Trajectories of sleep duration and quality and their association with mild cognitive impairment, frailty, and all-cause mortality.

OBJECTIVES: To identify longitudinal trajectories of sleep duration and quality and estimate their association with mild cognitive impairment, frailty, and all-cause mortality. METHODS: We used data from three waves (2009, 2014, 2017) of the WHO Study on Global Aging and Adult Health in Mexico. The sample consisted of 2722 adults aged 50 and over. Sleep duration and quality were assessed by self-report. Sleep trajectories were determined by applying growth mixture models. Mixed-effects logistic (mild cognitive impairment) and ordinal logistic (frailty), and Cox proportional hazards (all-cause mortality) models were fitted. RESULTS: Three classes for sleep duration ("optimal-stable," "long-increasing," and "short-decreasing") and quality ("very good-increasing," "very good-decreasing," and "moderate/poor stable") were identified. Compared to the optimal-stable group, the long-increasing trajectory had greater odds for mild cognitive impairment (odds ratio=1.68, 95% CI: 1.01-2.78) and frailty (odds ratio=1.66, 95% CI: 1.13-2.46), and higher risk for all-cause mortality (hazard ratio=1.91, 95% CI: 1.14-3.19); and the short-decreasing class had a higher probability of frailty (odds ratio=1.83, 95% CI: 1.26-2.64). Regarding the sleep quality, the moderate/poor stable trajectory had higher odds of frailty (odds ratio=1.71, 95% CI: 1.18-2.47) than very good-increasing group. CONCLUSIONS: These results have important implications for clinical practice and public health policies, given that the evaluation and treatment of sleep disorders need more attention in primary care settings. Interventions to detect and treat sleep disorders should be integrated into clinical practice to prevent or delay the appearance of alterations in older adults' physical and cognitive function. Further research on sleep quality and duration is warranted to understand their contribution to healthy aging.

La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores que viven en la comunidad.

OBJETIVO: Determinar la asociación entre mala autopercepción de salud oral y fragilidad en personas mayores. Material y métodos. Estudio transversal en personas mayores de la Ciudad de México. La autopercepción de salud oral se midió con el Geriatric/General Oral Health Assessment Index (GOHAI) y la fragilidad con el fenotipo de Fried y colaboradores. RESULTADOS: 1 173 personas mayores, media de edad de 66.0 (5.7) años, mujeres 46.1% (n=541). La media (IC95%) de GOHAI-Sp fue de 49.2 (48.9-49.6). El 9.2% (n=108) presentaron fragilidad, 59.9% (n=703) prefrágil y 30.9% (n=362) no frágiles. La fuerza de asociación (RM) para mala autopercepción de salud oral y frágil fue RM 2.4 (IC95% 1.5,3.7) y RM ajustada RM 1.7 (IC95% 1.1,2.8), referencia no frágil. No existe asociación significativa para la mala autopercepción de salud oral y prefrágil. Conclusión. La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores.

Factores que afectan el estado nutricional en personas mayores mexicanas: Enasem, 2018.

OBJETIVO: Analizar los factores que afectan el estado nutricional en personas mayores mexicanas del Estudio Nacional de Salud y Envejecimiento en México 2018 (Enasem 2018). Material y métodos. Análisis transversal secundario de determinantes sociales, factores relativos a la salud y eventos estresantes de la vida con dos problemas nutricionales relevantes en personas mayores: 1) desnutrición y 2) exceso de peso considerando sobrepeso y obesidad, mediante regresión logística múltiple. RESULTADOS: 4 587 participantes. La prevalencia de desnutrición fue 16.1% y está relacionada con edad ≥80 años, sin pareja, sin escolaridad, sobrestimación de índice de masa corporal (IMC), dificultad motriz, dependencia funcional instrumental, hospitalización en año previo y caídas en los últimos dos años, autorreporte de fuerza prensil débil, reporte de desastre que afectó vivienda o accidente que afectó la salud. La prevalencia de exceso de peso fue 43.6%, relacionada con ser mujer, tener 60 a 79 años, percibirse sin sobrepeso u obesidad y subestimarlo contra IMC, tener ≥3 enfermedades, síntomas somáticos e inactividad física. CONCLUSIONES: Los factores que afectan el estado nutricional hacia desnutrición o exceso de peso en las personas mayores requieren considerarse como áreas de intervención importante en el envejecimiento.

