Understanding Frailty: Perspectives and Experiences of Rural Older Adults in India.

OBJECTIVES: In India, frailty has been predominantly studied as a physiological aspect, overlooking the subjective perceptions of community-dwelling older adults, which holds global significance. This study aims to explore frailty perceptions among community-dwelling older adults, comparing those enrolled in a geriatric welfare program facility to those not-enrolled. METHODS: A cross-sectional design with a qualitative descriptive framework was employed, using focus group methodology. The study took place in rural West Bengal, located in eastern India, with a sample of 27 participants aged 60-87 years. Data collection occurred between October 2018 and January 2020, conducted through a face-to-face, semistructured discussion guide. Thematic analysis was performed to ensure data saturation and reliability. RESULTS: Three key themes emerged from the analysis: (a) Perceptions of frailty were associated with aging, functional dependence, and psychosocial health, (b) Exposure to a scientific definition led to an ideological dilemma influenced by personal experiences, (c) Walking speed and grip strength were prominent components of frailty. The findings revealed that there was no difference in perception between program-enrolled and nonenrolled older adults, likely due to the concept of frailty being new to all participants. However, it was noteworthy that participants enrolled in the welfare program exhibited a resilient mindset toward the definition and demonstrated a proactive interest in preserving their overall health. DISCUSSION: This novel study underscores the necessity of enhancing community awareness and integrating frailty management into the Indian health care system, which is yet to be fully integrated, aiming to promote the well-being of older adults.

Heat Exposure, Heat-Related Symptoms and Coping Strategies among Elderly Residents of Urban Slums and Rural Vilages in West Bengal, India.

The impact of heat stress among the elderly in India-particularly the elderly poor-has received little or no attention. Consequently, their susceptibility to heat-related illnesses is virtually unknown, as are the strategies they use to avoid, or deal with, the heat. This study examined perceptions of comfort, heat-related symptoms, and coping behaviors of 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages south of Kolkata during a 90-day period when the average 24-h heat indexes were between 38.6 °C and 41.8 °C. Elderly participants in this study reported being comfortable under relatively warm conditions-probably explained by acclimatization to the high level of experienced heat stress. The prevalence of most heat-related symptoms was significantly greater among elderly women, who also were more likely to report multiple symptoms and more severe symptoms. Elderly women in the rural villages were exposed to significantly hotter conditions during the day than elderly men, making it likely that gender differences in symptom frequency, number and severity were related to gender differences in heat stress. Elderly men and elderly village residents made use of a greater array of heat-coping behaviors and exhibited fewer heat-related symptoms than elderly women and elderly slum residents. Overall, heat measurements and heat-related symptoms were less likely to be significant predictors of most coping strategies than personal characteristics, building structures and location. This suggests that heat-coping behaviors during hot weather were the result of complex, culturally influenced decisions based on many different considerations besides just heat stress.

Individually experienced heat stress among elderly residents of an urban slum and rural village in India.

The elderly are one of the most vulnerable groups to heat-related illnesses and mortality. In tropical countries like India, where heat waves have increased in frequency and severity, few studies have focused on the level of stress experienced by the elderly. The study presented here included 130 elderly residents of Kolkata slums and 180 elderly residents of rural villages about 75 km south of Kolkata. It used miniature monitoring devices to continuously measure temperature, humidity, and heat index experienced during everyday activities over 24-h study periods, during hot summer months. In the Kolkata slum, construction materials and the urban heat island effect combined to create hotter indoor than outdoor conditions throughout the day, and particularly at night. As a result, elderly slum residents were 4.3 times more likely to experience dangerous heat index levels (≥ 45°C) compared to rural village elderly. In both locations, the median 24-h heat indexes of active elderly were up to 2°C higher than inactive/sedentary elderly (F = 25.479, p < 0.001). Among Kolkata slums residents, there were no significant gender differences in heat exposure during the day or night, but in the rural village, elderly women were 4 times more likely to experience dangerous heat index levels during the hottest times of the day compared to elderly men. Given the decline in thermoregulatory capacity associated with aging and the increasing severity of extreme summer heat in India, these results forecast a growing public health challenge that will require both scientific and government attention.

