Association between frailty and activities of daily living disability in older adults residing in a high-altitude Peruvian Andean community: the Aunqui-Andes study.

BACKGROUND: The prevalence of frailty and activities of daily living (ADL) disability may be higher in high-altitude Andean regions, due to chronic hypoxia, malnutrition, and physical challenges. and their association is relevant. This study aimed to evaluate the association between frailty and ADL disability among older adults residing in the Totos district in Peru during the year 2022. METHODS: A cross-sectional study was conducted in Totos district (mean altitude: 3286 m above sea level), located in Ayacucho, Peru, during 2022. A complete census was employed including residents aged 60 and above. The exposure variable was frailty, defined by fulfilling 3 or more criteria of the Fried phenotype. The outcome variable was ADL disability, defined as a score below 95 on the Barthel index. Generalized linear models with a Poisson family, logarithmic link function, and robust variances were employed to estimate crude prevalence ratios and adjusted prevalence ratios (aPRs), along with their corresponding 95% confidence intervals (CIs). RESULTS: We evaluated 272 older adults with a mean age of 74 years, of whom 59.9% were female, 62.1% were cohabiting or married and 83.1% had not completed primary education. We found that 19.5% were frail, while 51.1% had ADL disability. In the adjusted regression model, we found frailty increased the prevalence of ADL disability (aPR = 1.77; 95%CI: 1.44-2.16; p < 0.001). CONCLUSION: Frailty was associated with an increased prevalence of ADL disability. These findings could contribute to establishing government intervention plans to manage disability and frailty within the high-risk group comprising older adults living at high altitudes.

Effects of a sequential square mat walking training program Fisior® on improving physical performance in older adults with Parkinson's disease: A pilot study.

BACKGROUND: This study aimed to assess the efficacy of a 12-week functional walking training program utilizing a sequential square mat (Fisior® Mat) on the physical performance of older adults diagnosed with Parkinson's Disease (PD). METHODS: Participants, aged over 60 and diagnosed with mild to moderate PD, underwent progressive resistance training sessions lasting 30-40 minutes, three times a week, using the Fisior® sequential square mat. A randomized clinical trial was conducted with participants from a patient association. Multiple linear regression models were employed to analyze physical performance variation between intervention and control groups. RESULTS: Twenty-eight patients (14 in each group) participated, with improvements observed in total Short Physical Performance Battery (SPPB) score, chair test score, gait speed score, and balance test score. Participants in the intervention group showed significant improvement in chair and balance test scores compared to controls. CONCLUSION: The Fisior® sequential square mat program, as an adjunct to conventional outpatient physiotherapy, effectively enhances physical performance in older adults with PD.

Motoric cognitive risk syndrome as a predictor of mortality in older male adults with cancer: A prospective cohort study in Peru.

We aimed to assess motoric cognitive risk syndrome (MCRS) as a mortality predictor in older male adults with cancer at Centro Médico Naval (CEMENA) in Peru from 2012 to 2015. We conducted a secondary analysis of a prospective cohort within CEMENA's Geriatrics Service. We considered all-cause mortality as the primary outcome. MCRS was defined as slow gait speed, cognitive impairment, preserved activities of daily living, and absence of dementia. We utilized Poisson family generalized linear models with a logarithmic link function and robust variance to calculate both crude and adjusted relative risks (RR) with 95 % confidence intervals (95 % CI). We included 832 older male adults, with an MCRS frequency of 18.27 % (n = 152) and a mortality incidence of 22.84 % (n = 190). MCRS was a predictor of mortality in older adults at the end of follow-up (aRR=2.55; 95 % CI: 2.13-2.66). Survival was lower in older adults with MCRS (log-rank test p < 0.001). MCRS was a mortality predictor in older male adults with cancer.

Association between depressive symptoms and disability in older adults of 12 high Andean communities from Peru.

