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

OBJECTIVES

The study explored the associated factors of depression among older Indian adults and the influences of individual and socio-environmental factors in explaining the rural-urban difference in the prevalence of late-life depression.

METHODS

Data come from the Longitudinal Aging Study in India, with a sample of 30,637 older adults aged 60 and above. Multivariable logistic regression and nonlinear multivariate decomposition analyses were conducted to fulfill the objectives.

RESULTS

About 6.2% older adults in urban areas and 9.5% in rural areas were depressed. Older adults in rural areas had significantly higher likelihood to be depressed than those in urban areas. Poor self-rated health, multiple chronic conditions, functional difficulty, low life satisfaction, social inactivity, low satisfaction with living arrangement, ill-treatment and being widowed increased the risk of depression. Additionally, work status similar to urban older adults, physical activity, living arrangement satisfaction, self-rated health and ill-treatment would decrease the urban-rural difference in depression.

CONCLUSIONS

The study showed significant rural-urban difference in late-life depression, with a rural disadvantage.

CLINICAL IMPLICATIONS

The findings suggest the need for identifying at-risk populations and developing a framework of targeted policy interventions for mitigating the increased risk of late-life depression among older Indians and in rural areas in particular.

Urban-rural and gender differential in depressive symptoms among elderly in India

Background

To date, evidence remained inconclusive explaining rural-urban and male-female differential in depression. Unlike other previous research on the association of several risk factors with depressive symptoms among the elderly, this study focussed on the socio-economic status-related inequality in the prevalence of depression among the elderly along with focussing urban-rural and male-female gradients of depression among the elderly.

Methods

This study used data from Longitudinal Ageing Study in India (LASI) Wave-I, 2017-18, survey. The outcome variable for this study was self-reported depression. Bivariate analysis was used to understand the prevalence by sociodemographic clusters. Fairlie decomposition analysis has been done to measures rural-urban inequalities for depression among older men and women.

Results

Results found that around 22 percent of urban elderly and 17 percent of rural elderly reported depression. A higher proportion of female elderly (22.6% vs. 18.4%) reported depression than male elderly. Almost one in every five elderly (20.6%) reported depression in India. The results found that a higher percentage of women in rural and urban areas reported depression than their male counterparts. While examining SES-related inequality in the prevalence of depression, education was a significant factor explaining the SES-related inequality in the prevalence of depression among female elderly and not in male elderly.

Conclusion

Given the large proportion of elderly reporting depression, this study highlights the need for improving health care services among the elderly. The increasing burden of depression in specific sub-populations also highlights the importance of understanding the broader consequences of depression among rural and female elderly.

Gender differences in the association between perceived income sufficiency and self-rated health among older adults: A population-based study in India

This study explores whether gender differences in self-rated health can be attributed to socioeconomic status and self-perceived income sufficiency in particular. We used data from the Building a Knowledge Base on Population Ageing in India (BKPAI-2011) and carried out the descriptive and bivariate analysis along with a chi-square test to explore the significance of possible associations between explanatory and outcome variables in the study. Also, sex-stratified multiple logistic regression models were employed to fulfill the study objectives. The results show that a higher percentage of older women (58.4%) reported their health as fair/poor than older men (52%). Older women reported poor self-rated health than older men with similar self-perceived income sufficiency (OR: 2.04; p < .001 vs. OR: 1.56; p < .010). All the health indicators such as suffering from higher number of chronic conditions (AOR: 3.70; p < .001 vs. AOR: 2.73; p < .001) and disability (AOR: 3.79; p < .001 vs. AOR: 3.33; p < .001) increased odds of rating of poor health among older women than men, except having two plus difficulty in activities of daily living (ADL), which was positively associated with reporting poor health among men than women (OR: 4.03; p < .001 vs. OR: 2.36; p < .001). The study highlights the gender differences in self-rating of health associated with subjective income status and other socioeconomic and health-related variables that are important while framing social policies for the Indian graying population.

Self-rated health among older adults in India: Gender specific findings from National Sample Survey

INTRODUCTION

The self-rated health (SRH) is a widely adopted indicator of overall health. The sponge hypothesis suggests that predictive power of SRH is stronger among women compared to men. To gain a better understanding of how gender influences SRH, this study examined whether and what determinants of gender disparity exist current self-rated health (SRHcurrent) and change in SRH (SRHchange) among older adults in Indian setting.

