1. Well-being of older people with Chronic diseases Dr Aravinda Meera Guntupalli Dr Priya Khambhaita Prof Barrie Margetts IFA, Hyderabad 12 th June 2014

2. Introduction Chronic diseases, such as heart disease, cancer and diabetes, are the leading causes of mortality in middle income countries such as India According to the WHO, 15% of the 36 million global deaths from chronic diseases in 2008 occurred in India with 38% males and 32% females aged below 60 (WHO, 2012) In addition, more than 60 million Indians were diagnosed with diabetes in 2011 (IDF, 2012) 2

3. Migration and changing living arrangements Simultaneously, several families have experienced a shift in traditional living arrangements –According to the recent Census of India, 30% of the total population (1.21 billion) move within India, and 5 million Indians have emigrated from India (Census of India, 2011) –In short, three out of ten Indians are internal migrants, and 2/3rds of the migrants are from rural areas pointing towards a major change in the traditional family system –Accordingly, the study aims to examine wellbeing of older people in India in relation to emerging chronic diseases and changing living arrangements 3

4. Well-being methodolgy The wellbeing of older people in countries such as India is commonly studied using unidimensional discipline specific indicators such as quantity or quality of life, living arrangements or financial security However, these indicators independently are not able to capture wellbeing in a holistic perspective in a period of rapid transitions Hence, these domains will be combined and assessed in relation to rapid demographic, epidemiological and economic transitions Indians have been experiencing in the past decade 4

5. Aims of the study The study aims to capture the ways older people cope with the emerging non-communicable diseases, especially when they live away from children with their spouse or alone, by focusing on financial, mental and physical measures of individual wellbeing Also, it focuses on the association between SES, type of residence and chronic diseases 5

6. Research questions 1. What is the impact of the surging chronic diseases on the wellbeing of older people? 2. Is there an association between wellbeing of older people with chronic diseases and their living arrangements? If so, how can we explain the changing association in the context of recent demographic changes in the country? 3. How can we capture the wellbeing of older people with chronic diseases using multidimensional measures covering a range of multidisciplinary domains such as financial wellbeing, quality of life, mental wellbeing and physical wellbeing? 6

7. Data and methods To investigate the association between family dynamics and individual wellbeing, the project employed methods such as systematic review of existing literature and secondary data analysis using datasets such as the Study of AGEing (SAGE) and UNFPA ageing study. A multidimensional indicator of individual wellbeing will be constructed to capture financial, physical, psychological and subjective aspects of wellbeing. By focusing on multidisciplinary aspects of wellbeing, we can compare and contrast different domains of wellbeing, and locate the important life domains 7

8. 8 Well-being of older people with Chronic diseases More than 30% of the older people aged 60 and above have reported chronic diseases such as asthma, hypertension, diabetes, stroke and angina –WHO SAGE data provides objective than self-reported data Males have reported slightly higher levels of chronic diseases, and urban respondents are more likely to have chronic diseases in later life compared to rural respondents Between 33% and 40% of the respondents with chronic diseases are widowed, and they seek support from other family members The paper further compares and contrasts well-being indicators of older people with chronic diseases with well-being of older people without chronic diseases

9. Odds of reporting of chronic disease Wealth quintile Poorest 20% (reference) Quintile 2 1.4 (p<0.001) Quintile 3 2.1 (p<0.001) Quintile 4 2.5 (p<0.001) Richest 20% 4.0 (p<0.001) 9

10. Wealth quintiles 10

11. Odds of reporting of chronic disease Living arrangements: Living alone (reference) Living with spouse 1.06 (not significant) Living with others members 1.06 (not significant) Never attended school 0.75 (p<0.001) Age, gender and residence are also significantly associated with reporting of Chronic diseases 11

12. Living alone Living alone is more among poorer people Richer older people are likely to live together and chronic disease reporting is more among richer people There is a weaker bivariate association between chronic diseases and living arrangements 12

13. Reasons for living alone No NCD (16.54 live alone as they have no children) NCD (11% live alone as they have no children) 13 Living arrangements and wealth quantile

14. Social well-being of older people with NCDs Older men and women with chronic diseases reported poorer social wellbeing –For example, 21.5% of older men with chronic diseases never had friends or family visiting them in the past 12 months –30.1% of older women with chronic diseases never had friends or family visiting them in the past 12 months Frequency of attending social programmes in the last 12 months is lower for older men and women with chronic diseases (36% never attended any religious programme) –63.0% did not attend social programmes due to health problems 14

15. Financial well-being 80% of older people with chronic diseases contributed to medical expenses compared to only 70% of older people without chronic diseases However, only 41% of older people with chronic diseases feel that they earn sufficient income to fulfil the basic needs compared to 47% of older people without chronic diseses 15

16. Self-rated health Older people with chronic diseases reported poorer health compared to older people without chronic diseases They are likely to report –Poor self-reported health –Felt that health declined in the past 12 months –Experience poorer health compared to older people of similar age –35% of older people with chronic diseases rated their health as worse compared to 24% of older people without chronic diseases 16

17. 17 Nutrition in resource poor setting Adapted from Prentice and Moore; Arch Dis Child (2005) Guntupalli, A.M..Inquiry into simultaneous existence of threatening malnutrition and obesity in India using NFHS-3 data.

18. 18 Nutrition during and after the transition period Adapted from Prentice and Moore; Arch Dis Child (2005)