Relationship Between Diabetes-Related Complications and Sleep Complaints in Older Mexican Americans.

INTRODUCTION/OBJECTIVE: The prevalence of Type 2 Diabetes Mellitus is increasing in the older American population, especially Mexican Americans. Sleep disorders are common in older adults with T2DM. This study examined the relationship between T2DM-related complications and sleep complaints in older Mexican Americans over 9 years of follow-up. METHODS: Study included 310 participants aged 77 years or older with self-reported diabetes from the Hispanic Established Population for the Epidemiological Study of the Elderly (2007/08-2016). RESULTS: Of the 310 participants, the mean age was 82.04 years. The cohort had significantly more females (69.03%) than males (30.97%). A substantial number of participants had trouble falling asleep (16.13%), waking up several times (36.45%), trouble staying asleep (15.16%), and feeling tired and worn out after waking up (12.90%). The percent of diabetes complications were 70.2% for circulation problems, 58.2% for eye disorders, 15.9% for kidney disease, and 4.4% for amputation. Participants who experienced sleep complaints for 15 or more days in a month were more likely to experience diabetic complications. DISCUSSION: This study demonstrated a significant relationship between T2DM macro- and micro-vascular complications and increased risk of sleep disorders in older Mexican Americans.

Trajectories of concurrent depressive symptoms and cognitive function on health outcomes and mortality among older Mexican Americans.

BACKGROUND: We sought to identify distinctive concurrent trajectory classes of depressive symptoms (DS) and cognitive function (CF) in Mexican Americans aged 75+ years, and to examine whether these trajectories were associated with an increased risk of adverse outcomes. METHODS: We used 4 waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data from 2004 to 5 to 2013. Latent growth curve analysis was used to identify distinctive concurrent trajectory classes of DS and CF. Generalized linear mixed models were further used to examine the association between the concurrent trajectories and health outcomes. Cox proportional hazards regression model was used to examine the risk of mortality as a function of the concurrent trajectories. RESULTS: 1,302 older adults followed-up approximately 9-years were successfully classified into 6 distinct concurrent trajectory classes of DS (low-increasing, high) and CF (high, high-declining, medium-declining). Compared to the co-occurrence of low DS and high CF trajectories, those with the high DS and declining CF trajectories were at greater risk of ADL and IADL functional limitations (1.6 - 2.9 times), more medical visits (1.3 - 1.4 times), hospital admissions (1.6 - 1.9 times), and mortality (1.7 - 2.6 times). CONCLUSIONS: Differences in adverse health outcomes across concurrent trajectory classes of DS and CF suggest that differences in underlying co-occurrence and progression have important implications for public health interventions as well as development of aging social and health policies.

Imputation Procedures for Cognitive Variables in the Mexican Health and Aging Study: Evaluating the Bias from Excluding Participants with Missing Data.

Non-response of cognitive data in cohort studies is a barrier to cognitive aging research. We describe the procedures for the imputation of non-responses for cognitive data in the Mexican Health and Aging Study (MHAS). Data came from the 2001-2015 MHAS waves. We also describe the association of cognition with education, age, and other variables in 2015 with and without the imputed values. Between 12.3% and 37.9% of participants were missing data for at least one cognition variable. When we conducted the analysis with and without the imputed values, the relationships between education, age, and cognition were similar in direction and significance, but different in magnitude. Non-response of cognitive data is common and non-random in the MHAS. Investigators should use the data sets that include the imputed values, which are publicly available.

La no-respuesta en datos de cognición en estudios poblacionales dificulta la realización de investigaciones del envejecimiento cognitivo. Describimos procedimientos para imputarla en la Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM) del Instituto Nacional de Estadística y Geografía usando datos de las rondas 2001 a 2015. También, describimos la asociación de cognición con años de educación, edad y otras variables en el 2015, incluyendo y excluyendo los valores imputados. Entre 12.3 y 37.9% de los participantes tenían datos faltantes en una o más variables cognitivas. Tras comparar los análisis con y sin los valores imputados, las relaciones entre educación, edad y cognición fueron similares en dirección y significancia, pero diferentes en magnitud. Puesto que la no-respuesta en variables de cognición es común y no-aleatoria en la ENASEM, sugerimos que los investigadores usen las bases de datos con los valores imputados, las cuales se encuentran a disposición de los usuarios.

Depressive symptoms in child caregivers of very old Mexican Americans.

OBJECTIVE: To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. METHODS: This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. RESULTS: Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. CONCLUSIONS: In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.

Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans.

OBJECTIVES: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies. DESIGN: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure. SETTING: Five southwestern states. PARTICIPANTS: A total of 1833 community-dwelling Mexican Americans aged 67 years or older. MEASUREMENTS: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing "low physical activity" with "limitations in walking half a mile"). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13). RESULTS: The original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81-.86; weighted κ = .86; 95% CI = .84-.88; bootstrap κ = .84; 95% CI = .81-.86; bootstrap-weighted κ = .86; 95% CI = .84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants. CONCLUSION: "Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019.

Physical Performance Trajectories and Mortality Among Older Mexican Americans.

Background: We sought to identify distinct trajectory classes of physical performance in Mexican Americans aged 75 years and older and to examine whether these trajectories predict mortality. Methods: We used four waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data for adults 75 years and older from 2004-2005 to 2013. Latent growth curve analysis was used to identify distinct trajectory classes. Multinomial logistic regression analysis was used to examine the association between baseline characteristics and the newly constructed trajectories. Cox proportional hazards regression models examined the hazard of mortality as a function of Short Physical Performance Battery (SPPB) trajectories. Results: The study follow-up period was approximately 9.5 years. One thousand four hundred and eleven adults were successfully classified into three (low-declining, high-declining, and high-stable) physical performance trajectory classes. Depressive symptoms (relative risk ratio = 1.94, 95% confidence interval [CI] = 1.17-3.22), diabetes (relative risk ratio = 2.44, 95% CI = 1.63-3.65), number of other comorbid health conditions (relative risk ratio = 1.40, 95% CI = 1.16-1.68), and obesity (relative risk ratio = 2.83, 95% CI = 1.67-4.80), increased the relative risk of classification into the low, relative to high-stable trajectory class. Male gender and foreign-born status significantly reduced risk of classification in the low-declining and high-declining trajectory classes. We observed a statistically significant association between low-declining (hazard ratio = 3.01, 95% CI = 2.34-3. 87) and high-declining (hazard ratio = 1.64, 95% CI = 1.32-2.03) trajectories and increased risk of mortality. Conclusions: Differences in mortality across physical performance trajectory classes suggest that these physical performance classes represent differences in underlying disease progression, and thus differences in mortality risk among older Mexican Americans, which warrants additional research to better understand differential physical performance trajectories and their effects on morbidity and mortality in heterogeneous aging populations.

Falls in Mexican older adults aged 60 years and older.

BACKGROUND: Falls are a major cause of disability, morbidity, institutionalization, and mortality in older adults. OBJECTIVES: The purpose of the study was to examine the risk factors for falls among Mexican older adults aged 60 years and older. METHODS: This study included 6247 participants and their spouse or partner aged 60 years and older from the Mexican Health and Aging Study, an ongoing longitudinal study (2001-2012) conducted in Mexico. Measures included socio-demographics, falls, physical activity, comorbid conditions, pain, vertigo, vision and hearing impairments, urinary incontinence, lower extremity functional limitation, activities of daily living (ADLs), cognitive function, and depressive symptoms. RESULTS: Mean age was 69.6 years (standard error = 0.18) and 51.8% were female. Forty percent reported one or more falls at baseline. Older age, being female, obesity, arthritis, fractures, stroke, suffering pain, vertigo, lower extremity functional limitations, physical activity, depressive symptoms, urinary incontinence, and ADL disability were significant factors associated with one or more falls over time. DISCUSSION: Early detection and treatment of the risk factors for falls in this population will help improve the quality of life and reduce medical complications and health care costs.

Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans.

The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later-life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican-American population. The results indicate that early-life and late-life migrant women spend more years with Performance-Oriented Mobility Assessment limitations than U.S.-born women. Conversely, midlife migrant women were not statistically different from U.S.-born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability-free years than U.S.-born men. For morbidity, late-life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.-born women, but late-life migrant men spent more years with morbidity than U.S.-born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.

A longitudinal study of cognitive trajectories in Mexican Americans age 75 and older.

