyle risk factors are closely associated with QoL. multimorbidity was significantly associated with reduced quality of life. Older adults with multimorbidity had 5 points lower quality of life than those with no chronic diseases. Conclusions Multimorbidity along with demographic and lifestyle factors are significantly associated with QoL. Healthcare programmes need to factor in multimorbidity while promoting a healthy and risk-free lifestyle to control modifiable risk factors. Government assistance is necessary for the most economically dependent older population for their day-to-day needs.

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.

BackgroundCognitive ability is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height on cognitive functioning among older adults aged 50 and above for the two middle-income countries of India and China. We further assess the age pattern of cognitive decline with measures of life course socioeconomic status. MethodsCross-sectional comparative analysis was conducted using the WHO’s Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect regression analysis was used to predict the association of life course socioeconomic status, height with cognitive functioning. ResultsIn India and China, better childhood socioeconomic status measured as parental education is positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and highly significant. Height was significantly associated with improved cognitive functioning for India and China. Furthermore, the age-related cognitive decline was faster among older adults whose parents had no schooling, particularly the association between mother’s education and cognitive functioning is stronger in China. The cognitive decline is much faster among less-educated older adults than those with 10+ years of schooling in China. Wealthier older adults in India had higher cognitive functioning in middle age, however, wealth differences narrowed in older ages, suggesting the convergence of cognitive functioning by economic status at older ages. ConclusionsThe results of this study suggest a significant long-term impact of childhood conditions on later-life cognitive functioning in middle-income settings.

This study assesses socioeconomic differences in handgrip strength among older adults age 50 years and over in six middle-income countries, focusing on the association with selected measures of intrinsic capacity. Cross-sectional nationally representative data from the WHO’s Study on global AGEing and adult health (SAGE) was used. 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; 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. Age, sex, work status, nutritional status showed significant association with handgrip strength, an important biomarker of health among older adults, across countries. Socioeconomic differences in handgrip strength, are notable across all countries except South Africa. Further, handgrip strength showed significant association with measures of intrinsic capacity across five domains: locomotion, psychological, cognition, vitality and sensory. The significant association of handgrip strength with measures of intrinsic capacity, suggest handgrip strength as an important measure of health in old age. Life-course interventions to improve the handgrip strength will be useful for the overall wellbeing of older adults.

Background Muscle strength, measured as grip strength is a potential marker of bodily function and sarcopaenia. Yet, not much is known about its patterns and correlates among older population in India. This study assesses the age and socioeconomic patterns and state variations in grip strength among older adults (50+) in India. Methods A cross-sectional and nationally representative data from the first wave of WHO’s Study on global Ageing and Adult Health (SAGE) −2007 (n = 6262) was used. Multivariable linear regression analyses were used to understand the regional variations and association of socioeconomic status and general health with grip strength, adjusting for anthropometric and demographic confounders. Results Socioeconomic status has a significant association with grip strength. Moreover, the association between wealth quintile and grip strength was highly significant. Further, the socioeconomic differences in grip strength narrowed in older ages, especially among men, supporting the convergence of health inequality hypothesis. Notable differences were observed in grip strength across selected states of India. Poor self-rated health was negatively associated with grip strength. Edentulism in men was associated with reduced grip strength. Conclusion This study has contributed to a better understanding of significant social and regional inequalities in grip strength among older population in India. State-specific and subgroup level interventions are important to improve the physical functioning of the growing older population in India.

Sleep is an important predictor of health and quality of life. This study examined the association between sleep problems and sleep duration with self-rated poor health and grip strength among respondents aged 50 years and above in India and China. Methods: The data for this study were derived from the first wave of WHO’s Study on Global Aging and Adult Health (SAGE), a nationally representative panel survey conducted in six LMICs. Grip strength and poor self-rated health were the main outcome variables, while sleep problems and sleep duration were the main predictors. Multivariate logistic regression models and ordinary least squares regression models were used to understand the association between sleep problems and sleep duration with poor self-rated health and grip strength. Sleep problems and sleep duration were strongly and significantly associated with poor self-rated health and grip strength in India and China. Compared to older adults with no sleep problems, the odds ratio for poor self-rated health among older adults with sleep problems was 4.86 (95% CI = 4.12, 5.73, p

Supplemental material, Supplimentary_file_of_regression_results for Visual impairment, low vision acuity, and the mediating effect of sleep indicators among older adults in India by Himanshu Himanshu, Perianayagam Arokiasamy, Bedanga Talukdar and Y Selvamani in The British Journal of Visual Impairment

Background 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. Methods 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. Results 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. Conclusion 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.

Socioeconomic status (SES) has occupied a central stage in predicting the health of the population, even in old age the association continues; however, the role childhood SES remains unclear in developing countries. Using the data of aged 50 and above drawn from WHO-SAGE-20070-10 wave 1, this study assess the effect of childhood SES and current SES on subjective health measures in six LMICs: India, China, Ghana, Mexico, Russia and South Africa. Parental education is used as the indicator of childhood SES and household wealth and individual education are used as the measures of current SES. Poor self-rated health (SRH) and limitations in activities of daily living (ADLs) are used as the measure of subjective health. Logistic regression analysis is used to examine the effect of indicators of adult and childhood SES on poor SRH and ADL limitations. Results show considerable variations across nations in the prevalence of poor health status. The poor SRH was high in Russia and India. Also, the larger proportion of older adults in India, Ghana, Mexico and South Africa had 1 + ADL. Higher socioeconomic status is associated with less poor health and ADL limitations. Further, our results suggest that the mother’s education had a significant and independent effect on self-rated health and ADL limitations. Our findings confirm the association of education, wealth and mother’s education with subjective health measures, moreover the association with self-rated health stronger than the 1 + ADL limitation. This result therefore reiterate the importance of childhood and current SES on health, thus suggest the life course intervention to improve the health of the older population in LMICs.