Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity.

BACKGROUND: Life-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity. METHODS: Our dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization's Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities. RESULTS: We discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory. CONCLUSIONS: These findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.

Predictors of Frailty Transitions in Mexican Older Adults.

BACKGROUND: Frailty is a dynamic state in older adults. Current evidence, mostly in high-income countries, found that improving frailty is more likely in mild states (prefrailty). We aimed to determine the probability of frailty transitions and their predictors. METHODS: Participants were adults aged 50 years or over from the Study on Global Ageing and Adult Health in Mexico during 4 waves (2009, 2014, 2017, and 2021). We defined frailty with the frailty phenotype and we used multinomial logistic models to estimate the probabilities of frailty transitions and determine their predictors. RESULTS: For the 3 analyzed periods (2009-2014, 2014-2017, and 2017-2021), transition probabilities from frail to robust were higher for the younger age group (50-59 years) at 0.20, 0.26, and 0.20, and lower for the older age group (≥80 years), 0.03, 0.08 and 0.04. Transitioning from prefrail to robust had probabilities of 0.38, 0.37, and 0.35, for the younger age group, and 0.09, 0.18, and 0.10, for the older age group. The probabilities of transitioning to frail and to death were lower for the younger age group and for the robust at baseline; but higher for the older age group and for the frail at baseline. We identified age, disability, and diabetes as the most significant predictors of frailty transitions. CONCLUSIONS: These findings show that frailty has a dynamic nature and that a significant proportion of prefrail and frail individuals can recover to a robust or prefrail state. They also emphasize that prefrailty should be the focus of interventions.

Longitudinal trajectories of intrinsic capacity and their association with quality of life and disability.

OBJECTIVES: Intrinsic capacity (IC) is a key concept within the World Health Organization's (WHO) healthy aging model. The systematic assessment of IC could provide a better understanding of the functional trajectories of individuals. Our aims were to identify the longitudinal trajectories of IC and estimate their association with quality of life and disability. STUDY DESIGN: The study data comes from the three waves of the WHO Study on global AGEing and adult health (SAGE) in Mexico (2009, 2014, 2017). In total, 2735 adults aged 50 years or more were included. An IC score was constructed using item response theory. We used growth mixture modeling (GMM) to investigate the longitudinal trajectories of IC. Three-level linear mixed effect models were used to estimate the associations of IC with quality of life and disability. MAIN OUTCOME MEASURES: Disability was measured using the WHO Disability Assessment Schedule (WHODAS 2.0) and quality of life using the WHOQOL (WHO Quality of Life) instrument. RESULTS: Three classes were identified: low baseline IC with a steeply decreasing trajectory, medium baseline IC with a slightly decreasing trajectory, and high baseline IC with a moderately increasing trajectory. The class with the better trajectory (higher baseline IC score and a moderately increasing pattern) exhibited higher quality-of-life scores and lower disability scores. CONCLUSIONS: The findings show that older Mexican adults exhibit different IC trajectories, and that these may be associated with quality of life and disability. Results highlight the need for health policies and strategies to maintain intrinsic capacity and to promote primary prevention.

Physical activity and sedentary behavior trajectories and their associations with quality of life, disability, and all-cause mortality.

