Population-level trends in self-reported healthcare utilization among older adults in Mexico with and without cognitive impairment.

BACKGROUND: Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico. METHODS: Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used. RESULTS: For all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03-1.23) but lower risk of outpatient services (RR = 0.95, 0.93-0.97), cholesterol screening (RR = 0.93, 0.91-0.96), and diabetes screening (RR = 0.95, 0.92-0.97). No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment. CONCLUSIONS: We identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.

History of Incarceration and Dental Care Use Among Older Adults in the United States.

INTRODUCTION: Dental care is a critical component of healthy aging; however, emerging evidence suggests that having been previously incarcerated is a risk factor for not using dental care services. This study investigates the relationship between prior incarceration and dental care among older adults and assesses whether wealth and dental insurance explain this relationship. METHODS: Data are from the Health and Retirement Study, a nationally representative sample of community-dwelling older adults in the United States, collected in 2012 and 2014. Multivariable logistic regression is used to assess the relationship between a history of incarceration and dental care. Mediation analyses were conducted using the Karlson-Holm-Breen method of indirect effects in non-linear models. Statistical analyses were conducted from February to April 2024. RESULTS: Adjusting for potential confounding variables, a respondent's prior incarceration is associated with a 25% lower odds of dental care use (adjusted odds ratio [aOR] = 0.748, 95% CI = 0.624, 0.896). The relationship between incarceration and dental care use is fully mediated-over 90% is explained by-wealth and having dental care insurance. Prior incarceration decreased the likelihood of dental care only among non-Hispanic White respondents. CONCLUSIONS: The findings offer new evidence that prior incarceration is a risk factor for lacking the ability to utilize dental care among older adults and suggest that broader consequences of incarceration for wealth accumulation and access to dental insurance underpin this relationship. These results suggest the urgent need to expand access to affordable dental care services for older adults with a history of incarceration.

Patient Priorities Care Increases Long-Term Service and Support Use: Propensity Match Cohort Study.

OBJECTIVES: Patient priorities care (PPC) is an evidence-based approach designed to help patients achieve what matters most to them by identifying their health priorities and working with clinicians to align the care they provide to the patient's priorities. This study examined the impact of the PPC approach on long-term service and support (LTSS) use among veterans. DESIGN: Quasi-experimental study examining differences in LTSS use between veterans exposed to PPC and propensity-matched controls not exposed to PPC adjusting for covariates. SETTING AND PARTICIPANTS: Fifty-six social workers in 5 Veterans Health Administration (VHA) sites trained in PPC in 2018, 143 veterans who used the PPC approach, and 286 matched veterans who did not use the PPC approach. METHODS: Veterans with health priorities identified through the PPC approach were the intervention group (n = 143). The usual care group included propensity-matched veterans evaluated by the same social workers in the same period who did not participate in PPC (n = 286). The visit with the social worker was the index date. We examined LTSS use, emergency department (ED), and urgent care visits, 12 months before and after this date for both groups. Electronic medical record notes were extracted with a validated natural language processing algorithm (84% sensitivity, 95% specificity, and 92% accuracy). RESULTS: Most participants were white men, mean age was 76, and 30% were frail. LTSS use was 48% higher in the PPC group compared with the usual care group [odds ratio (OR), 1.48; 95% CI, 1.00-2.18; P = .05]. Among those who lived >2 years after the index date, new LTSS use was higher (OR, 1.69; 95% CI, 1.04-2.76; P = .036). Among nonfrail individuals, LTSS use was also higher in the PPC group (OR, 1.70; 95% CI, 1.06-2.74; P = .028). PPC was not associated with higher ED or urgent care use. CONCLUSIONS AND IMPLICATIONS: PPC results in higher LTSS use but not ED or urgent care in these veterans. LTSS use was higher for nonfrail veterans and those living longer. The PPC approach helps identify health priorities, including unmet needs for safe and independent living that LTSS can support.

The dementia care study (D-CARE): Recruitment strategies and demographic characteristics of participants in a pragmatic randomized trial of dementia care.

