Association of multi-morbidity, social participation, functional and mental health with the self-rated health of middle-aged and older adults in India: a study based on LASI wave-1

Factors linked to poor self-rated health in thyroid disorder patients: findings from LASI Wave-I

BACKGROUND

Thyroid disorders affect the physical, behavioural, and psychological aspects of an individual, leading to poor self-rated health (SRH). Hence, we aimed to determine the prevalence of poor SRH and the factors associated with it among thyroid disorder patients.

METHODS

This is an observational study consisting of 2336 thyroid disorder patients from LASI, 2017-19. Descriptive statistics were employed to calculate prevalence. The association between poor SRH and socio-demographic variables was evaluated using regression analysis, with results expressed as (AOR) and 95% CI.

RESULTS

The findings showed poor self-rated health predictors among thyroid disorder patients, where 25% rated their health as poor. Significant predictors included older age, with patients aged ≥ 75 years having a higher likelihood of reporting poor health (aOR = 2.36, 95% CI = 1.32-4.22, p = 0.004), and rural residence (aOR = 1.34, 95% CI = 1.07-1.67, p = 0.011). Belonging to the OBC caste (aOR = 1.57, 95% CI = 1.23-2.00, p < 0.001) and practicing Christianity (aOR = 1.90, 95% CI = 1.25-2.89, p = 0.003) were also associated with increased odds of poor SRH. Previous employment (aOR = 1.65, 95% CI = 1.20-2.25, p = 0.002), co-morbidities (aOR = 2.59, 95% CI = 1.88-3.59, p < 0.001), and lower education levels (aOR = 1.50, 95% CI = 1.06-2.13, p = 0.022) were significant. Limitations in activities of daily living and instrumental activities of daily living were linked to poorer health outcomes (aOR = 1.76, 95% CI = 1.33-2.31, p < 0.001; IADL: aOR = 1.41, 95% CI = 1.11-1.79, p = 0.004). Depression (aOR = 1.84, 95% CI = 1.32-2.56, p < 0.001) and healthcare utilization in the past year (aOR = 1.86, 95% CI = 1.33-2.58, p < 0.001) also predicted poor SRH, with most healthcare utilization (79.8%) occurring in private facilities.

CONCLUSION

The study highlights a high prevalence of poor SRH among patients, with significant associations observed with age, residence, comorbidity, and healthcare utilization. Targeted interventions focusing on healthcare access, physical activity, and mental health support are crucial to improve SRH.

Associations between social participation and psychological distress among older adults with hypertension in rural China: The mediating role of social capital

Psychological distress in older adults with hypertension in rural China significantly impacts their families and society. This study aims to explore how social participation affects psychological distress among older adults with hypertension in rural China, focusing on the mediating role of social capital. A total of 950 respondents completed surveys measuring social participation based on the frequency of social, recreational, and literary activities, the Resource Generator China scale, and the Kessler Psychological Distress Scale. Structural equation modeling was used to analyze the relationships between the variables. The results showed that social participation significantly affects psychological distress, with social capital mediating this relationship. The indirect effect of social capital accounted for 61.0% of the total effect. These findings suggest targeted interventions in social participation and social capital to reduce psychological distress among rural elderly individuals with hypertension in China.

Age- and sex-disaggregated disease burden among the older persons in India

BACKGROUND

In the context of the increasing number and proportion of population aged 60 years or more in India, it is imperative to understand their health needs for ensuring healthy ageing.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we identified the top ten causes of disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) disaggregated by sex and age groups (60-64 years, 65-69 years, 70-74 years, 75-79 years, and ≥ 80 years) for India in 2019. We analysed the proportional contribution of individual causes to the total DALYs due to communicable diseases (CMNNDs), non-communicable diseases (NCDs), and injuries disaggregated by age and sex. We report the state-level heterogeneity in the crude DALY rate for CMNNDs, NCDs, and injuries for older persons disaggregated by sex. Additionally, we reviewed if the data capture of service delivery indicators on older persons were age- and sex-disaggregated in the Health and Wellness Centres (HWCs), and in the National Programs aimed at the Health Care for the Elderly (NPHCE), Prevention and Control of Non-communicable Diseases (NP-NCD), Control of Blindness and Visual Impairment (NPCBVI), Prevention & Control of Deafness (NPPCD), the Mental Health Program (NMPH), and the AYUSH Musculoskeletal Disorders Program (MSDP) within the context of disease burden.