BACKGROUND: Physical activity (PA) and sedentary behavior (SB) are not stable conditions but change over time and among individuals, and both could have deleterious effects on health-related outcomes among older adults. This study aimed to identify the longitudinal trajectories of PA and SB and estimate their association with quality of life, disability, and all-cause mortality in a national sample of older Mexican adults. METHODS: Data comes from three waves of the WHO Study on global AGEing and adult health (SAGE) in Mexico (2009, 2014, 2017). In total, 3209 older adults ages 50 and above were included. PA and SB were determined by using the Global Physical Activity Questionnaire (GPAQ). Disability was measured using the WHO Disability Assessment Schedule (WHODAS 2.0), quality of life using the WHOQOL (WHO Quality of Life) instrument, and all-cause mortality using a verbal autopsy. We used growth mixture modeling (GMM) to investigate the longitudinal trajectories of PA and SB. Three-level linear mixed effect models were used to estimate the associations of PA and SB with quality of life and disability and the Cox model for the association with all-cause mortality. RESULTS: Three longitudinal trajectories of PA and SB were found: low-PA-decreasers, moderate-PA-decreasers, and high-PA-decreasers for PA; and low-maintainers, steep-decreasers, and steep-increasers for SB. Decreased quality of life, increased disability, and all-cause mortality were all consistently associated with worse PA and SB trajectories. CONCLUSIONS: Our results highlight the need for health policies and prevention strategies that promote PA and limit SB in middle-aged adults. Further studies should consider these activities/behaviors as exposures that vary throughout life and work to identify vulnerable groups of older adults for whom physical activation interventions and programs would be most impactful.

Longitudinal association of sarcopenia and mild cognitive impairment among older Mexican adults.

BACKGROUND: Recent evidence from cross-sectional and longitudinal studies supports the hypothesis that sarcopenia is associated with worsening cognitive function. However, primary evidence largely comes from high-income countries, whereas in low- and middle-income countries, this association has been underexplored. This study aimed to estimate the longitudinal association between sarcopenia and mild cognitive impairment in a sample of older Mexican adults. METHODS: Data come from the three waves of the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) in Mexico (2009, 2014, 2017). Four hundred ninety-six older adults, aged ≥50, were included. Sarcopenia was defined as having low muscle quantity and either/both slow gait speed and weak handgrip strength. Mild cognitive impairment was determined based on the recommendations of the National Institute on Aging-Alzheimer's Association. Cognitive function was evaluated by a composite cognitive score of five different cognitive tests: immediate and delayed recall, forward and backward digit span and semantic verbal fluency. Three-level mixed-effects models (logistic and linear) were used to estimate the longitudinal associations between sarcopenia, mild cognitive impairment and cognitive function. RESULTS: The prevalence of mild cognitive impairment (8.9%, 12.9%, 16.0%) and sarcopenia (10.5%, 20.7%, 23.3%) showed a significant temporal increase for Waves 1, 2 and 3 (P-value < 0.01, respectively). The presence of sarcopenia was significantly associated with mild cognitive impairment (OR = 1.74; CI95% 1.02, 2.96; P = 0.04) and worse cognitive function (ß = -0.57; CI95% -0.93, -0.21; P < 0.01). We observed significant associations between sarcopenia and immediate verbal recall (ß = -0.14; CI95% -0.28, -0.01; P = 0.04), delayed verbal recall (ß = -0.12; CI95% -0.23, -0.01; P = 0.03) and semantic verbal fluency (ß = -0.17; CI95% -0.28, -0.05; P = 0.01). The prevalence of mild cognitive impairment increased at an annual rate of 0.8% for non-sarcopenic older adults, but nearly 1.5% for sarcopenic adults. CONCLUSIONS: Significant longitudinal associations were observed between sarcopenia, mild cognitive impairment and cognitive function among older Mexican adults. Public health strategies, including policy research and clinical interventions, must be implemented in low- and middle-income countries in order to reduce or delay the onset of sarcopenia and thus improve population-level cognitive health among older adults.

Severity Levels of Disability Among Older Adults in Low- and Middle-Income Countries: Results From the Study on Global Ageing and Adult Health (SAGE).

