Complete dentures associated with frailty among edentulous older Japanese people: A prospective analysis.

OBJECTIVE: This study aimed to explore the cross-sectional and prospective associations between self-reported functionality of complete dentures (FCD), satisfaction with complete dentures (SCD) and the ability to chew hard food (ACHF) on the one hand and the frailty index (FI) on the other hand among edentulous community-dwelling older Japanese people. METHODS: The study examined 770 edentulous participants of the Nihon University Japanese Longitudinal Study of Aging. The self-reported FCD, SCD and ability to chew six groups of food (from hardest to softest) with complete dentures were the independent variables at the baseline. The FI was computed including 40 deficits as the dependent variable at the baseline and 4 years later. Cross-sectional and prospective generalized linear regression models were fitted controlling for age, gender, marital status, education, working status and area of residence. RESULTS: The use of non-functional complete dentures and dissatisfaction with complete dentures were both associated with a higher FI cross-sectionally (3.9% [95% CI 2.2-5.6] and 3.2% [95% CI 1.5-4.9], respectively) and prospectively (3.9% [95% CI 2.0-6.0] and 3.3% [95% CI 1.3-5.3], respectively). Regarding the ability to chew, a higher FI at baseline was observed among those able to chew food of Group 2 (1.9%, [95% CI 0.1-3.7]) and Groups 4-6 (1.9%, [95% CI 0.1-3.7]), and a progressive increment in the FI, as the participants reported being able to chew softer groups of food at the follow-up (Group 2: 2.2% [95% CI 0.05-4.3]; Group 3: 3.6% [95% CI 1.2-6.0]; and Groups 4-6: 3.4 [95% CI 0.7-6.1]). CONCLUSION: Self-reported use of non-functional complete dentures, dissatisfaction with dentures and a reduced ACHF with complete dentures were associated with a higher FI both cross-sectionally and prospectively.

Psychosocial characteristics and cognitive function in community-dwelling adults over 50 years old from the Mexican Health and Aging Study (MHAS)

Aging is an inevitable process that can be associated with cognitive impairment. Evidence about the simultaneous evaluation of psychosocial variables that could be associated with cognitive function is crucial. We aimed to determine the association between psychosocial characteristics and cognition in adults over 50 years in Mexico. The fifth round of the Mexican Health and Aging Study (MHAS) (2018) provides the basis for this paper. The study is part of a longitudinal analysis, for which wave pasting 2012, 2015, and 2018 were performed. The final sample comprised 6,709 individuals. Ten psychosocial variables were measured through scales or specific questions. Cognition was assessed with the Cross-Cultural Cognitive Examination (CCCE). Confounders included sociodemographics, multimorbidity, and functionality. The analysis was performed by adjusting the regression model. Of the total sample, 2,761 (41.1%) were men; 3,948 (58.8%) were women. The mean age was 68.2 years (SD = 8.1). Cognition is significantly affected in people with higher age (ß=-1.30, Cl 95% -1.54, -.1.06 p= 0.000), less schooling (ß=.559, CI 95% .498, .621 p<0.001), depressive symptoms (ß=-.066, CI 95% -.115, -.018 p=0.007), those who do not perform any volunteer service (ß=-.057, CI 95% -.102, -.102 p=0.013), or do not participate in decision making (ß=-.242, CI 95% -.295, -.189 p<0.001), low internal locus of control (ß=-.012., CI 95% -.023, -.001 p=0.023), and poor economic perception (ß=-.070., CI 95% -.115, -.024 p=0.002). When analyzing the cognitive function of older people, it is vital to consider the possible related psychosocial variables.