MATERIALS AND METHODS

We used cross-sectional data from the 75th National Sample Survey Organizations (NSSO), collected from July 2017 to June 2018. The analytical sample constitutes 42,759 older individuals aged 60 years or older with 21,902 older men and 20,857 older women (eliminating two non-binary individuals). Outcome measures include two variables of poor/worse SRH status (SRHcurrent and SRHchange). We have calculated absolute gaps in the prevalence of poor SRHcurrent and worse SRHchange by background characteristics. We carried out binary logistic regression models to examine the predictors of poor SRHcurrent and worse SRHchange among older adults.

RESULTS

The overall absolute gender gap in poor SRHcurrent was 3.27% and it was 0.58% in worse SRHchange. Older women had significantly higher odds of poor SRHcurrent [AOR = 1.09; CI = 0.99, 1.19] and worse SRHchange [AOR = 1.09; CI = 1.02, 1.16] compared to older men. Older adults belonging to middle-aged, oldest-old, economically dependent, not working, physically immobile, suffering from chronic diseases, belonging to Muslim religion, and Eastern region have found to have higher odds of poor SRHcurrent and worse SRHchange. Educational attainments showed lower odds of have poor SRHcurrent and worse SRHchange compared to those with no education. Respondents belonging to richest income quintile and those who were not covered by any health insurance, belonging to Schedule caste, OBC, Western and Southern regions are found to have lower odds of poor SRHcurrent and worse SRHchange. Compared to those in the urban residence, respondents from rural residence [AOR = 1.09; CI = 1.02, 1.16] had higher odds of worse SRHchange.

CONCLUSIONS

Supporting the sponge hypothesis, a clear gender gap was observed in poor current SRH and worse change in SRH among older adults in India with a female disadvantage. We further found lower socioeconomic and health conditions and lack of resources as determinants of poor current SRH and its worse change, which is crucial to address the challenge of the older people's health and their perception of well-being.

Degree of protection provided by poverty alleviation policies for the middle-aged and older in China: evaluation of effectiveness of medical insurance system tools and vulnerable target recognition

Background

China’s medical insurance schemes and poverty alleviation policy at this stage have achieved population-wide coverage and the system's universal function. At the late stage of the elimination of absolute poverty task, how to further exert the poverty alleviation function of the medical insurance schemes has become an important agenda for targeted poverty alleviation. To analyse the risk of catastrophic health expenditure (CHE) occurrence in middle-aged and older adults with vulnerability characteristics from the perspectives of social, regional, disease, health service utilization and medical insurance schemes.

Methods

We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database and came up with 9190 samples. The method for calculating the CHE was adopted from WHO. Logistic regression was used to determine the different characteristics of middle-aged and older adults with a high probability of incurring CHE.

Results

The overall regional poverty rate and incidence of CHE were similar in the east, central and west, but with significant differences among provinces. The population insured by the urban and rural integrated medical insurance (URRMI) had the highest incidence of CHE (21.17%) and health expenditure burden (22.77%) among the insured population. Integration of Medicare as a medical insurance scheme with broader benefit coverage did not have a significant effect on the incidence of CHE in middle-aged and older people with vulnerability characteristics.

Conclusions

Based on the perspective of Medicare improvement, we conducted an in-depth exploration of the synergistic effect of medical insurance and the poverty alleviation system in reducing poverty, and we hope that through comprehensive strategic adjustments and multidimensional system cooperation, we can lift the vulnerable middle-aged and older adults out of poverty.