[Quality of life and caregiver burden in caregivers with patients with complications from type 2 diabetes mellitus]. / Calidad de vida y sobrecarga del cuidador en cuidadores con pacientes con complicaciones por la diabetes mellitus tipo 2.

Background: Chronic diseases with partial dependence, including type 2 diabetes mellitus, modify the way of life of the patient and his family, who adopt the role of caregiver having to reorganize, rethink their expectations and adapt their goals and objectives to the situation, this may generate a deterioration of the quality of life and an overload syndrome. Objective: To identify the relationship between quality of life and caregiver overload in caregivers with patients with complications from type 2 diabetes mellitus assigned to the Family Medicine Unit No. 7. Material and methods: Cross-sectional study, carried out with 138 caregivers with a patient with complications from type 2 diabetes mellitus. The sociodemographic profile instruments, the SF-36 health questionnaire, and the Zarit scale were used for data collection. The analysis was carried out through descriptive statistics and Spearman's correlation test, with a significance level of p≤0.05. Results: It was identified that the health-related quality of life in caregivers with patients with complications from type 2 diabetes mellitus evaluated with the SF-36 questionnaire had a mean value of 74.8; with a score in the physical and mental components of 63.9 and 38.1 respectively. The best qualified dimensions were social function (84.9) and physical function, on the other hand, vitality obtained a lower qualification. It was observed that 5.05% of the caregivers present light overload and 5.05% intense overload. When performing the correlation between the global rating of the Zarit scale with the 8 dimensions of the SF-36 health questionnaire in caregivers of patients with complications of type 2 diabetes mellitus, a moderate negative correlation was observed between the dimensions of mental health, physical function, emotional role and vitality, as well as a weak negative correlation between the dimensions of social role and physical role. Conclusions: The results show an inverse correlation between the caregiver's burden and the quality-of-life dimensions, that is, if one decreases, the other increases; It is important to carry out health promotion activities in this population to prevent caregiver overload.

Introducción: las enfermedades crónicas con parcial dependencia, incluyendo la diabetes mellitus tipo2, modifican el modo de vida del paciente y de su familia, quienes adoptan el rol de cuidador, por lo que tienen que reorganizarse, replantear sus expectativas y adecuar sus metas y objeticos a la situación, generando un deterioro de la calidad de vida y un síndrome de sobrecarga. Objetivo: identificar la relación entre calidad de vida y sobrecarga del cuidador en cuidadores con pacientes con complicaciones por la diabetes mellitus tipo 2 adscritos a la Unidad de Medicina Familiar No. 7. Material y métodos: estudio transversal, realizado con 138 cuidadores con paciente con complicaciones por la diabetes mellitus tipo 2. Para la recolección de los datos, fueron utilizados los instrumentos de perfil sociodemográfico, el cuestionario de salud SF-36 y la escala de Zarit. El análisis se realizó por medio de estadística descriptiva y de la prueba de correlación de Spearman, con un nivel de significancia de p ≤ 0.05. Resultados: se identificó que la calidad de vida relacionada con la salud en los cuidadores con pacientes con complicaciones por la diabetes mellitus tipo 2 evaluada con el cuestionario SF-36 tuvo un valor medio de 74,8; con una puntuación en los componentes físico y mental de 63,9 y de 38,1 respectivamente. Las dimensiones mejor calificadas fueron la función social y física, en cambio, la vitalidad obtuvo menor calificación. Se observó que el 5,05% de los cuidadores presentan sobrecarga ligera y el 5,05% sobrecarga intensa. Al realizar la correlación entre la calificación global de la escala de Zarit con las 8 dimensiones del cuestionario de salud SF-36 en cuidadores de pacientes con complicaciones por la diabetes mellitus tipo 2, se observó una correlación moderada negativa entre las dimensiones de salud mental, la función física, el rol emocional y la vitalidad, así como una correlación negativa débil entre las dimensiones de función social y el rol físico. Conclusiones: los resultados muestran una correlación inversa entre la sobrecarga del cuidador y las dimensiones de calidad de vida, es decir, si disminuye una aumenta la otra; es importante realizar actividades de promoción a la salud en esta población para prevenir la sobrecarga del cuidador.

