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Objective:To examine the bidirectional associations between older adult spouses’ cognitive functioning and depressive symptoms over time and replicate previous findings from the United States (US) in Mexico.Design:Longitudinal, dyadic path analysis with the actor-partner interdependence model.Setting:Data were from the three most recent interview waves (2012, 2015, and 2018) of the Mexican Health and Aging Study (MHAS), a longitudinal national study of adults aged 50+ years in Mexico.Participants:Husbands and wives from 905 community-dwelling married couples (N = 1,810).Measurements:The MHAS cognitive battery measured cognitive function. Depressive symptoms were assessed using a modified nine-item Center for Epidemiologic Studies Depression Scale. Baseline covariates included age, education, number of children, limitation with any activity of daily living, limitation with any instrumental activity of daily living, and pain.Results:As hypothesized, there were significant within-individual associations in which one person’s own cognitive functioning and own depressive symptoms predicted their own follow-up cognitive functioning and depressive symptoms, respectively. In addition, a person’s own cognitive functioning predicted their own depressive symptoms, and a person’s own depressive symptoms predicted their own cognitive functioning over time. As hypothesized, there was a significant partner association such that one person’s depressive symptoms predicted more depressive symptoms in the partner.Conclusion:Findings from this study of older Mexican couples replicates findings from studies of older couples in the US, showing that depressive symptoms in one partner predict depressive symptoms in the other partner over time; however, there was no evidence for cognition–depression partner associations over time.

OBJECTIVES Mexico has a rapidly aging population at risk for cognitive impairment. Social and leisure activities may protect against cognitive decline in older adults. The benefits of these behaviors may vary by patterns of cognitive impairment. The objectives of this study were to identify latent states of cognitive functioning, model the incidence of transitions between these states, and investigate how social and leisure activities were associated with state transitions over a 6-year period in Mexican adults aged 60 and older. METHODS We performed latent transition analyses to identify distinct cognitive statuses in the 2012 and 2018 waves of the Mexican Health and Aging Study (N = 9,091). We examined the transition probabilities between these states and their associations with social and leisure activities. RESULTS We identified 4 cognitive statuses at baseline: normal cognition (43%), temporal disorientation (30%), perceptual-motor function impairment (7%), and learning and memory impairment (20%). Various social and leisure activities were associated with reduced odds of death and disadvantageous cognitive transitions, as well as increased odds of beneficial transitions. DISCUSSION Mapping the effects of popular social and leisure activities onto common patterns in cognitive functioning may inform the development of more enjoyable and effective health-protective behavioral interventions.

Background and ObjectivesMany older adults face physical limitations to performing activities of daily life (ADLs) and instrumental activities of daily life (IADLs) and seek help performing them. In Mexico, family caregivers, especially spouses and adult children, traditionally take care of older adults. However, a detailed characterization of the care received has not been thoroughly provided. We sought to identify socioeconomic, demographic, and health-related differences in receiving help among older adults reporting physical limitations.Research Design and MethodsUsing the 2012 wave of the Mexican Health and Aging Study, we provided information on adults aged 60 and older who reported one or more physical limitations and whether they received help or not. We estimated 2 logistic regression models to obtain the odds ratios (ORs) of receiving help among individuals with an ADL limitation and those with an IADL limitation.ResultsAdults with ADL limitations received, on average, approximately 10.7 hr of assistance per day, whereas those with at least 1 IADL limitation received around 7.7 hr of help per day. Women were more likely to receive help with ADLs than men (OR = 2.35). Individuals with chronic conditions such as hypertension, diabetes, and arthritis also received more help with both ADLs and IADLs.Discussion and ImplicationsOur work suggests that help received does respond to the care needs of older adults, but future research should focus on the burden of care for caregivers and expand this analysis using a longitudinal data approach.

Supplemental Digital Content is Available in the Text. Older Mexicans had 2 trajectories of activity-limiting pain (low-stable and moderate-increasing) over 17 years. Compared with men, women were more likely to have moderate-increasing pain., Pain increases with age, disproportionately affects women, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. Few studies have examined longitudinal trajectories of pain, by gender, in Mexico. We used data from 5 waves (over 2001–2018) of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50 years and older. Pain was categorized as self-reported frequent pain that makes it difficult to do usual activities. Latent class mixture models were used to create pain trajectories (n = 9824). The sample was majority female (56.15%), with a mean age of 61.72 years. We identified 2 pain trajectories: low-stable (81.88%) and moderate-increasing (18.12%). Women had 1.75 times the odds of being in the moderate-increasing group compared with men (95% confidence interval= 1.41, 2.17). In addition, having zero years of education was associated with higher odds of being in the moderate-increasing group, compared with having any years of education. Fair/poor self-rated health, obesity, arthritis, elevated depressive symptoms, and falls were positively associated with pain for both trajectory groups. Being married was positively associated with pain in the low-stable group. Insurance status was negatively associated with pain in the low-stable group, but positively associated with pain in the moderate-increasing group. We identified 2 trajectories of activity-limiting pain, among older Mexican adults (50+) over 17 years of follow-up. Understanding gender differences in pain trajectories in later life and the factors associated with trajectory development is crucial to improve quality of life, especially in vulnerable populations.