Young Single Widow, Dynamics of In-Laws Interference and Coping Mechanisms: Simplicity-Parsimony Approach

The incidence of short marital duration due to the demise of a husband that often exposes young widows to in-laws' exploitation of the asset of the deceased spouses, without regard for negative health consequences and potential vulnerability to poverty has not been exhaustively investigated, especially in sub-Saharan Africa where 16% of adult women are widows. The study examined the coping mechanisms among the young widow (aged ≤ 40) who have experienced short conjugal relationships (≤5 years) and burdensome from in-laws. The research design followed a qualitative approach with the aid of semi-structured in-depth interviews among 13 young widows selected through snowballing and informant-led approaches in the purposively selected communities. Data collected were analysed using descriptive statistics and a thematic approach. The findings, among others, shows the median age of young widow as 29 years. All participants, except one, have faced exploitation from their in-laws over their husbands' assets. All the participants desired to re-marry in order to: have a father figure for their children, have their own children or have more children. There is an absence of government support, but a few have received support from religious organisations. The author proposed attitudinal-change campaigns targeting the in-laws through accessible media and legislature that could challenge the exploitation of widows and unhealthy widowhood rites.

Magnitude and determinants of inpatient health expenditure among the elderly in India

As India is experiencing both the epidemiological and demographic transition, the grey population is expected to incur huge expenditure on health care, especially hospitalization expenditure, in the coming decades. The present study, thus, examines the magnitude of different types of inpatient health expenditure (medical, non-medical, total and out-of-pocket expenditure) and factors affecting them among the Indian elderly, using a health expenditure model empirically tested by the World Health Organization. Data were drawn from the 75th Round of the Health Survey conducted by the National Sample Survey Office, Government of India. In addition to basic descriptive statistics, the study employs a two-stage least square and a generalized linear model with log-link and gamma distribution to conduct the econometric analysis. The study finds that higher income, education, and household size, diseases like cancer, treatment involving surgery, poor physical mobility, and the elderly opting for packages involve higher inpatient health spending, while both private and social health insurance tends to reduce the same. So, a thrust on insurance-financed health systems may reduce health spending among the elderly. In this context, the study suggests that a disease-specific policy is required for the elderly along with ensuring state-of-the-art treatment facilities for them in public hospitals for critical ailments.

Determinants of rural-urban differential in healthcare utilization among the elderly population in India

Background

Population aging poses a demographic burden on a country such as India with inadequate social security systems and very low public investment in health sector. This challenge of accelerated demographic transition is coupled by the rural-urban disparity in access to healthcare services among the elderly people in India. An important objective of India’s National Health Policy (2017) is to “progressively achieve universal health coverage” which is posited upon mitigating the sub-national disparity that necessitates identifying the drivers of the disparity for targeted policy intervention. This study, therefore, makes an attempt towards the exploration of the prominent contributory factors behind the rural-urban gap in utilisation of healthcare among the older population in India.

Methods

The analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0) of the 75th round of the National sample Survey conducted during July 2017–June 2018. Two binary logistic models have been proposed to capture the crude and the adjusted association between health seeking behaviour and place of residence (rural/ urban). To compute the group differences (between rural and urban) in the rate of healthcare utilization among the elderly population in India and to decompose these differences into the major contributing factors, Fairlie’s decomposition method has been employed.

Results

The logistic regression models established a strong association between place of residence and likelihood of healthcare utilisation among the Indian elderly people. The results of the Fairlie’s decomposition analysis revealed considerable rural-urban inequality disfavouring the rural residents and health care utilisation was found to be 7 percentage points higher among the older population residing in urban India than their rural counterparts. Level of education and economic status, both of which are indicators of a person’s Socio-Economic Status, were the two major determinants of the existing rural-urban differential in healthcare utilisation, together explaining 41% of the existing rural-urban differential.

Conclusion

Public health care provisions need to be strengthened both in terms of quality and outreach by way of greater public investments in the health sector and by building advanced health infrastructure in the rural areas. Implementation of poverty alleviation programmes and ensuring social-security of the elderly are also indispensable in bringing about equity in healthcare utilisation.

Assessment of How House Ownership Shapes Health Outcomes in Urban Ghana

Background: This study investigates home ownership and its apparent health outcomes in Urban Ghana, utilizing both quantitative and qualitative datasets. Methods: The sample for the study consisted of 442 respondents using a multi-stage sampling technique. Results: The context in which houses are situated affects social support networks, physical and mental health outcomes. House ownership is then a precondition that enables social contact within neighborhoods. A Cramer’s V test value of 0.750 suggests a strong association between house ownership and health outcomes. Conclusion: House acquisition and ownership can potentially improve overall physical, and mental health and wellbeing.