INTRODUCTION: Pragmatic research studies that include diverse dyads of persons living with dementia (PLWD) and their family caregivers are rare. METHODS: Community-dwelling dyads were recruited for a pragmatic clinical trial evaluating three approaches to dementia care. Four clinical trial sites used shared and site-specific recruitment strategies to enroll health system patients. RESULTS: Electronic health record (EHR) queries of patients with a diagnosis of dementia and engagement of their clinicians were the main recruitment strategies. A total of 2176 dyads were enrolled, with 80% recruited after the onset of the pandemic. PLWD had a mean age of 80.6 years (SD 8.5), 58.4% were women, and 8.8% were Hispanic/Latino, and 11.9% were Black/African American. Caregivers were mostly children of the PLWD (46.5%) or spouses/partners (45.2%), 75.8% were women, 9.4% were Hispanic/Latino, and 11.6% were Black/African American. DISCUSSION: Health systems can successfully enroll diverse dyads in a pragmatic clinical trial.

Does a Reduction in Receiving Assistance With Daily Activities Among Older Adults in Mexico Indicate An Increase in Unmet Needs or a Decrease in Needs for Care?

OBJECTIVES: The percentage of older adults in Mexico with difficulty completing activities of daily living (ADL) who receive assistance from family appears to be decreasing. We compared 2 birth cohorts of older adults in Mexico to investigate whether this trend reflects an increase in unmet caregiving needs or a decrease in the need for care. METHODS: We selected Mexican Health and Aging Study participants aged 60-76 in 2001 (n = 4,805) and 2018 (n = 6,494). ADL tasks were dressing, walking, bathing, getting in and out of bed, and toileting. Participants who reported difficulty with an ADL were asked if anyone helped them with the task. Logistic regression was used to estimate adjusted odds ratios (aOR) for cohort differences in ≥1 ADL limitations and help with ≥1 ADL. We used a decomposition analysis to identify participant characteristics that mediated cohort differences in receiving help with ≥1 ADL. RESULTS: The 2018 cohort had higher odds for ≥1 ADL limitations (aOR = 1.85, 95% CI = 1.60-2.14) but lower odds for help with ≥1 ADL (aOR = 0.66, 95% CI = 0.49-0.89). Among participants with ADL disability, the 2018 cohort had fewer living children and a lower prevalence of probable dementia. The lower number of living children and lower prevalence of probable dementia explained 9.34% and 43.7% of the cohort effect on receiving help with ≥1 ADL, respectively. DISCUSSION: The declining percentage of older adults in Mexico with ADL disability receiving assistance may not reflect increasing unmet needs. However, the increased prevalence of ADL disability will increase the number of older adults needing informal care.

Considerations When Designing and Implementing Pragmatic Clinical Trials That Include Older Hispanics.

Introduction: Pragmatic clinical trials (PCTs) are designed to connect researchers with clinicians to assess the real-world effectiveness and feasibility of interventions, treatments, or health care delivery strategies in routine practice. Within PCTs larger, more representative sampling is possible to improve the external validity of the research. Older adults from underrepresented groups can benefit from PCTs given their historically lower engagement in clinical research. The current article focuses on older Hispanic adults with Alzheimer disease and related dementias (ADRDs). Older Hispanic adults represent 19% of the US population and have a higher prevalence of ADRDs than Whites. We provide data from 2 PCTs about the recruitment of older Hispanics with ADRDs and discuss unique challenges associated with conducting PCTs and propose strategies to overcome challenges. Data and Methods: The first PCT outlined is the Patient Priorities Care for Hispanics with Dementia (PPC-HD) trial. PPC-HD is testing the feasibility of implementing a culturally adapted version of the Patient Priorities Care approach for older Hispanic adults with multiple chronic conditions and dementia. The second PCT is the Dementia Care (D-CARE) Study, which is a multisite pragmatic study comparing the effectiveness of a health care system-based approach and a community-based approach to dementia care to usual care in patients with ADRDs and their family caregivers. Lessons Learned and Recommendations for Future Studies: The lessons learned are summarized according to the various stakeholders that need to work together to effectively recruit diverse participants for PCTs: individuals, health care systems, research teams, and communities. Individual-level considerations include communication, priorities, and flexibility. Health care system-level considerations are grounded in 4 principles of Community-Based Participatory Research and include collaboration/partnership, available resources, priorities of the health care system, and sustainability. Research team-level considerations include team members, intentionality, and communication. Community-level considerations highlight the importance of partnerships, community members, and appropriate incentives. Discussion: PCTs provide a unique and potentially impactful opportunity to test interventions in real-world settings that must be culturally appropriate to reach underrepresented groups. Collectively, considering variables at multiple levels to address the needs of older adults with ADRDs is crucial, and the examples and suggestions provided in this report are a foundation for future research.

