Anemia Among Older Adults in India: A Comprehensive Assessment from LASI-DAD’s Latest Wave
Anemia, a chronic health condition characterized by decreased hemoglobin levels, continues to be a formidable public health challenge worldwide, with particularly pronounced effects on older populations. Recent findings from wave 2 of the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) have shed new light on the complex epidemiology of anemia among India’s aging demographic. This large-scale investigation offers unprecedented insights into not only the prevalence but also the multifactorial causes of anemia in older Indian adults, integrating demographic, biochemical, and clinical data to paint a comprehensive picture.
India’s aging population is growing at a rapid pace, intensifying concerns over age-related morbidities including anemia, which is often overlooked despite its profound health implications. Anemia in older adults can exacerbate frailty, impair cognitive function, reduce physical performance, and increase mortality risk. With the projected demographic shifts, understanding the burden and etiological factors of anemia among elderly Indians is more urgent than ever. The LASI-DAD wave 2 study employs sophisticated diagnostic protocols harmonized with international standards, enabling cross-cultural comparability while addressing India-specific variables such as nutritional deficiencies, infectious diseases, and socio-economic factors.
The study identifies that anemia prevalence among older Indians remains alarmingly high, indicating persistent gaps in public health interventions. Data from LASI-DAD wave 2 reveal that a significant proportion of individuals aged 60 and above exhibit hemoglobin levels below the World Health Organization’s threshold for anemia. This prevalence was consistent across both rural and urban settings, though with notable variations influenced by regional dietary patterns, access to healthcare, and prevalence of comorbidities such as chronic kidney disease and inflammatory disorders.
Diving into the causes, the research disaggregates anemia into its primary etiological categories: nutritional deficiencies, chronic diseases, and unexplained anemia linked to aging physiology. Nutritional anemia, particularly iron deficiency, emerges prominently, correlating strongly with socio-economic status and dietary insufficiencies, especially in populations with limited protein and micronutrient intake. Additionally, deficiencies in vitamin B12 and folate were documented, underscoring the multifaceted nutritional challenges faced by older adults in India’s diverse dietary landscape.
Chronic disease-associated anemia also figures prominently in this cohort. The inflammatory milieu generated by chronic infections like tuberculosis, alongside non-communicable diseases such as diabetes mellitus and chronic kidney disease, contributes to anemia of chronic disease (ACD). The LASI-DAD wave 2 data robustly illustrate the interplay of persistent inflammation and impaired erythropoiesis, which complicates anemia management in aging individuals. Importantly, the presence of comorbid conditions was a predictor of more severe anemia, highlighting the need for integrative care models.
Another critical dimension uncovered involves ‘unexplained anemia,’ a category that encompasses anemia linked to aging-related hematopoietic decline and possible subclinical pathologies. This entity necessitates advanced clinical evaluation and presents a diagnostic challenge, as it may mask early stages of myelodysplastic syndromes or marrow dysfunction. The research’s sophisticated biochemical profiling and comprehensive clinical assessment protocols have facilitated identification of this subset, encouraging future studies to unravel underlying mechanisms.
Spatial disparities in anemia prevalence were also examined, revealing higher burdens in socio-economically vulnerable states, underscoring social determinants of health. The data emphasize the intersectionality of poverty, education, healthcare access, and nutritional status, which compound anemia risk. This geographic variation demands policy responses tailored to regional needs, incorporating community-based nutritional programs and robust screening initiatives.
With respect to gender, the study finds a nuanced panorama. While anemia is generally more prevalent among females due to physiological factors, in older adults, this gender gap narrows but does not disappear. Postmenopausal biological changes, coupled with differential health service utilization, may contribute to this shift. Moreover, the data suggest that older women with anemia are at elevated risk of functional impairments and worse quality of life, signifying the imperative for gender-sensitive healthcare approaches.
The study’s methodological rigor is noteworthy, leveraging harmonized diagnostic tools across multiple biomarker assays, cognitive and functional assessments, and detailed questionnaires on lifestyle factors. This comprehensive multi-domain dataset enables robust causal inference and supports stratification by age, sex, residence, and health status, providing a granular epidemiological understanding essential for precision public health interventions.
Beyond prevalence and etiology, the research discusses the broader socio-economic consequences of anemia in older adults, linking it to increased healthcare utilization, diminished productivity, and greater dependency. This amplifies the economic burden at both household and national levels, creating a vicious cycle of poverty and poor health. Therefore, anemia control emerges not only as a medical imperative but also an economic strategy integral to the well-being of India’s aging society.
The study closes with a call to action, advocating for integrated public health policies that incorporate regular anemia screening into geriatric health services, enhance nutritional support programs, and address underlying chronic conditions comprehensively. It highlights the potential of community health workers in improving awareness and compliance with treatment, and stresses the need for multisectoral collaboration involving nutrition, healthcare, and social welfare sectors.
In conclusion, the findings from LASI-DAD wave 2 substantially advance our understanding of anemia among older adults in India, emphasizing that tackling this condition requires a multifaceted approach. Addressing nutritional deficits, managing chronic diseases, and recognizing social determinants are pivotal steps toward improving health outcomes in this vulnerable population. The study not only has direct implications for clinical practice but also presents critical evidence for policymakers aiming to reduce anemia’s burden and enhance healthy aging across the country.
Future research is encouraged to delve deeper into the molecular mechanisms underpinning unexplained anemia and to evaluate the efficacy of targeted interventions in various Indian contexts. Longitudinal analyses from subsequent LASI-DAD waves will be invaluable for tracking anemia progression and outcomes, optimizing resource allocation, and refining public health strategies tailored to India’s heterogeneous elderly population.
This landmark study, published in the International Journal for Equity in Health, establishes a foundation from which India can build effective, equitable, and sustainable anemia control programs, ultimately ensuring improved longevity and quality of life for its older citizens as they navigate the challenges of aging.
Subject of Research: Prevalence and causes of anemia among older adults in India
Article Title: Prevalence and causes of anemia among older adults in India: findings from wave 2 of the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD)
Article References:
Dhankhar, A., Khobragade, P., Chopra, G. et al. Prevalence and causes of anemia among older adults in India: findings from wave 2 of the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD). Int J Equity Health 24, 315 (2025). https://doi.org/10.1186/s12939-025-02671-4
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