Burden of disease among elderly: Evidence from LASI

The United Nations Populations Division has projected India to become the world’s most populous country in the next six years. As per the 2011 census, the total elderly population age 60 and above was 103 million which accounted for 8.6% of the total Indian population and the share of the elderly population is projected to further rise to 19.5% by 2050 and the total elderly population age 60 and above is projected to touch 319 million by the middle of this century. Population ageing results from demographic transition, a process whereby reductions in mortality are followed by reductions in fertility. People are living longer than ever before. The expectation of life at birth in India has increased from 36 years in 1950 to 69 years in 2018 and by 2050, the life expectancy in India is projected to increase to 75 years. The dramatic and widespread nature of these current and ongoing demographic shifts indicates that the population ageing challenges that India will face are both inevitable and exist on an enormous scale. These demographic changes present complex health, social, and economic challenges to which this heterogeneous country must rapidly adapt, both in the present and continuing into the future.

The demographic transition vis-a-vis the epidemiological transition in the country has shifted a major share of the country’s burden of disease from communicable to non communicable diseases and the emerging incidence of chronic and degenerative diseases. These alarming population projections and the dramatic shift in age-structure call for robust and internationally harmonized data on ageing. Although adult health and ageing is being increasingly investigated, there are currently no comprehensive and internationally comparable national survey data in India that encompass the full range of topics necessary to understand the health, economic, social, and psychological aspects of the ageing process. The Longitudinal Ageing Study of India (LASI) was designed to fill this gap. LASI Wave-1 is a full-scale national survey of scientific investigation of the health, economic, and social determinants and consequences of population ageing in India. It is India’s first and the world’s largest ever survey that provides a longitudinal database for designing policies and programmes for the older population in the broad domains of social, health, and economic well-being. The National Programme for Health Care of Elderly, Ministry of Health & Family Welfare undertook the LASI, through International Institute for Population Sciences, (IIPS), Mumbai in collaboration with Harvard School of Public Health, University of Southern California, USA, Dte.GHS, United Nations Population Fund (UNFPA) and National Institute on Ageing. The author is privileged to be associated with this study as the Project Director for the collection of information in Jammu and Kashmir. In Jammu and Kashmir, information was collected from a baseline sample of 1613 individuals aged 45 and above including 731 elderly persons aged 60 and above. The LASI embraced state-of-the-art large-scale survey protocols and field implementation strategies including use of Computer Assisted Personal Interviewing technology for data collection, quality control, and Geographic Information System. A unique feature of LASI is the coverage of comprehensive biomarkers and information about the self-reported prevalence of diagnosed major chronic health conditions among older adults.

 The study shows that cardiovascular diseases (CVD) are the most prominent among people age 45 and above in Jammu and Kashmir compared to 27% at the national level. The prevalence of CVDs increases with age from 29% in age group 45-59 to 46% in age group 60-64, and further to 59% among elderly age 70 and above. The self-reported prevalence of diagnosed CVDs in the J&K is 51% among older adults age 60 and above as compared to 35% in India as a whole. Chronic hypertension follows a similar trajectory. About 30 per cent of population between 45 years and 59 years of age suffer from hypertension and the level increased to 48 per cent among those aged 60 and above. The corresponding prevalence among those aged 60 and above at the national level is 32%. Roughly 11% of population age 60 and above were diagnosed with chronic heart disease and 4% with stroke. The self-reported prevalence of diagnosed CVDs and hypertension is higher among the elderly residing in urban areas (51%) and among elderly women (46%). In J&K the self-reported prevalence of diabetes mellitus among older adults age 45-59 is 6.2% and among the elderly age 60 and above is 9.4% . The self-reported prevalence of diabetes mellitus among elderly age 60 and above is higher in urban areas and among women as compared to their counter parts.

The prevalence of chronic lung diseases which include chronic obstructive pulmonary disease (COPD), asthma and chronic bronchitis in J&K among elderly age 60 and above is 8%. Chronic lung diseases are more common among the elderly residing in urban areas and elderly women. Similarly, the self-reported prevalence of diagnosed neurological/psychiatric problems among the elderly age 60 and above in J&K is 5.3% and that of depression is 1.3%. The elderly living with others and divorced/deserted/separated are more likely to be diagnosed with depression. The prevalence of neurological or psychiatric problems among the elderly is higher among elderly women and elderly from urban areas.

J&K has also reported a very high prevalence of joint/bone issues compared to most of the Indian states. Bone and joint problems are prevalent among 27% elderly age 60 and above in J&K compared to 19 % at the national level;. Older women and elderly from rural areas have a higher probability of having been reported bone/joint problems. In J&K, 0.3% of the elderly age 60 and above have been diagnosed with cancer, and fortunately, the prevalence of cancer in J&K is lower than most of the States of the country.

The assessment of the burden of chronic health conditions such as cardiovascular diseases, diabetes, chronic respiratory diseases, bone diseases, and cancers, as well as their risk factors, are important for promoting appropriate and effective health care policies for the prevention and control of NCD in J&K. By 2030, more than half of the total burden of diseases in J&K, majorly non-communicable, is expected to be borne by the old-age population. Adequate investment in elderly healthcare and efficacious policies and their timely management are thus imperative. Given the prevalence of chronic health issues are more common among women, suggests the need to have gender sensitive institutional mechanism to deal with the burden. The NCD clinics at district kevel and the establishment of Health and Wellness Centers under Bharat Ayushman in the present form cannot serve this increasing burden of diseases of elderly population unless they are equipped with trained manpower, infrastructure, drugs, diagnostics, drugs and medicines. Promoting healthy behaviors to effect lifestyle behavior change is critical for prevention and control of hypertension and diabetes and some other forms of non-communicable disease. The survey also shows that 21% of the elderly has difficulty in performing daily functions such as walking, eating, toilet etc., and 36% of them require helpers for ADL/IADL limitations. Although presently most of these people are taken care of at home, but as the family support for elderly is collapsing due to the collapse of joint family system and non-family sources of care giving would steadily increase. This has the potential to create employment opportunities in future and the state should plan to train adequate skilled manpower to cater to the needs of the elderly.

Bashir Ahmad Bhat, Associate Professor, Population Research Centre, University of Kashmir Srinagar.