Alteraciones del comportamiento de pacientes con diagnóstico de trastorno neurocognoscitivo en Bogotá (Colombia) / Behavioural Disturbances in Patients with Diagnosis of Neurocognitive Disorder in Bogotá (Colombia)

RESUMEN Introducción: El objetivo de este estudio es determinar la frecuencia de alteraciones conductuales (AC) en un grupo de pacientes con diagnóstico de trastorno neurocognoscitivo (TN) valorado por clínica de memoria en un centro de evaluación en Bogotá, Colombia, durante el ano 2015. Material y métodos: Estudio observacional descriptivo y de corte retrospectivo de 507 pacientes con diagnóstico de trastorno neurocognoscitivo (según criterios del DSM-5), valorados en un centro de referencia en Bogotá en 2015. Resultados: La media de edad de los sujetos con trastorno neurocognoscitivo leve en el momento del diagnóstico era 71,04 arios y la de aquellos con trastorno neurocognoscitivo mayor, 75,32 años (p < 0,001). El 62,72% de la muestra son mujeres. La etiología más frecuente del trastorno neurocognoscitivo fue la enfermedad de Alzheimer probable, seguida por la degeneración lobar frontotemporal, variante conductual, y el trastorno neurocognoscitivo debido a múltiples etiologías. Las AC se presentan con mayor frecuencia en TN debido a degeneración frontotemporal variante conductual (100%), enfermedad de Alzheimer (77,29%) y vascular (76,19%). Las AC más prevalentes en el grupo evaluado fueron la apatía (50,75%), la irritabilidad (48,45%), la agresividad (16,6%) y la labilidad emocional (14,76%). Conclusiones: Las AC son prevalentes en pacientes con diagnóstico de trastorno neurocognoscitivo mayor. Según la etiología del trastorno neurocognoscitivo mayor, las AC son más prevalentes en la degeneración frontotemporal variante conductual. Apatía, irritabilidad, labilidad emocional y agresividad son las AC más comunes en toda la muestra.

ABSTRACT Introduction: The main aim of this study is to determine the prevalence of behavioural disturbances (BD) in a group of patients with diagnosis of neurocognitive disorders assessed by a memory clinic in a referral assessment centre in Bogotá, Colombia, in 2015. Material and methods: This is an observational, retrospective descriptive study of 507 patients with a diagnosis of neurocognitive disorder (according to DSM-5 criteria) evaluated in a referral centre in Bogotá, Colombia, in 2015. Results: Among the group of patients assessed, analyses reveal mean age for minor neurocognitive disorders of 71.04 years, and 75.32 years for major neurocognitive disorder (P < 0.001). A total of 62.72% of the sample were female. The most prevalent aetiology of the neurocognitive disorders was Alzheimer's disease, followed by behavioural variant fronto-temporal dementia and neurocognitive disorders due to multiple aetiologies. BD occur more frequently in neurocognitive disorder due to behavioural variant frontotemporal dementia (100%), Alzheimer's disease (77.29%) and vascular disease (76.19%). The most prevalent BD in the group assessed were apathy (50.75%), irritability (48.45%), aggression (16.6%), and emotional lability (14.76%). Conclusions: BD are highly prevalent in patients with diagnosis of major neurocognitive disorder. BD are more prevalent in behavioural variant frontotemporal dementia than any other group. Apathy, irritability, emotional lability and aggression are the BD that occur with greater prevalence in our sample. We discuss the importance of BD in the clinical progression of neurocognitive disorders.

