Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults.

BACKGROUND: Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. METHODS: The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. RESULTS: Four different types of patterns were identified: 'Neuro-psychiatric', 'Metabolic', 'Cardiovascular', and 'Mixt' configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07-2.57); 'Mixt' HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09-1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + 'Cardiovascular' HR:1.56 (1.00-2.42); frailty + 'Mixt':1.42 (0.95-2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02-1.49)]. CONCLUSIONS: Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.

Association between the changes in socialsecurity continuity condition and mortality: MHAS 2001-2018 analysis.

OBJECTIVE: To analyze the association of changes in social security (SS) continuity and mortality, using the Mexican Health and Aging Study (MHAS) in people aged 60 years and more. MATERIALS AND METHODS: Retrospective cohort. We analyzed the SS continuity condition -classified as stable, unstable with SS, unstable without SS, and without SS- and its relation with mortality; a probit regression model was utilized to obtain marginal effects, taking into consideration covariates related to mortality. RESULTS: Unstable continuity with and without SS and multimorbidity (two or more diseases) increased the probability of dying by 52.9% (p = 0.000, 95%CI: 0.508,0.551), 50.3% (p = 0.000, 95%CI: 0.474,0.531) and 13.3% (p = 0.000, 95%CI: 0.108,0.159), respectively. Meanwhile, being woman, at least one year of formal education, and marriage reduced it in 8.8% (p = 0.000, 95%CI: -0.106,-0.071), 7% (p = 0.000, 95%CI: -0.091,-0.050) and 7.8% (p = 0.000, 95%CI: -0.096,-0.061), respectively. CONCLUSION: Belonging to SS was associated with higher mortality, compared to other social health determinants, like education.

Psychometric properties of ability to contribute measurements as a domain of functional ability of older persons: a COSMIN systematic review.

BACKGROUND: Older person's ability to contribute covers contributions divided into five subdomains: assisting friends and neighbours, mentoring peers and younger people, caring for family, engaging in the workforce and voluntary activity. OBJECTIVE: To evaluate the psychometric properties of ability to contribute measurements as a domain of functional ability of older persons using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic reviews. METHODS: A systematic search was performed in PubMed, Embase and PsycINFO databases, for observational studies published within the last 10 years. The measurement properties of these ability measures were evaluated against the COSMIN taxonomy. Risk-of-bias assessment was performed using the COSMIN Risk of Bias checklist. RESULTS: Of the 32,665 studies identified, we selected 19, of which the main purpose was to develop or validate an instrument or have related items that measure at least one of the subdomains. None of the instruments contained items that were fully related to the five subdomains, 60% (n = 12) were related to voluntary activities and 15% (n = 3) to mentoring peers and younger people. As for psychometric properties, two studies assessed content validity. Factor analysis was used to evaluate structural validity in 10 studies. Internal consistency was evaluated in 63% of the instruments and Cronbach's alpha ranges from 0.63 to 0.92. No study reported predictive validity. A very limited overview of their scope and limitations for their application was observed. CONCLUSIONS: We found no single instrument measuring all subdomains of ability to contribute. We found several instruments containing items that could indirectly measure some of the subdomains of the ability to contribute.

Higher frailty levels are associated with lower cognitive test scores in a multi-country study: evidence from the study on global ageing and adult health.

Background: Frailty has been recognized as a growing issue in older adults, with recent evidence showing that this condition heralds several health-related problems, including cognitive decline. The objective of this work is to determine if frailty is associated with cognitive decline among older adults from different countries. Methods: We analyzed the baseline the Study on Global Ageing and Adult Health (SAGE), that includes six countries (Ghana, South Africa, Mexico, China, Russia, and India). A cross-section analysis was used to assess how Frailty was related with the Clinical Frailty Scale decision tree, while cognitive decline was evaluated using standardized scores of tests used in SAGE. Results: A total of 30,674 participants aged 50 years or older were included. There was an association between frailty levels and cognitive performance. For example, women had an inverse relationship between frailty levels and cognitive scores, even when comparing robust category with frailty level 2 (RRR = 0.85; p = 0.41), although the relative risks decrease significantly at level 3 (RRR = 0.66; p = 0.03). When controlling for age, the relative risks between frailty levels 4 to 7 significantly decreased as cognitive performance increased (RRR = 0.46, RRR = 0.52, RRR = 0.44, RRR = 0.32; p < 0.001). Conclusion: Our results show an association between frailty levels measured in a novel way, and cognitive decline across different cultural settings.