Background: Recent studies suggest the importance of distinguishing the severity levels of disability in the older adult population. However, there is still no consensus regarding an optimal classification. Few studies have estimated the prevalence of severe disability, and the results have been confined to high-income countries. There is no evidence for low- and middle-income countries (LMICs). Therefore, the aim of this study was to provide estimates of the levels of severity associated with disability in older adult populations in LMICs and to examine their relationship with health and socioeconomic factors. Methods: We used data from the Study on global AGEing and adult health (SAGE), wave 1 (2007-2010). Nationally representative samples of adults over 50 years from China, Ghana, India, Mexico, Russian Federation, and South Africa were analyzed (n = 33,641). We measured disability using the World Health Organization Disability Assessment Instrument version 2.0 (WHODAS 2.0). Disability levels according to severity were identified through the use of latent class analysis. Socioeconomic and health factors associated with severe disability were estimated using ordinal logistic regression models. Results: We identified four groups of older adult: (1) without disability, 43.4%; (2) mild disability, 33.3%; (3) moderate disability, 15.3%; and (4) severe disability, 8.0%. These results were heterogeneous for the six countries analyzed. Education and socioeconomic status were significantly associated with severe disability along with the following chronic conditions: angina, arthritis, asthma, cataracts, chronic obstructive pulmonary disease, depression, diabetes, and stroke. Severe disability was also associated with the frailty status, sarcopenia, and mild cognitive impairment. Conclusions: In this study, we estimated severity levels of disability for the older adult population in LMICs. Our results show that severe disability affects 8% of older adult, and that there are important socioeconomic and health factors associated with this condition. Measuring the severity of disability is a critical element to study the causes and consequences of aging. Moreover, the identification of older adult with severe disability is vital to design prevention programs, modify interventions, or develop enabling environments.

Polypharmacy is associated with multiplem health-related outcomes in Mexican community-dwelling older adults.

OBJECTIVE: To determine the association between polypharmacy and multiple health-related outcomes in older adults. MATERIALS AND METHODS: We carried out a cross-sectional analysis with 274 community-dwelling older adults aged ≥60 years in Mexico City. We used the following health-related outcomes: frailty, dementia, functional capacity, falls, disability, and quality of life. The main exposure was polypharmacy (chronic use of six or more drugs). Ordinal logistic regression, binary logistic regression, Poisson regression, and linear regression models were used to estimate the association between polypharmacy and the outcomes analyzed. RESULTS: Polypharmacy was present in 45% of the sample. Polypharmacy was significantly associated with frailty status, and marginally, with dementia. We also observed significant associations for instrumental activities of daily living, falls, disability, and quality of life. CONCLUSIONS: Given that polypharmacy has reached levels of a global epidemic, it is necessary to take radical actions to reduce the concomitant problems of the use of multiple drugs.

OBJETIVO: Determinar la asociación entre la polifarmacia y múltiples resultados relacionados con la salud de los adultos mayores. MATERIAL Y MÉTODOS: Se llevó a cabo un análisis transversal con 274 adultos mayores que residen en comunidad, edad ≥60 años, en la Ciudad de México. Se utilizaron los siguientes resultados relacionados con la salud: fragilidad, demencia, capacidad funcional, caídas, discapacidad y calidad de vida. La exposición principal fue la polifarmacia (uso crónico de seis o más fármacos). Se utilizaron modelos de regresión logística ordinal, regresión logística binaria, regresión de Poisson y regresión lineal para estimar la asociación entre la polifarmacia y los resultados analizados. RESULTADOS: La polifarmacia estuvo presente en 45% de la muestra. La polifarmacia se asoció significativamente con el estado de fragilidad y marginalmente con la demencia. También se observaron asociaciones significativas para actividades instrumentales de la vida diaria, caídas, discapacidad y calidad de vida. CONCLUSIONES: Dado que la polifarmacia ha alcanzado niveles de epidemia global, es necesario tomar medidas radicales para reducir los problemas concomitantes del uso de múltiples medicamentos.

