Dual-Language Use and Cognitive Function Among Mexican Americans Aged 65 and Older.

Background: Better English proficiency and higher frequency of using English among non-native speakers are associated with lower dementia risk. Objective: We investigated if Mexican American older adults who use English and Spanish to a more similar degree demonstrate better cognitive function than those who use one language more than the other. Methods: We used data from waves one (1992/93) to eight (2012/13) of the Hispanic Established Population for the Epidemiological Study of the Elderly. At baseline, participants were asked what language they usually use across communicative contexts. We based dual language on participants' use of Spanish and English within and across contexts. We categorized participants as low (n = 1,145), medium (n = 717), and high (n = 702) dual-language users. Linear mixed models were used to estimate the association between dual-language use, baseline Mini-Mental State Examination (MMSE) scores, and change in MMSE. Results: Participants in the medium and high dual-language use categories scored 1.91 points and 3.03 points higher at wave one compared to the low dual-language use category. Adjusting for education reduced the association between dual-language use and baseline MMSE (medium B = 0.99 SE = 0.19 p < 0.01; high B = 1.41 SE = 0.21 p < 0.01). The association between dual-language use and decline in the MMSE was not statistically significant. Conclusions: Greater dual-language use was associated with higher MMSE scores but not change in MMSE scores among Mexican Americans aged 65 and older. Future work should characterize bilingualism with greater nuance and use more rigorous cognitive measures to identify the components of the bilingual experience that may benefit the cognitive functioning of older adult bilinguals.

Pain and incident cognitive impairment in very old Mexican American adults.

BACKGROUND: Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity-limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. METHODS: Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010-2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini-Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6-year period (n = 313). RESULTS: Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09-4.36; treated aOR: 1.99; 95% CI: 1.15-3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. CONCLUSIONS: Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non-pharmacological treatments in these pathways.

The Influence of Education and Occupation Type on Birth Cohort Differences in Cognitive Function of Mexican Older Adults.

OBJECTIVES: Mexico's population aging is occurring in the context of social changes such as increased educational attainment and occupational shifts from agriculture to service and industry. The current study compares cognitive function between two birth cohorts of Mexican adults aged 60-76 to determine if population-level changes in education and occupation type contribute to cohort differences in cognitive function. METHODS: We used the Mexican Health and Aging Study to examine adults aged 60-76 in 2001 (men: 2,309; women: 2,761) and 2018 (men: 2,842; women: 3,825). Global cognition was calculated from five measures. Five main lifetime occupation types were created: no main job; agriculture; service; professional; and industrial. Ordinary least squares regression and structural equation models (SEM) were used to examine cohort differences in cognitive functioning. RESULTS: Ordinary least squares models that adjusted for age, community size, and marital status indicated that men and women had higher global cognition in 2018 than 2001 (men: b = 0.44, p < .01; women: b = 0.54, p < .01). These differences were reduced after adjusting for education and occupation type (men: b = 0.27, p < .01; women: b = 0.37, p < .01). Results from SEM indicated that the indirect effects of education on cognitive functioning were larger than occupation type for men (education: b = 0.18, p < .05; occupation: b = 0.001, p = .91) and women (education: b = 0.18, p < .05; occupation: b = 0.002, p = .22). DISCUSSION: Cognitive functioning is higher among more recent birth cohorts of older adults in Mexico. These cohort differences are partially mediated by education but not main lifetime occupation. Additional factors may contribute to cohort differences in cognitive function for older adults in Mexico.

Association of sleep duration and quality with serum testosterone concentrations among men and women: NHANES 2011-2016.

BACKGROUND: The association between testosterone concentrations and sleep duration is poorly understood. OBJECTIVE: To evaluate the association between sleep duration and quality with serum testosterone concentrations and its variation by sex and age. METHODS: Data were analyzed for 8748 men and women (≥20 years old) who participated in the cycles of the National Health and Nutrition Examination Survey 2011-2016, a cross-sectional study. Total testosterone (ng/dL) was measured and categorized (low, moderate, and high) based on established cut-offs for men and its tertile distribution among women. Sleep duration was classified as ≤6, 7-8, and ≥9 h. Sleep quality was classified as poor or good based on the frequency of trouble falling or staying asleep or sleeping too much. Weighted multivariable adjusted and multinomial logistic regression models were conducted to assess these associations. RESULTS: The association between sleep duration and testosterone concentrations, varied according to sex and age. Sleep deprivation (≤6 h) was associated with high testosterone (odds ratio = 3.62; 95% confidence interval: 1.37, 9.53) among young men (20-40 years old); meanwhile, middle-aged men (41-64 years old) who reported more sleep duration had low testosterone (odds ratio = 2.03; 95% confidence interval: 1.10, 3.73). A J-shaped association between sleep duration and low testosterone (odds ratio≤6 h  = 1.57; 95% confidence interval: 1.10, 2.27; odds ratio≥9  h  = 2.06; 95% confidence interval: 1.18, 3.59) was observed in women aged 41-64 years. We did not find any association with sleep quality. CONCLUSION: The association of sleep duration with serum testosterone concentrations varies with sex and age group. Prospective studies are warranted to confirm these sex and age group differences.

