Longitudinal Study on Ageing in India (LASI)

Edition #8: Results from a groundbreaking study among India’s 45+ population.

In the last newsletter, I shared the report Silver Economy: A case for market-based solutions, a self-authored report on my research into ageing, elder care and market-solutions available in India. In one of the sections, I highlighted early results from the Longitudinal Study on Ageing in India. Earlier this week, and amidst hectic preparations for the Covid-19 vaccine drive, the Minister for Health and Family Welfare (MoHFW) Dr Harsh Vardhan released results from the first wave of LASI data. This is a significant study for many reasons, for researchers, policy makers, health practitioners working on geriatric care, and for the general population.

Talking to Rajya Sabha TV, Prof T V Sekher, Principal Investigaror of LASI and Professor in IIPS, spoke about key aspects of the study results from the first wave data.

  • 34% of surveyed have at least one chronic health condition.
    • Cardiovascular – 34%; hypertension – 32%; bone and joint diseases – 19%; diabetes – 14%; lung diseases – 8%; heart disease – 5%; anaemia – 5%; stroke – 3%; cancer – 0.7%
    • 3/4th of them that reported chronic conditions are getting treated for various chronic conditions. Diabetes – 83%; hypertension – 77%, etc.
  • In the context of the pandemic, 23% have multi-morbidity health conditions. This was sponsored as part of the National Program on Healthcare for the Elderly.
  • Mental illness (like depression) is seen among 8% of the population; among  the 75+ group, this increases to 10%. Most seen among rural residents, widows and elderly living alone.
  • 11% of the elderly have physical impairment; locomotor – 6%; visual – 4%; others – mental, hearing.
  • The study also captures information under “activities of daily living” of elderly (taking a bath, food intake, using toilets, etc.). 24% of elderly have at least one limitation; 14% have more than one limitation.

About LASI

The LASI study was launched in 2016 to generate scientific evidence and data about India’s growing elderly population.

First, and foremost, LASI is India’s first longitudinal study on ageing and the world’s largest longitudinal study.

The International Institute for Population Sciences (IIPS) based in Mumbai is carrying out this study. The first wave of the study was conducted in all states and UTs (except Sikkim) covering 72000 individuals from 43000 households across the country. This survey and study will go back to the same households over 25 years and every 2.5 years, the changes in their physical, health and economic conditions will be recorded.

The international partners on this study are Harvard and University of Southern California (USC) while the India project is financially supported by MoHFW, NIH (US) and UNPA. With this, India joins an elite club of health and retirement studies with 40 countries around the world. In particular, India joins other Asian countries like Korea, Japan, Indonesia and China in undertaking similar studies in their countries. By being part of an international grouping, researchers have access to standardized survey tools and protocols thus allowing for internationally comparable data.

The first wave survey results were released by the health minister on the 6th of Jan, 2021. The survey also captures various social security measures available for elderly, their level of awareness and use among the elderly.

The 2011 census estimated 100M Indians over the age of 60 and this population is expected to be approx. 320M by 2050, accounting for roughly 20% of the total population. While a lot of the focus of the goverment over the last decade has been on youth policies and programs, focused on the opportunities arising from the demographic dividend, this emerging area of research puts much needed focus on the other demographic – older adults – in a scientific manner.

What is a longitudinal study?

Source: BMJ

In a longitudinal study subjects are followed over time with continuous or repeated monitoring of risk factors or health outcomes, or both. Such investigations vary enormously in their size and complexity. At one extreme a large population may be studied over decades.  At the other extreme, some longitudinal studies follow up relatively small groups for a few days or weeks. 

