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India's economy is among the fastest growing in the world. However, a large share of informal workforce is a common characteristic of country's economy, comprises a significant portion of most of its labour markets. This workforce often receives low wages and lacks benefits such as strong social security and health coverage for all. The majority of healthcare spending in India is private. As India's population ages and the informal sector expands, it is expected that many of these workers will continue to work beyond the retirement age to bear their own healthcare costs due to lack of savings, pensions, and the precarious nature of their employment. In this context, this study estimates the burden of out-of-pocket (OOP) payments on India's informal older workers compared to their formal counterparts, using data from the first wave of the nationally representative Longitudinal Ageing Study in India. According to estimates from the two-part regression model, informal older workers pay, on average, INR 1113 (P  < 0.01) and INR 55 (P  < 0.05) less than their formal counterparts for inpatient and outpatient care, respectively. Further, probit regression models revealed that the burden of combined (both inpatient and outpatient) OOP payments exceeding (by 40, 20 and 10%) of their income is significantly higher among informal older workers compared to formal older workers. The study underscores the need for strengthening of universal health insurance schemes to ensure everyone has access to medical services without experiencing financial hardship. It also advocates for policies specifically tailored towards informal workers, considering their unique challenges with regard to livelihoods and healthcare security. In particular, this encompasses bolstering the existing social security and healthcare system, and related policies for ensuring financial security against OOP payments, especially for informal workers and all the population in general. [ABSTRACT FROM AUTHOR]

