This study investigates state-specific frailty risks and common predictors among older adults in India, using data from the Longitudinal Ageing Study in India (LASI) wave 1, comprising 27,540 individuals aged 60 and above. By integrating ecological systems theory framework with innovative Bayesian spatial modeling, the methodology incorporates a holistic approach. The findings identify Telangana (RR1.382, 95%CI1.246–1.524), West Bengal (RR1.369, 95%CI1.249–1.482), Sikkim (RR1.286, 95%CI1.075–1.516), and Kerala (RR1.236, 95%CI1.109–1.356) as states with significantly higher frailty risks. Key predictors include living alone (RR5.76, 95%CI5.472–5.969), a history of falls (RR2.55, 95%CI2.501–2.592), and experiences of everyday discrimination (RR2.12, 95%CI 2.048–2.141). These results emphasize the critical need for state-specific interventions that account for the complex interactions of micro, meso, and macro-level determinants. The study advocates for the development of tailored strategies, highlighting the limitations of a one-size-fits-all approach in addressing frailty within India’s heterogeneous aging population.
AdhikariT.YadavJ.TolaniH.TripathiN.KaurH.RaoM. V. V. (2022). Spatio-temporal modeling for malnutrition in tribal population among states of India a Bayesian approach. Spatial and Spatio-temporal. Epidemiology, 40, 100459. https://doi.org/10.1016/j.sste.2021.100459
2.
BiritwumR. B.MinicuciN.YawsonA. E.TheouO.MensahG. P.NaidooN.WuF.GuoY.ZhengY.JiangY.MaximovaT.KalulaS.ArokiasamyP.Salinas-RodríguezA.Manrique-EspinozaB.SnodgrassJ. J.SternerK. N.EickG.LiebertM. A.WHO Sage Collaboration. (2016). Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas, 91, 8–18. https://doi.org/10.1016/j.maturitas.2016.05.012
3.
BramhankarM.KunduS.PandeyM.MishraN. L.AdarshA. (2023). An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India. Scientific Reports, 13(1), 9117. https://doi.org/10.1038/s41598-023-36041-3
4.
Bronfenbrenner. (1979). The ecology of human development: Experiments by nature and design. Encyclopedia of Quality of Life and Well-Being Research. Epub ahead of print 1979.
5.
ChaudharyM. (2018). Association of food insecurity with frailty among older adults in India. Journal of Public Health, 26(3), 321–330. https://doi.org/10.1007/s10389-017-0866-4
6.
ChaudharyM.ArokiasamyP. (2019). Patterns of frailty and quality of life among older adults: Comparative analysis using Sage states of India. Journal of Population Ageing, 12, 1–23. https://doi.org/10.1007/s12062-017-9201-7
7.
ChauhanS.KumarS.BhartiR.PatelR. (2022). Prevalence and determinants of activity of daily living and instrumental activity of daily living among elderly in India. BMC Geriatrics, 22(1), 64. https://doi.org/10.1186/s12877-021-02659-z
8.
da Cunha LemeD. E. (2021). The use of Bayesian network models to identify factors related to frailty phenotype and health outcomes in middle-aged and older persons. Archives of Gerontology and Geriatrics, 92, 104212. https://doi.org/10.1016/j.archger.2020.104212
9.
DasS. (2022). Cognitive frailty among community-dwelling rural elderly population of West Bengal in India. Asian Journal of Psychiatry, 70, 103025. https://doi.org/10.1016/j.ajp.2022.103025
DasS.PooleyE.HollandC. (2024). A holistic approach to cognitive frailty in community- dwelling older adults in India: Evidence from a nationally representative survey. medRxiv. Epub ahead of print 2024. https://doi.org/10.1101/2024.03.19.24304523
12.
DasS.PrasadJ. (2023). Gender differences in determinants of the components of the frailty phenotype among older adults in India: Findings from LASI wave-1. International Journal of Environmental Research and Public Health, 20(4), 3055. https://doi.org/10.3390/ijerph20043055
13.
DasT.GuhaP. (2024). The puzzle of public health expenditure and healthcare infrastructure in India: An empirical investigation. Regional Science Policy & Practice, 16(2), Article 12710. https://doi.org/10.1111/rsp3.12710
14.
DasguptaA.BandyopadhyayS.BandyopadhyayL.RoyS.PaulB.MandalS. (2019). How frail are our elderly? An assessment with Tilburg frailty indicator (TFI) in a rural elderly population of West Bengal. Journal of Family Medicine and Primary Care, 8(7), 2242–2248. https://doi.org/10.4103/jfmpc.jfmpc_445_19
FriedL. P.FerrucciL.DarerJ.WilliamsonJ. D.AndersonG. (2009). Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 59(3), 255–263. https://doi.org/10.1093/gerona/59.3.m255
17.
