Understanding Frailty, Functional Health and Disability among Older Persons in India: A Decomposition Analysis of Gender and Place of Resident

Background: We estimated and compared the differences in frailty, disability, and functional limitation among men and women, and among urban and rural dwellers. Further, this study also provides the analysis of key factors influencing frailty, functional limitation and disability among older persons in India. Study design: Two cross-sectional surveys. Methods: WHO-SAGE (2007-10) and BKPAI-2011 (Building Knowledgebase for Population Ageing in India) (2007-10) were used. Oaxaca decomposition method was used to decompose the gender and place of resident differentials. Statistical software RStudio (Version 1.2.1335) was used to perform these analyses Results: The decomposition model was able to explain 46.5%, 41.6% and 46.4% of the difference between frailty, functional limitation and disability among older persons respectively. The key factors, which significantly (P<0.05) explained the gap for both frailty and functional limitation, were Education (0.009 &1.24), working status (0.018 & 1.93), physical activity (0.001 & 0.15) and migration (0.018 & 1.98). Higher educational attainment (0.008 & 1.10) and wealth quintile (0.009 & 1.18) in urban areas might be a factors resulting in the lowering of frailty and functional limitations. Conclusion: The poorer functional health among older women can largely be explained by gender differentials in socioeconomic status and consequent empowerment (such as less control of their mobility and financial independence). This implies that efforts to improve gender disadvantages in earlier life stages might get reflected in better health for females in older age.