El envejecimiento es un proceso inevitable que puede asociarse al deterioro cognitivo. La evidencia sobre la evaluación simultánea de variables psicosociales que pudieran estar asociadas con la función cognitiva es crucial. Nuestro objetivo fue determinar la asociación entre las características psicosociales y la cognición en adultos mayores de 50 años en México. La quinta ronda del Estudio Mexicano de Salud y Envejecimiento (ENASEM) (2018) proporciona la base para este trabajo. El estudio forma parte de un análisis longitudinal, para el que se recabaron datos en 2012, 2015 y 2018. La muestra final estuvo compuesta por 6,709 individuos. Se midieron diez variables psicosociales a través de escalas o preguntas específicas. La cognición se evaluó con el Cross-Cultural Cognitive Examination (CCCE). Entre los factores de confusión se incluyeron los sociodemográficos, la multimorbilidad y la funcionalidad. El análisis se realizó ajustando un modelo de regresión. De la muestra total, 2.761 (41,1%) eran hombres; 3.948 (58,8%) eran mujeres. La edad media era de 68,2 años (DE = 8,1). La cognición se ve significativamente afectada en las personas con mayor edad (ß=-1,30, Cl 95% -1,54, -.1.06 p<0.001), menor escolaridad (ß=-.559, IC 95% .498, .621 p<0.001), síntomas depresivos (ß=-.066, IC 95% -.115, -.018 p=0.007), quienes no realizan ningún servicio voluntario (ß=-.057, IC 95% -.102, -.102 p=0. 013), o no participan en la toma de decisiones (ß=-.242, CI 95% -.295, -.189 p<0.001), presentan bajo locus de control interno (ß=-.012., CI 95% -.023, -.001 p=0.023), y pobre percepción económica (ß=-.070., CI 95% -.115, -.024 p=0.002). Al analizar la función cognitiva de las personas mayores, es vital considerar las posibles variables psicosociales relacionadas.

O envelhecimento é um processo inevitável que pode estar associado a défices cognitivos. A evidência sobre a avaliação simultânea de variáveis psicossociais que podem estar associadas à função cognitiva é crucial. O nosso objetivo foi determinar a associação entre as características psicossociais e a cognição em adultos com mais de 50 anos no México. A quinta rodada do Estudo Mexicano de Saúde e Envelhecimento (MHAS) (2018) fornece a base para este artigo. O estudo faz parte de uma análise longitudinal, para a qual foram realizadas colagens de ondas 2012, 2015 e 2018. A amostra final foi composta por 6.709 indivíduos. Dez variáveis psicossociais foram medidas por meio de escalas ou perguntas específicas. A cognição foi avaliada com o Cross-Cultural Cognitive Examination (CCCE). Os factores de confusão incluíram dados sociodemográficos, multimorbilidade e funcionalidade. A análise foi efectuada através do ajuste do modelo de regressão. Da amostra total, 2.761 (41,1%) eram homens; 3.948 (58,8%) eram mulheres. A idade média foi de 68,2 anos (DP = 8,1). A cognição é significativamente afetada nas pessoas com mais idade (ß=-1,30, Cl 95% -1,54, -.1.06 p= 0.000), menor escolaridade (ß=.559, IC 95% .498, .621 p<0.001), sintomas depressivos (ß=-.066, IC 95% -.115, -.018 p=0.007), aqueles que não realizam nenhum serviço voluntário (ß=-.057, IC 95% -.102, -.102 p=0. 013), ou não participam na tomada de decisões (ß=-.242, IC 95% -.295, -.189 p<0.001), baixo locus de controlo interno (ß=-.012., IC 95% -.023, -.001 p=0.023), e fraca perceção económica (ß=-.070., IC 95% -.115, -.024 p=0.002). Ao analisar a função cognitiva dos idosos, é vital considerar as possíveis variáveis psicossociais relacionadas.

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.

Association of loneliness and social isolation with all-cause mortality among older Mexican adults in the Mexican health and aging study: a retrospective observational study.

BACKGROUND: Plenty of evidence shows how social isolation and loneliness are associated with increased risk for numerous diseases and mortality. But findings about their interactive or combined effects on health outcomes and mortality remains inconclusive. OBJECTIVE: Analyze the longitudinal association of loneliness, social isolation and their interactions, with the all-cause mortality among older adults in Mexico. METHODS: A retrospective observational study was conducted. Mexican adults older than 50 years were included. Data from the Mexican Health and Aging Study (MHAS) in the 2015 and 2018 waves were used. The subjects were classified according to their level of loneliness and the presence of social isolation. Multivariate logistic regression analyzes were performed to determine the degree of association between loneliness and social isolation with all-cause mortality at a 3-year follow-up. RESULTS: From the total sample of 11,713 adults aged 50 years or over, 707 (6%) did not survive, 42% presented loneliness, and 53% were classified as socially isolated. After multivariate adjustment only social isolation (OR = 1.30, 95%CI:1.03-1.64) was associated with all-cause mortality, loneliness (Mild: OR = 0.83, 95%CI:0.59-1.16; Severe: OR = 1.03, 95%CI:0.71-1.64), and the interaction between loneliness and social isolation were not associated with all-cause mortality. CONCLUSION: Social isolation, but not loneliness or their interaction, was associated with all-cause mortality in Mexican adults older than 50 years. This finding may help direct possible future interventions that help improve mental health in older adults from a highly collectivistic country.

Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis.

OBJECTIVES: To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people. BACKGROUND: Studies suggest that the association between frailty and oral conditions are mediated by nutrition. MATERIALS AND METHODS: This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome. RESULTS: Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index. CONCLUSION: Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.

Structural and Pharmacological Network Analysis of miRNAs Involved in Acute Ischemic Stroke: A Systematic Review.

Acute ischemic stroke (AIS) is among the main causes of mortality worldwide. A rapid and opportune diagnosis is crucial to improve a patient's outcomes; despite the current advanced image technologies for diagnosis, their implementation is challenging. MicroRNAs have been recognized as useful as biomarkers since they are specific and stable for characterization of AIS. However, there is still a lack of consensus over the primary miRNAs implicated in AIS. Here, we performed a systematic review of the literature covering from 2015-2021 regarding miRNAs expression during AIS and built structural networks to analyze and identify the most common miRNAs expressed during AIS and shared pathways, genes, and compounds that seem to influence their expression. We identified two sets of miRNAs: on one side, a set that was independent of geographical location and tissue (miR-124, miR-107, miR-221, miR-223, miR-140, miR-151a, miR-181a, miR-320b, and miR-484); and on the other side, a set that was connected (hubs) in biological networks (miR-27b-3p, miR-26b-5p, miR-124-3p, miR-570-3p, miR-19a-3p, miR-101-3p and miR-25-3p), which altered FOXO3, FOXO4, and EP300 genes. Interestingly, such genes are involved in cell death, FOXO-mediated transcription, and brain-derived neurotrophic factor signaling pathways. Finally, our pharmacological network analysis depicted a set of toxicants and drugs related to AIS for the first time.

A spatio-temporal study of state-wide case-fatality risks during the first wave of the COVID-19 pandemic in Mexico.

spatio-temporal analysis of the first wave of the coronavirus (COVID-19) pandemic in Mexico (April to September 2020) was performed by state. Descriptive analyses through diagrams, mapping, animations and time series representations were carried out. Greater risks were observed at certain times in specific regions. Various trends and clusters were observed and analysed by fitting linear mixed models and time series clustering. The association of co-morbidities and other variables were studied by fitting a spatial panel data linear model (SPLM). On average, the greatest risks were observed in Baja California Norte, Chiapas and Sonora, while some other densely populated states, e.g., Mexico City, had lower values. The trends varied by state and a four-order polynomial, including fixed and random effects, was necessary to model them. The most common risk development was observed in states belonging to two clusters and consisted of an initial increase followed by a decrease. Some states presented cluster configurations with a retarded risk increase before the decrease, while the risk increased throughout the time of study in others. A cyclic behaviour with a second increasing trend was also observed in some states. The SPLM approach revealed a positive significant association with respect to case fatality risk between certain groups, such as males and individuals aged 50 years and more, and the prevalence of chronic kidney disease, cardiovascular disease, asthma and hypertension. The analysis may provide valuable insight into COVID-19 dynamics applicable in future outbreaks, as well as identify determinants signifying certain trends at the state level. The combination of spatial and temporal information may provide a better understanding of the fatalities due to COVID-19.

Widowhood Status and Cognitive Function in Community-Dwelling Older Adults from the Mexican Health and Aging Study (MHAS).