FriedL. P.TangenC. M.WalstonJ.NewmanA. B.HirschC.GottdienerJ.SeemanT.TracyR.KopW. J.BurkeG.McBurnieM. A.Cardiovascular Health Study Collaborative Research Group. (2001). Frailty in older adults: Evidence for a phenotype. The journals of gerontology. Series A, Biological sciences and medical sciences, 56(3), M146–M156. https://doi.org/10.1093/gerona/56.3.m146
18.
GhoshA.KunduM.DevasenapathyN.WoodwardM.JhaV. (2023). Frailty among middle-aged and older women and men in India: Findings from wave 1 of the longitudinal ageing study in India. BMJ Open, 13(7), Article e071842. https://doi.org/10.1136/bmjopen-2023-071842
19.
González-PichardoA. M.Navarrete-ReyesA. P.Adame-EncarnaciónH. (2014). Association between self–reported health status and frailty in community–dwelling elderly. Journal of Frailty & Aging. Epub ahead of print 2014. https://doi.org/10.14283/jfa.2014.9
20.
GuptaS.DebnathA.YadavA. (2025). Nationwide insights into frailty: Systematic review and meta-analysis of community-based prevalence studies from India. The Journal of Frailty & Aging, 14(2), 100032. https://doi.org/10.1016/j.tjfa.2025.100032
21.
HarttgenK.KowalP.StrulikH.ChatterjiS.VollmerS. (2013). Patterns of frailty in older adults: Comparing results from higher and lower income countries using the survey of health, ageing and retirement in europe (SHARE) and the study on global AGEing and adult health (Sage). PLoS One, 8(10), Article e75847. https://doi.org/10.1371/journal.pone.0075847
IrshadC.GovilD.SahooH. (2024). Social frailty among older adults in India: Findings from the longitudinal ageing study in India (LASI)–Wave 1. Experimental Aging Research, 50(3), 331–347. https://doi.org/10.1080/0361073X.2023.2195291
24.
JesteD. V. (2019). Frailty and mental health: Association with cognition, sleep, and well-being in older adults. International Psychogeriatrics, 31(6), 755–757. https://doi.org/10.1017/S1041610219000863
25.
KashikarY.NagarkarA. (2012). Prevalence and determinants of frailty in older adults in India. Indian Journal of Gerontology, 9(3), 365–381. http://gerontologyindia.com/pdf/Vol-30-3.pdf.
26.
KojimaG.LiljasA. E. M.IliffeS. (2019). Frailty syndrome: Implications and challenges for health care policy. Risk Management and Healthcare Policy, 14(12), 22–30. https://doi.org/10.2147/RMHP.S168750
27.
KojimaG.TaniguchiY.KitamuraA.FujiwaraY. (2020). Is living alone a risk factor of frailty? A systematic review and meta-analysis. Ageing Research Reviews, 59, 101048. https://doi.org/10.1016/j.arr.2020.101048.
28.
KshatriJ. S.PaloS. K.BhoiT.BarikS. R.PatiS. (2020). Associations of multimorbidity on frailty and dependence among an elderly rural population: Findings from the AHSETS study. Mechanism of Ageing and Development, 192, 111384. https://doi.org/10.1016/j.mad.2020.111384
29.
MajumderS.RoyS.BoseA.ChowdhuryI. R. (2023). Understanding regional disparities in healthcare quality and accessibility in West Bengal, India: A multivariate analysis. Regional Science Policy & Practice, 15(5), 1086–1114. https://doi.org/10.1111/rsp3.12607
30.
MarmamulaS.ModepalliS. B.KumbhamT. R.ChallaR.KeeffeJ. E. (2021). Prevalence of disabilities and non-communicable diseases in an elderly population in the Telangana state, India: A population-based cross-sectional study. BMJ Open, 11(2), e041755. https://doi.org/10.1136/bmjopen-2020-041755.
31.
MauryaP.SharmaP.MuhammadT. (2022). Prevalence and correlates of perceived age-related discrimination among older adults in India. BMC Public Health, 22(1), 561. https://doi.org/10.1186/s12889-022-13002-5
32.
MeratwalG.BanseriaR.KhannaM.KumarA. (2023). Prevalence and factors associated with frailty among elderly in central Rajasthan: A cross-sectional study. Clinical Epidemiology and Global Health, 20, 101215. https://doi.org/10.1016/j.cegh.2023.101215
33.