Iluminando las decisiones e intervenciones públicas para la población adulta mayor: estudio SABE Bogotá / Enlightening decisions and public interventions for the older adult population: SABE Bogotá study

ResumenObjetivo: Destacar los resultados de mayor impacto para la población adulta mayor en Bogotá, de ma-nera 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 conglome-rados, 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 desnutri-ción, 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 agre-sión 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

AbstractObjective:thisworkhighlightstheresultswiththegreatestimpactfortheolderadultpopula-tioninBogotá.Theseresultsshouldserveasreferencestoprioritizedecisionsanddeveloppublichealthinterventionstobenefittheseolderadults.Materials and methods:W euseddatafromacross-sectionalstudy,withamultistageprobabilisticsamplingbyconglomerates.Aofreliabilitylevelof95%wasestablishedandthesamplesizewas2000individualsbetweentheagesof60and100years.Adescriptiveanalysisofallthevariableswasconducted,esti-matingfrequenciesandsubsequentlyanalyzingdependencyandassociationwithChisquare,T-testsandmultivariatelogisticregressionsasappropriateforeachcase.Additionally,Spear-manRhotestswereusedtoanalyzecorrelations.Themaintopicsanalyzedwere:frailty,sarcopenia,nutrition,hypertension(HTN),depression,violence,disability,livingaloneandpoverty.Results:about40%ofthepopulationwasmalnourishedoratriskofmalnutrition,morethan60%waspre-frailorfrailandmorethan11%hadsarcopenia.HTNwasreportedin58%ofolderadults,42%hadbeenvictimsofviolenceinthelastyearand43%hadbeendisplacedbyviolenceduringtheirlife.Morethanhalfhaddisability,12,6%livedaloneand7,8%hadextremepoverty.Conclusions: theseresultsshouldhelpidentifythemostpressingissuesfacedbyolderadultsinthecapitalofColombiaandshoulddrivethedevelopmentofpublichealthinterventionsforthecity.Onlyintegrationoftheseresultswithactiveparticipa-tionofpolicymakersandthecommunitywillresultinimprovementsforolderadultsandthepopulationatlarge

Evaluación de factores asociados al estado funcional en ancianos de 60 años o más en Bogotá, Colombia / Assessment of factors associated with functional status in 60 years-old and older adults in Bogotá, Colombia

Resumen Introducción. La declinación funcional produce un amplio espectro de efectos negativos, como dificultad para la movilidad, aislamiento social, deterioro de la calidad de vida, discapacidad e internación en instituciones especializadas, lo cual convierte la medición de la funcionalidad en un marcador importante del bienestar. Objetivo. Caracterizar y determinar los factores asociados con el deterioro funcional del anciano en Bogotá. Materiales y métodos. Se utilizaron los datos del Estudio SABE-Bogotá. El estado funcional de los participantes se evaluó mediante las escalas de Barthel y Lawton. Se usaron como variables independientes los factores sociodemográficos, las enfermedades concomitantes, las medidas antropométricas y los terciles de actividad física, y se obtuvieron análisis bivariados y multivariados con regresiones lineales. Resultados. Se entrevistaron 2.000 personas de 60 o más años, con una edad promedio de 71,2 ± 8 años. Una mayor funcionalidad en actividades instrumentales se asoció con una menor edad (valor beta estandarizado: -0,15; p<0,01), un menor número de medicamentos (valor beta: -0,13; p<0,01), un mayor puntaje en el Mini-mental State Examination, MMSE) (valor beta: 0,3; p<0,01), un mayor nivel de actividad física (tercil medio: 0,18; p<0,01 y tercil alto de beta: 0,18; p<0,01 Vs. tercil bajo) y una mayor fuerza de prensión (valor beta: 0,10; p<0,01),en tanto que una mayor funcionalidad en las actividades básicas se asoció con un mayor puntaje en el MMSE (valor beta: 0,3; p<0,01) y una mayor fuerza de prensión (valor beta: 0,07; p=0,020). Conclusiones. En este estudio se determinaron múltiples factores relacionados con la alteración funcional que pueden modificarse para disminuir la dependencia en este grupo poblacional.

