Page 37 - IJPS-4-2

Sreerupa, et al.

as the Longitudinal Study of Ageing in India (LASI), will be useful in addressing this lack; we plan to use data from LASI
in future analyses on health expectancy when they are available. Second, this study employs a vital yet a single measure
of health, that is, mobility status. This, as mentioned before, was due to the lack of comparability of other measures of
disease and disability between the two NSS rounds. Going forward, the NSSO, and other organizations and researchers
conducting repeated cross-sectional and/or longitudinal surveys, should be mindful of maintaining consistency in all
aspects (such as wording, referent time period, and response options) of included questions over time. Utilization of
additional indicators of “health” over a longer period of time in future analyses using data, when available, from studies
like the LASI, will be useful in determining whether there is a compression or expansion of morbidity among older
persons in India. Third, health expectancy computed with the Sullivan method does not take into account the expected
life cycle events of individuals exposed to current morbidity conditions (Saito, Robine, and Crimmins, 2014). Thus, it
may underestimate (or overestimate) healthy life expectancy because it produces estimates based on past (as opposed
to current) probabilities of becoming unhealthy. Finally, the NSS does not capture information on the environmental
characteristics of older persons. Environmental characteristics play a role in defining functional ability (World Health
Organization, 2015). We cannot, therefore, categorically comment on the role played by environmental characteristics in
enabling or restricting mobility for older persons in our sample and thereby in the observed compression or expansion
of morbidity. Having said that, mobility is less likely to be affected by environmental changes than other measures like
instrumental ADL used to define “health” (Crimmins and Beltrán-Sánchez, 2011).

5. Conclusions
While the prevalence of mobility limitation fell among older men, older women, and older urban and rural persons
from 1995–1996 to 2004, this did not translate into an absolute and relative reduction in the duration of remaining life
without mobility limitation for all older people in India. Older men and older rural persons did experience a compression
of morbidity, whereas older women and older urban persons seem to have experienced an expansion of morbidity over
this decade. This suggests that current national programs in India, such as the National Health Mission and the National
Program for Health Care of the Elderly, which aim to address health issues in general or, specifically, among older
persons, need to focus on addressing mobility limitation among older women and older urban persons. At the same
time, one cannot ignore the high absolute numbers of older persons (6.2 million, comprising 2.6 million older men and
3.6 million older women, or 4.5 million older rural persons and 1.7 million older urban persons [based on the observed
prevalence estimates in 2004 and the 2001 India population census]) who are confined either to their beds or their homes
and who need assistance with mobility. Clearly, there is a need for a policy focus on promoting and maintaining mobility
and functional capacity among all older persons in India, concurrently with development and support for formal and
informal long-term care services.
Authors’ Contributions
Sreerupa, S Irudaya Rajan, and Yasuhiko Saito conceptualized and conducted the data analyses, interpreted the results of
the analyses, and contributed in drafting the manuscript. Shweta Ajay and Rahul Malhotra interpreted the results of the
analyses and contributed to drafting the manuscript.
Ethics

Secondary analysis of the available de-identified data was done. The de-identified data are publicly available. Therefore,
we did not seek any ethical approval.

Availability of Supporting Data
Secondary analysis of the available de-identified data was done. The de-identified data are publicly available, i.e., ASDR
from the Sample Registration System and two rounds of the NSS on Morbidity and Treatment of Ailments, 52 Round
nd
(National Sample Survey Organisation, 1998), conducted from July 1995 to June 1996, and on Morbidity, Health Care,
and the Conditions of the Aged, 60 Round (National Sample Survey Organisation, 2006), conducted from January to
th
June 2004.
Conflicts of Interest
No conflicts of interest were reported by the authors.

International Journal of Population Studies | 2018, Volume 4, Issue 2 31