OBJECTIVE: Our objective was to evaluate the association between depressive symptoms and disability in older adults residing in 12 high Andean communities in Peru. MATERIAL AND METHODS: We carried out a secondary data analysis of a cross-sectional study that included older adults (60 years or older) from 12 high Andean communities in Peru from 2013 to 2019. Depressive symptoms were defined as a score of two or more in the abbreviated Geriatric Depression Scale, while disability was defined as a score of less than 95 in the Barthel index. We also included sociodemographic characteristics, medical and personal history, and functional and performance-based tests. We used crude and adjusted Poisson regression models to evaluate the association of interest and estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). RESULTS: We included 442 older adults with a mean age of 73 ± 6.9 in the analysis; 63.1% (n = 279) were women, and 79.9% (n = 353) had no education or incomplete primary school. 50.9% (n = 225) of the participants had depressive symptoms, and 49.8% (n = 220) had disability. The adjusted Poisson regression model showed that depressive symptoms increased the probability of disability (adjusted PR = 1.67; 95% CI: 1.34-2.08; p < 0.001) in older adults living at high altitude. CONCLUSIONS: Depressive symptoms was associated with a greater probability of disability in older adults living at high altitude. Longitudinal studies are needed for better understanding of this association in high altitude populations along with timely interventions to reduce the impact of both geriatric syndromes.

[Impact of social support on limited mobility in older people in high Andean communities in PeruImpacto do apoio social na mobilidade reduzida em idosos de comunidades do altiplano andino no Peru]. / Impacto del soporte social sobre la movilidad limitada en personas mayores de comunidades altoandinas peruanas.

OBJECTIVE: To determine whether there is a relationship between physical mobility and lack of social support in elderly people living in high Andean communities in Peru. METHODOLOGY: Observational, analytical, retrospective study using the database of a previous cross-sectional study containing information on 449 people aged 60 years and over, who participated in the ANDES-FRAIL project. The dependent variable was mobility, evaluated using the Short Physical Performance Battery; the independent variable was social support, evaluated using an item from the Edmonton Frail Scale. Sociodemographic parameters, comorbidities, number of drugs commonly used, and scores received from several instruments were used as covariates. These included the Barthel Index to determine functionality in older people and the Yesavage questionnaire to evaluate depression in the elderly. Frequencies and percentages were calculated for the categorical variables. An adjusted model was developed using the variables that were statistically significant in the two-factor logistic regression analysis. RESULTS: The frequency of limited mobility in the studied population was 58.6% (n = 263) and the frequency of inadequate social support was 58.1% (n = 261); 70.7% of participants (n = 186) with inadequate social support had limited mobility. According to the adjusted regression model, inadequate social support would make it 2.5 times more likely (95% CI: 1.3-4.5) to have limited mobility, regardless of the confounding covariates. CONCLUSIONS: Lack of social support is associated with limited mobility in older people living in high Andean communities in Peru.

OBJETIVO: Determinar se existe relação entre mobilidade física e falta de apoio social em idosos que vivem em comunidades do altiplano andino no Peru. MÉTODOS: Estudo observacional analítico de coorte retrospectiva baseado em dados obtidos em uma pesquisa transversal anterior com 449 participantes, com idade de 60 anos ou mais, como parte do Projeto ANDES-FRAIL. A variável dependente foi a mobilidade, avaliada com o Short Physical Performance Battery, um instrumento que avalia o desempenho físico funcional com uma série curta de testes. A variável independente foi o apoio social, avaliado por um item da Escala de Fragilidade de Edmonton (The Edmonton Frail Scale, EFS). As covariáveis foram parâmetros sociodemográficos, presença de comorbidades, número de medicamentos de uso habitual e pontuação em vários instrumentos de avaliação, como o índice de Barthel de avaliação da independência funcional de idosos e a Escala de Depressão Geriátrica de Yesavage. Foram calculadas as frequências e as porcentagens das variáveis categóricas e elaborado um modelo ajustado com as variáveis com significância estatística na análise de regressão logística bifatorial. RESULTADOS: Na amostra estudada, 58,6% (n = 263) apresentavam mobilidade reduzida e 58,1% (n = 261) recebiam apoio social inadequado. Entre as pessoas com apoio social inadequado, 70,7% (n = 186) apresentavam mobilidade reduzida. De acordo com o modelo de regressão logística ajustado, a chance de ter mobilidade reduzida foi 2,5 vezes maior (IC 95% 1,3­4,5) quando o apoio social era inadequado, independentemente das covariáveis de confusão. CONCLUSÃO: A falta de apoio social está associada à mobilidade reduzida em idosos que vivem em comunidades do altiplano andino no Peru.

