The effect of prevalent cardiovascular conditions on the association between alcohol consumption and mortality among older Mexican American men.

PURPOSE: To examine the association between alcohol consumption and mortality among older Mexican American men, with and without pre-existing cardiovascular conditions. METHODS: We conducted survival analysis among 908 men aged 65-80 years from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), a longitudinal population-based study of older Mexican Americans who reside in the southwestern United States. Men were categorized into four alcohol-consumption groups: lifetime abstainers, former drinkers, low risk drinkers (< or =30 drinks/month and < or =3 drinks/occasion) and at-risk drinkers (>30 drinks/month or >3 drinks/occasion) and stratified into two groups: those with and those without pre-existing cardiovascular conditions. Mortality was ascertained from 1993-1994 to 2007. RESULTS: Among participants without pre-existing cardiovascular conditions, former, low risk, and at-risk drinkers had a lower risk for all-cause mortality compared to lifetime abstainers [HR: .70, 95% CI (.50-.99), .64 (.42-.97) and .60 (.40-.92), respectively]. There was no statistically significant association between mortality and any of the alcohol consumption groups among those with cardiovascular conditions. CONCLUSIONS: Among older Mexican-American men without cardiovascular conditions, former and current drinkers had lower mortality compared to abstainers. No such associations were observed between alcohol use and mortality among those with cardiovascular conditions.

Surgical Excision Versus Medical Management of Primary Breast Lymphoma: A Case Report.

Lymphoma of the breast accounts for 0.4-0.5% of all breast-located cancers and is found in a similar fashion to breast cancers. Here we present a 74-year-old woman who presented for a biopsy of a breast mass found on a routine mammogram, which was found to be a primary breast lymphoma. According to current practice guidelines, medical therapy is favorable for the definitive management of primary breast lymphomas. However, biopsy specimen cytology found neoplastic cells positive for human germinal center-associated lymphoma, a nonspecific marker for various types of lymphomas. Without a definitive classification of lymphoma, optimal medical therapy could not be achieved. Therefore, a decision was made to undergo a lumpectomy of the mass, which yielded a specimen that was found pathologically favorable for diffuse large B-cell lymphoma. With this information, the patient was referred to follow-up oncology for adjuvant chemotherapy and radiotherapy.

Infant obesity: are we ready to make this diagnosis?

OBJECTIVES: To assess the prevalence, risk factors, diagnosis and treatment of infant obesity (weight-for-length) in a pediatric practice. STUDY DESIGN: This was a retrospective nested case-control design. The investigators reviewed and abstracted data from the records of the mothers (while pregnant) and their offspring. RESULTS: The prevalence of infant obesity was 16%. Children who were obese at age 24 months were highly likely to have been obese at age 6 months (odds ratio=13.3, 95% CI=4.50-39.53). Mothers of obese infants gained more weight during pregnancy (+6.9 kg, P<.05) than mothers of healthy weight infants. Obese infants were more likely to have been large for gestational age (Odds ratio=2.81, 95% CI=1.27-6.22). However, only 14% and 23% of obese infants aged 6 and 24 months were diagnosed with obesity. CONCLUSION: Infant obesity was common in our practice. Infant obesity strongly predicted obesity at age 24 months. Risk factors included excessive intrapartum weight gain or being born large for gestational age. Clinicians diagnosed obesity in only a minority of children. Primary care providers need to diagnose obesity in infants and work to develop effective interventions.

Frailty and 10-year mortality in community-living Mexican American older adults.

BACKGROUND: The older Hispanic population of the United States is growing rapidly. Hispanic older adults have relatively high-risk profiles for increased morbidity and disability, yet little is known about how the construct of frailty is related to health trajectories in this population. OBJECTIVE: The purpose of this study was to examine the relationship between frailty and 10-year mortality in older community-dwelling Mexican Americans. METHODS: Data were from the Hispanic Established Populations for Epidemiologic Studies of the Elderly and included 1,996 Mexican Americans, aged 65 and older, living in the southwestern US. Primary measures included mortality and a 5-item frailty index comprised of weight loss, exhaustion, walking speed, grip strength, and physical activity. RESULTS: Mean baseline age was 74.5 years (SD 6.1) and 58.5% were women. Baseline frailty assessments yielded the following distribution: 44.9% non-frail, 47.3% pre-frail, and 7.8% frail. Overall, 892 (44.7%) participants died during the 10-year study period. Hazard ratios (HR), adjusted for sociodemographic, health, and medical factors, demonstrated increased odds for mortality in the pre-frail (HR = 1.25, 95% confidence interval, CI(95%), 1.07-1.46) and frail (HR = 1.81, CI(95%) 1.41-2.31) groups compared to the non-frail cohort. CONCLUSION: The 5-item frailty index differentiated odds of 10-year mortality in older community-dwelling Mexican Americans. This clinical index has the potential to identify older minorities at risk for poor health outcomes and mortality.

