Frailty among middle-aged and older women and men in India: findings from wave 1 of the longitudinal Ageing study in India

Abstract

Objectives: Few studies have examined frailty in Indian adults, despite an increasing population of older adults and an escalating burden of chronic diseases. We aimed to study the prevalence and correlates of frailty in middle-aged and older Indian adults.

Setting: Cross-sectional data from Wave 1 of Longitudinal Ageing Study in India, conducted in 2017-2018 across all states and union territories, were used.

Participants: The final analytical sample included 57 649 participants aged 45 years and above who had information on frailty status.

Primary outcome measure: The deficits accumulation approach to measuring frailty was employed, creating a frailty index between 0 and 1, based on 40 deficits. Individuals with a frailty index of 0.25 or more were defined as 'frail'.

Results: Prevalence of frailty among 45+ adults was 30%. 60+ women were two times as likely to be frail compared with 60+ men, after adjusting for a wide range of sociodemographic, economic and lifestyle factors. The sex difference was more pronounced in adults aged 45-59 years. Odds of hospitalisation in the last 12 months, and having falls in the past 2 years, were two times as high in frail adults compared with non-frail adults. Frail middle-aged and older adults had 33% and 39% higher odds, respectively, of having poor cognition than non-frail adults. The relative increase was higher in women for all three outcomes, although not statistically significant.

Conclusions: There needs to be careful consideration of sex differences when addressing frailty, particularly for optimising frailty interventions. Frailty, although typically assessed in older adults, was shown in this study to be also prevalent and associated with adverse outcomes in middle-aged Indian adults. More research into assessment of frailty in younger populations, its trajectory and correlates may help develop public health measures for prevention of frailty.

Keywords: EPIDEMIOLOGY; GERIATRIC MEDICINE; PUBLIC HEALTH; Quality of Life.

Figure 1

State-wise prevalence of frailty, by sex and age group. Individuals with frailty index ≥0.25 are defined as ‘frail’. Prevalence estimates are weighted, using state-level individual sampling weights provided in data.

Figure 2

Forest plot of adjusted ORs (95% CI) for frailty, by participants’ background characteristics. MPCE (monthly per capita expenditure) is defined as total monthly household consumption expenditure divided by household size. Food constraint refers to household food unavailability in the past 12 months, where household members either reduced their meal size, did not eat even though they were hungry, or did not eat for a whole day because enough food was not available in the household.