The impact of insomnia symptoms on obesity among Mexicans aged 50 and older.

OBJECTIVE: To examine the association between insomnia and obesity in Mexican adults aged 50 and older. MATERIALS AND METHODS: We used data from the Mexican Health and Aging Study (2015-2018). Self-reported insomnia was measured using the modified insomnia severity index with scores ranging from zero to six. Obesity was categorized using body mass index (BMI ≥ 30 kg/m2). We used generalized estimating equations to assess the association between insomnia and obesity over three years. RESULTS: Insomnia was associated with obesity (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.01,1.11), among those with no obesity at baseline. Among those with obesity, insomnia was not associated with changes in BMI. Lastly, obesity was not associated with changes in insomnia symptoms. CONCLUSION: This work highlights the association between insomnia and obesity among older Mexican adults and demonstrates the importance of further studies on the effects of insomnia within this population.

Diabetes Complications and Pain Among Mexican Americans Aged 80 and Older.

Background and Objectives: Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over 6 years among Mexican Americans aged 80 years and older. Research Design and Methods: We used data from Waves 7 to 9 (2010-2016) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (n = 853). Participants were categorized as having no diabetes, diabetes without complications, and diabetes with complications. Pain was defined as reporting pain when standing or walking (pain on weight-bearing) and having pain that limited daily activities (pain interference). We used generalized estimating equations to estimate the odds of pain over 6 years as a function of diabetes status controlling for socioeconomic and health characteristics. Results: At baseline, the mean age was 85.7 (standard deviation = 3.9) years, 65.2% female, 68.5% had no diabetes, 14.7% had diabetes without complications, and 16.9% had diabetes with complications. Those with diabetes without complications had lower odds of reporting pain on weight-bearing and pain interference, compared to those with no diabetes. Among those reporting diabetes (n = 269), those with complications had higher odds of pain on weight-bearing and pain interference, compared to those without complications. Those with both micro and macro complications had over 2 times the odds of pain, compared to those having no complications. Discussion and Implications: The lower burden of pain in those with diabetes but no complications may reflect optimal management of diabetes. Routine screening and treatment of pain in patients with diabetes complications can mitigate excess disability and increase the quality of life for patients with diabetes.

The Landscape of Geriatric Fellow Scholarly Activity Participation: Findings From a National Survey of Program Directors.

Introduction As the US population continues to age, there is a critical need for geriatricians to be trained and engaged in research to inform high-quality care for older adults. Our objective was to understand the extent, type, barriers, and facilitators of research training and the attitudes toward research training and scholarly activity among Accreditation Council for Graduate Medical Education (ACGME)-accredited US geriatric fellowship programs. Methods We conducted a cross-sectional survey of geriatric fellowship program directors from September to November 2022. Surveys assessing program characteristics, requirements for scholarly activity, director demographics, and director attitudes toward scholarly activity were distributed via email. We used descriptive statistics to assess fellowship scholarly activity requirements, facilitators, and perceived barriers. Results The survey response rate was 35.3% (41/116 programs). Most programs (82.9%) required participation in scholarly activity and provided protected time (73.2%). Definitions of scholarly activities greatly differed among programs. The most common scholarly activity requirements included participation in a scholarly project (70.7%) or local presentation (46.3%). The short duration of fellowship was the most common major barrier, reported by 70.7% of directors. Lastly, 34.1% of directors indicated satisfaction with the quality of research training provided, while 65.9% of directors reported satisfaction with the opportunities provided to participate in scholarly activities. Conclusions Overall, program requirements, facilitators, and perceived barriers to scholarly activity were heterogeneous among US geriatric program directors. Additionally, only about one-third of directors were satisfied with the research training provided. Our future work will compare the attitudes and reported barriers/facilitators of program director and fellow participants toward participation in scholarly activity.