Abstract Introduction: Functional impairment produces a wide range of negative effects such as difficulty in mobility, social isolation, decreased quality of life, disability and institutionalization. Thus, functional status measurement is a marker of social wellbeing. Objective: To determine and characterize the socio-demographic factors and health conditions related to functional impairment in older adults in Bogotá, Colombia. Materials and methods: Data was collected from the SABE Bogotá Study. Functional status was assessed using the Barthel and Lawton scales. Independent variables included socio-demographic factors, comorbidities, anthropometric measurements and physical activity (by tertiles). Bivariate analyzes were performed, and multivariate results were obtained using linear regression models. Results: There were 2,000 participants aged 60 years and older, with a mean age of 71.2 ± 8 years. Younger age (standardized beta = -0.15, p<0.01), fewer medications (beta= -0.13, p<0.01), higher MMSE score (beta = 0.3, p< 0.01), higher level of physical activity (middle beta tertile = 0.18, p<0.01, and higher beta tertile= 0.18, p<0.01vs lower tertile) and better performance in the handgrip test (beta=0.10, p<0.01) were associated with better function in daily life instrumental activities. Similarly, higher MMSE score (beta= 0.3, p<0.01) and better performance in the handgrip test (beta= 0.07, p= 0.02) were associated with better function in daily life basic activities. Conclusions: We found several factors related with functional impairment, which are likely to be modified to reduce dependence in this population.

Uso de medicamentos en adultos mayores de Bogotá, Colombia / Medication use among older adults in Bogota, Colombia

RESUMEN Objetivos. Determinar la frecuencia y tipo de medicamentos que utiliza un grupo de adultos mayores que viven en la capital colombiana, y cuáles son potencialmente inapropiados, con base en los criterios revisados de Beers. Materiales y métodos. Los datos fueron obtenidos del estudio SABE (estudio de salud, bienestar y envejecimiento) que se llevó a cabo en áreas urbanas y rurales de Bogotá en el 2012. Se utilizó la prueba U de Mann-Whitney para analizar las diferencias por sexo en los diferentes grupo de edad con relación al número de medicamentos tomados. Resultados. Un total de 1268 (63,4%) de los adultos mayores fueron mujeres; entre los participantes, 1514 (75,7%) tenían 5 años de educación básica o menos. El promedio de medicamentos tomados en general fue de 3,24 siendo mayor en mujeres (3,50) que en hombres (2,79). Un total de 549 sujetos (27,4%) reportaron recibir cinco medicamentos o más. De los medicamentos utilizados, 443 (6,9%) eran potencialmente inapropiados de acuerdo con los criterios de Beers. La prevalencia autorreportada de hipertensión fue de 56,9% y para diabetes de 17,5%. Solo 311 sujetos (15,6%) no tomaban ningún medicamento. Conclusiones. El uso de medicamentos inapropiados es un problema importante que afecta a los adultos mayores en Bogotá. Estudios adicionales deberán identificar factores que aumentan el riesgo de polifarmacia y uso inapropiado de medicamentos y diseñar intervenciones para prevenir el uso inapropiado de medicamentos entre adultos mayores.

ABSTRACT Objectives. To determine the frequency and types of medication used by older adults living in the Colombian capital, Bogota, and to identify the use of potentially inappropriate medications according to the revised Beers criteria. Materials and methods. Data were obtained from the health, welfare, and aging (SABE, Spanish: salud, bienestar y envejecimiento) study conducted in both urban and rural areas of Bogota in 2012. The Mann–Whitney U test was used to analyze sex-related differences in the number of medications used among age-stratified subgroups. Results. Of 2 000 subjects, 1,268 (63.4%) were women; furthermore, 1,514 (75.7%) of the total participants had ≤5 years of basic education. The self-reported prevalence rates of hypertension and diabetes were 56.9% and 17.5%, respectively. The average number of medications per subject was 3.24, and it was higher in women (3.50) than in men (2.79). A total of 549 subjects (27.4%) reported using ≥5 medications. Only 311 subjects (15.6%) reported not using any medication. According to the Beers criteria, 443 (6.9%) of the medications were potentially inappropriate. Conclusions. The use of inappropriate medications is a major problem among older adults in Bogota. Further studies should identify factors that increase the risks of polypharmacy and inappropriate medication use and design interventions that would allow older adults to avoid these risks.