Insomnia Impairs Both the Pro-BDNF and the BDNF Levels Similarly to Older Adults with Cognitive Decline: An Exploratory Study.

Sleep disorders, including insomnia, are common during aging, and these conditions have been associated with cognitive decline in older adults. Moreover, during the aging process, neurotransmitters, neurohormones, and neurotrophins decrease significantly, leading to the impairment of cognitive functions. In this sense, BDNF, the most abundant neurotrophic factor in the human brain, has been suggested as a potential target for the prevention and improvement of cognitive decline during aging; however, the current evidence demonstrates that the exogenous administration of BDNF does not improve cognitive function. Hence, in the present study, we quantified pro-BDNF (inactive) and BDNF (active) concentrations in serum samples derived from older individuals with insomnia and/or cognitive decline. We used linear regression to analyze whether clinical or sociodemographic variables impacted the levels of BNDF concentration. We observed that insomnia, rather than cognitive decline, is significantly associated with BDNF concentration, and these effects are independent of other variables. To our knowledge, this is the first study that points to the impact of insomnia on improving the levels of BDNF during aging and suggests that opportune treatment of insomnia may be more beneficial to prevent cognitive decline during aging.

[Answer to "Comment on article "Sleep disorders in older people. How do older people in Mexico City sleep?""]. / Respuesta a "Comentario al artículo: "Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México?"".

The response of the authors of the article "Sleep disorders in older people. How do older people in Mexico City sleep?" is presented, in which they carry out pertinent clarifications.

Se presenta la respuesta de los autores del artículo "Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México?" en la que llevan a cabo aclaraciones pertinentes.

The Relationship Between Social Isolation and Mortality Among Adults Aged 50 and Older in a 12-year Follow-Up Analysis in Mexico.

Social relationships have a complex nature shaped mainly by two dimensions: structure and function. Previous research raised the importance of considering both features simultaneously given that they may operate differently. However, research on social relationships and mortality mainly refers to European and U.S. populations. This study examines structural and functional features of social relationships to understand social isolation among adults aged 50 and older in Mexico. In addition, we analyze that association with mortality, using panel data from a 12-year follow-up from the Mexican Health and Aging Study (2003-2015). Results reveal that structural and functional features of social relationships are intertwined, and social isolation was shaped by two aspects that we label lack of socialization and being alone and feeling lonely. After controlling for a series of sociodemographic and health variables, Cox proportional hazard regression models indicate that both aspects significantly increase mortality among older adults in Mexico.

[Interinstitutional Command Mexico: organizational decision-making in the face of COVID-19]. / Comando interinstitucional México: toma de decisiones organizacionales ante COVID-19.

Background: The third wave of COVID-19 in Mexico produced a high demand for hospital care, which is why it was created a multidisciplinary group to optimize decision-making: the Interinstitutional Command for the Health Sector (COISS, according to its initials in Spanish). So far, there is no scientific evidence of the COISS processes or their effect on the behavior of epidemiological indicators and the hospital care needs of the population in the context of COVID-19 in the entities involved. Objectives: To analyze the trend on epidemic risk indicators throughout the COISS group's management in the third wave of COVID-19 in Mexico. Material and methods: Mixed study: 1) non-systematic review of information from technical documents issued by COISS, 2) secondary analysis of open-access institutional databases through the description of healthcare needs of cases notified with COVID-19 symptoms, and an ecological analysis by each Mexican state on the behavior of hospital occupancy, RT-PCR positivity, and COVID-19 mortality in two-time points. Results: The COISS activity in identifying states with epidemic risk generated actions aimed at a reduction in hospital occupancy of beds, positivity by RT-PCR, and mortality from COVID-19. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need.

