In recent years, the unprecedented rise in global life expectancy coupled with declining fertility rates has precipitated a demographic shift towards an aging population. This demographic transformation poses formidable challenges for public health systems worldwide, particularly in developing countries such as India, where social and economic infrastructures remain under strain. One of the most pressing concerns in this context is the increased prevalence of cognitive impairments among the elderly. However, the complexities surrounding cognitive decline, especially through the lens of gender differentials, remain insufficiently explored and understood. Addressing this scientific gap, a groundbreaking study leveraging extensive data from the Longitudinal Ageing Study in India (LASI) 2017–2018, sheds new light on the underpinnings of gender disparities in cognitive impairment among Indian older adults.
The study meticulously examines cognitive impairment among 31,464 Indian adults aged 60 and above, stratifying the dataset into 15,098 males and 16,366 females. Employing the Harmonized Cognitive Assessment Protocol (HCAP), a comprehensive tool evaluating five distinct cognitive domains—memory, orientation, arithmetic function, executive function, and object naming—the researchers sought to construct a nuanced understanding of cognitive deficits. The utilization of HCAP is particularly noteworthy; by incorporating various facets of cognition, it offers a multidimensional assessment that transcends traditional screening methods, thereby capturing subtle gradations in cognitive function critical for early intervention.
Delving into the analytic approach, the researchers deployed a multivariate decomposition analysis using STATA 17 software. This advanced statistical technique enables dissection of the observed gender gap in cognitive impairment into constituent parts, distinguishing how much is explained by differences in population composition (such as socio-demographic characteristics) and how much stems from differential effects of these characteristics on men and women. This methodological choice is sophisticated, reflecting a commitment to unraveling not just the presence of disparities but the mechanisms fueling them.
The findings are striking: cognitive impairment prevalence among females stood at 19.8%, nearly triple that of males, who registered at 6.4%. This marked disparity attains profound significance when considering p-values well below 0.001, underscoring the robustness of these gender-related differences. Further stratification revealed even wider gaps within subpopulations—particularly the oldest-old (those aged 80 and above), widowed individuals, those with no formal education, and elderly persons living alone. These subgroup analyses illuminate the intersectionality of gender with other social determinants, accentuating vulnerability patterns that demand tailored public health responses.
Further insights emerge from the decomposition analysis, which attributes a substantial 62% of the cognitive impairment gender gap to compositional differences. Chief among these is education, which alone accounts for 42% of the disparity, followed by marital status at 6%, working status at 6%, difficulties in instrumental activities of daily living (IADLs) at 3%, and physical activity levels at 2%. This quantification delineates education as a pivotal determinant in cognitive health, highlighting its far-reaching influence beyond conventional economic or social domains into neurological outcomes. The remaining 38% of the disparity, attributed to differing impacts of these factors on men and women, suggests gendered biology or psychosocial mechanisms may modulate risk in ways not solely captured by demographic variables.
These revelations carry substantial implications for policy and intervention strategies. Gender disparities in education, a lingering legacy in many parts of India, evidently translate into significantly higher cognitive decline risk among older women. Addressing these educational inequalities could thus constitute a pivotal preventive measure, with potential ripple effects extending into improved cognitive resilience in aging populations. Moreover, marital status and social support emerge as crucial modifiers, indicating that psychosocial interventions designed to reduce isolation, especially among widowed women, could mitigate cognitive impairment trajectories.
The observed impact of working status on cognitive outcomes adds an important occupational health perspective to the discourse. Engagement in work, often linked with social interaction, cognitive stimulation, and financial autonomy, appears protective. This facet is particularly germane for women in India, where labor force participation remains lower compared to men, thereby potentially exacerbating vulnerabilities related to cognitive health. Encouraging and facilitating continued productive engagement among older women could therefore be a strategic avenue for cognitive preservation.
Instrumental activities of daily living (IADLs)—which include tasks like managing finances, medication adherence, and use of transportation—serve as proxies for functional independence. The identified gender differences in difficulty performing IADLs point to a reciprocal relationship between cognitive decline and loss of autonomy, especially among women, who may already face compounded social disadvantages. Integrating functional assessments into routine geriatric care and designing rehabilitative strategies to maintain independence could thus be critical.
Physical activity, albeit contributing a smaller fraction (2%) to explained disparities, remains an essential modifiable factor. Evidence from gerontology underscores its benefits in preserving neuroplasticity and delaying cognitive deterioration. Promoting gender-sensitive physical activity programs tailored for older adults—cognizant of cultural and environmental constraints experienced by Indian women—can enhance cognitive outcomes.
The study’s conclusions emphasize that cognitive impairments are considerably more pronounced in elderly Indian women compared to their male counterparts. These findings compel the public health sphere to prioritize gender-responsive interventions aimed at bridging educational gaps and enhancing social and health support mechanisms. Such targeted strategies could substantially reduce the burden of cognitive impairments, improve quality of life for older adults, and alleviate systemic healthcare pressures in the long term.
The innovative use of decomposition methods also highlights the necessity for future research to unpack the multifactorial causality inherent in cognitive gender disparities. Longitudinal studies following cohorts over time could elucidate causal pathways and intervention points more definitively. Moreover, integrating biological markers with socio-demographic data could clarify the extent to which genetic, hormonal, or psychosocial factors contribute to the unexplained 38% of gender differences.
From a broader perspective, this study contributes to a global discourse on aging and cognitive health, underscoring the indispensable role of context-specific data in shaping effective strategies. In India, where the demographic transition portends a demographic explosion of older adults in coming decades, ensuring equitable cognitive healthcare is both a scientific and moral imperative. Policymakers must leverage such rigorous evidence to design inclusive programs that transcend mere healthcare provision, encompassing educational reform, social welfare, and economic empowerment.
In summary, this extensive examination of gender disparities in cognitive impairment among older adults in India harnesses robust longitudinal data and advanced analytic techniques to delineate the social determinants of cognitive health. By identifying education and social factors as critical levers, the research sets a foundation for deconstructing entrenched gender inequalities in health outcomes. As the global community grapples with an aging population, such insights are invaluable in steering efforts towards healthier, more equitable aging societies.
Subject of Research: Gender differences in cognitive impairment among older adults in India
Article Title: Multivariate decomposition of gender differentials in cognitive impairment among older adults in India based on Longitudinal Ageing Study in India, 2017–2018
Article References: Sharma, M., Goswami, I. Multivariate decomposition of gender differentials in cognitive impairment among older adults in India based on Longitudinal Ageing Study in India, 2017–2018. BMC Psychiatry 25, 385 (2025). https://doi.org/10.1186/s12888-025-06811-6
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