Category Archives: Asia

Asia is the largest and most populous continent with a blend of many different climates. It varies across and within its regions concerning ethnic groups, cultures, environments, economics, historical ties, and government systems. Many of the world’s major religions have their origins in Asia.

Five Questions With Mental Health Advocate Drona Dewi

Name: Drona Dewi
Job: Author and Mental Health First Aider
Country: Malaysia and Nepal
Age: 35

Drona Dewi is a holistic wellness trainer from a biotechnology background with more than ten years of experience in research and development. Dewi is a triple threat: she is a certified trainer, certified image consultant, and certified skincare consultant. She works as a training manager at the Medhini group, where she manages all aspects of planning and execution of training programs related to science and technology. A licensed mental health first aider, Dewi is passionate about mental health and started her research on diabetes care and lifestyle modification. In the last five years, she has ventured into wellness to improve both inner and outer beauty. Her approaches are backed by science because she believes good skincare is an investment and says a lot about one’s lifestyle. Dewi is passionate about creating awareness of the importance of lifestyle balance through science communication. Connect with her on Instagram, FacebookLinkedIn, YouTube, and website.

On making time for self-care and mental health:

“Since I need to help myself before I help others, I have a routine that puts me first before my family. I am home most of the time, and working from home, even pre covid, has put me into a fixed routine. My “me time” is in my kitchen preparing food for the family, and as a wellness mama, I find time to bond with my sons through exercise. Our exercise time is added to my routine because it is critical, and I see my body as a temple. The best part of founding Drona Wellness is I get to practice what I preach. Drona means balance in Sanskrit, and wellness is a lifestyle. Whenever I am sharing with my clients, I feel more empowered because it reminds and reassures me of my wellness knowledge and how I can improve. Seeing science in everything brings me joy! I do not try to reinvent the wheel. Instead, I share my points based on science-backed research findings. I am co-author of “Life is a Gift: Loving You,” a beautiful anthology covering a wide range of subjects aimed at teaching one how to love oneself unconditionally along the journey through life.”

On a surprising fact about the skin and health connection:

“While the connection between skin and health needs a holistic approach, spiritual beauty is especially important because it is how you feel about yourself emotionally. Spiritual beauty is the Tejas (Sanskrit word), meaning the radiant energy that gives the glow from activities and actions such as love, truthfulness, kindness, face yoga, and exercise to release feel-good hormones. These will assist you in dealing with stress and emotional difficulties. I have met people without skincare routines who have good skin, and it’s because of their spiritual energy – a light that shines brightly within. One can start by having a gratitude journal and practicing mindfulness because you sometimes need to pause, breathe, and learn to love your life!”

On the role of diet in maintaining healthy skin:

“There is a famous quote, “you are what your skin eats.” What you feed yourself will be reflected on your skin, such as the deficiency of trace minerals and vitamins. Due to an increased level of free radicals from poor diet, premature aging is a common problem. A simple Skin Profiling Analysis can check if there is an imbalance in the body using the elements of oriental analysis, and the results will show the imbalance on the skin surface. This method has been used, since ancient times, even before the advancement of technology. One sentence that sums it all is glowing skin, glowing health.” Read more about beauty stereotypes in older women.

On improving both nutrition and skin health:

“Embracing our genetic makeup is important. The 40/60 rule of 40 percent nature (genes) and 60 percent nurture (environment) is the key to understanding the relationship with the skin. We need to have the courage to love ourselves wholeheartedly. As a mental health first aider, I get people to rediscover their purpose in life. We often need to pause, breathe, and be grateful for life! When you feel good about yourself and eat good food, then good genes get turned on, AND good skincare works wonders. People are into quick fixes and investing in cosmetic surgery and skincare, trying to improve their skin and beauty when often a simple improvement in diet, health mindset, exercise, skincare, and makeup routine can dramatically improve the health of skin cells. This month, I am starting a series called Let’s Talk Wellness about different science-backed trends.

On her future goals:

“I would love to coach and help businesses and entrepreneurs in the health, beauty, and wellness industries. I also want to provide solutions to their needs, opinions, and ideas by communicating science better. For example, over-claiming a product as ‘chemical-free’ does a disservice to the consumer. Instead, it is better to communicate in a more specific way, such as naming the toxic or harsh chemicals to be avoided in skincare or food. I plan to influence the world with science-backed research on the holistic approach to a better lifestyle. Just like Dr. Rangan Chatterjee! It includes relaxing more, eating smart, moving better, and clever sleeping. Post-COVID, a new religion will be born, the religion of “lifestyle,” and this has made my goals more achievable in a sustainable way. Because even now, people realize the importance of a healthy lifestyle and are looking for creative ways to attain it. Wish me luck!”