El objetivo de este manuscrito es analizar las características socioeconómicas y familiares de personas de 50 años o más que están en riesgo alto de dar positivo a Covid-19, ser hospitalizado o intubado en México. Para ello se utilizan dos fuentes de información, la base de datos de la Secretaría de Salud sobre Covid-19 y el Estudio Nacional de Salud y Envejecimiento en México, en la primera se estiman modelos de regresión para calcular el riesgo y se aplican en la segunda para analizar las vulnerabilidades socioeconómicas y familiares. Los resultados señalan que el sexo y la edad son fuertes predictores de riesgo alto. Los de menos escolaridad, los que trabajan sin disponer un local, los que perciben su situación económica como regular o mala, así como los que viven en hogares unipersonales, reciben ayuda económica y no económica de sus hijos se presentan como un grupo altamente vulnerable a Covid-19 y sus repercusiones.

OBJECTIVES: The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN: We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions of those who died on their last year of life. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS: The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in 1 or 2 waves (occasional and persistent), and on the pain, intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS: Pain was reported by 71.5% of older adults who died between 2001-2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (p

The proportion of the world's older adults and of its dementia cases is increasing in low and middle-income countries. This is particularly true in Colombia. There, the number of individuals with dementia may increase five-fold by 2050. Yet research is lacking on dementia in such settings. This work estimates the prevalence of dementia in a community-dwelling population in Colombia. It also assesses how gender-based differences in cardiovascular conditions and socioeconomic disparities affect dementia. This work analyzes data on 2000 respondents at least 60 years of age in the Health, Well-Being, And Aging (SABE) study in Bogota. Respondents with dementia are those who have cognitive impairment and at least two limitations in instrumental activities of daily living. The SABE study finds 8.4% of respondents have dementia. Age, cardiovascular risks, and socioeconomic disparities contributed to higher odds of dementia. The contributors to dementia can differ for men and women. For example, socioeconomic disparities were a larger contributor to dementia for women than men. The findings support the cognitive reserve hypothesis on dementia. This holds that pre-existing cognitive processes and compensatory mechanisms influence dementia. Women in Latin America are more likely to suffer from socioeconomic disparities that limit their cognitive reserve. This research points to several policy implications that can help offset these disparities and reduce the prevalence of dementia.

Resumen Introduccion El objetivo de este estudio es determinar la frecuencia de alteraciones conductuales (AC) en un grupo de pacientes con diagnostico de trastorno neurocognoscitivo (TN) valorado por clinica de memoria en un centro de evaluacion en Bogota, Colombia, durante el ano 2015. Material y metodos Estudio observacional descriptivo y de corte retrospectivo de 507 pacientes con diagnostico de trastorno neurocognoscitivo (segun criterios del DSM-5), valorados en un centro de referencia en Bogota en 2015. Resultados La media de edad de los sujetos con trastorno neurocognoscitivo leve en el momento del diagnostico era 71,04 anos y la de aquellos con trastorno neurocognoscitivo mayor, 75,32 anos (p Conclusiones Las AC son prevalentes en pacientes con diagnostico de trastorno neurocognoscitivo mayor. Segun la etiologia del trastorno neurocognoscitivo mayor, las AC son mas prevalentes en la degeneracion frontotemporal variante conductual. Apatia, irritabilidad, labilidad emocional y agresividad son las AC mas comunes en toda la muestra.

Epigenetics refers to changes in gene function, not resulting from the primary DNA sequence, influenced by the environment. It provides a link between the molecular regulation of the genome and the environmental signals exposed during the life of individuals (including lifestyle, social behavior, development, and nutrition). Notably, early development (intrauterine or postnatal) is highly influenced by the adverse socioeconomic status that leads to malnutrition or obesity; these conditions induce changes over the fetal epigenetic programming and can be transferred by transgenerational inheritance, inducing alterations of the transcription of genes related to several metabolic and neurological processes. Moreover, obesity during pregnancy, and excessive gestational weight gain are associated with an increased risk of fatal pregnancy complications, and adverse cardio-metabolic, respiratory and cognitive-related outcomes of the future child. However, most of our knowledge in this field comes from experimental animal models, that partially resemble the nutritional effects of humans. In this context, nutritional effects implicated in historical famines represent valuable information about the transgenerational effects of undernutrition and stress. In the present review, we attempt to describe the most outstanding results from the most studied famines about the impact of malnutrition on the epigenome.