The Prevalence of Cognitive Impairment and Dementia in Incarcerated Older Adults.

OBJECTIVES: In view of the growing number of older incarcerated persons in the United States, cognitive impairment represents one of the most challenging and costly health care issues facing the U.S. correctional system. This study examined the prevalence and correlates of this growing public health issue in the nation's largest prison system. METHODS: In this study of a random sample of 143 older (≥55 years) adults incarcerated in the Texas prison system, we assessed-using the Montreal Cognitive Assessment (MoCA)-the percentage of inmates who met the MoCA thresholds for mild cognitive impairment (MCI; <23) and dementia (<18). Due to sample size limitations, our multivariable analysis assessed the binary outcome, MoCA <23. RESULTS: Overall, 35.0% of our random sample of incarcerated older adults in Texas met the threshold for MCI and 9.1% met the threshold for dementia. After adjusting for covariates, study participants who were Black (odds ratio [OR] = 4.12, 95% confidence interval [CI] = 1.57-10.82), Hispanic (OR = 4.34, 95% CI = 1.46-12.93), and those with a diagnosis of major depressive disorder (8.56, 95% CI = 1.21-60.72) all had higher prevalence of a positive screen for MCI or dementia. Dementia was underdiagnosed in our study sample of incarcerated adults, with 15.4% of MoCA-diagnosed dementia patients having a dementia diagnosis documented in their medical records. DISCUSSION: Future studies of cognitive impairment in prisons and jails can inform health care planning and resource allocation, such as expansion of access to palliative care, advance care planning, and targeted cognitive screening in older age groups.

Social and Leisure Activities Predict Transitions in Cognitive Functioning in Older Mexican Adults: A Latent Transition Analysis of the Mexican Health and Aging Study.

OBJECTIVES: Mexico has a rapidly aging population at risk for cognitive impairment. Social and leisure activities may protect against cognitive decline in older adults. The benefits of these behaviors may vary by patterns of cognitive impairment. The objectives of this study were to identify latent states of cognitive functioning, model the incidence of transitions between these states, and investigate how social and leisure activities were associated with state transitions over a 6-year period in Mexican adults aged 60 and older. METHODS: We performed latent transition analyses to identify distinct cognitive statuses in the 2012 and 2018 waves of the Mexican Health and Aging Study (N = 9,091). We examined the transition probabilities between these states and their associations with social and leisure activities. RESULTS: We identified 4 cognitive statuses at baseline: normal cognition (43%), temporal disorientation (30%), perceptual-motor function impairment (7%), and learning and memory impairment (20%). Various social and leisure activities were associated with reduced odds of death and disadvantageous cognitive transitions, as well as increased odds of beneficial transitions. DISCUSSION: Mapping the effects of popular social and leisure activities onto common patterns in cognitive functioning may inform the development of more enjoyable and effective health-protective behavioral interventions.

Gender, Personality, and Cognitive Resilience Against Early-Life Disadvantage.

OBJECTIVES: Early-life disadvantage (ELD) relates to lower late-life cognition. However, personality factors, including having an internal locus of control (LOC) or a conscientious personality, relate to resilience and effective stress coping. We explore whether personality factors convey resilience against the negative effects of ELD on cognition, by gender, in Mexico. METHODS: Using the 2015 Mexican Health and Aging Study, we estimated expected cognition using multiple ELD markers to identify a subsample in the lowest quartile of expected cognition given ELD (n = 2,086). In this subsample, we estimated cross-sectional associations between personality and having above-median observed cognitive ability (n = 522) using logistic regression. RESULTS: Among those in the lowest quartile of expected cognition, a more internal LOC (ß = 0.32 [men] and ß = 0.44 [women]) and conscientious personality (ß = 0.39 [men] and ß = 0.17 [women]) were significantly associated with having above-median cognitive ability in models adjusted for demographic confounders. Larger benefits of conscientiousness were observed for men than women. Associations between personality and having above-median cognitive ability remained statistically significant after further adjustment for health, stress, and cognitive stimulation variables, regardless of gender. DISCUSSION: Personality factors may convey resilience among individuals who experienced ELD, potentially breaking the link between ELD and worse late-life cognition. Structural factors and gender roles may affect how much women benefit from personality factors.