Introducción: la tercera ola por COVID-19 en México provocó una alta demanda de atención hospitalaria, por lo cual se conformó un grupo multidisciplinario para optimizar la toma de decisiones sanitarias: Comando Interinstitucional del Sector Salud (COISS). Hasta el momento, no hay evidencia científica de los procesos del COISS ni de su efecto sobre el comportamiento de indicadores epidemiológicos y las necesidades de atención hospitalaria de la población bajo el contexto de COVID-19 en entidades federativas involucradas. Objetivos: analizar la tendencia de indicadores de riesgo epidémico durante la gestión del grupo COISS en la tercera ola por COVID-19 en México. Material y métodos: estudio mixto: 1) revisión no sistemática de documentos técnicos del COISS, 2) análisis secundario de bases de datos de libre acceso, mediante la descripción de necesidades de atención hospitalaria de los casos notificados con síntomas de la COVID-19 y un análisis ecológico por entidades federativas sobre el comportamiento de la ocupación hospitalaria, positividad y mortalidad por COVID-19 en dos cortes temporales. Resultados: la actividad del COISS en la identificación de entidades federativas de riesgo epidémico generó acciones encaminadas a una reducción en la ocupación hospitalaria de camas generales, positividad por RT-PCR y mortalidad por COVID-19. Conclusiones: las decisiones del grupo COISS disminuyeron los indicadores de riesgo epidémico. Continuar el trabajo del grupo COISS es una necesidad apremiante.

[Sleep disorders in older people. How do older people from Mexico City sleep?] / Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México?

Background: Good sleep is essential for physical and mental health throughout life. However, there are few reports describing the sleep problems experienced by communitydwelling older people. Objective: To describe the prevalence of sleep disorders and their relationship with medical conditions in communitydwelling older people. Material and methods: Cross-sectional study with 1678 older people (60 years and over) from the Mexican Institute of Social Security (IMSS) in Mexico City. Sleep duration, sleep quality, daytime sleepiness, insomnia and risk of obstructive sleep apnea were evaluated, alongside with sociodemographic variables and medical conditions. Results: Participants self-reported an average sleep duration of 6.04 (± 1.5) hours per night, approximately half had poor sleep quality (49.1%), and 2 out of 10 experienced daytime sleepiness (19.1%); one third had insomnia (30.8%) and risk of obstructive sleep apnea (27.5%). A pattern of higher prevalence of sleep problems was observed in older adults with depression, with cognitive impairment, with difficulties in basic activities of daily living and in those taking medications for the nervous system. Conclusions: This study showed that older people sleep few hours, have low sleep quality, and have a high prevalence of sleep disorders. The identification and treatment of sleep disordes in older people should be a priority in the IMSS.

Introducción: el buen sueño es esencial para la salud física y mental a lo largo de la vida. Sin embargo, existen pocos reportes sobre los problemas del sueño que enferentan las personas mayores que viven en la comunidad. Objetivo: describir la prevalencia de los principales problemas de sueño y su relación con condiciones médicas en las personas mayores que viven en la comunidad. Material y métodos: estudio transversal descriptivo con 1678 personas de 60 años y más, derechohabientes del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México. Se evaluó la duración del sueño, la calidad del sueño, la somnolencia diurna, el insomnio y el riesgo de apnea obstructiva de sueño, junto con algunas variables sociodemográficas y condiciones médicas. Resultados: las personas mayores reportaron dormir, en promedio, 6.04 (± 1.5) horas por noche; el 49.1% tenía baja calidad del sueño y el 19.1% experimentaba somnolencia diurna; el 30.8% presentó insomnio y el 27.5% tenía riesgo de apnea obstructiva del sueño. Se observó un patrón de mayor prevalencia de problemas de sueño en las personas mayores con depresión, deterioro cognitivo, dificultades para realizar actividades básicas de la vida diaria y en quienes consumían medicamentos para el sistema nervioso. Conclusiones: este estudio mostró que las personas mayores duermen pocas horas, tienen baja calidad de sueño y prevalencia alta de trastornos del sueño. La identificación y el tratamiento de los problemas del sueño en las personas mayores debe ser una prioridad en el IMSS.

Trastornos del sueño en personas mayores. ¿Cómo duermen las personas mayores de la Ciudad de México? / Sleep disorders in older people. How do older people from Mexico City sleep?