The University of Texas Medical Branch (UTMB) is the main healthcare system in Galveston County where about 15% of older adults identify as Hispanic. Our recruitment efforts for the Dementia (D-CARE) study included adapting and translating in Spanish the screening, recruitment, and intervention materials. The study is being conducted by a bilingual team, and actively engages a highly diverse Local Patient and Stakeholder Council. After obtaining a partial HIPAA waiver from the Institutional Review Board, we created a dementia registry in the UTMB Epic (TM) electronic health record which captured patients diagnosed with ICD-9/10 codes of dementia. Referral letters from UTMB primary care and neurology providers authorized us to contact eligible patients. We utilized outpatient clinic appointment schedules, direct referrals, and community outreach to meet our enrollment goal. This recruitment strategy resulted in inclusion of 478 patient-caregiver dyads with 27.4% of participants identifying as Hispanic and 17% as Black.

In low-and-middle-income countries like Mexico the impact of disadvantaged early childhood conditions (ECC) on later-life health in not well known and may be changing across birth cohorts. Our objective is to examine the impact of ECC on the propensity to have diabetes in three different cohorts of older adults aged 60-69 (born in 1930-1939, 1940-1949, 1950-1959). We examine to what extent differences in ECC, sociodemographic characteristics, and lifetime obesity explain the differences in the prevalence of diabetes across the cohorts. We use five waves of data from the Mexican Health and Aging Study (n=10,313). We estimate a series of logistic regression models and use counterfactual analyses to identify the roles of ECC and lifetime obesity on cohort-specific diabetes prevalence and on differences in diabetes prevalence across cohorts. Our results suggest that improvements in ECC would decrease prevalence of diabetes by 12.5% in the 1930-1939 cohort and 10% in the 1950-1959 cohort. However, the rise of obesity at age 50 counters this effect and leads to higher prevalence of diabetes in both cohorts. Our models show that if everyone had a normal weight at age 50, the prevalence of diabetes would decrease by 31.3% for the 1930-1939 cohort, 27.3% for the 1940-1949, and 26.7% for the 1950-1959 cohort. Despite improvements in socio-economic conditions during childhood in Mexico, the increase in lifetime obesity appear to offset the benefits derived from better ECC resulting in higher rates of diabetes.

Introduction A large body of research in the U.S. shows that non-Hispanic black (black) and Hispanic older adults have higher rates of cognitive impairment and dementia compared to Whites. Little research has examined how cognitive life courses differentially affect spouses of cognitively impaired older adults. Objectives This paper will describe the different life courses of spouses of cognitively impaired older adults by race and ethnicity in the U.S. Methods Using data from the 2010 Health and Retirement Survey, we examine differences in the health of spousal dyads where one partner becomes cognitively impaired over follow up, by 2016. Spousal dyads are limited to Hispanic (n=464 dyads), i black (n=345 dyads), or white (n=2,409 dyads) couples who were both cognitively normal at baseline and had cognition information at follow up. Results Hispanic and Black dyads were more likely to have at least one partner become cognitively impaired over the follow up period despite being younger than White dyads. A total of 23% of Hispanic dyads, 26% of Black dyads and 16% of White dyads were N/CI at follow up. Despite fewer chronic conditions at baseline, a higher proportion of Hispanic dyads with no chronic conditions had at least one member become cognitively impaired (20%) compared to Whites (6.28%). Conclusion Our results show that health of couples changes differently by race and ethnicity. A higher proportion of Hispanic and Black dyads have partners with cognitive impairment and the cognitive impairment happens earlier in life.