When you feel good about yourself and eat good food, then good genes turn on, and good skincare works wonders.

Drona Dewi, B.S.

Five Questions With Pharmacologist Monica Javidnia

Name: Dr. Monica Javidnia
Job: Experimental Therapeutics Fellow
Country: United States and Iran
Age: 31

Dr. Monica Javidnia is a neuropharmacologist and Experimental Therapeutics in Neurological Disease Fellow at the University of Rochester Medical Center. She earned both her Bachelor of Science and Master of Science in Neuroscience at the University of Texas at Dallas and her Ph.D. in Pharmacology from Georgetown University. Her work focuses on pharmacological and non-pharmacological management of motor and non-motor symptoms of Parkinson’s disease, disease progression modeling, and patient outcomes. Find Dr. Javidnia on Twitter and LinkedIn.

On her neurodegenerative and aging research:

“My work largely focuses on Parkinson’s disease, treatment and progression, and I’m interested in how we can use digital tools to monitor response to treatment. I’m fortunate to be working in the Center for Health + Technology and Department of Neurology with many innovative researchers and collaborators. With the addition of virtual study visits, telemedicine, and remote assessments, the team is bringing research opportunities and clinical care to people who may not have previously had access. One such program is Parkinson Disease Care New York, a state-wide telemedicine initiative that provides specialist care to people with Parkinson’s. Sometimes, the closest specialist is hours away, and driving or getting a ride can be a huge burden. With telemedicine, p­­­eople can see a neurologist from the comfort of their own home.”

On a surprising fact about Parkinson’s disease progression:

“When I learned about Parkinson’s disease through descriptions in a textbook (for example, average age 65, predominantly male, primary drug levodopa), I didn’t understand just how different things can be in real life. For about six months, I shadowed a movement disorders clinician once a week to learn more about Parkinson’s. It was eye-opening to see the range in ages, symptoms, other conditions they have, response to treatment, and more.”

On her work with 1000 girls, 1000futures:

“The New York Academy of Sciences 1000girls, 1000futures program pairs women in STEM with girls interested in pursuing STEM careers. In addition to the one-on-one mentorship, the program has message boards which are a great way to engage with people around the world, ask and answer questions, share articles, and participate in “Ask Me Anything” sessions. I have participated for two years now, and it has been wonderful getting to know the girls and other mentors.” 

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On her outreach and science-communication (SciComm) efforts:

“I try several methods to get my message out to the masses: Letters to a Pre-Scientist, Twitter, 1000girls, 1000futures program, Skype a Scientist, seminars, talking to people with Parkinson’s and their care partners, slipping some science in to my yoga classes, directing a science communication course at the University of Rochester Medical Center, and answering as many questions as I can. I started working with Ellen Wagner, a user-experience (UX) specialist, and it has definitely changed how I get my message across. Given my fields, I get a lot of questions from friends, family, and people I just met on all types of topics. I try to create a space in which they feel comfortable asking questions, gauge their background knowledge, respond clearly without excessive jargon, and hopefully leave the door open for a follow-up question or discussion. I don’t think I am perfect at SciComm, but I am definitely a better communicator than I used to be, and it just takes practice. As a side note, I applaud SciComm folks like Dr. Efra Rivera-Serrano, who have active social media accounts, post regularly, and maintain a large reach. I wish I had their skill and energy!”

On her future goals:

“Too many to count! Aside from my research goals, I want to provide personalized yoga practices for people with Parkinson’s. I believe yoga has the potential to improve symptoms, help prevent falls, and may also be beneficial for their care partner.”             

Watch Skype A Scientist Live Q&A session with Dr. Javidnia!

I believe yoga has the potential to improve symptoms, help prevent falls, and may also be beneficial for their care partner.

Dr. Monica Javidnia, PhD

Hong Kong plans for a city that’s growing older

Today, about 16 percent of Hong Kong’s population is age 65 or older. By 2064, that is expected to be 36 percent.

HONG KONG — For decades, this city of more than 7 million has been one of Asia’s most dynamic places, filled with a youthful energy that drove rapid growth in both the population and the local economy.

Planners here still see Hong Kong that way. But they also are looking at the long-term trends, and grappling with a force they cannot stop: Hong Kong is getting older. That’s true of both the city’s people and its built environment — a phenomenon planners here call “double ageing”.

