Non-communicable diseases (NCDs) are one of the significant public health problems globally.¹ In India, NCDs pose leading health threat attributing for more than 60% of total fatalities. The key drivers are cardiovascular diseases (CVDs), cancer, chronic respiratory diseases, and diabetes.² NCDs are highly prevalent in adults over the age of 60, as aging process naturally contributes to cellular deterioration and the cumulative impact of lifestyle factors.²

World Health Organization (WHO) projects that, if timely interventions are not accomplished for the control of NCDs, the annual cumulative deaths toll due to NCDs will rise to 55 million by 2030.³ India is considered to be the home to the second largest number of aging populations globally. This population is projected to increase to 198 million in 2030. ³

To address the health care needs of a geriatric population, healthcare systems should move toward integrated health care models which combine primary health care services with social support. It needs expanding geriatric training for healthcare providers, fostering management of chronic diseases like lifestyle diseases, and adapting preventive health care to boost functional ability.⁴

It is essential to underline the fact that disease as well as disability are not elements of old age and assistance should be sought to counteract health problems. The existing research indicates that elder females' health is often neglected and commonly understudied, causing systemic discrepancies in diagnosis and management. Several health professionals conflate critical, manageable symptoms with "normal aging". Subsequently, elder women experience greater rates of chronic diseases, medication side effects, and inappropriate diagnoses.^5,6

Compared to men, women are more likely to live to more advanced age when infirmities and several health concerns are more common.⁷ Old females, particularly in rural regions, are not aware of their NCD related health problems and their complications. Additionally, they are involved in household responsibilities and do not give much consideration to their health.⁷

The present study was implemented to estimate the prevalence of common NCDs among aging women. The emerging data may assist health system and policy makers in effective implementation of NCD related interventions in communities. 

Study Design and Study Setting A cross-sectional study was implemented at rural field practice region of the respective institute. All registered females aged 60 years and above in year 2025 were included as study participants. The existing study was approved by Brij Niramaya Memorial Hospital and Research Center in Maharashtra, India (approval number: BMC/EC/479/2024). The written informed consent was obtained from the study participants. Sample Size and Sampling Procedures All 350 elder females (60 years and above) who had been registered at the respective institute in specified period were enrolled as study participants through complete enumeration sampling size method. Women with records of migration, death, terminal illness, any severe cognitive impairment and unwilling to participate were excluded from the study. It was also decided to exclude those females who were not available for the survey due to any reasons within three follow up visits. Data Collection The data collection was facilitated by trained investigators through face-to-face interview method. The interviews were performed through house-to-house visits and the information was gathered using structured, pre-validated questionnaire. The study participants were interviewed to gather information about socio-demographic features and associated health problems including non-communicable diseases. It was followed by detailed clinical examination and relevant blood investigations if required. The diagnosed cases of NCDs were also considered. Blood pressure measurement was performed according to WHO standard recommendations.8 The clinical evaluation was conducted as per standard methods.8 Diagnosis of specific non communicable disease was performed on the basis several parameters including clinical presentation, precise investigations, laboratory results aligning with the specific disease and pre-existing diagnosis and treatment related documents etc. Hypertension was classified according to WHO guidelines.8 For type 2 diabetes mellitus, the globally recognized WHO diagnostic values were considered including HbA1c (Glycated Hemoglobin): ≥ 48 mmol/mol (≥ 6.5%), Fasting Plasma Glucose (FPG): ≥ 7.0 mmol/L (≥ 126 mg/dL), 2-Hour Plasma Glucose: ≥ 11.1 mmol/L (≥ 200 mg/dL) during an Oral Glucose Tolerance Test and Random Plasma Glucose: ≥ 11.1 mmol/L (≥ 200 mg/dL) in patients with classic symptoms of hyperglycemia.9 Statistical Analysis The gathered data was entered in Microsoft Office Excel Sheet. The statistical analysis was done using Statistical Package for Social Science (SPSS) Version 28. Descriptive statistics were computed to assess sociodemographic attributes of the participant. The statistical differences were analyzed using descriptive and inferential statistics through Chi square test and Fisher’s Exact test. P value less than 0.05 was considered as statistically significant.

Out of 350 registered participants, 278 participated in the study but 14 could not provide the necessary research related information due to any reasons and they were excluded from the study. Therefore, the data analysis was done for 264 participants.  

Table 1: Sociodemographic Characteristics of Participants (n = 264)

Table 1 depicts various sociodemographic features of study participants. Maximum participants belonged to 60-64 years followed by 65-69 years. Nearly 84% of participants were illiterates and the majority were Hindu. The percentage of unemployed participants was comparatively more in the present study (Table 1). Around 61% of participants were married while nearly 39% were widows and separated. The maximum (43.18%) participants were from joint families.  

Table 2: Association Between Type 2 Diabetes and Hypertension (n = 264)

T2DM = Type 2 Diabetes Mellitus, HT = Hypertension, P<0.05 = statistically significant

In current study, out of 264 participants, 28.40% were found to have hypertension, 6.43% had Type 2 Diabetes Mellitus (T2DM), 1.89% and 0.75% were suffering from ischemic heart disease (IHD) and cancer respectively. However, few participants had more than one NCD-related health problems. In our study, among detected T2DM cases, 17.64% of participants were previously diagnosed and remaining 82.36 % of participants were found to have impaired glucose tolerance and high HbA1c levels according to newly performed investigations. 