Factors that influence the health of older widows and widowers-A systematic review of quantitative research

AIM

To examine factors that influence the health of older widows and widowers. The review question was: What is the evidence of the relationship between widowhood and health in older adults?

DESIGN

Systematic review.

DATA SOURCES

Academic Search Elite, CINAHL, Medline (Ovid) and PubMed were searched for articles published between January 2013-December 2017.

REVIEW METHODS

A systematic review of quantitative research with a qualitative thematic analysis.

RESULTS

The selection process resulted in 12 studies. One of the themes that emerged was: emotional challenges related to experiences of bereavement, depression and anxiety, which was based on the sub-theme social support as the main strategy for coping with emotional pain and suffering. The second theme was: struggling with poor physical health. The findings indicate that healthcare professionals need knowledge and skills to deal with the health consequences of widowhood in old age. Building community teams can prevent emotional and physical health problems, as well as reduce mortality.

Factors affecting the choice of health care utilisation between private and public services among the elderly population in India

India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.

Emerging trends and patterns of self-reported morbidity in India: Evidence from three rounds of national sample survey

BACKGROUND

India is rapidly undergoing an epidemiological transition with a sudden change in the disease profile of its population. It is important to understand the changing nature of the burden of disease across the states of India for adequate policy intervention.

METHODS

We analyzed the trend and pattern of self-reported morbidity across states of India using three rounds of (52nd, 60th and 71st) National Sample Survey Organization (NSSO) data. Descriptive analysis was carried out to understand the prevalence of self-reported morbidity variation over a period of two decades (1995-2014) and multivariate analysis was performed to identify the significant determinants of various types of self-reported morbidities.

RESULTS

The results indicated an increasing trend of infectious disease, Cardio Vascular Diseases (CVDs) and Non-Communicable Diseases (NCDs) over the last two decades (1995-2014). CVDs increased by a whopping eight-fold and the NCDs increased by three times during this period. A higher prevalence of self-reported morbidity was observed among the elderly and female, particularly in the urban locality. The growing incidence of CVDs and NCDs, especially among the elderly were reported from Kerala, Tamil Nadu, Punjab and West Bengal.

CONCLUSIONS

The already constrained public health system in India is likely to face serious challenges with a double burden of communicable and non-communicable diseases. An effective and responsive public health system needs to be in place to make health care services available for NCDs and CVDs at the primary level. In order to ameliorate caregiving, the involvement of family will be critical. Informing the people inculcate healthy habits may be an effective health promotion measure.

Social Network and Mental Health Among Older Adults in Rural Uttar Pradesh, India: A Cross-Sectional Study

The rapid growth of the older population in India draws attention to the factors that contribute to their changing health realities. However, there has hardly been any study in India that has looked at the effects of specific social networks with children, relatives, friends and confidant on depression among older adults. The objective of the study is to investigate the association between social network and depression among the rural elderly. The study population comprised over 630 older adults (aged 60 and above) from the rural areas of Varanasi, Uttar Pradesh. We adopted Berkman's theoretical model of the impact of social relations on depression among the elderly in the Indian context. Results of the Confirmatory Factor Analysis (CFA) demonstrated that the four specific social network types: children, relatives, friends and confidant were tenable. The results showed that a better social network with 'friends/neighbours' was protective against depression among the rural elderly. This clearly points to the need for more social network centres for older adults, so that they can interact with friends within the community or between communities and participate in group activities.

Healthcare Norms under Universal Healthcare (UHC) for Maharashtra

Healthcare norms of a nation also reflect the extent of preventive, promotive, curative and rehabilitative services that is expected to be delivered by a nation’s health services system. It is a reflection of the model of healthcare delivery proposed, whether it is a physician-intensive model where the doctor requirement for a population is much higher than a community-health-worker-based model. Healthcare norms need to be differentiated from human resource requirement for health as the latter largely revolves around the professional to population ratio, which not only fail to consider inequities in the regional distribution of health personnel but also undermine the institutional level strengthening required for effective delivery of services. Thus, the present article is an attempt to propose a healthcare norm for the state of Maharashtra. This article will have two parts, first is the curative component, which is proposed based on the projected morbidity prevalence of the population, and the second part is the norm for a public health system competent enough to address the essential public health functions.