Risk of mortality related to widowhood in older Mexican Americans.

PURPOSE: To examine the risk and correlates of mortality after death of a spouse and whether mortality risk varies by sex. METHODS: Prospective cohort study (1993 to 2000) of 1693 Mexican Americans ages 65 years and older who were married at baseline. Mortality was confirmed by matching records with the National Death Index or through proxy report. Risk of death related to incidence of widowhood was estimated by using proportional hazard regression and adjusted for age, education, US nativity, financial strain, social support, health behaviors, medical conditions, disability, and depressive symptoms. RESULTS: In the unadjusted Cox hazard analysis, widowed men are significantly more likely to die (HR=2.32, CI=1.48 to 3.61), but loss of spouse has no significant effect on the subsequent risk of death for widowed women (HR=1.50, CI=0.90 to 2.49). After adjustment for covariates known to influence survival, the association between widowhood and mortality in men remained significant, but the magnitude of the association decreased by 26%, which suggests a partial mediation effect of these factors on survival. The trajectory of the survival curve shows that the risk of death associated with widowhood is highest within the first 2 years. CONCLUSIONS: Widowhood in older Mexican American men is a risk factor for mortality.

Factors associated with seven-year incidence of diabetes complications among older Mexican Americans.

BACKGROUND: Diabetes is common in elderly persons and is highly prevalent in Mexican Americans. Little is known about factors associated with the incidence of diabetes complications. OBJECTIVE: To examine the social, demographic and health factors associated with a 7-year incidence of diabetes complications among older Mexican Americans with diabetes. METHODS: A 7-year prospective cohort of 536 non-institutionalized Mexican Americans aged > or =65 years with diabetes residing in the Southwest of USA. Measures included socio-demographic factors, duration of diabetes, diabetes treatment, medical conditions and body mass index. Diabetes complications were assessed by self-reports of any kidney, eye and circulation problems or amputation due to diabetes over a 7-year period. RESULTS: Subjects with disease duration of > or =10 years were found to have an increased incidence of kidney, eye and circulation problems or amputation over a 7-year period. Hazard ratio (HR) for circulation problems was significantly higher in foreign-born subjects with >15 years in the USA. Foreign-born subjects with <15 years in the USA and those with a frequent number of physician visits were at increased risk of kidney complications. Subjects with baseline eye complications had a higher HR for incidence of amputations in the next 7 years. Subjects with baseline circulation complications had a higher incidence of amputations, eye and kidney complications in the next 7 years. CONCLUSIONS: Our data suggest that risks of diabetes complications are influenced by different factors. Prolonged diabetes duration, being foreign-born, living in the USA for a longer period, and frequent physician visits were factors associated with diabetes complications. Designing intervention strategies to reduce diabetes complication risks requires an understanding of the differences in demographic and health predictors of such risks.

History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans.

OBJECTIVE: To examine the association between previous fracture and risk of new hip and nonhip fractures over a seven-year period among older Mexican Americans. METHOD: Data used are from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) (1993-2001). Measures included history of previous fracture (hip fracture only, a nonhip fracture, hip and nonhip fractures, and no fractures), sociodemographic factors, smoking status, medical conditions (arthritis, diabetes, stroke and cancer), activities of daily living disability, and high depressive symptoms. Cox proportional regression model was used to estimate the seven-year incidence of fractures. RESULTS: Of the 2,589 subjects, 42 reported a hip fracture, 328 reported a nonhip fracture, and 2,219 did not report a fracture at baseline. After controlling for all covariates, the hazard ratio (HR) of new hip fracture at seven-year follow-up was 6.48 (95% CI: 3.26-12.97) for subjects with only hip fracture at baseline and 1.96 (95% CI: 1.22-3.16) for subjects with nonhip fracture at baseline. The HR of new nonhip fracture was 1.90 (95% CI: 0.96-3.77) for subjects with only hip fracture at baseline and 2.62 (95% CI: 1.95-3.52) for subjects with nonhip fracture at baseline. CONCLUSIONS: A previous history of fractures in older Mexican Americans is the strongest predictor of recurrent fractures at hip and nonhip sites, independent of other health measures. Our findings of recurrent fractures suggest the need for more aggressive detection and adequate treatment of osteoporosis- and fall-related factors in this population.