Falls Among the Elderly in Peruvian Andean Communities and the Rural far South of Brazil: Prevalence and Associated Factors.

Falls are the fifth leading cause of death and are one of the main causes of hospitalization. The literature about falls prevalence among older adults living in rural/remote communities in South America is scarce. To compare falls prevalence among the elderly in the Andes, Peru, and in the rural area of the municipality of Rio Grande, Rio Grande do Sul state, Brazil. Two separate cross-sectional studies were conducted in Peru, Andes (N = 413), and Brazil, Rio Grande, Rio Grande do Sul state (N = 1029). We stratified all data analysis according to location (Andes/Rio Grande). Characteristics of the samples were compared and the chi square test for proportions was used. Falls prevalence was then calculated for each independent variable and crude and adjusted prevalence ratios were estimated using Poisson Regression with robust variance. Falls prevalence in the last year was much higher in the Andes (64.1%) than in Rio Grande (25.3%). For most characteristics assessed, falls prevalence in Peru was at least double that found in Rio Grande. According to the adjusted analysis for the Andes, age (80 or more), being married, divorced and alcohol intake were significantly associated with falls. In Rio Grande, female gender and being in the 70-79 and 80 or more age ranges were associated with falls as well as those who self-rated their health as poor. This paper contributes to knowledge about falls prevalence among the elderly from rural and remote communities in two South American countries. Longitudinal multicentre studies with standardized methodologies are recommended.

Making rural and remote communities more age-friendly: experts' perspectives on issues, challenges, and priorities.

With the growing interest worldwide in making communities more age-friendly, it is becoming increasingly important to understand the factors that help or hinder communities in attaining this goal. In this article, we focus on rural and remote communities and present perspectives of 42 experts in the areas of aging, rural and remote issues, and policy who participated in a consensus conference on age-friendly rural and remote communities. Discussions highlighted that strengths in rural and remote communities, such as easy access to local leaders and existing partnerships, can help to further age-friendly goals; however, addressing major challenges, such as lack of infrastructure and limited availability of social and health services, requires regional or national government buy-in and funding opportunities. Age-friendly work in rural and remote communities is, therefore, ideally embedded in larger age-friendly initiatives and supported by regional or national policies, programs, and funding sources.

Correlation between Instrumental Activities of Daily Living and muscle mass in older adults: impact of comorbidities.

Background: There is evidence that sarcopenia and functionality are closely related. However, the association between geriatric syndromes, such as dependence, on instrumental activities and sarcopenia could be affected by the presence of certain comorbidities, such as overweight, obesity, diabetes, and chronic obstructive pulmonary disease (COPD). Therefore, the present study aimed to determine the association between instrumental activities of daily living and muscle mass in the elderly and evaluate the impact of certain comorbidities on this association. Methods: This was a retrospective analytical observational study, including 1897 patients. Muscle mass was measured with calf circumference, and instrumental activities were measured with the Lawton index. Results: Among different parameters studies, a statistical correlation was found in a stratified regression analysis between the Lawton index score and muscle mass in patients who were overweight (p value:0.001 ;beta coefficient: 0.08), obese (p value: 0.001 ; beta coefficient: 0.05), had diabetes (p value: 0.012 ;beta coefficient: 0.03), and had COPD (p value:0.001 ;beta coefficient:0.03). Conclusion: The correlation between muscle mass and instrumental activities of daily living should be evaluated individually according to the needs of each participant and according to their comorbidities, promoting patient-centered geriatric medicine.

Association between Subclinical Hypothyroidism and Glycemic Control in Older Adults in a Medical Center in Peru.