Health Issues and Challenges among Indian Urban Poor

In the last 60 years since independence, India had achieved considerable improvements in the health of its population as reflected in their life expectancies which have doubled within this period. This article aims at explaining pertinent health-care issues and challenges based on some health indicators in India by using the literature review method that involved collection of material from the online sources, which included government documents, articles and publications related to healthcare, healthcare indicators, poverty, financial burden and coping strategies. To avoid premature deaths among adults, children and maternal mortalities, greater attention should be given to prevention and treatment of non-communicable diseases, and women and other social determinants of health. More attention should also be given to the reduction of births among teenage girls in order to avoid premature morbidity and mortality. To protect the vulnerable and poor, the government should provide more resources since financial burden of curative care is higher among lower income groups. However, in poorer states, the government tends to have relatively low ability to raise their own resources and the people in these states have a lower ability to pay for private insurance. Therefore, it is worthwhile and pertinent that the government initiates social insurance.

Ageing and changing patterns in familial structure for older persons in India: a decomposition analysis

Purpose

– At the turn of twenty-first century, India is facing rapid population ageing coupled with consequential socio-economic development changes. Against the backdrop of such changes, its traditional familial support system of living arrangements for older persons is swiftly changing, undergoing rapid transition towards nuclear family systems. The paper aims to discuss these issues.

Design/methodology/approach

– This paper examined: first, the changing trends and patterns in joint family systems defined in terms of households with older persons and total households; and second, socio-economic and demographic determinants of changes in the proportion of nuclear households with older adults. The decomposition analysis segregated the contribution of determinants of the change in nuclear households with older persons in three different components: propensity, composition, and interaction. The study used data from three successive rounds of the National Family Health Survey.

Findings

– Results indicate that a lower proportion of households with older persons were nuclear compared to total households. However, for both types of households, nuclear households increased by nine percentage points during 1992-2006. Households with older persons that were headed by old aged persons, illiterates or females, situated in urban area, not owned agriculture land, lower affluent level, and from Southern India were at most risk of being nuclear than their counterparts.

Originality/value

– This study provided ample evidence of the increase in nuclear familial structure for older persons in the course of population ageing. Population ageing, urbanization and increase in education, primarily contributed to the increase in nuclear family households of older persons.

Gender Differentials in Self-Rated Health and Self-Reported Disability among Adults in India

Background

The extant literature on gender differentials in health in developed countries suggests that women outlive men at all ages, but women report poorer health than men. It is well established that Indian women live longer than men, but few studies have been conducted to understand the gender dimension in self-rated health and self-reported disability. The present study investigates gender differentials in self-rated health (SRH) and self-reported disability (SRD) among adults in India, using a nationally representative data.

Methods

Using data on 10,736 respondents aged 18 and older in the 2007 WHO Study on Global Ageing and Adult Health in India, prevalence estimates of SRH are calculated separately for men and women by socio-economic and demographic characteristics. The association of SRH with gender is tested using a multinomial logistic regression method. SRD is assessed using 20 activities of daily living (ADL). Further, gender differences in total life expectancy (TLE), disability life expectancy (DLE) and the proportion of life spent with a disability at various adult ages are measured.

Results

The relative risk of reporting poor health by women was significantly higher than men (relative risk ratio: 1.660; 95% confidence Interval (CI): 1.430–1.927) after adjusting for socio-economic and demographic characteristics. Women reported higher prevalence of severe and extreme disability than men in 14 measures out of a total20 ADL measures. Women aged less than 60 years reported two times more than men in SRD ≥ 5 ADLs. Finally, both DLE and proportion of life spent with a disability were substantially higher for women irrespective of their ages.

Conclusion

Indian women live longer but report poorer health than men. A substantial gender differential is found in self-reported disability. This makes for an urgent call to health researchers and policy makers for gender-sensitive programs.