We aimed to determine the association between the duration of widowhood and cognition decline. We compared the decline observed in widowed people compared with married, single, or separated persons using the scores obtained in the cognitive assessment of memory, learning, and visual exploration by adults and older adults in Mexico. The Mexican Health and Aging Study (MHAS) provides the base for this paper. This study is an analysis of the fourth data wave (2015), except for the independent variable: marital status. Marital status was built longitudinally with information from the four surveys (2001, 2003, 2012, and 2015). The sample comprised 6898 adults aged 50 and over. Cognition was assessed with an adapted Cross-Cultural Cognitive Examination (CCCE). Confounders include sociodemographic characteristics (sex, age, schooling, self-perception of economic status, and whether the individual worked or not), multimorbidity, functionality, support networks, and psychological characteristics. Of the total sample, 4094 (59.3%) were women. The mean age was 70.86 years (SD = 7.4). The baseline of the study is 2001. In 2001, 8.7% (n = 600) were widows or widowers. People widowed by 2001 scored -0.158 points in cognition while divorced participants scored - 0.095 points.

Transitions of disability, disability-free life expectancy and health insurance among adults aged 50 and older in Mexico: a multistate life table analysis.

OBJECTIVES: To analyse the transitions of disability onset and recovery, estimate life expectancy (LE) with and without disability and explore the relation between insurance and disability patterns in the population aged 50+ in Mexico. DESIGN: Multistate life table analysis of data from a longitudinal cohort survey. SETTING: Data came from the Mexican Health and Aging Study, a longitudinal and representative survey of older adults in Mexico. PARTICIPANTS: 10 651 individuals aged 50+ interviewed in 2012 and 2015, including those who died between waves. PRIMARY AND SECONDARY OUTCOME MEASURES: Disability is measured using the activities of daily living (ADL) scale. Transition rates between disability free, ADL disabled and death were employed to estimate total life expectancy (TLE) and disability-free life expectancy (DFLE). RESULTS: 46% of the individuals who reported an ADL limitation in 2012 recover from disability by 2015. TLE at age 60 for people without ADL limitations is 30 years (95% CI 28.9 to 31), out of which 4.7 years (95% CI 4.1 to 5.4) are lived with ADL limitations, while TLE at age 60 in the initially disabled is 18.7 years (95% CI 17.3 to 20), with 9.4 years (95% CI 8.4 to 10.3) lived with disability. DFLE at age 60 in people with social security is 24.2 years (95% CI 23.3 to 25.2), in people with public insurance is 24.6 years (95% CI 23.7 to 25.4) and in uninsured people is 26.9 years (95% CI 25.9 to 27.9). CONCLUSIONS: In Mexico, a substantial proportion of ADL disabled individuals recover from disability. Nevertheless, initially disabled individuals have a considerably lower DFLE regardless of age when compared with initially active individuals. There appeared to be no differences in terms of disability and LEs between the individuals with social security and public insurance.

Transiciones de la discapacidad según afiliación a instituciones de salud en adultos mayores en México / Transitions of disability according to health insurance enrollment among older adults in Mexico

Resumen: Objetivo: Estudiar las transiciones de la discapacidad de acuerdo con la afiliación a servicios de salud en adultos mayores de 50 años en México, así como el conjunto de variables socioeconómicas y de salud asociadas. Material y métodos: La información proviene de la Encuesta Nacional de Salud y Envejecimiento en México (Enasem-encuesta). Se ajustaron 20 modelos de regresión para las transiciones de la discapacidad medida a través de actividades básicas de la vida diaria en el periodo 2012-15, usando variables socioeconómicas y de salud. Resultados: Los afiliados al Seguro Popular tuvieron la mayor frecuencia de transición hacia la discapacidad con 13.26%. La afiliación a instituciones de salud no tuvo relación con ninguna de las cuatro transiciones estudiadas. Las enfermedades asociadas con el desarrollo de discapacidad varían de acuerdo con la afiliación. Conclusiones: Los factores socioeconómicos y de salud asociados con las transiciones de la discapacidad son diferentes entre afiliaciones.

Abstract: Objective: To study the transitions of disability according to health insurance in the population of adults over 50 in Mexico, as well as the set of socioeconomic and health variables associated with these transitions. Materials and methods: Data comes from the Mexican Health and Aging Study (MHAS). Twenty regression models were fitted for the transitions of disability measured through activities of daily living in the period 2012-15, using socioeconomic and health as explanatory variables. Results: Enrollees with Seguro Popular had the highest frequency of transition to disability with 13.26%. Health insurance was not found to be related to any of the four transitions studied. Diseases associated with the development of disability vary according to health insurance. Conclusions: The socioeconomic and health factors associated with disability transitions are different between health insurance enrolees.