Predictors of Successful Memory Aging in Older Mexican Adults.

Background: Research suggests a significant association between increasing age and memory impairments. Nevertheless, for some individuals, memory performance stays within or above the normative values of younger subjects. This is known as successful memory aging and is associated with specific neurophysiological features and psychological and lifestyle-related variables. To date, little is known about the association between successful memory aging and intrinsic capacity (IC) defined as "the composite of all the physical and mental (including psychosocial) capacities that an individual can draw on at any point in time" and resilience. Hence, the aim of this study was to determine if longitudinal associations between IC and successful memory aging and resilience exist and to find differences in cognitive performance between Mexican older adults with successful memory aging, older adults with average memory, and older adults with memory impairment. Methods: Longitudinal data from 590 individuals from the third wave (2012) and the Mex-Cog subsample (2016) of the Mexican Health and Aging Study was analysed. Subjects were classified into 3 groups: (1) older adults with successful memory aging (SUMA), (2) older adults with average memory (AVMA), and (3) older adults with memory impairment (IMA). Cognitive domains of orientation, language, attention, constructional praxis, and executive function were evaluated. IC and resilience were measured using items from the MHAS battery. Analysis of variance and multinomial logistic regressions were used to find differences in IC and resilience across the memory aging groups. Results: ANOVAs showed significant differences across the three cognitive performance groups in all cognitive domains. Multinomial logistic regression analyses revealed that respondents with higher scores in the psychological and cognitive domains of IC at baseline were more likely to have successful memory aging in the subsequent wave of the study. More resilient subjects in 2012 were not more likely to become a SUMA in 2016. However, this could be a result of the way resilience was measured. Conclusion: Our main findings suggest that intrinsic capacity could be used as a predictor of successful memory aging specifically in the psychological and the cognitive domains. More longitudinal studies are needed to further examine these associations.

Screening intrinsic capacity and its epidemiological characterization: a secondary analysis of the Mexican Health and Aging Study.

OBJECTIVE: To describe the levels of intrinsic capacity and those factors related to its decline in Mexican older adults, using the Mexican Health and Aging Study. METHODS: This is a cross-sectional secondary analysis of the 2015 data of the Mexican Health and Aging Study, including adults aged 50 years and above. Selected questions were included to represent each domain of intrinsic capacity screening: cognition, depression, hearing, vision, anorexia, weight loss, and mobility. Sociodemographic characteristics, psychosocial factors, and health conditions were included to assess their association with intrinsic capacity. Further categories were established to assess not only individual characteristics but also different groupings. Along with descriptive statistics, multinomial regression models were performed. RESULTS: From a total of 12 459 adults aged 50 years and above, 54.7% were women and the average age was 71.2 years; 87.8% of the individuals had at least one intrinsic capacity domain affected, and mobility had the highest frequency (47.6%). All domains showed a trend of increasing with age and were higher among women. Self-rated health, chronic diseases, number of visits to a physician in the last year, and ≥2 affected activities of daily living were consistently associated with more intrinsic capacity domains affected. CONCLUSIONS: Decreased levels of intrinsic capacity in Mexican older people are associated with less schooling, self-rated health, chronic diseases, visits to a physician, and activities of daily living.