SELF-REPORTED MORBIDITY AND BURDEN OF DISEASE IN UTTAR PRADESH, INDIA: EVIDENCE FROM A NATIONAL SAMPLE SURVEY AND THE MILLION DEATHS STUDY

Uttar Pradesh is India's most populous state with a population of 200 million. Any change in its fertility and mortality is bound to bring change at the national level. This study analysed the burden of disease in the state by calculating the disability-adjusted life year (DALY) for infectious and non-communicable diseases. Data were from two rounds (52nd and 60th) of the National Sample Survey Organization (NSSO) survey conducted in 1995-96 and 2004, respectively, and the Million Deaths Study (MDS) of 2001-03. Descriptive and multivariate analyses were carried out to identify the determinants of different types of self-reported morbidity and DALY. The results show that in Uttar Pradesh the prevalence of all selected self-reported infectious and non-communicable diseases increased over the study period from 1995 to 2004, and in most cases by more than two times. The highest observed increase in prevalence was in non-communicable diseases excluding CVDs, which increased from 7% in 1995 to 19% in 2004. The prevalence was higher for those aged 60 and above, females, those who were illiterate and rich across the time period and for all selected morbidities. The results were significant at p<0.001. The estimation of the DALY revealed that the burden of infectious diseases was higher during infancy, noticeably among males than females in 2002. However, females aged 1-5 years were more likely to report infectious diseases than corresponding males. The age distribution of the DALY indicated that individuals aged below 5 years and above 60 years were more susceptible to ill health. The growing incidence of non-communicable diseases, especially among the older generation, puts an additional burden on the health system in the state. Uttar Pradesh has to grapple with the unresolved problem of preventable infectious diseases on the one hand and the growth in non-communicable disease on the other.

Ageing as a global public health challenge: from complexity reduction to aid effectiveness

Since 2002, ageing populations worldwide have received increasing attention by global policy-makers. However, resources committed by inter-governmental donors and US-based private foundations in support of ageing-related policies and interventions in non-Organisation for Economic Co-operation and Development (OECD) countries have remained minimal during this decade and, where mobilised, have rarely responded to actual country-level demographics and institutional capacities. We argue that this lag between issue recognition and effective resource mobilisation, while mirroring known dynamics in global agenda-setting, has also been caused by a depiction of ageing as a uniform trend across the Global South. We develop and apply a comprehensive analytical framework to assess the state of ageing dynamics at the country level and uncover substantial regional and sub-regional variation. In response, we suggest replacing complexity reduction in the interest of issue recognition with targeted support for a more nuanced research agenda and policy debate on country-specific ageing dynamics in order to inform and catalyse effective international assistance.

The most frequent cardiovascular risk factors in Brazilian aged 80 years or older

To identify the most frequent cardiovascular risk factors (CRFs) in Brazilian participants. Sample of 113 individuals aged 80 to 95 years (83.4 + 2.9 years), of both sexes, from Presidente Prudente, São Paulo state. Waist circumference (WC), body mass index, percentage of total body fat (% BF), hypertension, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and glucose were used for characterization of risk factors. The chi-square test was used to assess proportions of risk factors and Student's t test to compare the results between the sexes. High prevalence of risk factor was observed, mainly hypertension (67.3%) and % BF (79.6%). Male participants presented higher weight, height, and WC (p < .001), and female participants, higher TC and % BF (p < .001). Only 7.1% of male and 4.2% of female participants showed no risk factors, and 71.3% of male and 85.9% of female participants had three or more. The participants presented a high prevalence of CRFs, particularly percentage of body fat and hypertension, and, in addition, female participants also presented TC.

Activating the knowledge-to-action cycle for geriatric care in India

Despite a rapidly aging population, geriatrics--the branch of medicine that focuses on healthcare of the elderly--is relatively new in India, with many practicing physicians having little knowledge of the clinical and functional implications of aging. Negative attitudes and limited awareness, knowledge or acceptance of geriatrics as a legitimate discipline contribute to inaccessible and poor quality care for India's old. The aim of this paper is to argue that knowledge translation is a potentially effective tool for engaging Indian healthcare providers in the delivery of high quality geriatric care. The paper describes India's context, including demographics, challenges and current policies, summarizes evidence on provider behaviour change, and integrates the two in order to propose an action plan for promoting improvements in geriatric care.