Spatial epidemiological study of the distribution, clustering, and risk factors associated with early COVID-19 mortality in Mexico.

COVID-19 is a respiratory disease caused by SARS-CoV-2, which has significantly impacted economic and public healthcare systems worldwide. SARS-CoV-2 is highly lethal in older adults (>65 years old) and in cases with underlying medical conditions, including chronic respiratory diseases, immunosuppression, and cardio-metabolic diseases, including severe obesity, diabetes, and hypertension. The course of the COVID-19 pandemic in Mexico has led to many fatal cases in younger patients attributable to cardio-metabolic conditions. Thus, in the present study, we aimed to perform an early spatial epidemiological analysis for the COVID-19 outbreak in Mexico. Firstly, to evaluate how mortality risk from COVID-19 among tested individuals (MRt) is geographically distributed and secondly, to analyze the association of spatial predictors of MRt across different states in Mexico, controlling for the severity of the disease. Among health-related variables, diabetes and obesity were positively associated with COVID-19 fatality. When analyzing Mexico as a whole, we identified that both the percentages of external and internal migration had positive associations with early COVID-19 mortality risk with external migration having the second-highest positive association. As an indirect measure of urbanicity, population density, and overcrowding in households, the physicians-to-population ratio has the highest positive association with MRt. In contrast, the percentage of individuals in the age group between 10 to 39 years had a negative association with MRt. Geographically, Quintana Roo, Baja California, Chihuahua, and Tabasco (until April 2020) had higher MRt and standardized mortality ratios, suggesting that risks in these states were above what was nationally expected. Additionally, the strength of the association between some spatial predictors and the COVID-19 fatality risk varied by zone.

Transitions of disability according to health insurance enrollment among older adults in Mexico / Transiciones de la discapacidad según afiliación a instituciones de salud en adultos mayores en México

Objective: To study the transitions of disability according to health insurance in the population of adults over 50 in Mexico, as well as the set of socioeconomic and health variables associated with these transitions. Materials and methods: Data comes from the Mexican Health and Aging Study (MHAS). Twenty regression models were fitted for the transitions of disability measured through activities of daily living in the period 2012-15, using socioeconomic and health as explanatory variables. Results: Enrollees with Seguro Popular had the highest frequency of transition to disability with 13.26%. Health insurance was not found to be related to any of the four transitions studied. Diseases associated with the development of disability vary according to health insurance. Conclusions: The socioeconomic and health factors associated with disability transitions are different between health insurance enrollees.

Random intercept and linear mixed models including heteroscedasticity in a logarithmic scale: Correction terms and prediction in the original scale.

Random intercept models are linear mixed models (LMM) including error and intercept random effects. Sometimes heteroscedasticity is included and the response variable is transformed into a logarithmic scale, while inference is required in the original scale; thus, the response variable has a log-normal distribution. Hence, correction terms should be included to predict the response in the original scale. These terms multiply the exponentiated predicted response variable, which subestimates the real values. We derive the correction terms, simulations and real data about the income of elderly are presented to show the importance of using them to obtain more accurate predictions. Generalizations for any LMM are also presented.

Spatial analysis of COVID-19 spread in Iran: Insights into geographical and structural transmission determinants at a province level.

