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Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators

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Abstract

Background

While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment.

Methods

Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson–Holm–Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions.

Results

The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment.

Conclusions

Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.

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Data availability

The study uses secondary data which is available at the Gateway to Global Aging Data (www.g2aging.org).

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Acknowledgements

The Longitudinal Aging Study in India Project is funded by the Ministry of Health and Family Welfare, Government of India, the National Institute on Aging (R01 AG042778, R01 AG030153), and United Nations Population Fund, India.

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Authors and Affiliations

  1. Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India

    T. Muhammad

  2. Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA

    Manacy Pai

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Conceived and designed the research paper: MP and TM, analyzed the data: TM, Wrote the manuscript: MP, Refined the manuscript: MP and TM. Both the authors reviewed, read and approved the manuscript.

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Correspondence to T. Muhammad.

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Ethics approval was obtained from the Central Ethics Committee on Human Research (CECHR) under the Indian Council of Medical Research (ICMR). And all methods were carried out in accordance with the relevant guidelines and regulations of ICMR.

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The survey agencies that conducted the field survey for the data collection have collected prior informed consent (signed and oral) for both the interviews and biomarker tests from the eligible respondents in accordance with Human Subjects Protection. Informed consent was obtained from all subjects and/or their legal guardian(s).

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Muhammad, T., Pai, M. Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators. Aging Clin Exp Res 35, 2517–2530 (2023). https://doi.org/10.1007/s40520-023-02531-7

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  • DOI: https://doi.org/10.1007/s40520-023-02531-7

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