Table 2 describes the relationship between T2DM and hypertension. Among diabetic participants, around 30% suffered with grade I hypertension and nearly 12 % reported grade 2 hypertension. Nearly 30% showed high normal blood pressure. However, the study did not reveal any significant (p>0.05) association.

Table 3 illustrates expanding relationship of NCDs with various major sociodemographic features of study participants. In this study, no statistically significant correlation was observed between educational level and NCD associated morbidity among participants though illiterates showed more NCD burden than literates.

Table 3: Association Between Sociodemographic Attributes and Non-Communicable Diseases

*Denotes statistically significant p value (p<0.05), HTN = Hypertension, T2DM = Type 2 Diabetes Mellitus, IHD = ischemic heart disease

The present study also revealed that NCDs were comparatively more common among participants from upper socioeconomic classes. All NCDs were common in unemployed participants as compared to employed participants (Table 3). Furthermore, NCD morbidities were reported to be more among participants from joint families than single or nuclear families (Table 3).  

The current study described mixed patterns of marital status where maximum participants were married followed by widow and minimal level of separation. This finding corroborates with the data of census 2011.10 Similar study findings were also noted in the study of Singh R et al. 11 The study revealed significant level of illiteracy among participants. This could be attributed to the region being rural. Similar results were also documented in the study implemented by Bora Lingaiah et al.12 Low education levels among elder females in rural India is a critical challenge, with statistics indicating that literacy rates for females of 60 years and above declined to below 30%.12 Deeply ingrained community biases, traditional domestic responsibilities, and inadequate educational infrastructure might be the possible reasons which may refrain elder generations from accessing formal education. 13 The existing study reported “hypertension” as the most common detected non-communicable disease followed by diabetes. Around 30% of participants were prehypertensive but approximately half of them were unaware of their hypertension status. Shrivastava RK et al.14 also observed similar findings in their study. This data is supported by WHO facts where almost 46% of adults with hypertension are unaware, they have the condition.8 High blood pressure is mainly asymptomatic in its initial phases; it is commonly referred to as a "silent killer". This reiterates the need for routine screening crucial to early detection. The reported proportion of elderly participants having hypertension was almost consistent with other studies. However, few studies documented high prevalence of hypertension among elderly females. Lena et al.15 mentioned very high prevalence rate of hypertension i.e. 60.3% among elderly women. The variations in the prevalence of hypertension could be due to different study settings as well as lifestyle patterns of participants. The present study also noted that hypertension was more common in illiterate participants than literates. This is supported by research that low educational attainment and constrained literacy skills are intently linked to a greater prevalence of hypertension and poor blood pressure management.16 It is imperative to note that females’ literacy is one of the most compelling drivers of positive health outcomes. As females achieve formal education, subsequently, their cognitive abilities, economic independence, and decision-making capacity increase, directly transforming how they navigate preventive health care, recognize health concerns, and manage family health. 16 In existing study, out of 264 participants, nearly 7% of them suffered with diabetes. Patel S et al.17 also reported almost similar prevalence (7.30%) of diabetes in their study. A multicentric study in India mentioned prevalence rates of around 14% and 10% in urban and rural regions respectively.18 These results were in near accordance with the present study. Conversely, Sharma et al.19 reported notable increase in prevalence (25.5%) of diabetes in their study participants. The differences in prevalence rates could be due to different settings and diverse methods for diagnosis. One of the strengths of the present study was that it emphasized on assessing prevalence rates of various common NCDs among geriatric females especially in rural provinces. Rural elder females frequently experience a higher likelihood of NCDs compared to their urban or male counterparts yet remain substantially underrepresented in epidemiological literature.17-19 Assessing the prevalence of NCDs in older females living in rural areas addresses a critical gap at global health research level. 18,19 The study had few limitations. Since it was a cross-sectional study so precludes evaluation of cause-effect relationships. Limited sample size in the study can not generalize study inferences. In context of our findings, we strongly reiterate the necessity to shift from the approach of managing single health conditions to a more integrated strategy where population’s health care needs can be more comprehensively addressed. It needs proceeding beyond fragmented, single-condition management to holistic, patient-centered care.20 Focusing elderly women for various common non-communicable diseases (NCD) control must be a vital global health priority. Globally, chronic health problems like cardiovascular diseases, diabetes, and mental health disorders disproportionately burden older females. Comprehensive gender-responsive healthcare policies are essential to bridge significant gaps in early recognition and prompt treatment.

Elderly women are one of the significant vulnerable groups for common non communicable diseases including hypertension, diabetes, ischemic heart disease and cancer. There is potential need to sensitize these population groups especially towards hypertension where they are unable to recognize warning signs due to asymptomatic and silent nature of disease. Female education can play a crucial role in promoting self-care as well as family health particularly for chronic diseases.

Source of Funding – NIL

Conflict of interest – None

Acknowledgements: Authors are thankful to all health educators and village volunteers for their valuable assistance in arranging visits to study participants.

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