Introducción: el buen sueño es esencial para la salud física y mental a lo largo de la vida. Sin embargo, existen pocos reportes sobre los problemas del sueño que enferentan las personas mayores que viven en la comunidad. Objetivo: describir la prevalencia de los principales problemas de sueño y su relación con condiciones médicas en las personas mayores que viven en la comunidad. Material y métodos: estudio transversal descriptivo con 1678 personas de 60 años y más, derechohabientes del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México. Se evaluó la duración del sueño, la calidad del sueño, la somnolencia diurna, el insomnio y el riesgo de apnea obstructiva de sueño, junto con algunas variables sociodemográficas y condiciones médicas. Resultados: las personas mayores reportaron dormir, en promedio, 6.04 (± 1.5) horas por noche; el 49.1% tenía baja calidad del sueño y el 19.1% experimentaba somnolencia diurna; el 30.8% presentó insomnio y el 27.5% tenía riesgo de apnea obstructiva del sueño. Se observó un patrón de mayor prevalencia de problemas de sueño en las personas mayores con depresión, deterioro cognitivo, dificultades para realizar actividades básicas de la vida diaria y en quienes consumían medicamentos para el sistema nervioso. Conclusiones: este estudio mostró que las personas mayores duermen pocas horas, tienen baja calidad de sueño y prevalencia alta de trastornos del sueño. La identificación y el tratamiento de los problemas del sueño en las personas mayores debe ser una prioridad en el IMSS.

Background: Good sleep is essential for physical and mental health throughout life. However, there are few reports describing the sleep problems experienced by community-dwelling older people. Objective: To describe the prevalence of sleep disorders and their relationship with medical conditions in community-dwelling older people. Methods: Cross-sectional study with 1678 older people (60 years and over) from the Mexican Institute of Social Security (IMSS) in Mexico City. Sleep duration, sleep quality, daytime sleepiness, insomnia and risk of obstructive sleep apnea were evaluated, alongside with sociodemographic variables and medical conditions. Results: Participants self-reported an average sleep duration of 6.04 (± 1.5) hours per night, approximately half had poor sleep quality (49.1%), and 2 out of 10 experienced daytime sleepiness (19.1%); one third had insomnia (30.8%) and risk of obstructive sleep apnea (27.5%). A pattern of higher prevalence of sleep problems was observed in older adults with depression, with cognitive impairment, with difficulties in basic activities of daily living and in those taking medications for the nervous system. Conclusions: This study showed that older people sleep few hours, have low sleep quality, and have a high prevalence of sleep disorders. The identification and treatment of sleep disordes in older people should be a priority in the IMSS.

Sex Differences in the Association Between Risk of Obstructive Sleep Apnea, Insomnia, and Frailty in Older Adults.

PURPOSE: To analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults. PATIENTS AND METHODS: Cross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex. RESULTS: This study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty. CONCLUSION: In community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.

Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort.

PURPOSE: To identify factors associated with recovered functionality after a hip fracture in a sample of older adult patients. PATIENTS AND METHODS: Nested case-control study in a cohort. Older adults (60 years or older) with a hip fracture were recruited between May 2017 and October 2018. The Barthel scale was used to measure performance in activities of daily living (ADL). A questionnaire was applied to collect information about demographic, clinic, psychological and social variables, and anthropometric measurements were taken. A logistic regression model was built to analyze various factors related to recovered functionality. RESULTS: A total of 346 older adults with a hip fracture were studied (n=173 cases and n=173 controls); 69.4% (n=240) women and 30.6% (n=140) men. Mean age was 79.4 years (±8.7) overall; for cases, 77.4 (±7.9) years and for controls, 81.4 (±9.0). Mean schooling was 6.3 (± 4.3) years. Recovered functionality was associated with normal nutritional status (OR 4.81, 95% CI = 2.54-9.12), absence of heart disease (OR 4.08, 95% CI = 1.48-11.20), self-efficacy for ADL (OR 4.07, 95% CI = 2.15-7.72), absence of depressive symptoms (OR 2.99, 95% CI = 1.69-5.28), prior functionality (OR 2.83, 95% CI = 1.51-5.31), high socioeconomic level (OR 2.41, 95% CI = 1.24-4.65) and transcervical fracture (OR 2.34, 95% CI = 1.05-5.22). CONCLUSION: In older adults who have suffered a hip fracture, clinical, psychological, and demographic characteristics are associated with recovered functionality. These factors should be considered as a priority in the care of older adults who have experienced hip fractures.