OBJECTIVE: To identify distinct trajectories for global cognition, memory, and non-memory domains among Mexican American adults 75 years of age and older. METHODS: The final sample included 1336 participants of the Hispanic Established Population for the Epidemiologic Study of the Elderly observed during four Waves from 2004-2005 to 2012-2013. Latent class growth curve models were used to identify distinct trajectories for global cognition, memory, and non-memory. RESULTS: Three trajectory classes were identified for global cognition, memory, and non-memory domains. Nearly 31% of the final sample maintained high global cognition (persistent high), 52.6% experienced slight decline (decline but high), and 15% experienced severe decline in global cognition (decline to low). Over 95% of participants classified in the decline to low trajectory for global cognition were also classified as decline to low for memory and non-memory. This high level of consistency for memory and non-memory domains was observed for the decline but high (97.0%) and persistent high (93.7%) trajectory classes. CONCLUSIONS: These results indicate that the majority of Mexican American older adults will experience varying degrees of cognitive decline. However, a substantial proportion of older Mexican Americans are able to maintain high cognitive functioning into advanced age despite the high prevalence of risk factors for cognitive decline in this population. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of Functional Disability and Depressive Symptoms on Mortality in Older Mexican-American Adults with Diabetes Mellitus.

OBJECTIVES: To examine the effect of co-occurring depressive symptoms and functional disability on mortality in older Mexican-American adults with diabetes mellitus. DESIGN: Longitudinal cohort study. SETTING: Hispanic Established Populations for the Epidemiological Study of the Elderly (HEPESE) survey conducted in the southwestern United States (Texas, Colorado, Arizona, New Mexico, California). PARTICIPANTS: Community-dwelling Mexican Americans with self-reported diabetes mellitus participating in the HEPESE survey (N = 624). MEASUREMENTS: Functional disability was assessed using a modified version of the Katz activity of daily living scale. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Mortality was determined by examining death certificates and reports from relatives. Cox proportional hazards regression analyses were used to examine the hazard of mortality as a function of co-occurring depressive symptoms and functional disability. RESULTS: Over a 9.2-year follow-up, 391 participants died. Co-occurring high depressive symptoms and functional disability increased the risk of mortality (hazard ratio (HR) = 3.02, 95% confidence interval (CI) = 2.11-4.34). Risk was greater in men (HR = 8.11, 95% CI = 4.34-16.31) than women (HR = 2.21, 95% CI = 1.42-3.43). CONCLUSION: Co-occurring depressive symptoms and functional disability in older Mexican-American adults with diabetes mellitus increases mortality risk, especially in men. These findings have important implications for research, practice, and public health interventions.

Self-Reported Health and Functional Characteristics of Mexican and Mexican American Adults Aged 80 and Over.

OBJECTIVE: To examine the health and functional characteristics of Mexican and Mexican American adults aged ≥80. METHOD: Data came from Wave I (2001) and Wave III (2012) of the Mexican Health and Aging Study (MHAS), and Wave IV (2000-2001) and Wave VII (2010-2011) of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (HEPESE). RESULTS: In 2000-2001, diabetes, arthritis, hypertension, and stroke were higher in the HEPESE than in the MHAS. In the HEPESE, activities of daily living (ADL) difficulties and all health conditions, except heart attack, were greater in 2010-2011 than in 2000-2001. In the MHAS, hypertension and ADL difficulties were greater, and arthritis was lower in 2012 compared with 2001. In 2010-2011, all self-reported health conditions were higher in the HEPESE compared with the 2012 observation of the MHAS. DISCUSSION: The observed differences may reflect worse health for Mexican Americans, health care access, reporting bias, and more selective survival to very old age in Mexico.

Trajectories of Depressive Symptoms in Elderly Mexican Americans.

OBJECTIVES: To identify depressive symptom trajectories and factors associated with trajectory group membership in the very old segment of the rapidly growing and long-living Mexican-American population. DESIGN: Latent growth curve modeling was used to identify depressive symptom trajectories and multinomial logistic regression to identify factors associated with trajectory group membership. SETTING: Data spanning three waves and 7 years (2004-05, 2007-08, 2010-11) drawn from the Hispanic Established Populations for Epidemiologic Studies of the Elderly; homes of Mexican-origin elderly adults. PARTICIPANTS: Community-dwelling Mexican Americans aged 75 and older living in the southwestern United States (N = 1,487). MEASUREMENTS: The 20-item version of the Center for Epidemiologic Studies Depression Scale. RESULTS: Three trajectory groups were identified: low throughout, increasing, and high but decreasing. Activity of daily living disability was the strongest predictor of depressive symptoms, followed by social support. Foreign-born individuals were at greater risk than those who are U.S. born for high but decreasing depressive symptoms than for low depressive symptoms. CONCLUSION: Early detection and treatment of chronic disabling conditions, especially heart disease, cancer, visual impairment, and cognitive impairment, and increasing access to social participation should be the focus of treatment and intervention strategies for depression in very old Mexican Americans.