Validation of the health literacy scale in patients with hypertension in Mexico.

INTRODUCTION: Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. OBJECTIVE: To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. METHODS: A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. RESULTS: In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. CONCLUSION: The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

ANTECEDENTES: La alfabetización en salud integra las habilidades en torno al cuidado de la salud. La medición de la alfabetización en salud es relevante para proponer intervenciones de mejora. La escala europea HLS-EU-Q16 permite evaluar la alfabetización en salud de forma integral, pero sus propiedades psicométricas no se han evaluado en México. OBJETIVO: Validar la escala HLS-EU-Q16 en pacientes con hipertensión en México. MATERIAL Y MÉTODOS: Se realizó estudio de validación de un instrumento de medición. El constructo se evaluó mediante análisis factorial, la consistencia interna mediante alfa de Cronbach y la confiabilidad prueba-reprueba mediante coeficiente de correlación intraclase (CCI). La información fue recolectada mediante entrevistas a 349 pacientes con hipertensión en una unidad de medicina familiar del Instituto Mexicano del Seguro Social, de abril a junio de 2022. RESULTADOS: El 23.8 % de los pacientes tuvo una alfabetización en salud inadecuada; 44.4 %, problemática; y 31.8 %, suficiente. Se encontró que la escala está conformada por 12 reactivos y dos factores (HLS-EU-Q12M). El alfa de Cronbach fue de 0.83 y el CCI, de 0.94. CONCLUSIÓN: La escala HLS-EU-Q12M es un instrumento válido en español de México para evaluar la alfabetización en salud en adultos con hipertensión arterial.

Validación de la escala de alfabetización en salud en pacientes con hipertensión arterial en México / Validation of the health literacy scale in patients with hypertension in Mexico

Resumen Antecedentes: La alfabetización en salud integra las habilidades en torno al cuidado de salud. La medición de la alfabetización en salud es relevante para proponer intervenciones de mejora. La escala europea HLS-EU-Q16 permite evaluar la alfabetización en salud de forma integral, pero sus propiedades psicométricas no se han evaluado en México. Objetivo: Validar la escala HLS-EU-Q16 en pacientes con hipertensión en México. Material y métodos: Se realizó estudio de validación de un instrumento de medición. El constructo se evaluó mediante análisis factorial, la consistencia interna mediante alfa de Cronbach y la confiabilidad prueba-reprueba mediante coeficiente de correlación intraclase (CCI). La información fue recolectada mediante las entrevistas a 349 pacientes con hipertensión en una unidad de medicina familiar del Instituto Mexicano del Seguro Social, de abril a junio de 2022. Resultados: El 23.8 % de los pacientes tuvo una alfabetización en salud inadecuada; 44.4 %, problemática; y 31.8 %, suficiente. Se encontró que la escala está conformada por 12 reactivos y dos factores (HLS-EU-Q12M). El alfa de Cronbach fue de 0.83 y el CCI, de 0.94. Conclusión: La escala HLS-EU-Q12M es un instrumento válido en español de México para evaluar la alfabetización en salud en adultos con hipertensión arterial.

Abstract Background: Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. Objective: To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. Material and methods: A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. Results: In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. Conclusion: The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

The association between low cognitive reserve and subjective memory complaints in functionally independent older women.