Objective:To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes and investigate the impact of midlife cardiovascular risk factors on late-life MCI among the aging Mexican population.Method:Analyses included a sample of non-demented adults over the age of 55 living in both urban and rural areas of Mexico (N = 1807). MCI diagnosis was assigned based on a comprehensive cognitive assessment assessing the domains of memory, executive functioning, language, and visuospatial ability. The normative sample was selected by means of the robust norms approach. Cognitive impairment was defined by a 1.5-SD cut-off per cognitive domain using normative corrections for age, years of education, and sex. Risk factors included age, education, sex, rurality, depression, insurance status, workforce status, hypertension, diabetes, stroke, and heart disease.Results:The prevalence of amnestic MCI was 5.9%. Other MCI subtypes ranged from 4.2% to 7.7%. MCI with and without memory impairment was associated with older age (OR = 1.01 [1.01, 1.05]; OR = 1.03 [1.01, 1.04], respectively) and residing in rural areas (OR = 1.49 [1.08, 2.06]; OR = 1.35 [1.03, 1.77], respectively). Depression (OR = 1.07 [1.02, 1.12]), diabetes (OR = 1.37 [1.03, 1.82]), and years of education (OR = 0.94 [0.91, 0.97]) were associated with MCI without memory impairment. Midlife CVD increased the odds of MCI in late-life (OR = 1.76 [1.19, 2.59], which was driven by both midlife hypertension and diabetes (OR = 1.70 [1.18, 2.44]; OR = 1.88 [1.19, 2.97], respectively).Conclusions:Older age, depression, low education, rurality, and midlife hypertension and diabetes were associated with higher risk of late-life MCI among older adults in Mexico. Our findings suggest that the causes of cognitive impairment are multifactorial and vary by MCI subtype.

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

Few studies assess the malnutrition risk of older Mexican adults because most studies do not assess nutritional status. This study proposes a modified version of the Mini Nutritional Assessment (MNA) to assess the risk of malnutrition among older Mexicans adults in the Mexican Health and Aging Study (MHAS). Data comes from the 2012, 2015, and 2018 waves of the MHAS, a nationally representative study of Mexicans aged 50 and older. The sample included 13,338 participants and a subsample of 1911 with biomarker values. ROC analysis was used to calculate the cut point for malnutrition risk. This cut point was compared to the definition of malnutrition from the ESPEN criteria, BMI, low hemoglobin, or low cholesterol. Logistic regression was used to assess predictors of malnutrition risk. A score of 10 was the optimal cut point for malnutrition risk in the modified MNA. This cut point had high concordance to identify malnutrition risk compared to the ESPEN criteria (97.7%) and had moderate concordance compared to BMI only (78.6%), and the biomarkers of low hemoglobin (56.1%) and low cholesterol (54.1%). Women, those older than 70, those with Seguro Popular health insurance, and those with fair/poor health were more likely to be malnourished. The modified MNA is an important tool to assess malnutrition risk in future studies using MHAS data.

Background: Frailty is a clinical state defined as an increase in an individual’s vulnerability to developing adverse health-related outcomes. Objectives: We propose that healthy behaviors could lower the incidence of frailty. The aim is to describe the association between healthy behaviors (physical activity, vaccination, tobacco use, and cancer screening) and the incidence of frailty. Design: This is a secondary longitudinal analysis of the Mexican Health and Aging Study (MHAS) cohort. Setting: MHAS is a population-based cohort, of community-dwelling Mexican older adults. With five assessments currently available, for purposes of this work, 2012 and 2015 waves were used. Participants: A total of 6,087 individuals 50-year or older were included. Measurements: Frailty was defined using a 39-item frailty index. Healthy behaviors were assessed with questions available in MHAS. Individuals without frailty in 2012 were followed-up three years in order to determine their frailty incidence, and its association with healthy behaviors. Multivariate logistic regression models were used to assess the odds of frailty occurring according to the four health-related behaviors mentioned above. Results: At baseline (2012), 55.2% of the subjects were male, the mean age was 62.2 (SD ± 8.5) years old. The overall incidence (2015) of frailty was 37.8%. Older adults physically active had a lower incidence of frailty (48.9% vs. 42.2%, p< 0.0001). Of the activities assessed in the adjusted multivariate models, physical activity was the only variable that was independently associated with a lower risk of frailty (odds ratio: 0.79, 95% confidence interval 0.71-0.88, p< 0.001). Conclusions: Physically active older adults had a lower 3-year incidence of frailty even after adjusting for confounding variables. Increasing physical activity could therefore represent a strategy for reducing the incidence of frailty. Other so-called healthy behaviors were not associated with incident frailty, however there is still uncertainty on the interpretation of those results.