Sleep duration and incident frailty: The Rural Frailty Study.

BACKGROUND: The association between sleep duration and frailty remains unconclusive since most of the studies have been cross-sectional. Therefore, this study aimed to analyze the association between sleep duration, sleep complaints, and incident frailty. METHODS: A community-based cohort study from rural areas in Mexico with 309 older adults aged 70 and over. Data from waves two and three of the Rural Frailty Study were used. We operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive waves. Sleep duration was classified as: ≤ 5 h, 6 h, 7-8 h, and ≥ 9 h; and the self-reported sleep complaints as a dichotomous variable. Analyses were performed using Poison regression models. RESULTS: The average age was 76.2 years and 55.3% were women; the incidence of frailty was 30.4%; 13.3% slept ≤5 h, and 38.5% ≥ 9 h. Compared with the group that slept 7-8 h, the risk of frailty at 4.4 years of follow-up was significantly higher among those who slept ≤5 h (adjusted RR 1.80, 95% CI: 1.04-3.11) and among those who slept ≥9 h (adjusted RR 1.69, 95% CI: 1.10-2.58). Sleep complaints were not associated with incident frailty (adjusted RR 1.41, 95% CI: 0.94-2.12). CONCLUSIONS: Our results show that short and long sleep duration are associated with the incidence of frailty. Studies that objectively evaluate sleep duration are needed to clarify whether meeting the recommended hours of sleep decreases frailty incidence.

Social isolation undermines quality of life in older adults.

OBJECTIVE: Several studies have documented associations between social isolation and poor physical health or well-being. However, little is known of the importance of social support among older adults on specific topics about their quality of life. The purpose of the present study was to determine the relationship between social isolation and quality of life among older adults. DESIGN: A cross-sectional study. SETTING: Mexico City. PARTICIPANTS: 1,252 subjects aged ≥ 60 years living at home. MEASUREMENTS: We used the Abbreviated Version of the Lubben Social Network Scale (LSNS-6) to assess social isolation and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-Old) to assess quality of life. Socio-demographic and health factors were collected through face-to-face interviews. A series of linear regression analyses were used to investigate relationship between social isolation and quality of life. The statistical models were controlled for socio-demographic and health factors. RESULTS: A total of 750 women (60%) and 502 men (40%) participated in the study. According to their LSNS-6 scores, 426 participants (34.0%) were classified into the highest group of isolation (range 0-10 points). Older adults with higher scores of social isolation exhibited lower quality of life. Regression analyses indicated that social isolation correlated with lower levels of global quality of life, autonomy, intimacy, and past, present, and future activities. CONCLUSIONS: Coping with life from a socially isolated situation entails serious difficulties concerning quality of life. Interventions that foster environments where older adults can forge social bonds might improve their quality of life.

Insomnia, low sleep quality, and sleeping little are associated with frailty in Mexican women.

OBJECTIVE: To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults. SUBJECTS & METHODS: Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty. RESULTS: Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men. CONCLUSION: In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.

Decreased Autonomy In Community-Dwelling Older Adults.