The Islamic Republic of Iran reported its first COVID-19 cases by 19th February 2020, since then it has become one of the most affected countries, with more than 73,000 cases and 4,585 deaths to this date. Spatial modeling could be used to approach an understanding of structural and sociodemographic factors that have impacted COVID-19 spread at a province-level in Iran. Therefore, in the present paper, we developed a spatial statistical approach to describe how COVID-19 cases are spatially distributed and to identify significant spatial clusters of cases and how socioeconomic and climatic features of Iranian provinces might predict the number of cases. The analyses are applied to cumulative cases of the disease from February 19th to March 18th. They correspond to obtaining maps associated with quartiles for rates of COVID-19 cases smoothed through a Bayesian technique and relative risks, the calculation of global (Moran's I) and local indicators of spatial autocorrelation (LISA), both univariate and bivariate, to derive significant clustering, and the fit of a multivariate spatial lag model considering a set of variables potentially affecting the presence of the disease. We identified a cluster of provinces with significantly higher rates of COVID-19 cases around Tehran (p-value< 0.05), indicating that the COVID-19 spread within Iran was spatially correlated. Urbanized, highly connected provinces with older population structures and higher average temperatures were the most susceptible to present a higher number of COVID-19 cases (p-value < 0.05). Interestingly, literacy is a factor that is associated with a decrease in the number of cases (p-value < 0.05), which might be directly related to health literacy and compliance with public health measures. These features indicate that social distancing, protecting older adults, and vulnerable populations, as well as promoting health literacy, might be useful to reduce SARS-CoV-2 spread in Iran. One limitation of our analysis is that the most updated information we found concerning socioeconomic and climatic features is not for 2020, or even for a same year, so that the obtained associations should be interpreted with caution. Our approach could be applied to model COVID-19 outbreaks in other countries with similar characteristics or in case of an upturn in COVID-19 within Iran.

Network analysis of frailty and aging: Empirical data from the Mexican Health and Aging Study.

BACKGROUND: Frailty remains a challenge in the aging research area with a number of gaps in knowledge still to be filled. Frailty seems to behave as a network, and in silico evidence is available on this matter. Having in vivo evidence that frailty behaves as a complex network was the main purpose of our study. METHODS: Data from the Mexican Health and Aging Study (main data 2012, mortality 2015) was used. Frailty was operationalized with a 35-deficit frailty index (FI). Analyzed nodes were the deficits plus death. The edges, linking those nodes were obtained through structural learning, and an undirected graph associated with a discrete probabilistic graphical model (Markov network) was derived. Two algorithms, hill-climbing (hc) and Peter and Clark (PC), were used to derive the graph structure. Analyses were performed for the whole population and tertiles of the total FI score. RESULTS: From the total sample of 10,983 adults aged 50 or older, 43.8% were women, and the mean age was 64.6 years (SD = 9.3). The number of connections increased according to the tertile level of the FI score. As the FI score raised, groups of interconnected deficits increased and how the nodes are connected changed. CONCLUSIONS: Frailty phenomenon can be modeled using a Bayesian network. Using the full sample, the most central nodes were self-report of health (most connected node) and difficulty walking a block, and all deficits related to mobility were very interconnected. When frailty levels are considered, the most connected nodes differ, but are related with vitality, mainly at lower frailty levels. We derived that not all deficits are equally related since clusters of very related deficits and non-connected deficits were obtained, which might be considered in the construction of the FI score. Further research should aim to identify the nature of all observed interactions, which might allow the development of specific interventions to mitigate the consequences of frailty in older adults.

Impact of social disadvantages in the presence of diabetes at old age.

BACKGROUND: Social disadvantages that start during childhood and continue into the later stages in life may be linked to the presence of diabetes during adulthood. OBJECTIVE: To analyze whether the presence of social disadvantages in childhood and in the present affects the presence of diabetes in older adults. METHODS: The present study was based on longitudinal data from the third and fourth Mexican Health and Aging Study (MHAS) waves (2012 and 2015). Data on diabetes diagnosis, past (e.g. "no shoes during childhood") and present (e.g. self-perception of economic status) social disparities, and other covariables were analyzed. RESULTS: From 8,848 older adults, 21.5% (n = 1903) were classified as prevalent cases (PG), 5.2% (n = 459) as incident cases (IG) and 77.4% (n = 6,486) were free of disease (NDG). The predictor variable "no shoes during childhood" was statistically significant in the model incident versus no diabetes group. Hypertension and body mass index (BMI) were the most relevant covariates as they were statistically significant in the three groups (PG, IG and NDG). CONCLUSIONS: Not having shoes during childhood, an indicator of social disadvantages, is associated with the incidence and prevalence of diabetes in older adults. This suggests that social disadvantages can be a determinant for the presence of chronic diseases in adulthood.