Screening intrinsic capacity and its epidemiological characterization: a secondary analysis of the Mexican Health and Aging Study

[ABSTRACT]. Objective. To describe the levels of intrinsic capacity and those factors related to its decline in Mexican older adults, using the Mexican Health and Aging Study. Methods. This is a cross-sectional secondary analysis of the 2015 data of the Mexican Health and Aging Study, including adults aged 50 years and above. Selected questions were included to represent each domain of intrinsic capacity screening: cognition, depression, hearing, vision, anorexia, weight loss, and mobility. Sociodemographic characteristics, psychosocial factors, and health conditions were included to assess their association with intrinsic capacity. Further categories were established to assess not only individual charac-teristics but also different groupings. Along with descriptive statistics, multinomial regression models were performed. Results. From a total of 12 459 adults aged 50 years and above, 54.7% were women and the average age was 71.2 years; 87.8% of the individuals had at least one intrinsic capacity domain affected, and mobility had the highest frequency (47.6%). All domains showed a trend of increasing with age and were higher among women. Self-rated health, chronic diseases, number of visits to a physician in the last year, and ≥2 affected activities of daily living were consistently associated with more intrinsic capacity domains affected. Conclusions. Decreased levels of intrinsic capacity in Mexican older people are associated with less school-ing, self-rated health, chronic diseases, visits to a physician, and activities of daily living.

[RESUMEN]. Objetivo. Describir los niveles de capacidad intrínseca y los factores relacionados con su declive en las per-sonas mayores en México, mediante un estudio sobre la salud y el envejecimiento en México. Métodos. Se llevó a cabo un análisis secundario transversal de datos de un estudio sobre la salud y el enve-jecimiento en México realizado en el 2015 con adultos de 50 años o más. Se seleccionaron preguntas para cada ámbito de la exploración de la capacidad intrínseca: cognición, depresión, audición, visión, anorexia, pérdida de peso y movilidad. Se incluyeron las características sociodemográficas, los factores psicosociales y la condición de salud para evaluar su relación con la capacidad intrínseca. Se establecieron categorías adicionales para evaluar las características no solo individuales sino también en diferentes grupos. Junto con las estadísticas descriptivas, se llevaron a cabo modelos de regresión polinómicos. Resultados. De un total de 12 459 adultos de 50 años o más, 54,7% eran mujeres y la edad promedio era 71,2 años; 87,8% de los participantes habían visto afectado al menos un ámbito de su capacidad intrínseca; la movilidad tuvo la frecuencia más alta (47,6%). Todos los ámbitos mostraron una tendencia al alza con la edad y se mostraron más elevados en las mujeres. La salud autoevaluada, las enfermedades crónicas, el número de consultas al médico el año anterior y ≥2 actividades cotidianas afectadas se asociaron sistemáticamente con una afectación de más ámbitos de la capacidad intrínseca. Conclusiones. La reducción de los niveles de capacidad intrínseca de las personas mayores en México está asociada con una menor educación, una salud autoevaluada, enfermedades crónicas, consultas médicas y la actividad cotidiana.

[RESUMO]. Objetivo. Descrever os níveis de capacidade intrínseca e os fatores relacionados ao seu declínio em idosos mexicanos, utilizando o Estudo Nacional de Saúde e Envelhecimento no México. Métodos. Esta é uma análise secundária transversal dos dados de 2015 do Estudo Nacional de Saúde e Envelhecimento no México, que inclui adultos de 50 anos ou mais. Foram incluídas perguntas selecionadas para representar cada domínio de avaliação da capacidade intrínseca: cognição, depressão, audição, visão, anorexia, perda de peso e mobilidade. Características sociodemográficas, fatores psicossociais e condições de saúde foram incluídos para avaliar sua associação com a capacidade intrínseca. Outras categorias foram estabelecidas para avaliar não apenas as características individuais, mas também diferentes agrupamentos. Além de estatísticas descritivas, foram utilizados modelos de regressão multinomial. Resultados. De um total de 12 459 adultos de 50 anos ou mais, 54,7% eram mulheres, e a idade média era de 71,2 anos; 87,8% dos indivíduos tinham pelo menos um domínio de capacidade intrínseca afetado, com mais frequência a mobilidade (47,6%). Todos os domínios tiveram tendência a aumentar com a idade e foram mais elevados entre as mulheres. A autopercepção de saúde, as doenças crônicas, o número de consultas médicas no ano anterior e ≥ 2 atividades da vida diária afetadas estavam consistentemente associados a um maior número de domínios de capacidade intrínseca afetados. Conclusões. Níveis menores de capacidade intrínseca em idosos mexicanos estão associados a um menor nível de escolaridade, à autopercepção de saúde, a doenças crônicas, a consultas médicas e às atividades da vida diária.