Montero-OdassoM.Van Der VeldeN.MartinF. C. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), afac205. https://doi.org/10.1093/ageing/afac205.
34.
O’CaoimhR.SezginD.O’DonovanM. R. (2021). Prevalence of frailty in 62 countries across the world: A systematic review and meta-analysis of population-level studies. Age and Ageing, 50(1), 96–104. https://doi.org/10.1093/ageing/afaa219
35.
PaiM.MuhammadT.DasS.ChaudharyM.SrivastavaS. (2023). Gender differences in the association between physical frailty and life satisfaction among older adults in India. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 23(6), 930–943. https://doi.org/10.1111/psyg.13014
36.
PengY.ZhongG. C.ZhouX.GuanL.ZhouL. (2022). Frailty and risks of all-cause and cause-specific death in community-dwelling adults: A systematic review and meta-analysis. BMC Geriatrics, 22(1), 725. https://doi.org/10.1186/s12877-022-03404-w
37.
PengpidS.PeltzerK. (2021). Associations of loneliness with poor physical health, poor mental health and health risk behaviours among a nationally representative community-dwelling sample of middle-aged and older adults in India. International Journal of Geriatric Psychiatry, 36(11), 1722–1731. https://doi.org/10.1002/gps.5592
38.
PlaisierI.Verbeek-OudijkD.de KlerkM. (2017). Developments in home-care use. Policy and changing community-based care use by independent community-dwelling adults in The Netherlands. Health Policy, 121(1), 82–89. https://doi.org/10.1016/j.healthpol.2016.11.006
39.
RanaG. S.ShuklaA.MustafaA.BramhankarM.RaiB.PandeyM.MishraN. L. (2022). Association of multi-morbidity, social participation, functional and mental health with the self-rated health of middle-aged and older adults in India: A study based on LASI wave-1. BMC Geriatrics, 22(1), 675. https://doi.org/10.1186/s12877-022-03349-0
40.
SeligmanB.AgarwalA.BloomD. E. (2024). Frailty among older Indians: State-level factors. Journal of Population Ageing, 17(1), 149–163. https://doi.org/10.1007/s12062-023-09433-6
41.
ShilpaK.NormanG. (2022). Prevalence of frailty and its association with lifestyle factors among elderly in rural Bengaluru. Journal of Family Medicine and Primary Care, 11(5), 2083–2089. https://doi.org/10.4103/jfmpc.jfmpc_1679_21
42.
SinghS. K.JaiswalA. K.VermaM.Aditi. (2023). Is there a ubiquitous association between sleep disorder and frailty? Findings from LASI (2017–18). BMC Geriatrics, 23, 429. https://doi.org/10.1186/s12877-023-04148-x
43.
SinhaA.KerkettaS.GhosalS.KanungoS.LeeJ. T.PatiS. (2022). Multimorbidity and complex multimorbidity in India: Findings from the 2017–2018 longitudinal ageing study in India (LASI). International Journal of Environmental Research and Public Health, 19(15), 9091. https://doi.org/10.3390/ijerph19159091
44.
SiriwardhanaD. D.HardoonS.RaitG.WeerasingheM. C.WaltersK. R. (2018). Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open, 8(3), e018195. https://doi.org/10.1136/bmjopen-2017-018195
45.
SrivastavaS.MuhammadT. (2022). Socioeconomic vulnerability and frailty among community-dwelling older adults: Cross-sectional findings from longitudinal aging study in India, 2017–18. BMC Geriatrics, 22(1), 201. https://doi.org/10.1186/s12877-022-02891-1
46.
SrivastavaS.MuhammadT.SulaimanK. M.KumarM.SinghS. K. (2022). Types of household headship and associated life satisfaction among older adults in India: Findings from LASI survey, 2017–18. BMC Geriatrics, 22(1), 78. https://doi.org/10.1186/s12877-022-02772-7
47.
ThakkarS.MuhammadT.SrivastavaS. (2022). Cross-sectional associations of physical frailty with fall, multiple falls and fall-injury among older Indian adults: Findings from LASI, 2018. PLoS One, 17(8 August), Article e0272669. https://doi.org/10.1371/journal.pone.0272669
YuanY.LinS.HuangX.ZhengJ.HuangF.ZhuP. (2022). The identification and prediction of frailty based on Bayesian network analysis in a community-dwelling older population. BMC Geriatrics, 22(1), 847. https://doi.org/10.1186/s12877-022-03520-7