Mortality and associated risk factors for older adults admitted to the emergency department: a hospital cohort.

BACKGROUND: Older emergency department patients are more vulnerable than younger patients, yet many risk factors that contribute to the mortality of older patients remain unclear and under investigation. This study endeavored to determine mortality and factors associated with mortality in patients over 60 years of age who were admitted to the emergency departments of two general hospitals in Mexico City. METHODS: This is a hospital cohort study involving adults over 60 years of age admitted to the emergency department and who are beneficiaries of the Mexican Institute of Social Security and residents of Mexico City. All causes of mortality from the time of emergency department admission until a follow-up home visit after discharge were measured. Included risk factors were: socio-demographic, health-care related, mental and physical variables, and in-hospital care-related. Survival functions were estimated using Kaplan-Meier curves. Hazard ratios (HR) were derived from Cox regression models in a multivariate analysis. RESULTS: From the 1406 older adults who participated in this study, 306 (21.8%) did not survive. Independent mortality risk factors found in the last Cox model were age (HR = 1.02, 95% CI, 1.005-1.04; p = 0.01), length of stay in the ED (HR = 1.003, 95% CI = 0.99, 1.04; p = 0.006), geriatric care trained residents model in Hospital A (protective factor) (HR = 0.66, 95% CI = 0.46, 0.96; p = 0.031), and the FRAIL scale (HR of 1.34 95% CI, 1.02-1.76; p = 0.033). CONCLUSIONS: Risk factors for mortality in patients treated at Mexican emergency departments are length of stay and variables related to frailty status.

Cost of hospitalizations for older adults at one IMSS regional general hospital / Costos por hospitalización de adultos mayores en un hospital general regional del IMSS

Background: Population aging has a direct impact on the increasing demand of health services and on medical care costs. The objective was to carry out a cost analysis of health care costs in older adults in a regional general hospital of the Instituto Mexicano del Seguro Social. Methods: A calculation of the costs was done based on a retrospective collection of health care data. Unit prices were used to estimate costs. These were reported in 2016 Mexican pesos. A cost analysis was carried out by means of a regression model. Explanatory variables were sex, age and comorbidity level, the latter measured by using the Charlson index. Results: The average cost of all the 509 patients was 34 769 Mexican pesos (SD = 2869 pesos). Age variable explains the costs; however, sex and comorbidity variables were not significant. Cost predictions with the statistical model show differences mainly by age. In the case of females, the model predicts greater costs compared with those of males. Costs for older adults of 85 years or more were greater than those for the group of younger people (75-84). Conclusion: The hospitalization costs estimated are high and they differ according to the age group. We suggest to make further research in order to know the factors associated with high hospital costs for this age group.

Introducción: el envejecimiento tiene como consecuencia el aumento de la demanda de servicios y los costos de la atención médica. El objetivo fue realizar un análisis de costos de la atención médica en población adulta mayor en un hospital general regional del Instituto Mexicano del Seguro Social. Métodos: se realizó la estimación de costos por medio de la recolección retrospectiva de bienes y servicios. Los precios unitarios oficiales fueron usados para valorar los costos. Los costos se reportan en pesos de 2016. Se realizó un análisis de costos por medio de un modelo de regresión. Las variables explicativas fueron la edad, el sexo y el nivel de comorbilidad medido por el índice de Charlson. Resultados: el costo promedio para 509 pacientes fue de 34 769 pesos mexicanos (DE = 2869 pesos). La variable de edad explica los costos pero las de sexo y nivel de comorbilidad no fueron significativas. Las predicciones de costos con el modelo estadístico muestran diferencias entre grupos de edad principalmente. Los costos promedio fueron más altos para mujeres que para hombres. Los costos para mayores de 85 años fueron superiores que para los del grupo de 75-84 años. Conclusiones: los costos estimados por hospitalizaciones son elevados y son distintos por nivel de edad. Se sugiere investigar más sobre los factores que pueden explicar el crecimiento de los costos de hospitalización.

Late-life depressive symptoms: prediction models of change.

BACKGROUND: Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms. METHODS: Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms. RESULTS: A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations. CONCLUSIONS: New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms. LIMITATIONS: The study has not included clinical evaluations and nutritional assessments.