BACKGROUND: Several factors have been found to defend against pathologic cognitive decline in aging (i.e., cognitive reserve [CR]); however, other factors, including subjective memory complaints (SMC) and decreased functionality are considered early indicators of underlying neurocognitive dysfunction. Despite these known associations, the relationship between the presence of CR and SMC remains equivocal. This study sought to determine the relationship between objectively measured CR and SMC in a sample of functionally independent older women. METHODS: This cross-sectional study recruited women aged ≥60 years who attended fitness or continuing education programs at the University for Seniors in Mexico City. Participants underwent a battery of physical and cognitive evaluations, including the Cognitive Reserve Questionnaire (CRQ), and were asked probing questions used to identify the presence of SMC. RESULTS: The 269 participants had a median age of 69 years; most were single (40.5 %), lived alone (32.7 %), retired (58.2 %), well-educated (≥12 years of education), and functionally independent (89.2 %). 62 % scored "high" on the CRQ, while 9.3 % scored "low". After adjusting for multiple covariates, an independent association between CRQ score and the probability to have SMC was found (adjusted OR = 0.87, 95% CI 0.80-0.95, p-value = 0.002). CONCLUSIONS: This study identified a relationship between low CR and the presence of SMC, independently of the cognitive function and motoric marker of muscle strength (i.e., low gait speed and handgrip strength) in functionally independent older women over 60y. This relationship remains independent of other variables such as age, symptoms of depression and instrumented activities of daily living.

Pattern of Adiponectin, Osteocalcin, Irisin, FGF-21, and MCP-1 According to the Body Size Phenotype: Could They Be Markers of Metabolic Health in Mexican-Mestizo Middle-Aged Women?

Variations in levels of some adipokines, myokines, osteokines, hepatokines and inflammatory cytokines contribute to abnormal glucose and lipid metabolism. The aim of this study was to determine the pattern of adiponectin, osteocalcin (OCN), irisin, FGF-21, and MCP-1 according to the body size phenotype of middle-aged women, and their associations with BMI, visceral adipose tissue (VAT), and HOMA-IR. A cross-sectional study in 265 women aged from 40 to 65 years was performed. The biochemical characteristics were evaluated in metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy obese, and metabolically unhealthy obese women. There was an association of OCN with BMI (r = -0.107; p = 0.047); adiponectin with BMI (r = -0.217; p = 0.001), insulin (r = -0.415; p = 0.0001), HOMA-IR (r = -0.429; p = 0.0001), and VAT (r = -0.134; p = 0.025); irisin with BMI (r = 0.604; p = 0.001), insulin (r = 0.446; p = 0.0001), HOMA-IR (r = 0.452; p = 0.0001), and VAT (r = 0.645; p = 0.0001); FGF-21 with insulin (r = -0.337; p= 0.030) and HOMA-IR (r = -0.341; p = 0.03); and MCP-1 with BMI (r = 0.481; p = 0.0001), VAT (r = 0.497; p = 0.001), insulin (r = 0.298; p= 0.001), and HOMA-IR (r = 0.255; p = 0.004). A multivariate analysis showed that an elevation of OCN (OR 1.4 (95%CI 1.06-1.81)) and a reduction of adiponectin (OR 0.9 (0.84-0.96)) were associated factors for a metabolic unhealthy phenotype in normal weight participants. Likewise, higher irisin (OR 1.007 (1.003-1.011)) and MCP-1 (1.044 (1.008-1.083)) were risk factors for a metabolic unhealthy phenotype in woman with obesity. OCN, adiponectin, irisin, FGF-21, and MCP-1 are associated with some metabolic parameters such as BMI, HOMA-IR, and VAT, and could be possible biomarkers of an unhealthy metabolic phenotype in middle-aged women.

The Paradoxical Effect of Living Alone on Cognitive Reserve and Mild Cognitive Impairment among Women Aged 60+ in Mexico City.

An elderly person who lives alone must often be autonomous and self-sufficient in daily living activities. We explored if living alone and marital status were associated with mild cognitive impairment and low cognitive reserve in a sample of Mexican women aged 60+ attending continuing education courses using a cross-sectional design. Objective cognitive functions were assessed using the MMSE and Blessed Dementia Scale. We administered the Cognitive Reserve Questionnaire. Independence skills were assessed with the Katz index and Lawton index. Multivariate logistic regression analysis was used. We recruited 269 participants (x¯ = 69.0 ± 5.8 years). Single, widowed, separated, and divorced women comprised 73% of the participants. A third lived alone and 84% had completed high school. Mild cognitive deficit was observed among 24.5-29.0%; the upper range for cognitive reserve was 61.7%. Living alone versus living with someone was associated with cognitive impairment (OR = 0.51, p = 0.04) and with low to medium cognitive reserve (OR = 0.51, p = 0.02) after adjusting for confounding variables. Living alone was an independent factor associated with a lower probability of displaying mild cognitive impairment and a higher probability of displaying high cognitive reserve. Women living alone in this study had a more robust cognitive framework and had built their own support networks.