Increasing Pain Interference Is Associated With Cognitive Decline Over Four Years Among Older Puerto Rican Adults.

BACKGROUND: Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective was to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto Rican adults. METHODS: Data came from baseline and 4-year follow-up of the Puerto Rican Elderly: Health Conditions Study, a longitudinal representative study of Puerto Rican older adults aged 60 and older. Pain and cognitive performance were assessed at each wave. A pain interference variable was created using the sum of pain status (yes/no) and pain interference (yes/no; range 0-2). Global cognitive performance was assessed with the Mini-Mental Cabán. We tested bidirectional associations using a path model with concurrent and cross-lagged paths between pain and cognitive performance, adjusting for sociodemographic and health factors (n = 2 349). RESULTS: Baseline pain interference was not associated with baseline cognitive performance (p = .636) or with cognitive performance at follow-up (p = .594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (ß = -0.07, standard error [SE] = 0.02, p = .003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (ß = -0.07, SE = 0.02, p = .007). CONCLUSIONS: These findings highlight the importance of worsening pain interference as a potentially modifiable risk factor for cognitive decline, as pain treatment options exist. Additionally, better baseline cognitive performance may be a protective factor for pain, providing further evidence of the dynamic relationship between pain and cognitive performance.

Perceptions of Research Participation among a Sample of Florida Residents Aged 50 and Over Reporting Dementia.

As the population ages, the prevalence of dementia will increase. More research is needed; however, low rates of research participation, especially by older adults, hinder progress. Data came from HealthStreet, a University of Florida community engagement program in which community health workers assess community members for their health conditions. Adults 50 and over were included in these analyses; their perceptions of health research studies were assessed. Our sample had an average age of 60.5 years and 4.3% reported dementia (n = 4,881). Overall, older adults reported a high willingness to participate in research. Individuals who reported dementia had 0.64 times the odds of reporting willingness to participate in a research study that required an overnight stay, compared to those who did not report dementia (95% CI: 0.45-0.89). We report on willingness to participate in research in a more granular basis than has been previously done. Community members reporting dementia, compared to those without, were as or more likely to desire future participation in health research. However, barriers to participation remain and must be addressed.

The pain and depressive symptoms cascade: A bidirectional analysis of the Mexican Health and Aging Study 2012-2015.

OBJECTIVES: The association of pain and depression has not been evaluated in low- and middle-income countries, which have a disproportionate burden of pain compared to high-income countries. METHODS: Using data from the Mexican Health and Aging Study (baseline, 2012; follow-up, 2015), we examined the bidirectional relationship between pain and depressive symptoms and identified shared predictors among community-dwelling participants ≥60 years (n = 7237). Multivariable logistic regressions models evaluated the association between (1) baseline pain and incident elevated depressive symptoms and (2) baseline depressive symptoms and incident pain, adjusting for demographic, socioeconomic, and health-related factors. Models included inverse probability weights and evaluated interactions by gender. RESULTS: Participants (55.0% women) were on average 69.1 years old. Over half reported no pain (60.7%) and low/no depressive symptoms (67.9%) in 2012, of which, 20.2% reported elevated depressive symptoms and 25.3% self-reported pain in 2015. Baseline pain was associated with higher odds of incident elevated depressive symptoms (aOR 1.65; 95% CI, 1.41-1.93). Baseline elevated depressive symptoms were associated with higher odds of developing pain (aOR 1.57; 95% CI, 1.32-1.87). Age, gender, self-rated health, and activity of daily living limitations were shared risk factors for pain and elevated depressive symptomatology onset. Although the incidence of elevated depressive symptoms and pain was higher in women, there were no statistically significant interactions. CONCLUSIONS: Older adults with pain or depression may be at risk for developing the other. These shared predictors could help identify patients in clinical settings, where pain and depression are often overlooked, reducing the cascading risk of this comorbidity.

Metformin and testosterone replacement therapy inversely associated with hormone-associated cancers (prostate, colorectal and male breast cancers) among older White and Black men.