Relación entre deterioro cognoscitivo y actividades instrumentales de la vida diaria: Estudio SABE-Bogotá, Colombia / Relationship between cognitive impairment and instrumental activities of daily living (IADL): SABE-Bogotá, Colombia Study

Introducción: En la vejez, el declinar en las Actividades Instrumentales de la Vida Diaria (AIVD), se relaciona con deterioro cognoscitivo; sin embargo, no todas ellas se ven alteradas, en especial al inicio de la enfermedad. Por lo tanto la identificación de estas actividades podría ayudar a obtener diagnósticos más tempranos y precisos. Objetivo: identificar las actividades instrumentales de la vida diaria (AIVD) que más se asocian con deterioro cognoscitivo en los adultos mayores. Materiales y métodos: se analizaron datos del estudio SABE Bogotá (2012), donde se entrevistó a 2.000 adultos mayores (≥60 años) en un estudio transversal, se recolectó una muestra probabilística por conglomerados, con una cobertura del 81.9%. En la recolección de los datos se utilizaron: el instrumento minimental modificado (MMSE-M) y t actividades instrumentales de la vida diaria. Se realizaron análisis bivariados y multivariados con modelos de regresión logística para hallar asociaciones estadísticamente significativas (p<0.05). Resultados: Las AIVD con mayor asociación fueron: no poder: "usar el teléfono" OR 5.007 (IC 95% 3.01-8.32), "manejar su propio dinero" OR 2.58 (IC 95% 1.57-4.23), "preparar su propia comida solo" OR 1.83 (IC 95% 1.11-3.02), "tomar sus propios medicamentos" OR 1.83 (IC 95% 1.06-3.02), y "hacer trabajo pesado en casa como lavar el piso o las paredes" OR 1.696 (IC 1.075-2.75). Conclusión: las actividades instrumentales de la vida diaria más asociadas con el deterioro cognoscitivo fueron las que requerían mayor capacidad de abstracción y planeación. Esta información puede ser de utilidad al clínico durante el interrogatorio hecho a los pacientes para optimizar el tiempo en la consulta, sospechar el deterioro cognoscitivo e indicar estudios diagnósticos para un tratamiento oportuno.

Introduction: In the elderly, the decline in Instrumental Activities of Daily Living (IADL), is related to cognitive impairment; however, not all of them are affected, particularly during the early in the disease. Therefore, identifying these associated IADL could help achieve earlier and more accurate diagnoses. Objective: Identifying which IADL are more associated with cognitive impairment in older adults. Materials and methods: Data from SABE Bogota Study (2012) was used, where 2000 older adults (≥60 years) were interviewed in a cross sectional study, collecting a probabilistic cluster sample, with a coverage of 81.9%. To collect the data were used: the modified instrument Minimental (MMSE-M) and 13 instrumental activities of daily living. Bivariate analyzes were performed and multivariate logistic regression models to find statistically significant associations (p <0.05). Results: The AIVD with the highest association were: not able to "use the phone" OR 5.007 (95% CI 3.01-8.32), "manage their own money" OR 2.58 (95% CI 1.57-4.23), "prepare your own food alone" OR 1.83 (95% CI 1.11-3.02), "taking their own medicine" OR 1.83 (95% CI 1.06-3.02), and doing "heavy labor at home such as washing the floor or walls" OR 1.696 (CI 1.075-2.75 ). Conclusion:Instrumental activities of daily life living associated with cognitive decline were those that required greater capacity for abstraction and planning. This information can be useful to the clinician during interrogation in order to maximize their time in the medical consult, detecting cognitive impairment and indicating an appropriate diagnostic and early treatment.

Mortality inequality among older adults in Mexico: the combined role of infectious and chronic disease / Desigualdad en cuanto a mortalidad en adultos mayores de México: el efecto combinado de las enfermedades infecciosas y las enfermedades crónicas

OBJECTIVE: To assess the effects of education and chronic and/or infectious disease, and the interaction between both variables, on the risk of dying among Mexicans 60 years and older. METHODS: Using data from the Mexican Health and Aging Study (MHAS), logistic regressions were performed to estimate the risk of mortality for older Mexicans between 2001 and 2003. Estimated mortality risks associated with chronic disease, infectious disease, and a combination of both were used to estimate additional life expectancy at age 60. RESULTS: Compared to the group with some schooling, the probability of dying over the twoyear inter-wave period was 26% higher among those with no schooling. Not having at least one year of formal education translated into a shorter additional life expectancy at age 60 by 1.4-2.0 years. Having chronic and/or infectious disease also increased the risk of mortality during the same period CONCLUSIONS: These results indicate that 1) a mixed epidemiological regime (the presence of both chronic and infectious disease) adds to the mortality health burden experienced by older people, and 2) there are persistent inequalities in mortality risks based on socioeconomic status.