Role of Pro-Inflammatory Cytokines and Vitamin D in Probable Alzheimer's Disease with Depression.

Symptoms of depression are present in a significant proportion of Alzheimer's disease (AD) patients. While epidemiological studies have shown a strong association between depression and AD, it has not been established whether depression is a risk factor or merely a co-morbidity of AD. It is also uncertain if depression affects the pathogenesis of AD. In this paper, we address these questions by measuring the serum levels of two common metabolic risk factors of AD and depression, inflammatory cytokines (IL 6 and TNF alpha) and serum 25-hydroxyvitamin D, in a case-control study. We measured the serum levels of IL 6, TNF α and 25-hydroxyvitamin D in age-matched healthy controls (n= 60) and in AD patients without depression (n=26) or AD patients with depression (n=34), and statistically analyzed the changes in these parameters among different groups under this study. Our results show that in AD there is a significant increase in IL 6 and TNF α and a marked decrease in 25-hydroxyvitamin D in the peripheral circulation compared to age-matched healthy controls. Furthermore, AD patients with depression have even significantly higher levels of IL 6 or TNF α and a lower level of 25-hydroxyvitamin D in circulation than in AD patients without depression. We also found a strong statistical correlation between the disease severity and the serum levels of IL 6, TNF α and 25-hydroxyvitamin D in AD patients with depression. These results suggest that altered circulating levels of common metabolic risk factors lead to the co-existence of depression with AD in many patients, and when they co-exist, the depression presumably affects the severity of AD presentations through more aggravated changes in these risk factors.

Reproductive health and its bio-cultural correlates among Rai and Bhutia women of rural Sikkim: a micro level study.

This study addresses the relationship between utilization of maternal health services in terms of antenatal care, delivery care, and contraceptive use, and current prevalence of gynecological problems mediated through socioeconomic, demographic and biological correlates, in two ethnic communities of Sikkim. Study participants included 506 parous, nonpregnant women of Rai and Bhutia communities. Information on morbidity status and utilization of maternal health care facilities were collected using appropriate pretested questionnaires. Bivariate and multivariate analyses were used. Anthropometric measurements were taken and blood tests were carried out for estimating hemoglobin concentration, and erythrocyte sedimentation rate (ESR). Logistic regression showed significant association between participant's education, parity, husband's cooperation and maternal health care utilization on one hand and prevalence of gynecological problems, hemoglobin concentration, ESR and parity on the other. Study results reinforce an interrelation between prevalence of gynecological problems and maternal health care utilization during pregnancy and delivery. A single effective health care program can be launched to meet the needs of these two ethnic groups.

Income and nutritional status of the fishing community residing in coastal bay of Bengal: a case study.

This is part of a project on the disadvantaged, marginalized, vulnerable/weaker section of the population and their survival strategy. The paper presents the results of a survey carried out during 2006-07 with the objective of throwing light on the life and living conditions of an economically weaker community such as 'fishing community' residing in the coastal area of Bay of Bengal in West Bengal and Orissa, India, in the context of global scenario. Various scientists have conducted quite a large number of studies to ascertain the income and nutritional status of people in rural India. Very few attempts, however, have been made to investigate in detail regarding the living standards of some specific communities, which are very often referred to, as the 'weaker section' of the people. The people belonging to fishing community are, by and large, not only economically weak in terms of earning and availability of work, the majority of them are not able to procure the minimum nourishment. The present study shows that some notable elements of living conditions such as food, shelter, health etc. matters much more than the conventional income or calorie deficiency. Commonly, the social scientists equate poverty with income or calorie deficiency which may not be the case as is evident from this study. We have hinted some measures to be undertaken to ameliorate the sufferings of the fishing community.

Hypertension and its correlates in two communities of dissimilar genetic ancestry in Sikkim, India.