Poor vision and hearing have been associated with lower cognitive function and greater social isolation (i.e., loneliness) among older adults. However, this evidence is based largely on data from non-Hispanic populations. Therefore, we investigated whether self-reported vision and hearing was associated with cognitive function and loneliness in a nationally-representative study of Mexican adults aged 50 and older in Wave 3 of the Mexican Health and Aging Study. The final sample included 12,426 participants. The majority were female (58%), and the mean age was 67. Self-reported vision and hearing status were categorized as excellent-very good [ref], good, and fair-poor. Measures for global cognition, memory, and non-memory cognition were calculated using z-scores based on nine cognitive tests. Participants who reported frequently feeling a lack of companionship, left out, or isolated were categorized as feeling lonely. All analyses controlled for age, sex, and years of education. Participants with fair-poor vision had lower global (β= -0.06, p

Author(s): Reuben, David B; Gill, Thomas M; Stevens, Alan; Williamson, Jeff; Volpi, Elena; Lichtenstein, Maya; Jennings, Lee A; Tan, Zaldy; Evertson, Leslie; Bass, David; Weitzman, Lisa; Carnie, Martie; Wilson, Nancy; Araujo, Katy; Charpentier, Peter; Meng, Can; Greene, Erich J; Dziura, James; Liu, Jodi; Unger, Erin; Yang, Mia; Currie, Katherine; Lenoir, Kristin M; Green, Aval-NaʼRee S; Abraham, Sitara; Vernon, Ashley; Samper-Ternent, Rafael; Raji, Mukaila; Hirst, Roxana M; Galloway, Rebecca; Finney, Glen R; Ladd, Ilene; Rahm, Alanna Kulchak; Borek, Pamela; Peduzzi, Peter | Abstract: Background/objectivesAlthough several approaches have been developed to provide comprehensive care for persons living with dementia (PWD) and their family or friend caregivers, the relative effectiveness and cost effectiveness of community-based dementia care (CBDC) versus health system-based dementia care (CBDC) and the effectiveness of both approaches compared with usual care (UC) are unknown.DesignPragmatic randomized three-arm superiority trial. The unit of randomization is the PWD/caregiver dyad.SettingFour clinical trial sites (CTSs) based in academic and clinical health systems.ParticipantsA total of 2,150 English- or Spanish-speaking PWD who are not receiving hospice or residing in a nursing home and their caregivers.InterventionsEighteen months of (1) HSDC provided by a nurse practitioner or physician's assistant dementia care specialist who works within the health system, or (2) CBDC provided by a social worker or nurse care consultant who works at a community-based organization, or (3) UC with as needed referral to the Alzheimer's Association Helpline.MeasurementsPrimary outcomes: PWD behavioral symptoms and caregiver distress as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity and Modified Caregiver Strain Index scales.Secondary outcomesNPI-Q Distress, caregiver unmet needs and confidence, and caregiver depressive symptoms. Tertiary outcomes: PWD long-term nursing home placement rates, caregiver-reported PWD functional status, cognition, goal attainment, "time spent at home," Dementia Burden Scale-Caregiver, a composite measure of clinical benefit, Quality of Life of persons with dementia, Positive Aspects of Caregiving, and cost effectiveness using intervention costs and Medicare claims.ResultsThe results will be reported in the spring of 2024.ConclusionD-CARE will address whether emphasis on clinical support and tighter integration with other medical services has greater benefit than emphasis on social support that is tied more closely to community resources. It will also assess the effectiveness of both interventions compared with UC and will evaluate the cost effectiveness of each intervention.

Background Diabetes is a risk factor for dementia and mortality, while obesity later in life is associated with a reduced risk. Their co-occurrence, diabesity, is common, but its association with dementia and mortality is unclear. Methods Using data from the Mexican Health and Aging Study, we used multinomial logistic regression to examine the associations of diabetes and body mass index (BMI), and diabesity, in 2012, with cognitive impairment and mortality in 2018, among participants aged ≥60 years with normal cognition at baseline (n = 7,885). Results Diabetes was associated with cognitive impairment, compared to not having diabetes (RRR=1.83, 95% CI=1.48–2.26). BMI was not associated with cognitive impairment. Regarding mortality, diabetes was associated with an increased risk (RRR=2.28, 95% CI=1.98–2.63) and being overweight or having obesity was associated with a reduced risk (RRR=0.74, 95% CI=0.65–0.86; RRR=0.79, 95% CI= 0.66–0.95). When BMI and diabetes were combined, having diabetes only (RRR=2.01, 95% CI=1.40–2.87), being overweight with diabetes (RRR=1.42, 95% CI=1.02–1.97) or having diabesity (RRR=1.50, 95% CI=1.08–2.06) were associated with cognitive impairment, compared to having a normal BMI without diabetes. Diabetes, regardless of BMI, was associated with an increased risk of mortality, while being overweight or having obesity was associated with a reduced risk of mortality. Conclusions With the increase in the prevalence of obesity and diabetes among Mexicans, it is important to understand how these conditions and their co-occurrence impact cognitive impairment and mortality. Among older Mexicans, diabesity is associated with 6-year mortality and cognitive impairment onset, likely driven by the effect of diabetes.