Polypharmacy is associated with multiple health-related outcomes in Mexican community-dwelling older adults / La polifarmacia se asocia con múltiples resultados en salud

Abstract: Objective: To determine the association between polypharmacy and multiple health-related outcomes in older adults. Materials and methods: We carried out a cross-sectional analysis with 274 community-dwelling older adults aged ≥60 years in Mexico City. We used the following health-related outcomes: frailty, dementia, functional capacity, falls, disability, and quality of life. The main exposure was polypharmacy (chronic use of six or more drugs). Ordinal logistic regression, binary logistic regression, Poisson regression, and linear regression models were used to estimate the association between polypharmacy and the outcomes analyzed. Results: Polypharmacy was present in 45% of the sample. Polypharmacy was significantly associated with frailty status, and marginally, with dementia. We also observed significant associations for instrumental activities of daily living, falls, disability, and quality of life. Conclusions: Given that polypharmacy has reached levels of a global epidemic, it is necessary to take radical actions to reduce the concomitant problems of the use of multiple drugs.

Resumen: Objetivo: Determinar la asociación entre la polifarmacia y múltiples resultados relacionados con la salud de los adultos mayores. Material y métodos: Se llevó a cabo un análisis transversal con 274 adultos mayores que residen en comunidad, edad ≥60 años, en la Ciudad de México. Se utilizaron los siguientes resultados relacionados con la salud: fragilidad, demencia, capacidad funcional, caídas, discapacidad y calidad de vida. La exposición principal fue la polifarmacia (uso crónico de seis o más fármacos). Se utilizaron modelos de regresión logística ordinal, regresión logística binaria, regresión de Poisson y regresión lineal para estimar la asociación entre la polifarmacia y los resultados analizados. Resultados: La polifarmacia estuvo presente en 45% de la muestra. La polifarmacia se asoció significativamente con el estado de fragilidad y marginalmente con la demencia. También se observaron asociaciones significativas para actividades instrumentales de la vida diaria, caídas, discapacidad y calidad de vida. Conclusiones: Dado que la polifarmacia ha alcanzado niveles de epidemia global, es necesario tomar medidas radicales para reducir los problemas concomitantes del uso de múltiples medicamentos.

Socioeconomic inequalities in health and nutrition among older adults in Mexico.

OBJECTIVE: To analyze the socioeconomic inequalities in health among the population of older adults in Mexico. MATERIALS AND METHODS: Analysis of two national health surveys in Mexico (Ensanut 2012 and Ensanut 100k) in which inequality gradients are estimated for various health and nutrition outcomes of older adults over 60 years, using the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). RESULTS: Older adults with lower socioeconomic status had worse levels of cognition, instrumental activities of daily living, depressive symptoms, muscle mass, low weight, and anemia. CONCLUSIONS: Substantial socioeconomic inequalities in health were observed in this study. Given the rapid growth of the population of older adults in Mexico, our results indicate that urgent actions are necessary to achieve health equity in this population group, particularly universal access to health, as well as universal coverage of health services.

OBJETIVO: Analizar las desigualdades socioeconómicas en salud entre la población de adultos mayores en México. MATERIAL Y MÉTODOS: Análisis de dos encuestas nacionales de salud en México (Ensanut 2012 y Ensanut 100k) en las que se estiman los gradientes de desigualdad para diversos desenlaces en salud y nutrición de los adultos mayores de 60 años en adelante, usando el Índice Relativo de Desigualdad (RII) y el Índice de la Pendiente de Desigualdad (SII). RESULTADOS: Los adultos mayores con menor nivel socioeconómico tuvieron peores niveles de cognición, actividades instrumentales de la vida diaria, síntomas depresivos, masa muscular y anemia. CONCLUSIONES: Se observaron desigualdades socioeconómicas en salud sustanciales. Dado el rápido crecimiento de la población de adultos mayores en México, nuestros resultados indican que son necesarias acciones urgentes para lograr la equidad en salud en este grupo poblacional, particularmente lograr el acceso universal a la salud, así como la cobertura universal de los servicios de salud.