RESULTS

The older persons accounted for a total of 136.1 million DALYs (29.1% of the total DALYs) in 2019 of which 77.9% were from NCDs, 14.8% from CMNNDs, and 7.3% from injuries, and nearly two-thirds of DALYs were accounted by YLLs. In NCDs, cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes and kidney diseases, and musculoskeletal disorders accounted for nearly 80% of DALYs for both sexes. There were variations in the magnitude of disease burden by specific diseases and conditions between females and males, and by age groups within both sexes particularly for injuries and CMNNDs. Injuries accounted for more YLDs than YLLs, ranging between 5.9%-15.2% for females and 15.3%-17.3% for males, with the females having a higher contribution to total injury related DALYs due to falls as compared to the males (54.4% vs 36.6%), whereas the males had a higher contribution to total DALYs due to road injuries (33.8% vs 19.4%). There was substantial variation in the crude DALY rates of major disease groups by the two sexes across the states of India in 2019. The crude DALY rate for CMNNDs varied between 3.6 times -3.7 times between the states for females and males, respectively; NCDs varied between 1.3 times -1.9 times, and injuries varied 2.0 times -1.7 times. The capture of service utilisation indicators was not age- or sex-disaggregated in NPHCE, NPCBVI, NMHP, MSDP, and HWCs; sex-disaggregation was available in NP-NCD but not age-disaggregation; sex-disaggregated data was available for many service indicators in NPPCD but with no age disaggregation beyond 50 years and more. Only NP-NCD and NPPCD allowed for data capture by disease/condition or severity of disease/condition for the older persons whereas the other programs including NPHCE did not allow for much disaggregated understanding by the type of services availed.

CONCLUSIONS

This comprehensive assessment of the differentials in disease burden among older persons across age, sex and states of India, and the gaps identified in the service utilisation data capture by age and sex for the older persons in the national health programs can provide crucial inputs for strengthening the on-going public health policy and programmatic efforts aimed at improving the health and well-being of the growing older population in India.

Intensity of care and the health status of caregivers to elderly rural South Africans

Objectives

Informal caregivers play an indispensable role in and are often the sole source of care for older adults in low and middle-income settings worldwide. Intensive informal care predicts mortality and morbidity among caregivers in higher-income settings. However, there is limited evidence from poorer settings, including Africa countries, where caregiving is shared widely, including across generations. We therefore investigated caregivers' health status in rural South Africa.

Methods

We conducted quantitative interviews with all household members and all non-household caregivers aged ≥12 (n=1012) of 106 older adults in rural Mpumalanga, South Africa. We used multivariable regression with care-recipient random intercepts to assess the relationships between four caregiving characteristics and both self-reported chronic conditions and self-reported health status, considering how caregiver age moderated each association.

Results

Over half of all caregivers reported at least one chronic health condition, despite half being aged under 40. Caregivers self-reporting the worst health status provided high hours of care. However, caregivers' health status was not significantly associated with weekly care quantity or history of caring. Those aged ≥40 who reported being a main caregiver had 52% increased odds of reporting poorer health compared to other same-aged carers (95% confidence interval: 0.99, 2.35), while having more chronic conditions was associated with being expected to act as a sole caregiver more often among caregivers aged ≤39.

Discussion

Greater caring responsibilities for older adults were not consistently associated with caregivers' health in a setting where poor health is common, and caregiving is spread widely. Longitudinal data is necessary to unpack possible explanations of these findings, and to determine whether intensive caregiving speeds downward health trajectories for carers.