Predictors of healthcare utilization among older Mexican Americans.

OBJECTIVE: To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. DESIGN: A two-year prospective cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 1987 non-institutionalized Mexican American men and women age > or =65 years. MAIN OUTCOMES MEASURES: Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. RESULTS: After two years of follow-up, predisposing and enabling factors accounted for <5% of the variance in physician and hospital use. Need factors explained 21% of the variance in physician use and 7% of the variance in hospital use. Older age; being female; insurance coverage; having arthritis, diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. CONCLUSIONS: Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.

Near vision impairment predicts cognitive decline: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly.

OBJECTIVES: To estimate the association between sensory impairment and cognitive decline in older Mexican Americans. DESIGN: A prospective cohort study. SETTING: The Hispanic Established Populations for Epidemiologic Studies of the Elderly from five southwestern states. PARTICIPANTS: The sample consisted of 2,140 noninstitutionalized Mexican Americans aged 65 and older followed from 1993/1994 until 2000/2001. MEASUREMENTS: The outcome, cognitive function decline, was assessed using the Mini-Mental State Examination blind version (MMSE-blind) at baseline and at 2, 5, and 7 years of follow-up. Other variables were near vision, distance vision, hearing, demographics (age, sex, marital status, living arrangements, and education), depressive symptoms, hypertension, diabetes mellitus, stroke, heart attack, and functional status. A general linear mixed model was used to estimate cognitive decline at follow-up. RESULTS: In a fully adjusted model, MMSE-blind scores of subjects with near vision impairment decreased 0.62 points (standard error (SE)=0.29, P=.03) over 2 years and decreased (slope of decline) 0.13 points (SE=0.07, P=.045) more per year than scores of subjects with adequate near vision. Other independent predictors of cognitive decline were baseline MMSE-blind score, age, education, marital status, depressive symptoms, and number of activity of daily living limitations. CONCLUSION: Near vision impairment, but not distance vision or hearing impairments, was associated with cognitive decline in older Mexican Americans.

Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes.

OBJECTIVE: To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. RESEARCH DESIGN AND METHODS: Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged >or=65 years. RESULTS: The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. CONCLUSIONS: Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.

Inconsistent use of diabetes medications, diabetes complications, and mortality in older mexican americans over a 7-year period: data from the Hispanic established population for the epidemiologic study of the elderly.

OBJECTIVE: The aim of this study was to examine the relationship between inconsistency in use of diabetes drugs and risk of renal, eye, and circulation problems and death over a 7-year period in community-dwelling older Mexican Americans. RESEARCH DESIGN AND METHODS: Data are from the four waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly. In-home interviewers assessed consistency in use of diabetes medications among 908 diabetic Mexican Americans, aged >or=65 years. Diabetes and complications were by self-report. Subjects with poor consistency in use of medication were those who, at any time during the 7-year follow-up, discontinued or inconsistently used their diabetes medications and those who had no diabetic medications at home despite self-report of taking medicine for diabetes. RESULTS: Thirty-six percent of our sample were inconsistent with diabetes medication usage. Older age and lack of supplemental health insurance were significantly associated with inconsistency of use of medication. In a multivariate logistic regression model, subjects with poor consistency in use of medication were more likely to report kidney problems (odds ratio [OR] 1.59; 95% CI 1.13-2.23; P = 0.008) at follow-up compared with those with good consistency, after controlling for age, sex, medication type, duration of diabetes, education, income, marital status, language of interview, insurance status, cognitive function, presence of depressive symptoms, activities of daily living, and instrumental activities of daily living. In Cox regression models, poor consistency with diabetic medication was also associated with increased all-cause mortality (hazard ratio [HR] 1.43; 95% CI 1.13-1.82; P = 0.003) and diabetes-related deaths (1.66; 1.20-2.30; P = 0.002) over a 7-year period after adjusting for relevant confounders. CONCLUSIONS: Inconsistent use of diabetic medication was associated with an increased risk of kidney problems and deaths over a 7-year period in older Mexican Americans.

Cognitive impairment and mortality in older mexican americans.