Today, about 16 percent of Hong Kong’s population is age 65 and over. By 2064, that’s expected to be 36 percent — and one in ten residents will be over the age of 85.

Meanwhile, housing stock that appears middle-aged today will become outdated tomorrow. By 2047, some 326,000 private housing units will be more than 70 years old. Many of them feature long flights of stairs unfriendly to older people. More than a third of seniors live in public housing, but the two-year wait list is bound to grow longer as citizens age.

The double-ageing problem is just one issue that Hong Kong’s planners are trying to figure out as they write a comprehensive plan called Hong Kong 2030+. The plan aims to take future demographic and economic trends into account while charting a path for improving quality of life in one of the world’s most densely settled cities.

Phyllis Li Chi Miu, deputy director of the city’s territorial planning department, says buildings, roads, parks and public transport all will need rejuvenation to make the city age-friendly. “It’s a challenging task,” she says.

Alignment with New Urban Agenda

Planners are also looking at how they can align the 2030+ plan with the New Urban Agenda. That’s the 20-year plan for sustainable urbanization that nations agreed to last October at the U. N.’s Habitat III conference in Quito, Ecuador.

Alignment was the main topic of conversation at a recent “Urban Thinkers Campus” conference here. At the event, Li noted that the 2030+ plan already stresses key elements of the New Urban Agenda such as social inclusion and environmental protection.

However, there was some debate about the New Urban Agenda’s relevance in the context of a city-state like Hong Kong. Paul Zimmerman, an environmentalist and elected councilor, said that some notable issues mentioned in the New Urban Agenda, such as increasing numbers of cars on the road, growth of slums and poor utility services, are not problems in Hong Kong.

“Hong Kong is a city and also a country,” Zimmerman said. “It’s a city in which hyper-density and wilderness co-exist. Other mega-cities have no space in their periphery, while Hong Kong has a massive open space in its periphery.”

However, Professor NG Mee Kam of the urban studies programme at the Chinese University of Hong Kong, told Citiscope that the 2030+ plan “needs to strongly align with the New Urban Agenda to plug in crucial policy gaps.” For example, she said, Hong Kong’s plan could take a cue from the New Urban Agenda’s focus on the informal sector and the importance of cultural heritage.

Retrofitting and reclaiming

The 2030+ plan proposes three “building blocks” for implementation — planning for a liveable high-density city, embracing new economic challenges, and creating capacity for sustainable growth.

A major focus, particularly when it comes to dealing with the double-ageing problem, is retrofitting districts with the most old buildings. Tall buildings are likely to be renovated, while many smaller buildings will likely be demolished to make way for new construction and open space. Retrofitting public spaces is also a priority. The city intends to add curb-cuts at sidewalks to make it easier for seniors to walk, and aims to increase the amount of public space from 2 square metres per person to 3.5 square metres.

The plan also aims for compact urban growth that is highly integrated with public transport. Homes and offices are to be within 200 to 300 metres of transit; open spaces within 400 metres; and community facilities, railway stations and educational institutes within a range of 500 metres.

“We are looking at optimum land use through retrofitting,” Li said.

The plan also envisions reclaiming a good bit of land from the sea. That’s a strategy that Hong Kong has long relied on to create room for the city to grow — the city’s airport and Hong Kong Disneyland resort are both located on reclaimed land.

Under the 2030+ Plan, Hong Kong would add another 4,800 hectares (nearly 12,000 acres) of land — a little less than the area of Manhattan. The land would be used for housing, industry, transport facilities and open space. These would include a few large urban extensions such as the East Lantau Metropolis, which is to be home to as many as 700,000 people.

Work on the 2030+ plan started in 2015 and is in the fourth of six phases of public consultation. The final plan is expected to be released next year.

Open Your Eyes: A Journey from Darkness to Sight

Open Your Eyes is a recently produced documentary on the impact of cataract surgery in Nepal. The film shows the transformation of health-related quality of life for older adults with access to medical care. In the film, Manisara and Durga make the long journey to get cataract surgery. Both husband and wife are blind and depend on family members for their most basic needs. Despite being blind, Manisara and Durga help care for their grandchildren and have an important place in the family. Their journey to the city is filled with nervous trepidation, but after the surgery, both are able to see their grandchildren and contribute to valuable work that benefits the entire family and community.