Identifying the Relationship Between Residential Type and Health Outcomes of the Community-Dwelling Thai Older Adults in the Baseline Analysis of a Cluster-Randomized Controlled Trial

BACKGROUND/OBJECTIVES

As people age, their environment plays a critical role in shaping their health. With Thailand's rapidly aging population, it is crucial to understand how different living environments affect the well-being of older adults. This study examines differences in biopsychosocial health indicators between older adults living in village communities and private housing estates in Chiang Mai, Thailand.

METHODS

A cross-sectional study was conducted using baseline data from the Community-Integrated Intermediary Care (CIIC) Service Model, a Cluster Randomized Controlled Trial in Thailand (TCTR20190412004). The study included 2788 older adults (aged 60+). Of these, 89.49% resided in village communities, and 10.51% in private housing estates. Validated instruments were used to assess health indicators. Descriptive statistics, multivariate analysis of variance, and multiple logistic regression analyses were performed.

RESULTS

Older adults in private housing estates had significantly lower odds of experiencing pain or discomfort (Adj OR: 0.64, 95% CI: 0.49-0.84) and were 1.36 times more likely to report positive perceived health. However, they had lower odds of perceiving themselves as physically and socially active (Adj OR: 0.74, 95% CI: 0.57-0.97) and were 0.30 times less likely to rate their quality of life higher (Adj OR: 0.30, 95% CI: 0.22-0.40) compared to their village community counterparts.

CONCLUSIONS

The residential environment significantly influences older adults' health and well-being. Tailored health promotion interventions should leverage the unique strengths of both village communities and private housing estates to enhance social connections, physical activity, and quality of life, promoting healthy, active aging across diverse settings.

Association between participation restriction due to hearing loss and self-perception of health, social support, and quality of life in elderly people: a cross-sectional study

PURPOSE

To verify the association between participation restriction due to hearing loss and self-perception of health, social support, and quality of life in elderly people.

METHODS

This is a cross-sectional, observational, and descriptive study with a quantitative data approach. A database with information collected in a medium-sized Brazilian municipality was used. The study was conducted with 235 elderly people registered in five Family Health Strategy Units. Sociodemographic and health information and the results of the following questionnaires were used: Hearing Handicap Inventory for the Elderly - Screening Version (HHIE-S), Medical Outcomes Study (MOS) Social Support Survey, Subjective Health Assessment, and Short-Form 6-Dimension (SF-6D) Health and Quality of Life Index. Groups with and without participation restriction were compared according to sociodemographic, health, social support, and quality of life variables. A multivariate binary logistic regression method was employed to evaluate the associations between the independent variables and participation restriction.

RESULTS

The group with participation restriction is composed of older individuals with lower quality of life and poorer self-perception of health. Poorer self-perception of health was the only predictor of participation restriction related to hearing loss.

CONCLUSION

Participation restriction is associated with poorer self-perception of health. The study highlights the importance of assessing individuals' self-perception regarding biopsychosocial issues, in addition to considering the environmental context to understand the social and emotional impacts caused by hearing loss.

Determinants of multimorbidity among elderly population in maharashtra, India: Logistic regression analysis

BACKGROUND

Population aging is an emerging global trend. Because of decreasing fertility rates and improved healthcare, the lifespan of elderly population increased. Consequently, proportion of elderly population is increasing at an alarming rate. This is accompanied by an increased recognition of the occurrence of multimorbidity and associated mortality risks. So, the purpose of this study was to determine the prevalence and predictors of multimorbidity among elderly population in Maharashtra with its variation among socio-demographic spectrum, functional health and health behaviors.

MATERIALS AND METHODS

Sample of elderly population aged > 60 years were selected to examine multimorbidity and its associated risk factors. Statistical methods such as Chi-square test were used to show the association between multimorbidity and other covariates. Binary logistic regression analysis was used to understand the effects of predictor variables on multimorbidity. Receiver Operating Characteristic (ROC) Curve Analysis was carried out to improve the performance of the classification model by using a modified cut-off probability value. Z scores were calculated to compare model performance in training data and test data.