Factors associated with COVID-19 preventive health behaviors among the general public in Mexico City and the State of Mexico.

OBJECTIVE: To evaluate factors associated with COVID-19 preventive health behaviors among adults in Mexico City and the State of Mexico. METHODS AND FINDINGS: We conducted a cross-sectional survey from June to October 2020 through a structured, internet-based questionnaire in a non-probabilistic sample of adults >18 years living in Mexico City and the State of Mexico. The independent variables included sociodemographic and clinical factors; health literacy; access to COVID-19 information; and perception of COVID-19 risk and of preventive measures' effectiveness. The dependent variable was COVID-19 preventive health behaviors, defined as the number of preventive actions adopted by participants. The data were analyzed through multivariate negative binomial regression analysis. The survey was completed by 1,030 participants. Most participants were women (70.7%), had a high school or above level of education (98.8%), and had adequate health literacy and access to COVID-19 information. Only 18% perceived having a high susceptibility to COVID-19, though 83.8% recognized the disease's severity and 87.1% the effectiveness of preventive measures. The median number of COVID-19 preventive actions was 13.5 (range 0-19). The factors associated with preventive health behavior were being female, of older age, a professional worker, a homemaker, or a retiree; engaging in regular physical exercise; having high health literacy and access to COVID-19 information sources; and perceiving COVID-19 as severe and preventive measures as effective. CONCLUSION: People with high education and internet access in Mexico City and the State of Mexico reported significant engagement in COVID-19 preventive actions during the first wave of the COVID-19 pandemic.

Double-task exercise programmes to strengthen cognitive and vascular health in older adults at risk of cognitive decline: protocol for a randomised clinical trial.

INTRODUCTION: Cognitive and physical declines are frequent causes of disability among older adults (OAs) in Mexico that imposes significant burden on the health system and OAs' families. Programmes to prevent or delay OAs' cognitive and physical decline are scarce. METHODS AND ANALYSIS: A double-blind randomised clinical trial will be conducted. The study will aim to evaluate two 24-week double-task (aerobic and cognitive) square-stepping exercise programmes for OAs at risk of cognitive decline-one programme with and another without caregiver participation-and to compare these with an aerobic-balance-stretching exercise programme (control group). 300 OAs (100 per group) affiliated with the Mexican Institute of Social Security (IMSS) between 60 and 65 years of age with self-reported cognitive concerns will participate. They will be stratified by education level and randomly allocated to the groups. The intervention will last 24 weeks, and the effect of each programme will be evaluated 12, 24 and 52 weeks after the intervention. Participants' demographic and clinical characteristics will be collected at baseline. The outcomes will include: (1) general cognitive function; (2) specific cognitive functions; (3) dual-task gait; (4) blood pressure; (5) carotid intima-media thickness; (6) OAs' health-related quality of life; and (7) caregiver burden. The effects of the interventions on each outcome variable will be examined using a repeated-measures analysis of variance (ANOVA), with study groups as the between-subjects variable and time as the within-subject variable. ETHICS AND DISSEMINATION: The study was approved by the IMSS Ethics and Research Committees (registration number: 2018-785-095). All participants will sign a consent form prior to their participation. The study results will be disseminated to the IMSS authorities, healthcare providers and the research community. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04068376).

OXIDATIVE STRESS, TELOMERE LENGTH, AND FRAILTY IN AN OLD AGE POPULATION.