Here is one such example on a comparable study at IISC. The Srinivasapura Ageing Senescence and Cognition (SANSCOG) is an initiative by CBR in collaboration with NIMHANS, Sri Devaraj Urs Medical College, Kolar and other departments of IISc. The project by the Centre for Brain Research at IISC Bangalore is envisioned as a prospective community based cohort study with long term follow-up over many years for comprehensive evaluation of the risk and protective factors associated with cognitive changes due to normal ageing, Alzheimer’s disease and other related disorders. The Srinivaspura taluk in Kolar district of the state of Karnataka is the site of the study. The study cohort (n=10,000) comprising of cognitively healthy individuals without dementia in the age group of 45 years and above will undergo detailed assessments comprising of clinical, neurocognitive, lifestyle, anthropometric,biochemical, genetic and multi-modal neuroimaging measures at baseline and periodic follow up. 

This 2017 archived article by FactorDaily delves deeper into the SANSCOG project but here is an interesting bit of information about how the private sector has contributed to establishing a largely under-funded but important research work.“CBR’s Vijaylakshmi says she got pulled into the project when Kris (Gopalakrishnan) walked into the then IISc director Padmanabhan Balaram’s office in October 2014. He wanted to “do something in neuroscience, particularly ageing”.

She had already raised funding to start brain-related research at IISc with Ratan Tata, an early donor, writing out a cheque for Rs 75 crore in 2014. And then, Kris ponied up Rs 225 crore right after that with just one ask: set up a dedicated brain research centre on the sylvan IISc campus.”

Kris Gopalakrishnan is the co-founder of Infosys, philanthropist and investor.

Why is th LASI study unique and also different?

Most surveys capture secondary and primary information through surveys. The LASI study captures physical, reported (survey) and measured (biomarkers) health conditions of the elderly.

For example, a large number of biomarkers (dry blood spot samples for diabetes and haemoglobin levels, vision test, memory test, grit strength, lung function using spirometry, anthropometric (measurement of human individuals) have been used to study specific health conditions. Here is a quick reference guide to understanding the importance of capturing biomarkers of the population group.

  • Dry blood spot tests: The test analyzes specific biochemistry parameters – uric acid, cholesterol, triglycerides, glucose, creatinine – in dried blood samples, using standard laboratory equipment. Source: WHO
  • Spirometry tests: Test used to assess how well your lungs work by measuring how much air you inhale, how much you exhale and how quickly you exhale. Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing. Source: Mayo Clinic
  • Anthropometric measurements: Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness. These measurements are important because they represent diagnostic criteria for obesity, which significantly increases the risk for conditions such as cardiovascular disease, hypertension, diabetes mellitus, and many more. There is further utility as a measure of nutritional status in children and pregnant women. Additionally, anthropometric measurements can be used as a baseline for physical fitness and to measure the progress of fitness. Source: NCBI

Prof Sekher also mentioned how LASI results can be used by policy makers to make evidence- and data-based decisions on some critical issues (few mentioned below).

  • 1/4th of the elderly in BPL receive pensions; 1/4th of widows are also pensioners.
  • 1/5th of older adults (45+) are covered by health insurance
  • 6% of elderly in India live alone, 9% among women. More people living alone or forced to live alone.
  • Increase in ill-treatment and abuse by family members. While the Maintenance and Welfare of Parents and Senior Citizens Act, 2007 (with amendments made in 2019), provides protection to elderly under the law, the awareness of such an Act is very low (20%). You can read more about this Act here – PRS India and MoSJE.

You can see the full 25-min discussion on the topic here.

The study has been covered by various media publications during the course of the week, and links to these articles (along with the headline), are highlighted below.

The Hindu (“Number of India’s elderly to triple by 2050”)

Times of India (“75m Indians above 60 suffer from chronic disease: Survey”)

Hindustan Times (“About 75 million elderly in India suffer from some chronic disease: Health ministry survey”)

Economic Times (“55 per cent Indians above the age of 60 suffer from a chronic disease, shows study”)

India CSR (“Care for India’s Elderly”)

DownToEarth (“Almost 70% senior citizens in India have a chronic illness”)

If you are a researcher with interest in this area, you can also access datasets here with a simple registration.

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