RESULTS

The prevalence of multimorbidity in Maharashtra in training data and test data was found to be 32.8% and 32.9%. Residence, living arrangement, MPCE Quintile, marital status, work status, education, tobacco consumption, physical activity, Instrumental Activities of Daily Living (IADL), Activities of Daily Living (ADL) and self-rated health of elderly population were important determinants that exert a significant adverse effect on multimorbidity.

CONCLUSION

Prediction percentages indicate that appropriate actions should be undertaken to ensure good quality of life for all the elderly in Maharashtra.

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions.

Impaired sleep, multimorbidity, and self-rated health among Canadians: Findings from a nationally representative survey

Background

Self-rated health (SRH) is a globally recognized measure of health status. Both impaired sleep (IS) and the presence of multimorbidity are related to poorer SRH, but the precise nature of these associations remains unclear. This study explored the association between IS, multimorbidity, and SRH among Canadian adults.

Method

We used 2017-18 Canadian Community Health Survey (CCHS) data for this study. The main variable of interest, self-rated health (SRH), measured participants' health on a 5-point Likert scale, later categorized as "good or better" vs. "fair or poor". The primary predictor, IS, was derived from two variables and categorized into four groups: no sleep issues; fewer sleeping hours (<7 hours) only; trouble sleeping only; and fewer hours & trouble sleeping. Multimorbidity was present (yes/no) if a participant indicated being diagnosed with two or more chronic conditions.

Results

Just over one in ten Canadians reported fair/poor SRH and approximately one-quarter had multimorbidity or experienced few sleep hours in combination with trouble sleeping. The adjusted model indicated greater odds of fair/poor SRH associated with the 40-64 years age group, male sex, and lower socio-economic status. It also suggested the presence of multimorbidity (AOR= 4.63, 95% CI: 4.06-5.28) and a combination of fewer sleep hours and troubled sleep (AOR= 4.05, 95% CI: 2.86-5.74) is responsible for poor SRH. Forty-four percent of the total effect of IS on SRH was mediated by multimorbidity.

Conclusion

This unique finding highlights the mediating role of multimorbidity, emphasizing the importance of addressing it alongside sleep issues for optimal health outcomes.

Current state, equality level and trends of self-rated health among old adults with intact physical condition

BACKGROUND

Self-rated health among old adults (SHOA) indicates individuals' subjective assessments and evaluations of their overall health based on objective physical circumstances. The purpose of this study was to analyze the current state and influencing factors of the subjective perception-based self-rated health (SH) by qualifying selected older adults with similar objective physical conditions, as well as to explore the equality and changing trends of SHOA based on influencing factors.

METHODS

This study designed a cross-sectional study, conducted in three provinces in east, central and west China, and included 1,153 older adults (> = 60 years) with intact physical condition (IPC). The current state of SHOA and its influencing factors were analyzed using mean comparisons and Logistic regression (LR) models. The equality level and trend of SHOA's effect on health literacy, health habits, and access to health care were determined using the Lorenz curve, Gini coefficient, and Vector Autoregression (VAR) model.

RESULTS

The mean SHOA with IPC was 74.37 ± 13.22. Findings from LR modeling indicated that SHOA with IPC was mainly influenced by age and communication methods (P < 0.05). It was also observed that the total Gini coefficient of the allocation of SHOA with IPC based on communication methods was equal to 0.0188, and the VAR results showed that the total effect of change in SHOA on health literacy among older adults was negative and its duration of the effect exceeded 50.

CONCLUSIONS

The SHOA with IPC was shown to be better and was primarily influenced by age and communication methods. The observed effect of SHOA on health literacy was negative and lasting. To improve SHOA with IPC even further, policymakers could consider promoting the use of modern and convenient communication methods (such as smartphones) through training and purchasing subsidies, as well as focusing on increasing sustained attention and promoting health literacy and behavior among older adults with improved SH.