Objective: To determine whether there is an association between subclinical hypothyroidism and glycemic control in older adults who received care at the "Centro Médico Naval" from 2010 to 2015. Methods: This retrospective analytical study analyzed a secondary database of the care of elderly in the study hospital. The sample was comprised of 1,385 older adults. To detect an association between variables, the Poisson regression with robust variance was used at a significance level of 95%. The analyses were carried out with the STATA 16 program. Results: Of the elderly 45.6% were between 71 and 80 years old; 58.4% were women and 43.8% had a normal body mass index. There was evidence of inadequate glycemic control in 8.1% and subclinical hypothyroidism in 15.2% of the elderly patients. Subclinical hypothyroidism was more frequent in the inadequate glycemic control vs. adequate glycemic control populations (41.1% vs. 13.0%). In the multivariance analysis, subclinical hypothyroidism (aPR = 2.22 95% CI [1.47-3.36]) was independent factor associated with inadequate glycemic control (p < 0.001). Conclusions: A significant association was detected between subclinical hypothyroidism and inadequate glycemic control in older adults who presented at the "Centro Médico Naval" from 2010 to 2015.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

INTRODUCTION: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. We aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥55 years in Lima, Peru. METHODS: This cross-sectional study was conducted between 2018 and 2020. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS2) guidelines. We measured muscle strength by maximum handgrip strength and muscle mass using bioelectrical impedance analyzer. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. RESULTS: The study participants had a mean age of 66.2 years (SD 7.1), age range between 60 to 92 years old, of which 621 (53.9%) were men. Among the sample, 41.7% were classified as obese (BMI ≥30.0 kg/m²). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI: 25.2-30.4) using the AWGS2 criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS2 criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). CONCLUSION: Our findings reveal substantial variation in the prevalence of sarcopenia and SO, underscoring the necessity for context-specific cut-off values. Although the prevalence of SO was relatively low, this result may be underestimated. Furthermore, the consistently high proportion of probable sarcopenia and sarcopenia point to a substantial public health burden.

Risk factors associated with dengue complications and death: A cohort study in Peru.

BACKGROUND: Dengue has emerged as an unprecedented epidemic in Peru, and it is anticipated that this issue will escalate further owing to climate change. This study aimed to determine the risk factors associated with death from dengue in patients treated at Hospital II in Pucallpa, Peru. METHODOLOGY: This retrospective cohort study collected information from the medical records of patients with a diagnosis of dengue treated at Hospital II Pucallpa-Peru between January 2019 and March 2023. The primary outcome was death, and the secondary outcome was death, development of severe dengue, or Intensive Care Unit (ICU) admission. Cox regression models were used to determine risk factors. FINDINGS: The clinical records of 152 patients were evaluated, with a median age of 27.5 years (interquartile range, 11-45). Among all patients, 29 (19.1%) developed severe dengue, 31 (20.4%) were admitted to the ICU, and 13 (8.6%) died during follow-up. In the survival analysis, bilirubin >1.2 mg/dL was associated with a higher risk of death aHR: 11.38 (95% CI: 1.2 106.8). Additionally, factors associated with poor prognosis included having 1 to 3 comorbidities aRR: 1.92 (1.2 to 3.2), AST ≥251 U/L aRR: 6.79 (2.2 to 21.4), history of previous dengue aRR: 1.84 (1.0 to 3.3), and fibrinogen ≥400 mg/dL aRR: 2.23 (1.2 to 4.1). SIGNIFICANCE: Elevated bilirubin was associated with death from dengue, whereas an increase in comorbidities and a history of previous dengue were related to a poor prognosis of the disease. Early identification of severe dengue would be more feasible with improved access to laboratory testing, particularly in tropical areas with a high dengue incidence.

Association between Gait Speed and Balance Disorders in Older Adults from 12 High Andean Peruvian Communities, 2013-2019.