Objectives: To identify trajectories of depression and daily disability in the context of serious falls and widowhood and to predict those trajectories before the events occurred. Methods: Longitudinal data were used from the Mexican Health and Aging Study. Trajectories were estimated using latent class growth analysis. Internal and socio-ecological resources were analyzed as predictors of the trajectories. Results: Unfavorable (worsening of symptoms and chronic high symptoms) and favorable (improvement of symptoms and stable low symptoms (resistance)) trajectories were identified. Favorable trajectories were more likely for daily disability. Persons who showed resistance in depression also tended to show resistance in daily disability. Net worth, cognition, and subjective well-being were early predictors for most trajectories. Discussion: Besides resistance, individuals rather show different co-occurring trajectories in the studied outcomes. While some factors could be identified that lead to favorable trajectories in both stressful contexts, the study also shows the necessity for context-specific research and praxis.

INTRODUCTIONWe estimated the prevalence and risk factors for mild cognitive impairment (MCI) and its subtypes in Mexican population using the cognitive aging ancillary study of the Mexican Health and Aging Study.METHODSUsing a robust norms approach and comprehensive neuropsychological criteria, we determined MCI in a sample of adult Mexicans (N=1,807;55-97years). Additionally, we determined prevalence rates using traditional criteria.RESULTSPrevalence of amnestic MCI was 5.9%. Other MCI subtypes ranged 4.3% to 7.7%. MCI with and without memory impairment was associated with older age and rurality. Depression, diabetes and low educational attainment were associated with MCI without memory impairment. Using traditional criteria, prevalence of MCI was lower (2.2% amnestic MCI, other subtypes ranged 1.3%-2.4%).DISCUSSIONOlder age, depression, low education, diabetes, and rurality were associated with increased risk of MCI among older adults in Mexico. Our findings suggest that the causes of cognitive impairment are likely multifactorial and may vary by MCI subtype.Research in ContextSystematic reviewWe reviewed the literature using Google Scholar and PubMed. Few studies have reported prevalence rates for mild cognitive impairment (MCI) in Mexican population. These studies have primarily relied on limited cognitive assessments, and diverse MCI criteria. Evaluating the prevalence of MCI with a robust neuropsychological approach can help understand the rates and risk factors associated with MCI across a large and representative sample of the aging Mexican population.InterpretationVarious sociodemographic and health factors such as older age, depression, low education, diabetes, and rurality were significant correlates of MCI and differed by MCI subtype.Future directionsLongitudinal studies will be needed to evaluate the diagnostic stability of MCI over time, and its association with incident dementia. Future work will evaluate the casual path of these sociodemographic and health factors on cognitive impairment to develop effective interventions.

espanolPoco se sabe sobre lo que sucede en el ultimo ano de vida de la poblacion envejecida. Mexico presenta caracteristicas demograficas, economicas, sociales y epidemiologicas que plantean in-quietudes sobre los desafios que el envejecimiento impondra. El objetivo es analizar el ultimo ano de vida de la poblacion mayor mexicana y describir el estado de salud, el funcionamiento fisico, el uso de los servicios de salud y el apoyo familiar que tenian antes de morir. Se utiliza in-formacion del Estudio Nacional de Salud y Envejecimiento en Mexico (ENASEM). Los resulta-dos senalan que durante el ultimo ano de vida, la presencia de enfermedades cronicas, dificultad en las actividades de la vida diaria, apoyo por parte de la familia y el uso de servicios de salud son una constante tanto para el individuo como para la familia. EnglishLittle is known on what happens in the last year of life of the aging population. Mexico has demographic, economic, social and epidemiological characteristics that raise concerns about the challenges that aging will impose. The objective is to analyze the last year of life of the Mexican elderly population and describe the state of health, physical functioning, use of health services and family support that they had before death. We used information from the Mexican Health and Aging Study (MHAS). The results indicate that during the last year of life, the presence of chronic diseases, difficulty in activities of daily living, support from the family and the use of health services are a constant for both the individual and the family.

Introduction Poor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities. Material and methods Analytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013–2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented. Results A total of 365 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60–91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05–1.73), exhaustion (PR = 2.22; 95%CI: 1.49–3.31), gait speed (PR = 0.67; 95%CI: 0.50–0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19–3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10–2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07–2.42) compared to none. Conclusions Approximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.

Objective: We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries. Method: In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]). Results: Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males. Discussion: Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health. © The Author(s) 2018.

