Ranjan, Alok

The immobile elderly are one of India’s most vulnerable population subgroups. This study aims to understand the progress towards universal health coverage regarding access to healthcare and financial protection for the immobile elderly in India. This study used data from the 75th Round National Sample Survey, conducted from July 2017 to June 2018 across 8077 rural villages and 6181 urban wards. Data from 555,115 individuals included 42,762 elderly individuals (60 years or above). Bivariate and multivariate analyses were used for the study. In India, 7.5% of the elderly are physically immobile, including 1.4% bedridden, 5.5% confined at home, and 0.6% in a wheelchair. Immobility was higher in urban areas [OR: 1.12 (95% CI: 1.04–1.21), p = 0.003] compared to rural areas, and in the non-literate population [OR: 1.85 (95% CI: 1.63–2.12), p < 0.001 compared to the secondary or above -educated population. The disease burden of psychiatric and neurological disorders was significantly higher in the immobile elderly (hospitalisation: 16.3%, outpatient: 12.6%) compared to the mobile elderly (hospitalisation: 5.2%, outpatient: 3.4%). The private sector was a major service provider (hospitalisation: 61.1%, outpatient care: 66.4%), but public healthcare utilisation was higher among the poor. Out-of-pocket expenditure was high in the immobile elderly compared to the mobile elderly, and the private sector compared to the public sector. There is an urgent need to invest in comprehensive primary healthcare with good referral linkages to tertiary and rehabilitative care for immobile elderly in India. Trial registration: Not applicable.

Mental health disorders, particularly depression, are significant contributors to the global burden of disease. This study aims to explore the prevalence and consequences of depression among older adults, focusing on current challenges and effective interventions. This study used data for the older adult population (age 60 years and above) from the Longitudinal Ageing Study in India (LASI). Descriptive statistics along with logistic regression was used to examine the disease burdens and challenges, and to investigate the relationships between depression and the various socio-economic factors. Prevalence of depression was observed in 20.1% of the older adult population out of which more than half (51.3%) of the older adults were noted to be severely depressed. Percentage of the older adults suffering from depression was found to be increasing with age. The odds of females having depression were higher than males (OR = 2.71, p < 0.01) and the richest quintile older adults (OR = − 0.79, p < 0.05) were more likely to suffer from depression than the poorest quintile older adults. Only 1.9% depressed older adults sought out-patient care while for in-patient care this percentage was as low as 0.36%. The fact that 21.1% of the older adults sought out-patient depression treatment from pharmacists and traditional/folk healers reflects stigma. The mean out-of-pocket expenditure for in-patient care for depression was ₹18,002 (₹3305 public; 29,307 private) and that for out-patient care was ₹1176 (₹1062 public; 1340 private). Depression-stricken older adults have reported a lower quality of life. Depression in the older adults is a pervasive and severe issue in India, necessitating urgent attention and action from policymakers, healthcare providers, and society at large.

Mental health disorders, particularly depression, are significant contributors to the global burden of disease. This study aims to explore the prevalence and consequences of depression among older adults, focusing on current challenges and effective interventions. This study used data for the older adult population (age 60 years and above) from the Longitudinal Ageing Study in India (LASI). Descriptive statistics along with logistic regression was used to examine the disease burdens and challenges, and to investigate the relationships between depression and the various socio-economic factors. Prevalence of depression was observed in 20.1% of the older adult population out of which more than half (51.3%) of the older adults were noted to be severely depressed. Percentage of the older adults suffering from depression was found to be increasing with age. The odds of females having depression were higher than males (OR = 2.71, p < 0.01) and the richest quintile older adults (OR = − 0.79, p < 0.05) were more likely to suffer from depression than the poorest quintile older adults. Only 1.9% depressed older adults sought out-patient care while for in-patient care this percentage was as low as 0.36%. The fact that 21.1% of the older adults sought out-patient depression treatment from pharmacists and traditional/folk healers reflects stigma. The mean out-of-pocket expenditure for in-patient care for depression was ₹18,002 (₹3305 public; 29,307 private) and that for out-patient care was ₹1176 (₹1062 public; 1340 private). Depression-stricken older adults have reported a lower quality of life. Depression in the older adults is a pervasive and severe issue in India, necessitating urgent attention and action from policymakers, healthcare providers, and society at large. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.

Background: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala’s approach towards UHC and health systems strengthening through a political economy approach. Methods: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state’s progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. Results: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. Conclusions: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in ‘public provisioning’ should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.

Objectives: The ageing phenomenon is accompanied by several challenges, among which decreased mobility and increased dependency remain prominent. This makes both caregiving and caregivers a crucial factor in ensuring the elderly population has a healthy and dignified life. This study emphasises the necessity of caregivers and the amount of time they dedicate to providing care for the elderly (60 years and above) in India. Method: This research used the national representative data, Longitudinal Ageing Study of India (LASI) Wave 1, 2017–18. The research encompasses the 31,336 elderly population from the LASI wave 1. Bivariate analysis and the logit regression method have been applied to analyse the caregiver support, number of caregivers, and caring time for the elderly with mobility restrictions in India. Results: The total sample size for the study was 31,336 elderly. Out of the total sample, 14,945 (52.04 %) indicated dependence in at least one Basic Activity of Daily Living (BADL) or Instrumental Activity of Daily Living (IADL). Among the aged population who indicated dependence in at least one BADL or IADL, 24.8 % reported receiving support from caregivers. The caregivers' support was determined for elderly people, regardless of their level of dependence on BADL or IADL. The overall caregiver support among India's elderly population was 12.9 %. Logistic regression analyses show that the odds of caregiver support among the elderly population who reported dependence for at least one BADL or IADL is higher among those aged 75 years and above [OR: 2.17, 95 % CI: 1.99–2.36, p < 0.001]. Conclusions: This study examines the assistance provided by caregivers to the elderly in India who expressed dependence on BADL and IADL. As individuals become older, they experience a decrease in functional capacity and a higher dependence on others for BADL and IADL, necessitating further support and care. The results of this study underscore substantial deficiencies in addressing the requirements of caregivers for the ageing population in Indian society. © 2025 Elsevier B.V., All rights reserved.