OBJECTIVES: To examine the extent to which cognitive status and decline in cognitive status predict mortality in older Mexican Americans. DESIGN: Longitudinal cohort. SETTING: Older Mexican Americans residing in five southwestern states in the United States. PARTICIPANTS: Two thousand six hundred twenty-five persons aged 65 and older living in Texas, New Mexico, Colorado, Arizona, and California. MEASUREMENTS: The cognitive function of participants was assessed using the Mini-Mental State Examination (MMSE) in 1993-94 and again in 1995-96. Cognitive decline was defined using two sets of criteria: a drop to 17 or less (moderate-severe cognitive impairment) on the MMSE at 2-year follow-up and a decrease of at least four points, a threshold change in scores that was used to predict mortality in this sample. Cox proportional hazards models were conducted to examine the association between the MMSE and increased risk for mortality, after controlling for sociodemographic characteristics, medical conditions, and depressive symptoms. RESULTS: Five-year mortality risk was significantly associated with persons in the moderately-severely cognitively impaired category (hazard ratio (HR) = 2.35, P <.001). Moreover, mild cognitive impairment was also predictive of mortality in older Mexicans (HR = 1.45, P <.001). Two-year declines in cognitive functioning, particularly in persons who had declined to the moderate-severe impairment category (HR = 2.23, P <.001) and those who dropped at least four points on the MMSE (HR = 1.30, P <.001), were predictive of mortality 3 years later, after controlling for important variables. CONCLUSIONS: Baseline moderate-severe and mild cognitive status and 2-year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.

Self-reported heart attack in Mexican-American elders: examination of incidence, prevalence, and 7-year mortality.

OBJECTIVES: To examine the prevalence, incidence, and mortality of self-reported heart attack in older Mexican Americans and to identify significant factors associated with heart attack. DESIGN: Cross-sectional and longitudinal study. SETTING: Baseline and three follow-up interviews in five southwestern states (Arizona, California, Colorado, New Mexico, and Texas) of the Hispanic Established Population for the Epidemiological Study of the Elderly. PARTICIPANTS: Three thousand fifty Mexican Americans aged 65 to 107 (mean age = 73). MEASUREMENTS: Sociodemographic factors (age, sex, marital status, language of interview, health insurance coverage, living arrangements, and financial strain) and health factors (smoking, alcohol consumption, obesity, diabetes mellitus, hypertension, stroke, cancer, hip fracture, arthritis, depression, limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and mortality) were determined at baseline (1993-94). New heart attacks were assessed at follow-ups in 1995-96, 1998-99, and 2000-01. Vital status was determined over the 7-year follow-up. RESULTS: Prevalence of self-reported heart attack was 9.1% at baseline. Incidence of self-reported heart attack was 6.1%, 9.1%, and 7.9%, respectively, for the three subsequent follow-ups. Older age, male sex, diabetes mellitus, hypertension, and stroke were significantly associated with heart attack at baseline. Age was a significant predictor for new heart attack at each follow-up. Having ADL (odds ratio (OR) = 2.91, 95% confidence interval (CI) = 2.19-3.86) and IADL (OR = 2.25, CI = 1.72-2.94) disabilities was significantly associated with self-reported heart attack. Subjects with heart attack were significantly more likely to die at 7 years (hazard ratio = 1.57, 95% CI = 1.29-1.91). Of those with self-reported heart attack, 42.4% had died of heart attack as the underlying cause of death by 7-year follow-up. CONCLUSION: In Mexican Americans, self-reported heart attack was associated with being older and male and having diabetes mellitus, hypertension, stroke, and ADL and IADL disabilities. Nearly half of subjects with heart attack had died of heart attack as underlying cause of death by 7-year follow-up. Prevention and control for this disease would be especially important in this population to avoid early mortality.

Predictors of decline in MMSE scores among older Mexican Americans.

BACKGROUND: The purpose of this analysis was to examine the association of sociodemographic variables and health-related conditions with 5-year declines in cognitive function among Mexican American elderly persons. METHODS: The cognitive function of 1759 participants was assessed by using the Mini-Mental State Examination (MMSE) in 1993/1994 and again in 1998/1999. Cognitive decline was defined by two sets of criteria: (1) a drop to 17 or below on the MMSE at follow-up, and (2) a decline of at least three points, the mean change in MMSE scores among respondents who obtained scores at or above the 5th percentile distribution at baseline. RESULTS: Cognitive decline was significantly associated with sociodemographic variables including age, education, marital status, and household composition. In addition, respondents with reported vision impairment, stroke, and diabetes were at increased risk for cognitive decline after controlling for multiple potential confounders. CONCLUSION: Although age and education have been reported as the more salient predictors of cognitive deterioration, other sociodemographic and several medical conditions including stroke and diabetes should be considered as part of cognitive aging studies among Mexican American elders.