BACKGROUND: Hypertension has emerged as a major health risk among adults and the elderly in India. In spite of sharing similar physical and cultural environments, group level cultural variability and distinct genetic ancestry may result in differences in patterns of hypertension prevalence. AIM: The present study investigates the relationships between socio-economic, lifestyle and anthropometric variables and hypertension in two communities (Rai and Bhutia) of Sikkim. Both groups live in a similar ecological setting and are exposed to forces of modernization of almost equal magnitude. SUBJECTS AND METHODS: The study sample consists of 582 Rais and 315 Bhutias. Information on socio-demographic characteristics, substance uses and other lifestyle variables were collected through relevant pre-tested questionnaires. Anthropometric measurements were taken following standard methods. Three consecutive blood pressure measurements were taken and averaged for analysis. RESULTS: The results of covariance analyses show that ethnicity is not a significant covariate of either systolic or diastolic blood pressure. Use of tobacco and alcohol consumption, level of education and activity patterns were found to be significant correlates of hypertension. The diagnostic ability of waist circumference is found to be better than body mass index for assessment of risk of hypertension among the present study populations. CONCLUSIONS: Lifestyle factors more than ethnicity and socio-economic factors contribute to the development of hypertension in these populations. Based on the results of this study, we would suggest that a sustainable increase in physical activity and reduction in alcohol consumption would be helpful in the proper management of hypertension for both groups.

High prevalence of metabolic syndrome and its correlates in two tribal populations of India and the impact of urbanization.

BACKGROUND AND OBJECTIVES: Metabolic syndrome is one of the major causes of morbidity and mortality in the world. The prevalence of this syndrome is high among Asians, including Indians, and is rising, particularly with the adoption of a modernized life style. Whether traditional societies in India have a low prevalence and the extent to which a transition to a modern life style contributes to the increase in prevalence are unknown. To examine the role of environmental and genetic factors in metabolic syndrome we conducted a study in two sub-Himalayan tribal populations with shared ancestry (Toto and Bhutia). The Toto live exclusively in a rural area, whereas a section of the Bhutia has adopted a modern life style. METHODS: Fasting (12 h) blood samples of Toto (n=258); rural Bhutia (n=75) and urban Bhutia (n=230) were collected, with written informed consent. Lipid profile, blood pressures, body fat and other anthropometric parameters were assessed. Criteria suggested by National Cholesterol Education Programme (NCEP) Adult Treatment Panel III (2001) were used for assessment of metabolic syndrome. RESULTS: The prevalence of metabolic syndrome was high (about 30-50%) among the Bhutia, with no significant rural-urban difference. Among the Toto, though the prevalence of metabolic syndrome was low (about 4-9%), their lipid levels were alarmingly adverse (about 37-67% had low HDLcholesterol or high triglyceride levels). There was an additional adverse impact of adoption of urban life-styles (perhaps primarily mediated through dietary changes) on cardiovascular risk factors. INTERPRETATION AND CONCLUSION: Our study suggested that metabolic syndrome and its correlates could be a major health problem even in traditional societies, indicating that this syndrome was not necessarily a result of modernization. Further, our study indicates that genetic factors that adversely affect the levels of such variables have long antiquities in Indian ethnic groups.

Prevalence of metabolic syndrome in two tribal populations of the sub-Himalayan region of India: ethnic and rural-urban differences.

This study was undertaken to estimate prevalence of metabolic syndrome in traditional societies in the sub-Himalayan region and to assess the impact of modernization on the risk to the syndrome. Two tribal populations--Toto and Bhutia--with a shared ancestry and habitat were selected. Some Bhutians have adopted a modern lifestyle. The study design permitted assessment of the relative roles of lifestyle and genetic factors in influencing the prevalence of metabolic syndrome. Our study has revealed that metabolic syndrome (or its contributing variables) can be a major health problem, even in traditional rural ethnic groups, indicating that this syndrome is not necessarily a result of modernization or urbanization. Dyslipidemia seems to be the major contributor to metabolic syndrome. Further, our study indicates that genetic factors that adversely affect the levels of such variables have long antiquities in Indian ethnic groups. We find that there is an additional adverse impact of adoption of urban lifestyles (perhaps primarily mediated through dietary changes) on metabolic syndrome.