Introduction: Frailty is an inevitable part of ageing, which is also associated with a variety of chronic diseases, the most common of which are cardiovascular diseases. The WHO non-laboratory-based CVD risk scores are reliable predictors of cardiovascular events and are used in treatment decision-making in primary health-care settings. The current study aims to find the association between the non-laboratory-based CVD risk scores and frailty scores., Methods: The association between frailty and CVD risk scores of 56,450 older adults was estimated using nationally representative survey (Longitudinal Aging Study in India -LASI-1st Wave). Separate multivariable logistic regression was performed after adjusting for socio-economic, demographic and health related variables. Restricted cubic splines were also estimated to explore the association between probability of frailty and non-lab-based CVD risk score., Results: The mean age of the participants was 59.3 ± 10.3 years. The prevalence of frailty was 15.6% in the participants above 45 years and 25.5% among participants aged more than 60 years. There was a significant association between the CVD risk scores and frailty in the participants and an increasing trend across the age groups (aOR = 1.3 (1.1-1.4), 2.3 (1.1-2.6), 3.6 (3.1-4.2) and 5.0 (2.9-8.6)) for CVD scores of 5-9, 10-19, 20-29 and > 30 respectively compared to a CVD risk score of < 5. The strength of association of frailty with CVD risk score when adjusted for both socioeconomic, demographic and health variables (model 2), was greater for females and ≥ 60 years age groups (aOR = 19.9 (CVD score > 30) and 4.6 (CVD score 20-29), respectively)., Conclusion: Screening for frailty should be performed in individuals with high non-laboratory-based CVD risk scores as a method of primary prevention to plan targeted interventions as a form of secondary prevention with more focusing on females and ≥ 60 years elderly population., Competing Interests: Declarations. Ethical approval and consent of participation: Ethical approval was granted by the Indian Council of Medical Research. Since the current study involved analysis of the data from the LASI, therefore the present study did not require a separate ethical approval [18]. This study was conducted in accordance with the Declaration of Helsinki. Informed consent was taken from the participants and privacy, confidentiality was maintained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Older adults are vulnerable to adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Evidence on clinically manifest DDIs in older outpatients is scanty. The present study aims to report clinically manifest DDIs, their risk factors, and preventive measures. A subgroup analysis of a 6-year (2015-2021) long prospective study was conducted in a tertiary hospital in North India. Older outpatients with ADRs constituted the study participants. Among 933 ADRs reported in 10,400 patient registrations, clinically manifest DDIs were involved in 199 (21.3%). DDIs accounted for 29.9%, 26.5%, and 21.3% of drug-related metabolic, vascular, and nervous system disorders, respectively. Movement disorders (n = 18), hypotension (n = 16), and hypoglycemia (n = 15) were the most common manifestations. Eighty-six percent of DDIs were of the pharmacodynamic type, and 13.1% were immune-mediated. Around 35% of DDIs resulted in hospitalization, with hyponatremia, movement disorder, and renal impairment as the common reasons. Older adults with Parkinsonism, infection, coronary artery disease, neuropsychiatric disease, and diabetes mellitus, respectively, had 3.28, 2.85, 1.97, 1.76, and 1.80 times higher odds of DDIs. Those receiving ≥ 10 drugs had 5.31 times higher odds of DDIs compared to individuals receiving 1-4 drugs. "Avoiding the causative drug," "optimal monitoring of the patient," and "start-low and go-slow" policy together could prevent 85% of DDIs. In conclusion, every fifth case of ADRs and nearly one third of ADR-related hospitalizations in older adults are related to DDIs. Movement disorder, hypotension, and hypoglycemia are the common manifestations. A holistic approach with drug omission, optimal patient monitoring, and slow titration of therapy can prevent significant DDIs in older adults., Competing Interests: Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of the Institute of Medical Sciences, Banaras Hindu University, with approval number Dean/2015–16/IEC/411 (EC Reg. No. ECR/526/Inst/UP/2014). Consent: Informed consent was obtained from the individual participants or their legal guardians for participation in the study. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The objective of the study was to evaluate the spectrum of skin diseases among older patients in a coastal city of Southern India and its association with systemic illness. Materials and Methods: In this retrospective, cross-sectional study, medical records from the dermatology outpatient clinics were assessed. Patients over 60 years old and attending the dermatology outpatient clinic between November 2021 and June 2022 were included in the study. Results: Of 1182 records, 663 were male (56%) and 519 were female (43.9%). Most of the patients were in the age group between 60 and 70 years (71.7%). Overall, the most frequent dermatologic diseases in this cohort of patients were infections (41.37%), eczematous dermatitis (30.02%), and papulosquamous disorders (9.39%). Among the physiological changes of aging skin, xerosis was the most common manifestation observed in 66 (5.5%) cases, followed by seborrheic keratosis in 24 (2%) cases. Twelve (1.01%) individuals had premalignant and malignant lesions identified. Bowen's disease (n = 5, 0.4%), basal cell carcinoma (n = 6, 0.5%), and leukoplakia (n = 1) were the most prevalent. Conclusion: Dermatoses in the older population are among the most common causes of daily consultations. In our study, infectious causes of dermatoses are more common than eczematous diseases. We discovered a higher prevalence of premalignant diseases like Bowen's disease, emphasizing the need for screening in people of skin color. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the impact of age, comorbidity, and vaccination in the fatality of older COVID-19 patients in the state of Kerala, India. METHODS A cross sectional study, adopting a mixed method approach was used and conducted among the older population in Kerala. To study the health profile of study participants 405 older people were surveyed and 102 people were interviewed in-depth at their households between June to November 2020. The results of the study were triangulated with elderly COVID-19 fatality data available from the citizen-science dashboards of the research team and Depar tment of Health, Kerala. Vaccination data was retrieved from the Co-WIN government website (cowin.gov.in) to study its impact. The data was analyzed using the IBM SPSS version 22.0. RESULTS Age is a predictor of COVID-19 fatality. Diabetes, hypertension, CAD, CKD and COPD are the significant predictors of elderly COVID-19 fatality in Kerala. The current comorbidity profile of the total older population matches with the comorbidities of the COVID-19 elderly death cases. CFR and IFR have declined even when the CMR is high in the second wave of COVID-19 with more deaths. This is attributable to vaccination even though there exists a lesser chance for breakthrough infection. CONCLUSIONS Age and comorbidities can predict potential fatality among older COVID-19 patients. Timely and accurate health data and better knowledge of high-risk factors such as comorbidity can easily guide the healthcare system and authorities to efficient prevention and treatment methodologies. Knowledge on prevailing NCDs can drive early preparedness before it converges with an epidemic like the present zoonotic disease. Vaccination is an effective tool in preventing infection compared to the unvaccinated even though the chance for breakthrough infection is there, particularly, in people with comorbidities. [ABSTRACT FROM AUTHOR]

Objective We report inequity in out-of-pocket payments (OOPP) for hospitalisation in India between 1995 and 2014 contrasting older population (60 years or more) with a population under 60 years (younger population). Methods We used data from nationwide healthcare surveys conducted in India by the National Sample Survey Organisation in 1995–96, 2004 and 2014 with the sample sizes ranging from 333,104 to 629,888. We used generalised linear and fractional response models to study the determinants of OOPP and their burden (share of OOPP in household consumption expenditure) at a constant price. The relationship between predicted OOPP and its burden with monthly per capita consumption expenditure (MPCE) quintiles and selected socioeconomic characteristics were used to examine vertical and horizontal inequities in OOPP. Results The older population had higher OOPP for hospitalisation at all time points (range: 1.15–1.48 times) and a greater increase between 1995–96 and 2014 than the younger population (2.43 vs 1.88 times). Between 1995–96 and 2014, the increase in predicted mean OOPP for hospitalisation was higher for the poorest than the richest (3.38 vs 1.85 times) older population. The increase in predicted mean OOPP was higher for the poorest (2.32 vs 1.46 times) and poor (2.87 vs 1.05 times) older population between 1995–96 and 2004 than in the latter decade. In 2014, across all MPCE quintiles, the burden of OOPP was higher for the less developed states, females, private hospitals, and non-communicable disease and injuries, more so for the older than the younger population. In 2014, the predicted absolute OOPP for hospitalisation was positively associated with MPCE quintiles; however, the burden of OOPP was negatively associated with MPCE quintiles indicating a regressive system of healthcare financing. Conclusion High OOPP for hospitalisation and greater inequity among older population calls for better risk pooling and prepayment mechanisms in India. [ABSTRACT FROM AUTHOR]

Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population. [ABSTRACT FROM AUTHOR]

This study quantified and decomposed health inequalities among the older population in India and analyzes how health status varies for populations between 60 to 69 years and 70 years and above. Data from the 60th round of the National Sample Survey (NSS) was used for the analyses. Socioeconomic inequalities in health status were measured by using Concentration Index (CI) and further decomposed to find critical determinants and their relative contributions to total health inequality. Overall, CI estimates were negative for the older population as a whole (CI = −0.1156), as well as for two disaggregated groups, 60 to 69 years (CI = −0.0943) and 70 years and above (CI = −0.08198). This suggests that poor health status is more concentrated among the socioeconomically disadvantaged older population. Decomposition analyses revealed that poor economic status (54 %) is the dominant contributor to total health inequalities in the older population, followed by illiteracy (24 %) and rural place of residence (20 %). Other indicators, such as religion, gender and marital status were positive, while Caste was negatively associated with health inequality in the older populations. Finally, a comparative assessment of decomposition results suggest that critical contributors for health inequality vary for the older population of 60 to 69 years and 70 years and above. These findings provide important insights on health inequalities among the older population in India. Implications are advanced. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to examine the linkages of employment, chronic disease prevalence and medical care of the older population in India. Design/methodology/approach -- This study used the India Human Development Survey data for the analysis. Bivariate, multinomial logit regression and multiple classification analysis are used as methods for the study Findings -- The findings suggest a bi-directional relationship between employment and chronic diseases: the older population who are engaged in regular paid work has lower likelihood to the risk of chronic diseases compared to those who are not working. Conversely, the older population with chronic diseases may be unable to work in regular paid jobs. The greater proportions of not-working older population with savings and retirement pensions are more likely to seek modern treatment for the chronic diseases. Overall, the results foster that employment determines and is determined by chronic disease prevalence among the older population in India. Originality/value -- This paper tor the first time presents evidence on the linkages of employment, chronic disease prevalence and medical care of the older population in India by using a unique and comprehensive data source. [ABSTRACT FROM AUTHOR]

Background: A rising proportion of elderly in India has infused notable challenges to the healthcare system, which is already underdeveloped. On one side, NCDs are increasing among the elderly in India; however, on the other side, CDs are also a cause of concern among the elderly in India. While controlling the outbreak of communicable diseases (CDs) remained a priority, non-communicable diseases (NCDs) are placing an unavoidable burden on the health and social security system. India, a developing nation in South Asia, has seen an unprecedented economic growth in the past few years; however, it struggled to fight the burden of communicable and non-communicable diseases. Therefore, this study aimed at examining the burden of CDs and NCDs among elderly in India., Methods: Data from Longitudinal Ageing Study in India (LASI Wave-I, 2017-18) were drawn to conduct this study. The LASI is a large-scale nationwide scientific study of the health, economics, and social determinants and implications of India's aged population. The LASI is a nationally representative survey of 72,250 aged 45 and over from all Indian states and union territories. Response variables were the occurrence of CDs and NCDs. The bi-variate and binary logistic regression were used to predict the association between communicable and non-communicable diseases by various socio-demographic and health parameters. Furthermore, to understand the inequalities of communicable and non-communicable diseases in urban and rural areas, the Fairlie decomposition technique was used to predict the contribution toward rural-urban inequalities in CDs and NCDs., Results: Prevalence of communicable diseases was higher among uneducated elderly than those with higher education (31.9% vs. 17.3%); however, the prevalence of non-communicable diseases was higher among those with higher education (67.4% vs. 47.1%) than uneducated elderly. The odds of NCDs were higher among female elderly (OR = 1.13; C.I. = 1-1.27) than their male counterparts. Similarly, the odds of CDs were lower among urban elderly (OR = 0.70; C.I. = 0.62-0.81) than rural elderly, and odds of NCDs were higher among urban elderly (OR = 1.85; C.I. = 1.62-2.10) than their rural counterparts. Results found that education (50%) contributes nearly half of the rural-urban inequality in the prevalence of CDs among the elderly. Education status and current working status were the two significant predictors of widening rural-urban inequality in the prevalence of NCDs among the elderly., Conclusion: The burden of both CD and NCD among the elderly population requires immediate intervention. The needs of men and women and urban and rural elderly must be addressed through appropriate efforts. In a developing country like India, preventive measures, rather than curative measures of communicable diseases, will be cost-effective and helpful. Further, focusing on educational interventions among older adults might bring some required changes., (© 2022. The Author(s).)