Self-reported diabetic complications and 7-year mortality in Mexican American elders. Findings from a community-based study of five Southwestern states.

PURPOSE: This study was designed to examine the relationship between self-reported diabetic complications and 7-year mortality in Mexican American elders. METHODS: We studied 3050 Mexican Americans aged 65 and older from the Hispanic Established Population for the Epidemiological Studies of the Elderly (EPESE), conducted in five Southwestern states of the United States, for whom data were available from the baseline interview in 1993-1994 and three follow-up interviews in 1995-1996, 1998-1999, and 2000-2001. A total of 690 respondents in the baseline interview reported a physician's diagnosis of diabetes. RESULTS: Of 690 patients with diabetes, 412 (59.7%) subjects had self-reported complications of eye, kidney, circulation problems, amputations, and 276 (40%) died within the 7-year follow-up. Compared to patients without any diabetic complications, subjects with only one complication were not statistically significantly different in terms of the 7-year mortality (hazard ratio with 95% CI: 1.30, 0.96-1.76), after adjusting for age, sex, living arrangements, smoking, drinking, past medical history of stroke, heart attack, hypertension, cancer, and hip fracture. However, those with two or three complications were nearly twice as likely to die within 7 years than those without complications (1.75, 1.26-2.43 and 1.80, 1.17-2.79, respectively), whereas patients with four complications were nearly three times more likely to die (2.86, 1.47-5.58). CONCLUSION: The risk of 7-year mortality increased with the number of diabetic complications among Mexican American older adults. Detection of and early treatment/control for diabetic complications may lead to increase survival in this population.

Correlates of diabetic complications in Mexican-American elders.

This study was designed to examine the association of sociodemographic and health-related factors with the development of diabetic complications in older Mexican Americans. Data came from the baseline interview of the Hispanic Established Population for the Epidemiological Study of the Elderly (EPESE), conducted in 1993-1994, a population-based study of 3,050 Mexican Americans aged 65 and older from 5 southwestern states. A total of 690 subjects (23%) reported having been diagnosed with diabetes. Of these, 412 (60%) reported having one or more diabetic complications. Multiple logistic regression analysis found that respondents with less than 12 years of education were more likely to report diabetic complications than those with higher school education. Having diabetes for over 15 years, and having had a stroke or a heart attack were also associated with elevated rates of complications. Circulation problems were the most common complication reported by 280 (40%) respondents, followed by eye problems (38%), kidney problems (14%) and amputations (8%). Special attention should be given to sociodemographic and health-related factors influencing the health of older Mexican Americans. Identification of these factors will help physicians better control the disease to prevent complications.

Cognitive status and incident disability in older Mexican Americans: findings from the Hispanic established population for the epidemiological study of the elderly.

OBJECTIVE: To determine the effects of baseline cognitive function on incidence of disability in activities of daily living (ADL) in initially non-disabled Mexican-American elderly over a 7-year period. DESIGN: A prospective cohort study. SETTING: Southwestern United States: Texas, California, Arizona, New Mexico, and Colorado. PARTICIPANTS: A population-based sample of Mexican Americans aged 65 and over who completed the Mini-Mental State Examination (MMSE) and other relevant variables at baseline. The sample at baseline consisted of 2731 subjects, of which 2431 were non-ADL disabled. MEASUREMENTS: In-home interviews in 1993-94, 1995-96, 1998-99, and 2000-2001 assessed sociodemographic variables, selected medical conditions (stroke, cancer, diabetes, arthritis, and hip fracture), cognitive function, depressive symptomatology, and ADLs. RESULTS: In a Cox proportional regression analysis, a significant relationship was evident between MMSE score at baseline and risk of incident ADL disability over a 7-year period. Among non-disabled subjects at baseline, the hazard ratio of any new ADL limitation was 1.58 (95% CI, 1.18-2.12) for those with impaired cognition (MMSE score 0-21), 1.38 (95% CI, 1.04-1.82) for low normal cognition (MMSE score 22-24), and 1.30 (95% CI, 1.02-1.66) for normal cognition (MMSE score 25-28) when compared to subjects with high-normal cognition (MMSE score 29-30), adjusting for sociodemographic variables, presence of selected medical conditions and depressive symptoms at baseline. Similar results were also found when MMSE score was used as a continuous variable. Among non-disabled subjects at baseline, each unit increase in MMSE score decreased the risk of onset of any ADL limitation over a 7-year follow-up period, controlling for relevant variables at baseline (HR=0.97; 95% CI, 0.95-0.99). CONCLUSION: Low MMSE score was associated with increased risk for incident ADL disability over a 7-year period in older Mexican Americans. Given the social, economic, and health impact of cognitive impairment, these findings suggest a need to develop effective intervention programs that delay or prevent the onset of cognitive and ADL disability in the elderly.