BACKGROUND: Gait speed is associated with a higher prevalence of balance disorders in older adults residing at high altitudes. This study investigated this association in older adults from 12 high-altitude Andean Peruvian communities. METHODS: We performed a secondary data analysis from an analytical cross-sectional study of adults >60 years of age, residing in 12 high-altitude Andean Peruvian communities, enrolled between 2013 and 2019. The exposure and outcome variables were gait speed (categorized in tertiles), and balance disorders (defined as a functional reach value of ≤20.32 cm), respectively. We built generalized linear models of the Poisson family with a logarithmic link function and robust variances, and estimated crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with 95% confidence intervals (CIs). RESULTS: We analyzed 418 older adults; 38.8% (n=162) were male, and the mean age was 73.2±6.9 years. The mean gait speed and functional reach were 0.66±0.24 m/s and 19.9±6.48 cm, respectively. In the adjusted regression model, the intermediate (aPR=1.88; 95% CI, 1.39-2.55; p<0.001) and low (aPR=2.04; 95% CI, 1.51-2.76; p<0.001) tertiles of gait speed were associated with a higher prevalence of balance disorders. CONCLUSION: The intermediate and low tertiles of gait speed were associated with a higher prevalence of balance disorders among older adult residents of 12 high-altitude Andean communities. We recommend further research on the behavior of this association to propose interventions for these vulnerable groups and reduce the impact of geriatric conditions.

Evaluation of Factors Influencing Handgrip Strength Asymmetry in Older Peruvian Adults.

BACKGROUND: Sarcopenia is a musculoskeletal disease involving the reduction of muscle mass, strength, and performance. Handgrip strength (HGS) measurements included in frailty assessments are great biomarkers of aging and are related to functional deficits. We assessed the association between potential influencing factors and HGS asymmetry in older Peruvian adults. METHODS: We used a database of the Peruvian Naval Medical Center "Cirujano Santiago Távara" located in Callao, Peru. All the patients included were ≥60 years old and had an HGS measurement in the dominant and non-dominant hand. RESULTS: From a total of 1,468 patients, 74.66% had HGS asymmetry. After adjustment, calf circumference weakness (adjusted prevalence ratio [aPR]=1.08; 95% confidence interval [CI], 1.01-1.15), falls risk (aPR = 1.08; 95% CI, 1.02-1.16), and an altered Lawton index (aPR=0.92; 95% CI, 0.84-0.99) were associated with HGS asymmetry. CONCLUSION: Our findings suggest that HGS asymmetry should be measured along with other geriatric assessments used to evaluate health outcomes in the elderly to enhance health promotion and prevention aimed at preserving muscle strength to curb functional limitations in the elderly.

Pilot trial protocol: community intervention to improve depressive symptoms among Peruvian older adults.

BACKGROUND: Non-pharmacological interventions have proven effective at alleviating depression and anxiety symptoms in older adults. Methodological refinement and testing of these interventions in new contexts are needed on a small scale before their effectiveness and implementation can be evaluated. The purpose of this pilot study is to assess the feasibility of a future large-scale trial comparing an adapted mental health multi-component evidence-based intervention (VIDACTIVA) versus standard care for older adults experiencing depression symptoms in urban, resource-limited settings in Lima, Peru. Furthermore, this study will explore the acceptability, feasibility, and fidelity of implementing the intervention. METHODS: We will conduct an open-label, mixed methods pilot feasibility study with two parallel groups. A total of 64 older adults, stratified by sex, will be randomized at a 1:1 ratio to either the "intervention" or "control." Participants will be followed for 22 weeks after enrollment. Those in the intervention group will receive eight VIDACTIVA sessions administered by community health workers (CHWs) over 14 weeks, with an additional eight weeks of follow-up. Participants in the control group will receive two psychoeducation sessions from a study fieldworker and will be directed to health care centers. Standard care does not involve CHWs. We will evaluate screening rates, recruitment strategies, retention rates, the acceptability of randomization, and assessments. Additionally, we will assess preliminary implementation outcomes-acceptability, feasibility, and fidelity-from the perspectives of CHWs (interventionists), older adults (main participants), older adults' relatives, and healthcare professionals. DISCUSSION: If the findings from this feasibility trial are favorable, a fully powered randomized controlled trial will be conducted to evaluate `both the effectiveness and implementation of the intervention. This research will make a substantial contribution to the field of mental health in older adults, particularly by emphasizing a meticulous examination and documentation of the implementation process. By doing so, this study will offer valuable methodologies and metrics for adapting and assessing mental health interventions tailored to the unique needs of older adults in resource-constrained contexts and diverse cultural settings. TRIAL REGISTRATION: The current trial registration number is NCT06065020, which was registered on 26th September 2023.