Background: A global aging population requires focusing on the risk factors for unhealthy aging, preventive medicine, and chronic disease management. The identification of adverse health outcomes in older adults has been addressed by the characterization of frailty as a biological syndrome. In this field, oxidative stress and telomere length have been suggested as biomarkers of aging. Objective: The objective of the study was to study the association of oxidative stress, telomere length, and frailty in an old age population. Methods: We conducted a cross-sectional study based on 2015 data from 202 members of a cohort of older adults (n = 202; F/M gender ratio: 133/69; mean age: 69.89 ± 7.39 years). Reactive oxygen species were measured by dichlorofluorescein diacetate and lipid peroxidation by malondialdehyde. Telomere length was determined using quantitative polymerase chain reaction with SYBR Green Master Mix. Results: Statistical analysis showed an association between telomere length and frailty but no association between oxidative stress and telomere length or frailty. Conclusions: Telomere length could eventually be used as a marker to differentiate between healthy and unhealthy aging as expressed by frailty phenotype; oxidative stress seemed merely a biological process of aging.

Oxidative stress, telomere length, and frailty in an old age population

Abstract Background A global aging population requires focusing on the risk factors for unhealthy aging, preventive medicine, and chronic disease management. The identification of adverse health outcomes in older adults has been addressed by the characterization of frailty as a biological syndrome. In this field, oxidative stress and telomere length have been suggested as biomarkers of aging Objective The objective of the study was to study the association of oxidative stress, telomere length, and frailty in an old age population Methods We conducted a cross-sectional study based on 2015 data from 202 members of a cohort of older adults (n = 202; F/M gender ratio: 133/69; mean age: 69.89 ± 7.39 years). Reactive oxygen species were measured by dichlorofluorescein diacetate and lipid peroxidation by malondialdehyde. Telomere length was determined using quantitative polymerase chain reaction with SYBR Green Master Mix Results Statistical analysis showed an association between telomere length and frailty but no association between oxidative stress and telomere length or frailty Conclusions Telomere length could eventually be used as a marker to differentiate between healthy and unhealthy aging as expressed by frailty phenotype; oxidative stress seemed merely a biological process of aging.

Soluble Intercellular Adhesion Molecule-1 (sICAM-1) as a Biomarker of Vascular Cognitive Impairment in Older Adults.

BACKGROUND: Endothelial dysfunction and subsequent inflammation contribute to the development of vascular cognitive impairment (VCI). Soluble intercellular adhesion molecule-1 (sICAM-1) is upregulated in endothelial dysfunction and promotes an inflammatory response; however, the relationship between sICAM-1 and VCI remains equivocal. OBJECTIVE: To determine whether sICAM-1 contributes to the prediction of VCI. METHODS: Community-dwelling older adults (n = 172) from the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA) study were identified as VCI or controls using standard neuropsychological evaluations and neuroimaging. sICAM-1 was quantified using ELISA, and multivariate logistic regression determined the association between sICAM-1 and VCI. RESULTS: A total of 31 VCI cases were identified. sICAM-1 was higher in VCI (VCI: 450.7 [241.6] ng/mL vs. controls: 296.9 [140.9] ng/mL). sICAM-1 concentrations above the 90th percentile (464.1 ng/mL) were associated with VCI group membership in all models (OR: 6.9, 95% CI: 1.1-42.2). The final saturated model explained 64% of the variance in VCI group membership. CONCLUSION: High concentrations of sICAM-1 are independently associated with VCI group membership. Efforts to further characterize the relationship between indices of endothelial dysfunction and pathological changes to the aging brain should be further pursued.

Monocyte chemoattractant protein-1 (MCP-1) and fibroblast growth factor-21 (FGF-21) as biomarkers of subclinical atherosclerosis in women.