Open Your Eyes highlights the successful use of foreign funds to combat treatable diseases. The funding helps develop sustainable infrastructure and pays for many public health interventions such as cataract surgeries. In a previous article titled Hoping to Health, Global Health Aging reviewed the impact of NGO’s working on health including the effect of global health volunteering. Such efforts look very different in the Lions Club of Nepal – a club established by the service membership organization Lions Clubs International – where medical volunteers are Nepali citizens.

Overall, some questions were not addressed in the documentary. It was unclear if there was adequate follow-up care to prevent infection. And while Manisari and Duraga had no complications, both would have been virtually unreachable if they needed medical attention after they returned home. Cataract surgeries have a positive health impact due to their low complication rate and high degree of efficacy. It is not clear, however, that this model would translate for more risky procedures. In the end, Open Your Eyes does not discuss the challenges of bringing medical care to rural areas. Instead, it makes a compelling case for older adults as valued members of society who deserve quality care. Check out the trailer!

 

Grace Mandel is a project manager for the Baltimore Fall Reduction Initiative Engaging Neighborhoods and Data (B’FRIEND) at the Baltimore City Department of Health.

One Child: The Story of China’s Most Radical Experiment

One Child: The Story of China’s Most Radical Experiment by Mei Fong presents a compelling analysis of the impact of China’s “One-Child Policy” on older adults. The one-child policy, a compelling story of population control for economic growth, has long term implications that are only now apparent. Fong describes the challenges of a rapidly aging population as she focuses on families who are struggling to care for older adults, and those who have no children to care for them in old age.

Published November 2015

One of the book’s most gripping stories is of parents during the 2008 Sichun earthquake. According to official reports, “eight thousand families lost their only children in the disaster.” (p.3) These parents, and other parents who have lost their only children, face barriers in accessing nursing homes, health care, and burial plots. Fong notes, “they are also more financially vulnerable than ordinary retirees, and more prone to depression, studies show.” (p. 41) While these challenges are tangible, the emotional challenges of losing support systems in old age is also a prominent problem. Fong addresses the growth of China’s hospice industry, stating that many older adults without family feel unable to contribute to society. (p.151)

The book also digs into the cultural complexities in aging and filial obligation. In one notable story, that received national acclaim in china, Liu Ting brought his mother with him to college, when she was too ill to care for herself. His mother suffered from kidney disease and uremia. Although Ting received fame and attention, his job opportunities after college were limited at the expense and time required to properly care for his mother. (p. 92)

While Fong discusses other implications of China’s one-child policy such as rise in adoptions, increase in bride prices to compensate for the greater number of men than women, and the further consequences of sex-selective abortions, the primary implications of the policy relate to the care and treatment of older adults. With only one child per two aging parents, the traditional way of caring for Chinese parents will cause economic slow down, and place burdens on the younger generation.

Fong is at the forefront of a wave of journalism that will detail the challenges of aging in China. She acknowledged that it could be difficult to find many children who were burdened by caring for aging parents, as more parents of children from this time period are in their 50’s and 60’s (p. 86) However, her book is at the forefront of a problem that will only become more prominent in the coming decades.

Grace Mandel is pursuing a Master of Public Health in Health Systems and Policy at the Johns Hopkins University Bloomberg School of Public Health.

Japan Confronts Crime Wave With Aging Population

“It wasn’t great to get caught, but I just didn’t give a damn…” Fumio Kageyama

A crime wave among older people is underway in the world’s greyest nation. Just last year in Japan, the number of criminals over 65 overtook the number of teenage criminals for the first time since the country started publishing age-related crime statistics in 1989. Over a third of shoplifting crimes are committed by those over 60, and 40 percent are repeat offenders. Criminal offenses by those age 60 and over have also quadrupled between 1994 and 2014.

Photo Credit: Geoff Stearns
Photo Credit: Geoff Stearns

This curious phenomenon has its roots in the age-old problem of poverty and loneliness. Japan is an expensive place to live in, with even a frugal lifestyle costing 25 percent higher than the basic state pension. The cost of living simply does not match the pension rates of the elderly. Hence older people are committing crimes that result in imprisonment but assure them of food, shelter and healthcare. Loneliness is another factor that encourages crime among older people. About 40 percent of the elderly population live alone. Once released from prison, many do not have access to money, food or shelter, which perpetuates the vicious cycle of crime.