Risk factors for falling in older Mexican Americans.

OBJECTIVE: To estimate the prevalence of falls and the risk factors associated with falls in Mexican-American men and women aged 72 and older, from the Hispanic Established Population for the Epidemiological Study of the Elderly. DESIGN: A 2-year cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. METHODS: Data on sociodemographic characteristics, health status, cognitive function, affective function, functional status, body mass index, and summary performance measures of lower body function, were obtained (1998-1999). Two years later (2000-2001), falls in the previous 12 months were assessed by self-report. Chi-square, univariate statistics, and multivariate logistic regression analyses were used. RESULTS: Of the 1,391 participants, 31.8% fell one or more times, and 14.2% reported 2 or more falls. In the logistic regression analysis, aged > or = 80 years (adjusted odds ratio [OR]=1.52, 95% confidence interval [CI]=1.17-1.98), being female (OR=1.45, 95% CI 1.13-1.86), having diabetes (OR=1.37, 95% CI 1.06-1.77), having arthritis (OR=1.32, 95% CI 1.04-1.68), experiencing impairment of instrumental activities of daily living (OR=1.05, 95% CI 1.01-1.10), and exhibiting high depressive symptoms (OR=1.59, 95% CI 1.16-2.19), were significant (P<.05) independent risk factors for one or more falls. The risk of falling increased linearly with the number of risk factors, from 14% with none, to 41% with 3 or more risk factors (P<.001). CONCLUSIONS: Prevalence of falls among older Mexican Americans was similar to that reported in non-Hispanic Caucasians. Potential modifiable conditions, such as functional deficits, arthritis, diabetes, and depressive symptoms were independent risk factors for falls in this population.

Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites.

BACKGROUND: The oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old. OBJECTIVE: To compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. METHODS: This study included 568 community-dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly 2004-2005 and 933 non-Hispanic whites (NHW) of the same age from the Health and Retirement Study 2004. Measures included sociodemographic variables, self-reported medical conditions, activities of daily living (ADLs), and instrumental activities of daily living. Logistic regression analysis was used to examine 2-year mortality in both populations. RESULTS: Heart attack was significantly more prevalent in oldest old NHW compared with MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared with their NHW counterparts. Compared with NHW men, MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared with NHW women. Significant differences in ADL disability were observed only between both groups of women, whereas significant differences in instrumental activities of daily living disability were observed only between men. MA men and women had higher prevalence of obesity compared with NHW. Predictors of 2-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was a mortality predictor only for NHW. Similarly, lung disease was a predictor only for MA. CONCLUSION: Health-related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of the oldest old adults.

Social support, stressors, and frailty among older Mexican American adults.

BACKGROUND: There is little research on the effects of stressors and social support on frailty. Older Mexican Americans, in particular, are at higher risk of medical conditions, such as diabetes, that could contribute to frailty. Given that the Mexican American population is rapidly growing in the United States, it is important to determine whether there are modifiable social factors related to frailty in this older group. METHOD: To address the influence of social support and stressors on frailty among older Mexican Americans, we utilized five waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (Hispanic EPESE) to examine the impact of stressors and social support on frailty over a 12-year period. Using a modified version of the Fried and Walston Frailty Index, we estimated the effects of social support and stressors on frailty over time using trajectory modeling (SAS 9.2, PROC TRAJ). RESULTS: We first grouped respondents according to one of three trajectories: low, progressive moderate, and progressive high frailty. Second, we found that the effects of stressors and social support on frailty varied by trajectory and by type of stressor. Health-related stressors and financial strain were related to increases in frailty over time, whereas social support was related to less-steep increases in frailty. CONCLUSION: Frailty has been hypothesized to reflect age-related physiological vulnerability to stressors, and the analyses presented indicate partial support for this hypothesis in an older sample of Mexican Americans. Future research needs to incorporate measures of stressors and social support in examining those who become frail, especially in minority populations.