Objetivo: Destacar los resultados de mayor impacto para la población anciana en Bogotá, de manera que sirvan como referencias para priorizar las decisiones y las medidas públicas en su beneficio. Materiales y métodos: Estudio de cohorte transversal, con un muestreo probabilístico por conglomerados, polietápico, con un nivel de confiabilidad del 95% y un tamaño de 2000 personas entre 60 y 100 años. Se realizó un análisis descriptivo de todas las variables, calculando distribuciones de frecuencias simples y posteriormente se hizo un análisis de dependencia y asociación con Chi cuadrado, T-test y regresiones logísticas multivariadas según correspondiera para cada caso. Adicionalmente se utilizan pruebas de Spearman Rho para analizar correlaciones. Se analizaron los temas principales: fragilidad, sarcopenia, nutrición, hipertensión arterial (HTA), depresión, violencia, discapacidad, vivir solo y pobreza. Resultados: Cerca del 40% de la población tenía desnutrición o estaba en riesgo de desnutrición, más del 60% era prefrágil o frágil y más del 11% tenía sarcopenia. La HTA se presentó en el 58% de los ancianos; la depresión estaba presente en uno de cada cuatro; 42% había sido víctima de agresión en el último año y el 43% desplazado por violencia en el transcurso de su vida. Más de la mitad tenía una discapacidad, 12,6% vivía solo y el 7,8% estaba en pobreza extrema. Conclusiones: Cada una de las temáticas desarrolladas aporta individualmente en la selección de los mejores derroteros de la política pública para el Distrito Capital, pues sólo su integración, bajo la tutela de los gestores de la misma y la participación ciudadana desde los diferentes escenarios y participantes, logrará el mejor impacto en la aplicabilidad de este trabajo de investigación.

Depression among older adults is a public health issue, and a large literature highlights the importance of close relationships as both a risk and protective factor for depression. Research in U.S. samples suggests that one spouse’s depressive symptoms can increase their partner’s depressive symptoms, especially for women (Kouros & Cummings, 2010; Tower & Kasl, 1996). Little is known about interpersonal associations in depression, mitigating factors, and the role of gender among older couples in Mexico. This study examined (1) the effects of an individual’s depressive symptoms on their spouse’s symptoms and 2) whether living close to family buffered depression associations using data from the Mexican Health and Aging Study (n=4,071 dyads, age 50+ at initial interview). Depressive symptoms were measured in 2001, 2003, 2012, 2015, and 2018 using a modified 8-item version of the Center for Epidemiologic Studies-Depression Scale. Multilevel modeling was used to fit a dual-intercept growth model (centered at 2012) of husbands’ and wives’ depressive symptoms over time, controlling for age and education. Results showed a partner effect for husbands and wives, such that having a spouse with greater depressive symptoms in 2001 was associated with greater subsequent depressive symptoms, but not with rate of change in symptoms, in 2012. There was also a moderation effect such that the deleterious effect of husbands’ depressive symptoms on wives’ symptoms, as well as rate of increase in symptoms, was higher when family lived nearby, suggesting family may potentially exacerbate depression associations among spouses rather than a buffering them as hypothesized.

Objective: This paper seeks to document changes in the effect of educational attainment on cognitive function of older adults in Mexico, and measure gender differences using data from two time periods. Methods: The data come from the Mexican Health and Aging Study (MHAS), taking the cross-sections of adults aged 60 years or older interviewed in 2001 and 2012. We perform an OLS regression using standardized z-scores for five individual cognitive domains and for total cognition. Results: Total cognitive scores and educational attainment were higher for men than women in both years. When cognitive components were analyzed separately, women had higher verbal memory and verbal recall scores than men. The gender gap in overall cognition score was smaller in 2012 compared to 2001, while the gender gap in educational attainment was larger in 2012 than in 2001. Even though men had higher educational attainment than women, the effect of educational attainment on cognition was higher for women. Similarly, the difference between total scores for each task for men compared to women decreased between 2012 and 2001, except for verbal learning and verbal recall where the gender difference widened. Conclusions: If younger cohorts of women continue to progressively achieve higher levels of education, the gender gap in old-age cognition should close. Additional work should determine the mechanisms through which added formal education seems to translate into higher cognitive gains for women compared to men.

The objective is to assess if the effect of diabetes on cognition differs by race/ethnicity in the U.S. and how this association differs between older Hispanics in the U.S. and older Mexicans in Mexico. Data comes from a sample of older adults 50 and older with direct interviews from the 2012 waves of the Health and Retirement Study (N=17,810) and the Mexican Health and Aging Study (N=13,270). Cognition was measured as a total cognition score. OLS regressions were used to test the association between diabetes and cognition by race/ethnicity in the U.S. and among older Mexicans in Mexico. Results showed that Non-Hispanic Whites (NHW) had the highest cognition scores in the U.S., followed by Hispanics and non-Hispanic blacks (NHB). Mean cognition score of older Mexicans was higher than for NHB and Hispanics in the U.S. but lower than NHWs. The prevalence of diabetes was highest among Hispanics (32.3%), followed by NHB (30.6%) and NHW (19.9%). The prevalence of diabetes in Mexico was like those NHW in the U.S. (19.9%). In the U.S., the effect of being NHB and Hispanic (compared to white) on cognition was equivalent to having 5.3 and 2.4 fewer years of education, respectively. However, the effect of diabetes on cognition did not differ by race/ethnicity. The final analysis will include a direct comparison between Hispanics in the U.S. and a matched sample of older adults in Mexico with similar sex and age to test differences in the effect of diabetes on cognition between these two samples.