The rise in elderly crime is set against the gloomy national economy of the country. ‘Abenomics’ is a set of economic policies that are currently in place to revive Japan’s stagnant economy, and provide much-needed context to this crime wave. The impetus for these economic policies has been the two decade long stagnant national economy. Japan’s stock market and property bubble burst in the early 1990s, leading to long-term stagnant wages and markedly reduced spending. For the past two decades, the country has not seen any major economic improvement. Worsening the situation were the nuclear meltdown and natural disasters of 2011. Now Japan is caught between reducing the national debt and dealing with roughly 30 percent pensioner population.

‘Abenomics’ is a three-pronged strategy, encouraging monetary easing, government spending, and business deregulation. So far, critics remain unconvinced about the impact of these regulations, and current crime cases reiterate the ineffectiveness of these policies regarding the elderly population. The Japanese government has responded to the crime wave among older people with a short-sighted measure to increase prison capacity by a whopping 70 percent. This does little to address the crime spree that is embedded in poverty and lack of economic security. Furthermore, it takes a huge amount of resources to maintain a prison full of pensioners. A 2-year prison sentence can cost as much as USD 74,700 in a Japanese prison, compared to USD 6,900 on pension annually.

Inmates with health problems can even increase prison costs. In fact, a 2012 Justice Ministry report found that two-thirds of inmates had at least one health condition, including cardiovascular diseases, mental health illnesses, and behavioral disorders. This has resulted in prison guards often going above their disciplinary duties by changing diapers, cleaning inmates and helping them to walk. Japan can respond with long-term measures, such as prison reform, to prevent prisons from turning into dysfunctional nursing homes.

Namratha Rao recently graduated with a Master of Science in Public Health in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.

The Not-so-Novel Concept of Elderly Homes in Asia

Photo Credit: elvisinchina
Photo Credit: elvisinchina

Old age homes are no longer a taboo! The waiting lists of nursing homes in Korea are at three times their capacity and the number of elder care homes in Nanjing, China has increased from 27 in 1990 and 52 in 2000 to 148 in 2009!

In Asia, people are seeing a shift in the traditional roles for elderly care. Changes in family structure, urbanization, and other factors of contemporary lifestyles often compel older members to seek care outside of the family. Elderly residential facilities, such as old age homes, retirement villages, and other forms of institutionalized care for the elderly, have become increasingly popular in Asia. Given the high demand for such facilities, there is a need to monitor its growth and the quality of care provided.

Thailand, Malaysia, and Sri Lanka are among the Asian countries that offer renewable visas to older expatriates. Private companies and developers in India and Malaysia are investing in senior citizen villages and assisted living infrastructure such as temples, spas and golf courses to attract the wealthy older population. There are some financially well-off older adults who choose to retire in such elderly villages. However, not many can afford this kind of lifestyle.

Two cross-sectional studies from India surveyed elderly residents of old-age homes to understand their reasons for opting to live in one. It is interesting to note that poor health was not cited as a reason explicitly. The cross-sectional study in Madhya Pradesh, India reported that the top reasons for the elderly to opt for old age homes are because there was no one to look after them (68.2 percent), they did not have a place to live (56.4 percent) and to meet like-minded people (53.8 percent). The other cross-sectional study in Uttar Pradesh, India found that the two most common reasons were misbehavior by son and/or daughter-in-law (29.8 percent) and poverty (29.3 percent). This survey data hints that moving to an old age home was more a necessity than a voluntary life choice.

In addition to lifestyle changes, the surge in dementia and other health conditions among the elderly is driving the need for high quality care. Caring for such long-term conditions places huge emotional, physical and financial burdens on families. For instance, the symptoms of dementia can include hallucinations and depression which require swift and expert medical care. Many institutions are hence better able and equipped to provide timely care and rehabilitation.

Asian countries can learn a lot from studying trends in elderly residential facilities in developed nations of the Western world. A study in the UK reported that the overall standard of care in both nursing and residential homes was highly deficient when judging against quality indicators. This study serves as a warning to the rapidly aging countries in Asia: Provide adequate regulation to ensure a high standard of quality care in elderly residential facilities.

Namratha Rao recently graduated with a MSPH in Social and Behavioral Interventions from the Johns Hopkins University Bloomberg School of Public Health.

Elderly Refugees: The Experiences of Cambodian populations under the Khmer Rouge

Photo Credit: Extraordinary Chambers in the Courts of Cambodia
Photo Credit: Extraordinary Chambers in the Courts of Cambodia

War, natural disaster and fear of persecution often result in the tragic displacement of people far away from their homes. These people, refugees, live in uncertainty and under significant psychological and physical stress. Among these refugees are the elderly who are a particularly vulnerable group. Aging is not limited to disease and disability, but also the sudden change and a loss of belonging. The experiences of Cambodian elderly refugee populations is a clear example.