Agency and Mental Health Among Peruvian Older Adults During the COVID-19 Lockdown.

OBJECTIVES: To explore the experiences of older Peruvian adults living in urban areas of Lima under lockdown due to the National COVID-19 Emergency, this study analyzes how older adults (aged 60 and older) exercise agency while also living with the negative impacts of coronavirus disease 2019 (COVID-19) and related control measures. METHODS: Between August and December 2020, our research team conducted a telephone-based, qualitative study, in which we undertook semistructured interviews with a purposive sample of low-income older adults living with chronic multimorbidities and limited resources. Forty older adults, 24 women and 16 men, with a mean age of 72 years, participated in the study. For data analysis, we employed thematic analysis with a predominantly inductive approach. RESULTS: Older adults demonstrated several forms of agency to regulate emotions, maintain crucial bonds, foster social relationships, and seek economic and food security. Older adults experienced entertainment and support by caring for pets, undertaking farm work, and practicing their religious beliefs. For several participants and their families, quarantine was an opportunity to strengthen family relationships and learn new technologies. Older adults and their families reorganized themselves to assume new roles and perform activities that improved self-worth and confidence, thereby improving their well-being and mental health. DISCUSSION: Peruvian older adults exerted agency in different ways to respond to and sustain their mental health during the COVID-19 lockdown. Policymakers should value and recognize the agency of older adults when planning future health responses.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study.

Background: Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. However, there remains a lack of consensus on the criteria and cut-off thresholds for assessing sarcopenia and SO. Moreover, limited data are available on the prevalence of these conditions in Latin American countries. To address this evidence gap, we aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥ 55 years in Lima, Peru. Methods: Data collection for this cross-sectional study was conducted between 2018 and 2020 in two urban low-resource settings in Lima, Peru. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS) guidelines. We measured muscle strength by maximum handgrip strength; muscle mass using a whole-body single-frequency bioelectrical impedance analyzer, and physical performance using the Short Physical Performance Battery and 4-meter gait speed. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia. Results: The study participants had a mean age of 66.2 years (SD 7.1), of which 621 (53.9%) were men, and 41.7% were classified as obese (BMI ≥ 30.0 kg/m2). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI:25.2-30.4) using the AWGS criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3). Conclusions: Our findings reveal substantial variation in the prevalence of sarcopenia and SO when using different guidelines, underscoring the necessity for context-specific cut-off values. Nevertheless, regardless of the chosen guideline, the prevalence of probable sarcopenia and sarcopenia among community-dwelling older adults in Peru remains noteworthy.

A task force for diagnosis and treatment of people with Alzheimer's disease in Latin America.

Alzheimer's disease (AD) represents a substantial burden to patients, their caregivers, health systems, and society in Latin America and the Caribbean (LAC). This impact is exacerbated by limited access to diagnosis, specialized care, and therapies for AD within and among nations. The region has varied geographic, ethnic, cultural, and economic conditions, which create unique challenges to AD diagnosis and management. To address these issues, the Americas Health Foundation convened a panel of eight neurologists, geriatricians, and psychiatrists from Argentina, Brazil, Colombia, Ecuador, Guatemala, Mexico, and Peru who are experts in AD for a three-day virtual meeting to discuss best practices for AD diagnosis and treatment in LAC and create a manuscript offering recommendations to address identified barriers. In LAC, several barriers hamper diagnosing and treating people with dementia. These barriers include access to healthcare, fragmented healthcare systems, limited research funding, unstandardized diagnosis and treatment, genetic heterogeneity, and varying social determinants of health. Additional training for physicians and other healthcare workers at the primary care level, region-specific or adequately adapted cognitive tests, increased public healthcare insurance coverage of testing and treatment, and dedicated search strategies to detect populations with gene variants associated with AD are among the recommendations to improve the landscape of AD.