Socioeconomic inequalities in health and nutrition among older adults in Mexico / Desigualdades socioeconómicas en salud y nutrición entre adultos mayores en México

Abstract: Objective: To analyze the socioeconomic inequalities in health among the population of older adults in Mexico. Materials and methods: Analysis of two national health surveys in Mexico (Ensanut 2012 and Ensanut 100k) in which inequality gradients are estimated for various health and nutrition outcomes of older adults over 60 years, using the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). Results: Older adults with lower socioeconomic status had worse levels of cognition, instrumental activities of daily living, depressive symptoms, muscle mass, low weight, and anemia. Conclusions: Substantial socioeconomic inequalities in health were observed in this study. Given the rapid growth of the population of older adults in Mexico, our results indicate that urgent actions are necessary to achieve health equity in this population group, particularly universal access to health, as well as universal coverage of health services.

Resumen: Objetivo: Analizar las desigualdades socioeconómicas en salud entre la población de adultos mayores en México. Material y métodos: Análisis de dos encuestas nacionales de salud en México (Ensanut 2012 y Ensanut 100k) en las que se estiman los gradientes de desigualdad para diversos desenlaces en salud y nutrición de los adultos mayores de 60 años en adelante, usando el Índice Relativo de Desigualdad (RII) y el Índice de la Pendiente de Desigualdad (SII). Resultados: Los adultos mayores con menor nivel socioeconómico tuvieron peores niveles de cognición, actividades instrumentales de la vida diaria, síntomas depresivos, masa muscular y anemia. Conclusiones: Se observaron desigualdades socioeconómicas en salud sustanciales. Dado el rápido crecimiento de la población de adultos mayores en México, nuestros resultados indican que son necesarias acciones urgentes para lograr la equidad en salud en este grupo poblacional, particularmente lograr el acceso universal a la salud, así como la cobertura universal de los servicios de salud.

Longitudinal associations of multimorbidity, disability and out-of-pocket health expenditures in households with older adults in Mexico: The study on global AGEing and adult health (SAGE).

BACKGROUND: Empirical evidence suggests that multimorbidity and disability are each significantly associated with out-of-pocket (OOP) health expenditures; however few efforts have been made to explore their joint association with OOP health expenditures. OBJECTIVES: To estimate the association of multimorbidity and disability with OOP health expenditures in households with older adults in Mexico, as well as the potential interaction effects of multimorbidity and disability on OOP health expenditures. METHODS: Longitudinal study based on data collected as part of the Study on global AGEing and adult health Wave 1 (2009) and Wave 2 (2014), a nationally representative study in Mexico with a sample of older adults aged 50 and older. The dependent variable was OOP health expenditures, and main exposure variables were multimorbidity and disability. Two-Part regression models were used to analyze the relation between multimorbidity, disability and OOP health expenditures. RESULTS: Multimorbidity was associated with the probability of incurring OOP health expenditures (OR = 1.28, CI95% 1.11-1.48), and also the tertiles of disability (2nd tertile: OR = 1.45, CI95% 1.23-1.70; 3rd tertile: OR = 2.19, CI95% 1.81-2.66). The presence of multimorbidity was associated with an increase of 13% in average OOP health costs (ß = 0.13, CI95% 0.01-0.25), and 16% for the 3rd tertile of disability (ß = 0.16, CI95% 0.01-0.31). We did not find significant interaction effects of multimorbidity and disability. CONCLUSIONS: Multimorbidity and disability appear to be important determinants of OOP health expenditures. The economic implications for the households and the health system should be highlighted, particularly in low- and middle-income countries because of the rapid growth of their aging populations.

Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty.

BACKGROUND: Multimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions. METHODS: Analytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO's Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models. RESULTS: Multimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (ß = 5.05; p < 0.01 and ß = 5.10; p < 0.01, respectively) and decreased WHOQOL score (ß = - 1.81; p < 0.01 and ß = - 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (ß = 3.27; p < 0.01) and quality of life (ß = - 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: ß = 5.02; p < 0.01; frail: ß = 13.29; p < 0.01) and quality of life (pre-frail: ß = - 2.23; p < 0.01; frail: ß = - 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant. CONCLUSIONS: Multimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.