The Khmer Rouge took over Cambodia in the 1970s, prompting several years of genocide and a mass exodus of Cambodians into Thailand, US and other countries. By 1979, there were 160,000 Cambodians in refugee camps in Thailand.

A 10 year study sought to capture the experiences of Cambodian Americans in Northern California. Most Cambodian Americans lived in run down neighborhoods with a high prevalence of criminal activity. Elderly immigrants were at high risk of occupying poor housing conditions. Despite this fact, some refugees chose to move back into inner city neighborhoods as they aged to be a part of the community they once were as recent immigrants. In the case of this refugee population, many elderly people did not want to return to Cambodia given the turmoil which influenced their flight. Of those who did, they were constantly reminded of the differences in living conditions between the two countries.

Many Cambodian refugees in the US had poor education. With low income and little to non-existent English skills, elderly refugees constantly needed support from other immigrant populations, their children, and resources from the government. One woman says, “At my age, I’ve nothing to do, but pray for my children. I know that now I am their pillar, but later when they all grow up and leave, I will be alone with only myself to rely on.”

The past experiences with the hardships of the Khmer Rouge are constantly woven into their current narratives. For instance, many elderly complain of diseases such as high blood pressure or sleeplessness, and attribute such ailments to the harsh lives under the the Khmer regime. Post-traumatic stress disorder and depression are also common among Cambodian refugees. According to one study, family-related anger is prevalent among refugee families because of the cultural gap between refugees and the general population, as well as between refugees and their children who are much better adjusted to American lifestyle.

There are many organizations working towards improving the lives of elderly immigrants. The International Rescue Committee (IRC), one of the world’s leading organizations for refugees, has an Elderly Refugee Program. This program provides English as a Second Language classes, and assists in part-time employment and obtaining citizenship.

Yet the question remains – What can be done about the sense of loss of loved ones, one’s home, country and citizenship?

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.

India is Diabetes Capital of the World

Photo Credit: Pixabay
Photo Credit: Pixabay

P Pushpam, a resident of Chennai, India, was denied her job appointment with the Indian Railways on the grounds that she was a chronic diabetic. The court ruled in her favor and pointed out the impracticality of discriminating against people suffering from diabetes in a country that has over 40 million diabetics.

As India makes its demographic transition toward lower birth rates and higher life expectancy, the prevalence of non-communicable diseases is on the rise. India is the “Diabetes Capital of the World” with over 60 million diabetics in the country, that is projected to at least double by 2030. The country ranks second, between China with 90 million and USA with 24 million diabetics. About 17% of the country has diabetes and about 77 million are considered to be pre-diabetic, which refers to those individuals who have higher than normal blood glucose levels, but not high enough to categorize them as diabetic.

Disability-adjusted life years (DALYs) is a measure of the burden of a specific disease in a population. A study shows that the DALYs attributed to communicable diseases in India such as malaria and TB will decrease. However, the DALYs associated with diabetes and other non-communicable diseases will increase. When compared to China, another country with a large and rapidly aging population, one sees a decrease in the DALYs for both communicable and non-communicable diseases.

Smoking, poor physical activity and alcohol use are some pertinent risk factors of diabetes in India. A survey revealed that close to 40% of Indian men are daily smokers and approximately 18% of the study respondents had poor physical activity levels. The survey also suggested that in addition to these individual level risk factors, environmental factors, specifically indoor air pollution contributes to the increasing prevalence of diabetes. The incidence of solid fuel use, contributing to air pollution in India is 83.5%. An urban lifestyle, and increasing strength of the food, fertilizer, pharmaceutical and beverage industries in the past decades, also contributes to a higher prevalence of diabetes.

A major obstacle to diabetes in elderly health is the lack of awareness of one’s status. A study in the urban slum of New Delhi reported that only 36% of their respondents were aware of their diabetic status. Low awareness among the elderly is linked with difficulties in screening, diagnosis and treatment abilities. Elderly patients tend to have lower mobility and are more likely to be dependent on their family members, delaying their ability to seek care.

The increasing prevalence of diabetes management among the elderly places a huge burden on the Indian health care system. While lifestyle modification is the most cost-effective solution to this growing epidemic, a more intense plan of management and care for elderly diabetics is needed.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.