PURPOSE: The present study aims to explore characteristics associated with low perception of autonomy among community-dwelling older adults. PATIENTS AND METHODS: This original research was derived from a cross-sectional study based on the study COSFOMA with information from 1,252 (60 years and older) community-dwelling older adults whose data was obtained through a questionnaire that included sociodemographic characteristics, as well as different scales of geriatric assessment. The perception of autonomy was evaluated with the autonomy sub-scale of the Quality of Life Scale of Older Adults from the World Health Organization (World Health Organization Quality of Life of Older Adults, WHOQOL-OLD). RESULTS: The mean (SD) age of the 1,252 community-dwelling older adults participating in the study was 68.5 (7.2) years. The average perception of autonomy was 65.3 (18.2) points out of 100. In the final logistic regression model, schooling <6 years (Odds Ratio, OR = 2.1, 95% Confidence Interval, CI = 1.5-2.9), low social support (OR = 1.6, 1.2-2.2), low spirituality (OR = 2.6, 95% CI = 1.9-3.4), presence of cognitive impairment (OR = 1.9, 95% CI = 1.4-2.5), anxiety (OR = 1.7, 95% CI = 1.2-2.5), and limitation in activities of daily living (ADL) (OR = 1.6, 95% CI = 1.1-2.2) were statistically associated with the presence of low autonomy in older adults. CONCLUSION: The perception of autonomy among community-dwelling older adults is moderate. Social support and spirituality, as well as cognitive impairment, anxiety, and limitations in ADL, play a significant role for degree of perceived autonomy in this population. Health professionals can use this information to promote participation in decision-making processes through programs that improve quality of life.

The impact of poor oral health on the oral health-related quality of life (OHRQoL) in older adults: the oral health status through a latent class analysis.

BACKGROUND: Determine the impact of poor oral health on the oral health-related quality of life (OHRQoL) in community-dwelling older adults. METHODS: Cross-sectional study of community-dwelling older adults in Mexico City. Sociodemographic characteristics were obtained and assessed their OHRQoL according to the Geriatric/General Oral Health Assessment Index (GOHAI). Clinical evaluation of their oral health: painful chewing, use of dentures, dry mouth, xerostomia, plaque, calculus, coronal and root caries, tooth loss and gingival bleeding. Finally, we determined the oral health of participants through Latent Class Analysis (LCA), excluding totally edentulous. The strength of association was determined (Odds Ratio [OR] and 95% confidence interval [95% CI]) through logical regression between the oral health categories (latent classes) and OHRoL in older adults, adjusted with the other variables included in the study: age, sex, marital status, living arrangements (lives alone), educational level, paid work status, comorbidity, cognitive deterioration, depression and use of medical and dental services in the previous 12 months. RESULTS: The mean (SD) GOHAI score for the 228 older adults to 46.5 (8.7), number of classes to characterize oral health through LCA was three (entropy 0.805). The GOHAI mean for Class 3 (57.0%), acceptable oral health was 50.1 (7.1); totally edentulous (9.6%), 47.9 (8.4); for Class 2 (16.7%), regular oral health, 43.8 (9.3); and for Class 1 (16.7%), poor oral health, 42.2 (9.7). Significant differences were observed among means (p < .001). Using Class 3 an as a reference, the strength of association between the GOHAI scores and low OHRQoL (GOHAI 25th percentile = 24.0) was OR = 0.7, 95% CI = 0.2-3.3 for totally edentulous; OR = 3.0, 95% CI = 1.2-7.6 for Class 2 and OR = 5.0, 95% CI = 2.1-12.1 for Class 1. CONCLUSION: Poor oral health was associated with a negative impact on the OHRQoL of community-dwelling older adults. CLINICAL RELEVANCE: It is essential to design and implement oral health care policies specifically targeted at improving the quality of life in this older adult population.

Does poor sleep impair cognition during aging? Longitudinal associations between changes in sleep duration and cognitive performance among older Mexican adults.

Alterations in sleep patterns are common among older adults; further, short and long sleep durations have been linked with impaired cognitive performance in older individuals. Yet most research examining these relationships has been cross-sectional, limited to high-income nations, and has failed to consider how changes in sleep duration may impact cognitive decline. The present longitudinal study uses nationally-representative data to test whether changes in sleep length among "healthy" baseline sleepers are associated with reduced cognitive function in older Mexican adults (>50 years old) at follow-up. Data were drawn from the first and second waves of the World Health Organization's Study on global AGEing and adult health. Self-report data captured sleep duration over two nights, and five cognitive tests (immediate and delayed verbal recall, forward and backward digit span, and verbal fluency) were used to measure various cognitive domains and create a composite z-score of cognitive performance. Linear regressions were performed to assess associations between sleep length changes and cognitive decline, controlling for relevant lifestyle and health factors. Increased sleep durations at follow-up among individuals who reported intermediate sleep durations (6-9 h/night) at baseline were significantly associated with greater rates of decline in overall cognitive function. Longer sleepers also trended toward greater rates of decline for attention/working memory and executive function. This study suggests that long sleep durations are a risk factor for certain types of impaired cognition among older adults living in a middle-income country. These findings are clinically important given the growing rates of dementia and aging populations globally.