Never Thought I was Going to be Placed in a Situation Like This: In the Shoes of the Doctor Responsible for Municipal Health, Back in My Country, Perú.

The COVID-19 pandemic changed the way of living on the planet and, in my case, revealed the fragility of primary care services to respond to a health emergency that mainly affected older adults. Upon obtaining my medical degree, I felt guaranteed to have the skills to be a primary care physician; however, the coronavirus gave me "a reality bath with the aroma of impotence, bewilderment, and abandonment." Contradictory provisions and regulations, absence of a continuous policy, poor leadership, insufficient resources, and mismanagement by the Ministry of Health. Scandals of possible corruption and vices in the processes of research studies on vaccines. Anti-vaccine strategies, screening tests without evidence. The reference hospitals without oxygen, intensive care beds, and the outpatient consultations of specialist doctors closed. A community that is organized and wants to help but does not have a clear technical guide. These are some of the things I have had to deal with as head of a municipal health program. Meanwhile, I watched helplessly as members of my community continued to die and become disabled. Learning from mistakes and horrors is our duty. I narrate this experience to contribute to being prepared for the next time.

The depressed frail phenotype as a risk factor for mortality in older adults: A prospective cohort in Peru.

INTRODUCTION: Frailty and depression can coexist as depressed frail phenotype, useful for the comprehensive evaluation of older adults and prevention of adverse outcomes. The objective of this study was to evaluate the role of the depressed frail phenotype and its components as risk factors for mortality in older adults of the Centro Médico Naval (CEMENA) of Peru during 2010-2015. MATERIAL AND METHODS: We carried out a secondary data analysis of a prospective cohort that included older adults (60 years and older) treated in the Geriatrics service of CEMENA between the years 2010-2015. Frailty was defined as the presence of three or more Fried phenotype criteria and depression was determined using a Yesavage ultrashort scale score of three or more. The presence of both conditions was defined as depressed frail phenotype. In addition, sociodemographic characteristics, medical and personal history, and performance-based measures were included. We employed crude and adjusted Cox regression models to evaluate the association of interest and estimate Hazard Ratios (HR) with their respective 95% confidence intervals (95% CI). RESULTS: 946 older adults were included in the analysis, with a mean age of 78.0 ± 8.5 years. 559 (59.1%) were male, 148 (15.6%) were found to be frail, 231 (24.4%) had depressive symptoms, 105 (11.1%) had depressed frail phenotype, and 79 (8.3%) participants died during follow-up. The adjusted Cox regression analysis revealed that depressed frail phenotype (HR = 3.53; 95%CI: 2.07-6.00; p < 0.001) was a risk factor for mortality in older adults. CONCLUSIONS: The depressed frail phenotype was associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies that allow estimating this phenotype's impact on mortality and evaluate interventions to improve quality of life and reduce the risk of adverse outcomes.

Validation of Picture Free and Cued Selective Reminding Test for Illiteracy in Lima, Peru.

Dementia in Latin America is a crucial public health problem. Identifying brief cognitive screening (BCS) tools for the primary care setting is crucial, particularly for illiterate individuals. We evaluated tool performance characteristics and validated the free and total recall sections of the Free and Cued Selective Reminding Test-Picture version (FCSRT-Picture) to discriminate between 63 patients with early Alzheimer's disease dementia (ADD), 60 amnestic mild cognitive impairment (aMCI) and 64 cognitively healthy Peruvian individuals with illiteracy from an urban area. Clinical, functional, and cognitive assessments were performed. FCSRT-Picture performance was assessed using receiver operating characteristic curve analyses. The mean ± standard deviation scores were 7.7 ± 1.0 in ADD, 11.8 ± 1.6 in aMCI, and 29.5 ± 1.8 in controls. The FCSRT-Picture had better performance characteristics for distinguishing controls from aMCI compared with several other BCS tools, but similar characteristics between controls and early ADD. The FCSRT-Picture is a reliable BCS tool for illiteracy in Peru.