BACKGROUND: The independent and joint association of metformin and testosterone replacement therapy (TTh) with the incidence of prostate, colorectal, and male breast cancers remain poorly understood, including the investigation of the risk of these cancers combined (HRCs, hormone-associated cancers) among men of different racial and ethnic background. METHODS: In 143,035 men (≥ 65 yrs old) of SEER-Medicare 2007-2015, we identified White (N = 110,430), Black (N = 13,520) and Other Race (N = 19,085) men diagnosed with incident HRC. Pre-diagnostic prescription of metformin and TTh was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards models were conducted. RESULTS: We found independent and joint associations of metformin and TTh with incident prostate (odds ratio [OR]joint = 0.44, 95% confidence interval [CI]: 0.36-0.54) and colorectal cancers (ORjoint = 0.47, 95% CI: 0.34-0.64), but not with male breast cancer. There were also inversed joint associations of metformin and TTh with HRCs (ORjoint = 0.45, 95% CI: 0.38-0.54). Similar reduced associations with HRCs were identified among White, Black, and Other Race men. CONCLUSION: Pre-diagnostic use of metformin and TTh were, independently and jointly, inversely associated with incident prostate and colorectal cancers. The risk of HRCs was also reduced among White, Black and Other Race men. Greatest reduced associations of prostate and colorectal cancers and HRCs were mainly observed in combination of metformin and TTh. Larger studies are needed to confirm the independent and joint association of metformin plus TTh with these cancers in understudied and underserved populations.

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective.

Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.

Multimorbidity Is Associated With Pain Over 6 Years Among Community-Dwelling Mexican Americans Aged 80 and Older.

Introduction: Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is associated with decreased quality of life, greater disability, and increased mortality. Yet, the association of multimorbidity with pain, another significant contributor to decreased quality of life, has not been widely studied. This is especially understudied among very old (aged ≥ 80) Mexican Americans, a fast-growing segment of the United States (US) population. Objective: To assess the association of multimorbidity with pain in very old Mexican Americans, over six years of follow-up. Methods: We used data from Waves 7 (2010/2011) to 9 (2015/2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly, a longitudinal study of older Mexican Americans residing in the Southwestern US. Multimorbidity was defined as reporting two or more chronic health conditions. Pain was defined as (1) pain on weight-bearing, (2) pain in back, hips, knees, ankles/feet, legs, entire body, or two or more locations, and (3) pain that limits daily activities. We use generalized estimation equations to estimate the odds ratio of pain as a function of multimorbidity over 6 years. Results: At baseline (n = 841), 77.3% of participants had multimorbidity. Those with multimorbidity had greater odds [2.27, 95% confidence interval (CI): 1.74, 2.95] of reporting pain on weight-bearing over time, compared to those without multimorbidity. Also, those with multimorbidity had 2.12 times the odds of reporting pain that limited their daily activities (95% CI: 1.61, 2.78) compared to those without multimorbidity. Lastly, those with multimorbidity had higher odds of reporting pain in their back, knee, ankles/feet, legs, hips, entire body, or two or more locations, compared to those without multimorbidity. Conclusions: Those with multimorbidity consistently had higher odds of all types of pain, highlighting the need for early management of pain among those with multiple chronic conditions and complex health needs. This is especially important among very old Mexican Americans, who have a high burden of chronic health conditions.

Effects of diabetes and obesity on cognitive impairment and mortality in older mexicans.

BACKGROUND: Diabetes is a risk factor for dementia and mortality, while obesity later in life is associated with a reduced risk. Their co-occurrence, diabesity, is common, but its association with dementia and mortality is unclear. METHODS: Using data from the Mexican Health and Aging Study, we used multinomial logistic regression to examine the associations of diabetes and body mass index (BMI), and diabesity, in 2012, with cognitive impairment and mortality in 2018, among participants aged ≥60 years with normal cognition at baseline (n = 7,885). RESULTS: Diabetes was associated with cognitive impairment, compared to not having diabetes (RRR=1.83, 95% CI=1.48-2.26). BMI was not associated with cognitive impairment. Regarding mortality, diabetes was associated with an increased risk (RRR=2.28, 95% CI=1.98-2.63) and being overweight or having obesity was associated with a reduced risk (RRR=0.74, 95% CI=0.65-0.86; RRR=0.79, 95% CI= 0.66-0.95). When BMI and diabetes were combined, having diabetes only (RRR=2.01, 95% CI=1.40-2.87), being overweight with diabetes (RRR=1.42, 95% CI=1.02-1.97) or having diabesity (RRR=1.50, 95% CI=1.08-2.06) were associated with cognitive impairment, compared to having a normal BMI without diabetes. Diabetes, regardless of BMI, was associated with an increased risk of mortality, while being overweight or having obesity was associated with a reduced risk of mortality. CONCLUSIONS: With the increase in the prevalence of obesity and diabetes among Mexicans, it is important to understand how these conditions and their co-occurrence impact cognitive impairment and mortality. Among older Mexicans, diabesity is associated with 6-year mortality and cognitive impairment onset, likely driven by the effect of diabetes.

