Social and physical environment effects on toileting disability among older adults in India

TL;DR

This study explores how social and physical environments affect toileting disability in older adults in India, finding that factors like low neighborhood trust and lack of accessible toilets increase disability risks.

Contribution

The study introduces a holistic framework linking social and physical environmental factors to toileting disability in older adults in India.

Findings

One in five older Indian adults experience toileting disability, with regional variations.

Low neighborhood trust and lack of accessible toilets are strongly associated with increased toileting disability.

Urban older adults without private toilets face higher odds of toileting disability.

Abstract

To examine the prevalence of toileting disability among older adults in India and its association with broad aspects of the physical and social environment.

We use data from the inaugural wave of the Longitudinal Ageing Study in India and focus on adults aged 65 and older (N = 20,789). We draw on the disablement process model and existing frameworks to identify environmental factors and other risk factors that may be associated with toileting disability. Hierarchical logistic regressions are implemented to analyze the health impacts from physical and social environment characteristics.

One in five older Indian adults had difficulties with toileting, and the prevalence rate of this functional disability varied across sub-national regions. We find that low neighborhood trust was associated with an increased likelihood of toileting disability, as was the use of assistive mobility devices. The negative effects of these social and external environment characteristics hold when we stratified the sample by rural and urban residency. Also, older adults in urban areas without access to toilets and using shared latrines had higher odds of being disabled in terms of toileting. Other factors important in explaining toileting disability among older adults included poor self-rated health, arthritis, currently working, living in the East or West region, and having functional limitations.

Poor person-environment fit can compromise older adults’ ability to perform self-care tasks. Policymakers need to look beyond the physical environment (e.g., dedicating resources to construct toilet facilities) to adopt a more holistic, multi-faceted approach in their sanitation policies. Improving the safety of neighborhood surroundings in which shared latrines are located and the availability of accessible toilets that cater to those with mobility impairments can help improve independence in toileting among older adults.

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