Sleep disturbances are associated with frailty in older adults / Las dificultades del sueño se asocian con fragilidad en adultos mayores

Background: Sleep plays a vital role in good health. Since sleep disturbances have been linked to a series of adverse physical health outcomes, the objective was to analyze the association between sleep disturbances and the frailty criteria in Mexican older adults from Mexico City. Methods: The study design was cross-sectional. A total of 1252 people aged 60 years or older were assessed according to Fried criteria for defining frailty. Sleep disturbances (sleeping without rest, sleeping more than usual and having trouble sleeping) were collected by self-report through a face to face questionnaire. The association between sleep disturbances and frailty was estimated with ordinal logistic regression controlled by covariates. Results: It was found that 6.9% of older people reported sleeping more than usual, 18.9% slept without rest and 16.3% had trouble sleeping. There was a statistically significant association between sleeping more than usual (OR = 1.96, 95% CI: 1.23-3.12) and having trouble sleeping (OR = 1.53, 95%CI: 1.09-2.17) with frailty. Conclusion: Sleeping more than usual or having trouble sleeping contribute to increase frailty in older people from Mexico City.

Introducción: el sueño es importante para una buena salud. Las dificultades como dormir mal, de manera insuficiente o excesiva, entre otras, traen consigo diversos desenlaces adversos para la salud. El objetivo fue analizar la asociación entre las dificultades del sueño y la presencia de fragilidad de adultos mayores de la Ciudad de México. Métodos: el diseño del estudio fue transversal. Se evaluaron 1252 personas de 60 años o más con base en los criterios de Fried para definir fragilidad. Las dificultades del sueño (dormir sin descansar, dormir más de lo habitual y dificultad para dormir) se recolectaron mediante un cuestionario de entrevista directa. La asociación entre dificultades del sueño y fragilidad se estimó con regresión logística ordinal controlada por covariables. Resultados: se encontró que 6.9% de personas mayores reportaron que dormían más de lo habitual, 18.9% dormía sin descansar y a 16.3% le costaba mucho dormir. Se observó una asociación estadísticamente significativa entre dormir más de lo habitual (RM = 1.96; IC95%: 1.23-3.12) y la dificultad para dormir (RM = 1.53; IC 95%: 1.09-2.17) con la fragilidad. Conclusiones: dormir más de lo habitual o presentar dificultad para dormir están asociadas con la presencia de fragilidad en los adultos mayores.

Multidimensional social support is associated with healthcare utilization among older Mexican adults.

In this study, we aimed to estimate the association between social support and healthcare utilization among older Mexican adults. We conducted a prospective study with 4027 older adults aged 65-74 in rural areas in seven Mexican states. Data were collected at baseline (2007) and 14 months later (2009). Healthcare utilization was defined as number of visits to a physician for preventive or curative purposes in the last 6 months. Multidimensional social support was operationalized into two components: structural (living arrangements, marital status and network size) and functional (perceived availability of support; and perceived support across emotional, instrumental, economic and information domains). Mixed-effects regression models were used to estimate the probability of healthcare use and to examine the association between social support and the number of visits to a physician. Results showed that perceived availability of social support was associated with the probability of visits to a physician (OR 1.44; p < .01). Meanwhile, the following domains of functional component of social support were associated with the probability of visits to a physician: instrumental (OR 1.55; p < .01), economic (OR 1.19; p = .03) and informational (OR 1.39; p < .01); and also with the number of visits to a physician: instrumental (e ß  = 1.27; p < .01), economic (e ß  = 1.14; p = .01) and informational (e ß  = 1.12; p < .10). Our findings suggest that a significant association exists between social support, measured from a multidimensional viewpoint, and healthcare utilization, in which greater social support was related to a greater extent of use of health services.