Gender differences in activity-limiting pain trajectories over a 17-year period in the Mexican Health and Aging Study.

ABSTRACT: Pain increases with age, disproportionately affects women, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. Few studies have examined longitudinal trajectories of pain, by gender, in Mexico. We used data from 5 waves (over 2001-2018) of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50 years and older. Pain was categorized as self-reported frequent pain that makes it difficult to do usual activities. Latent class mixture models were used to create pain trajectories (n = 9824). The sample was majority female (56.15%), with a mean age of 61.72 years. We identified 2 pain trajectories: low-stable (81.88%) and moderate-increasing (18.12%). Women had 1.75 times the odds of being in the moderate-increasing group compared with men (95% confidence interval= 1.41, 2.17). In addition, having zero years of education was associated with higher odds of being in the moderate-increasing group, compared with having any years of education. Fair/poor self-rated health, obesity, arthritis, elevated depressive symptoms, and falls were positively associated with pain for both trajectory groups. Being married was positively associated with pain in the low-stable group. Insurance status was negatively associated with pain in the low-stable group, but positively associated with pain in the moderate-increasing group. We identified 2 trajectories of activity-limiting pain, among older Mexican adults (50+) over 17 years of follow-up. Understanding gender differences in pain trajectories in later life and the factors associated with trajectory development is crucial to improve quality of life, especially in vulnerable populations.

Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic.

Importance: The ongoing COVID-19 pandemic and associated mitigation measures have disrupted access to psychiatric medications, particularly for women. Objective: To assess the sex differences in trends in the prescribing of benzodiazepines, Z-hypnotics and serotonergic (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine reuptake inhibitors [SNRIs]), which are commonly prescribed for anxiety, insomnia, and depression. Design, Setting, and Participants: This cohort study used data from Clinformatics Data Mart, one of the largest commercial health insurance databases in the US. Enrollees 18 years or older were required to have complete enrollment in a given month during our study period, January 1, 2018, to March 31, 2021, to be included for that month. Main Outcomes and Measures: Prescription of a benzodiazepine, Z-hypnotic, or SSRI or SNRI. For each month, the percentage of patients with benzodiazepine, Z-hypnotic, or SSRI or SNRI prescriptions by sex was calculated. Results: The records of 17 255 033 adults (mean [SD] age, 51.7 [19.5] years; 51.3% female) were examined in 2018, 17 340 731 adults (mean [SD] age, 52.5 [19.7] years; 51.6% female) in 2019, 16 916 910 adults (mean [SD] age, 53.7 [19.8] years; 51.9% female) in 2020, and 15 135 998 adults (mean [SD] age, 56.2 [19.8] years; 52.5% female) in 2021. Compared with men, women had a higher rate of prescriptions for all 3 drugs classes and had larger changes in prescription rates over time. Benzodiazepine prescribing decreased from January 2018 (women: 5.61%; 95% CI, 5.60%-5.63%; men: 3.03%; 95% CI, 3.02%-3.04%) to March 2021 (women: 4.91%; 95% CI, 4.90%-4.93%; men: 2.66%; 95% CI, 2.65%-2.67%), except for a slight increase in April 2020 among women. Z-hypnotic prescribing increased from January 2020 for women (1.39%; 95% CI, 1.38%-1.40%) and February 2020 for men (0.97%; 95% CI, 0.96%-0.98%) to October 2020 (women: 1.46%; 95% CI, 1.46%-1.47%; men: 1.00%; 95% CI, 0.99%-1.01%). Prescribing of SSRIs and SNRIs increased from January 2018 (women: 12.77%; 95% CI; 12.75%-12.80%; men: 5.56%; 95% CI, 5.44%-5.58%) to April 2020 for men (6.73%; 95% CI, 6.71%-6.75%) and October 2020 for women (15.18%; 95% CI, 15.16%-15.21%). Conclusions and Relevance: In this cohort study, coinciding with the COVID-19 pandemic onset was an increase in Z-hypnotic as well as SSRI and SNRI prescriptions in both men and women along with an increase in benzodiazepine prescriptions in women, findings that suggest a substantial mental health impact of COVID-19-associated mitigation measures.