OBJETIVO: Evaluar los efectos del nivel de educación y de las enfermedades crónicas o infecciosas, y de la interacción entre ambas variables, sobre el riesgo de muerte en mexicanos de 60 años o mayores. MÉTODOS: Mediante la utilización de datos del Estudio Nacional de Salud y Envejecimiento en México (ENASEM), se llevaron a cabo análisis de regresión logística para calcular el riesgo de mortalidad en mexicanos de 60 años o mayores entre el 2001 y el 2003. Se usaron los riesgos calculados de mortalidad asociada con enfermedades crónicas, enfermedades infecciosas y una combinación de ambas para calcular la esperanza de vida adicional a los 60 años. RESULTADOS: En comparación con el grupo con cierto grado de escolaridad, la probabilidad de muerte en el período de dos años entre las dos fases de recopilación de datos fue 26% mayor en las personas sin escolaridad. La carencia de como mínimo un año de educación formal se tradujo en una esperanza de vida adicional a los 60 años de 1,4 a 2,0 años más corta. La presencia de una enfermedad crónica o infecciosa también aumentó el riesgo de mortalidad durante el mismo período. CONCLUSIONES: Estos resultados indican que 1) un régimen epidemiológico mixto (la presencia de una enfermedad crónica y de una enfermedad infecciosa) incrementa la carga sanitaria en forma de mortalidad experimentada por las personas mayores y 2) siguen existiendo desigualdades en cuanto al riesgo de mortalidad basadas en el nivel socioeconómico.

Older adults under a mixed regime of infectious and chronic diseases

OBJECTIVE: Analyze the impact of a mixed regime of infectious and chronic conditions among older adults in Mexico on their health progression. MATERIALS AND METHODS: A total of 12 207 adults from the Mexican Health and Aging Study were included. Logistic regression analyses were conducted to assess the relationship between self-reported health (SRH) and covariates, including infectious and chronic diseases. Changes in SRH between 2001-2003 were analyzed using multinomial analysis. RESULTS: Older age, low SES, poor SRH and type of disease at baseline increase the odds of poor SRH at follow-up. Odds of poor SRH are highest for persons with both types of diseases (OR 2.63, SE 0.24), followed by only chronic (OR 1.86; SE 0.12) and finally only infectious (OR 1.55; SE 0.25). CONCLUSION: Mexico is experiencing a mixed regime of diseases that affects the health and wellbe-ing of older adults. Despite the rising importance of chronic diseases in countries like Mexico, it is premature to disregard the relevance of infectious diseases for public health.

OBJETIVO: Analizar el impacto del régimen epidemiológico mixto presente en México sobre la salud de los adultos mayores. MATERIAL Y MÉTODOS: Participaron adultos mayores de la Encuesta Nacional de Salud y Envejecimiento en México (n=12 207). Se usaron regresiones logísticas para evaluar la relación entre autorreporte de salud (ARS) y variables como enfermedades infecciosas y crónicas. Se analizó el cambio en ARS mediante análisis multinomiales. RESULTADOS: Edad, estatus socioeconómico, pobre ARS y tipo de enfermedad aumentan el riesgo de pobre ARS en el futuro. La razón de probabilidades de pobre ARS fue más alta para individuos con ambos tipos de enfermedad (OR 2.63, SE 0.24), seguida por aquellos con crónicas (OR 1.86; SE 0.12) y aquellos con infecciosas (OR 1.55; SE 0.25). CONCLUSIÓN: El régimen mixto presente en México afecta a los adultos mayores. En países como México, es prematuro dejar de lado el impacto de las enfermedades infecciosas para enfocarse únicamente en prevenir las crónicas.