Pain increases with age, disproportionately affects females, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. However, few studies have looked at longitudinal trajectories of pain, by sex, using population data. We used data from the 2001, 2003, 2012, and 2015 waves of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50 and older. Individuals who had direct interviews at each time point and complete information on analytical variables were included (n=5,135). Pain reported at these time points was used to define pain trajectories as persistent pain, development of pain, diminishing pain, fluctuating pain, and never pain, by sex. Multinomial logistic regression was used to assess the association of sex with pain trajectories, adjusting for baseline demographic, behavioral, and health factors. Females had a higher prevalence of persistent pain (25.1% vs. 11.5%) while males had a higher prevalence of never pain (35.8% vs. 22.2%). Development of pain, diminishing pain, and fluctuating pain was similar between males and females (14.4% and 14.6%; 14.8% and 15.8%; 23.9% and 22.4%, respectively). Females had higher odds of persistent pain (OR: 2.13; 95%CI 1.67-2.70) and development of pain (OR: 1.40; 95%CI 1.11-1.75) compared to males. Overall, females had a much higher burden of persistent pain compared to males. Understanding trajectories of pain in later life and life course mechanisms for this large sex difference observed is crucial to improve quality of life.

Objective Measure health-related quality of life using the EuroQol instrument in people aged 60 years and older using the survey of Health, well-being and aging (SABE) Bogota. Methods The EQ-5D portion of EuroQol instrument was used to assess health-related quality of life (HRQOL) in the SABE Bogota study, a cross-sectional study conducted in 2000 community-dwelling older adults in 2012. Bivariate and multivariate analyses were used to identify factors associated to poor HRQOL. Statistical significance was set at 0.05. Results A total of 46.9% of participants reported pain/discomfort, 29% reported impaired mobility, 27.5% reported anxiety/depression, 20.7% reported limitations with usual activities and 11.4% reported self-care issues. Some factors associated with poor HRQOL in the different dimensions were: older age, receiving aid from relatives, listless mood, cognitive/functional impairment and comorbidities. In multivariate analyses, factors most frequently associated with poor HRQOL were functional and cognitive impairment and comorbidities such as joint disease (JD), stroke and chronic obstructive pulmonary disease (COPD). Conclusions In our study, debilitating and highly symptomatic diseases like JD, COPD and cognitive impairment significantly increase the odds of poor HRQOL. The EuroQol is a useful instrument that can help clinicians in Colombia better assess quality of life among older adults.

In Mexico, palliative care and pain relief was recently added to the essential health services offered through Seguro Popular. Pain is more frequent in older adults, a growing segment of this population, and is a major contributor to decreased quality of life and increased morbidity. However, Mexico only has enough opioid analgesics to treat 36% of those in need. We used logistic regression models to examine correlates of pain using data from the 2012 wave of the Mexican Health and Aging Study, which includes Mexicans aged 50 and older (n=13,727). Overall, 38.2% of individuals reported that they often suffered from pain. Those who reported pain were more likely to be female (OR: 1.56; 95% CI: 1.41, 1.72), insured (OR: 1.17; 95% CI: 1.03, 1.33), live in a semi-rural locality (OR: 1.18; 95% CI: 1.04, 1.34), report their health as fair or poor (OR: 2.99; 95% CI: 2.73, 3.29), be a past smoker (OR: 1.17; 95% CI: 1.06, 1.29), have at least one ADL limitation (OR: 2.58; 95% CI: 2.27, 2.93), report depression (OR: 2.19; 95% CI: 2.02, 2.37), or report arthritis (OR: 2.74; 95% CI: 2.45, 3.07). Those who did not report pain were more likely to be widowed or have higher education. Diabetes, stroke, and cancer were not significantly associated with pain. Given that Mexico does not have the resources to treat over half of individuals living with pain, understanding the high burden of pain in this population is important to inform interventions and improve quality of life.

Objectives To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. Method We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. Results The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behaviors and in early nutritional status in the middle-income settings. Discussion Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future.