BACKGROUND: Atherosclerosis is a primary risk factor for cardiovascular disease (CVD). Proinflammatory biochemical factors can influence vascular health; monocyte chemoattractant protein-1 (MCP-1) is elevated in patients with CVD while fibroblast growth factor-21 (FGF-21) acts directly on cardiac tissue to reduce infarction damage. However, the relationship between plasma concentrations of MCP-1, FGF-21 and subclinical CVD indices remains equivocal. AIM: To determine the association between MCP-1, FGF-21 and subclinical atherosclerosis [i.e., carotid intima-media thickness (cIMT)] in women without clinical evidence of CVD. METHODS: A cross-sectional analysis of 140 women without history of CVD was performed. Anthropometrics were collected, serum concentrations of MCP-1 and FGF-21 were determined by enzyme-linked immunosorbent assay, and cIMT was quantified (B-mode ultrasonography). The correlations between MCP-1, FGF-21 and the presence of clinical and laboratory of subclinical atherosclerosis (i.e., cIMT ≥0.70 mm), comparison intergroup and odd ratio with multiple logistic regression were analyzed. RESULTS: MCP-1, but not FGF-21 correlated with some obesity indicators. In median comparison among groups, subclinical atherosclerosis showed higher serum concentrations of MCP-1and lower serum concentrations of FGF-21. In postmenopausal women, there were significant differences MCP-1 (p = 0.001), and FGF-21 (p = 0.010). Multiple logistic regression analysis in postmenopausal women with subclinical atherosclerosis, between MCP-1 (p = 0.001) and FGF-21 (p = 0.037) showed association with cIMT, along with age. CONCLUSIONS: MCP-1 and FGF-21 levels are associated with subclinical atherosclerosis disease severity (i.e., cIMT) in postmenopausal women without CVD. Further efforts focused on characterizing the relationship between novel blood-borne markers of early CVD pathology are warranted and should be pursued.

Telomere shortening and frailty in Mexican older adults.

AIM: Telomere shortening has been associated with several age-related diseases, in addition to being considered a hallmark of aging. Frailty is a clinical syndrome characterized by an accentuated physiological and functional decline that might be a predictor of an adverse condition in older age. The present study evaluated the relationship between frailty and telomere shortening in older adults from Mexico City, Mexico. METHODS: This was a cross-sectional study. Data were collected from 323 frail older adults, including physical and environmental factors, such as body mass index, comorbidities, physical activity and tobacco consumption. Telomere length was measured by real-time polymerase chain reaction. The frailty syndrome was diagnosed using the Fried criteria. RESULTS: An association between frailty and telomere shortening was found in both sexes. Telomere length decreased from 6.05 kb (5.54-6.48 kb) to 4.20 kb (3.80-4.54 kb; P < 0.001). It was also observed that tobacco consumption could be a significant modifying factor in the association between these two variables. Previous reports are contradictory, suggesting that there is no relationship between telomere length and frailty; however, it is possible that there are genetic and/or environmental variables to be elucidated, that might influence this association, particularly in the studied population. CONCLUSIONS: Telomere length is inversely related to frailty in Mexican frail older adults, and tobacco consumption is the main environmental modifying factor. Geriatr Gerontol Int 2018; 18: 1286-1292.

Relationship between bone remodeling and metabolism in the elderly / Relación entre la actividad ósea y el metabolismo en el adulto mayor

Background: Recent studies have shown that osteocalcin (OC) is related to not only bone metabolism but also energy metabolism. The aim of the present study was to investigate whether OC was associated with metabolic factors and bone mineral density (BMD) in elderly men. Methods: A cross-sectional study was done including 122 healthy men aged 60 years or older. Serum glucose, lipids, insulin, adiponectin and OC were measured and BMD was estimated using dual energy X-ray absorptiometry. Results: 42.8% of men had metabolic syndrome (MetS). OC levels were not significantly different between men with and without MetS. OC concentrations were inversely associated with body mass index (BMI) (r = −0.226, p = 0.04), waist circumference (r = −0.261, p = 0.02), glucose (r = −0.245, p = 0.03), insulin (r = −0.235, p = 0.03), and HOMA-IR (r = −0.211, p = 0.04). In addition, OC levels were higher in patients with diminished BMD compared with those with normal BMD. Conclusions: OC levels correlate negatively with BMI, waist circumference, glucose, insulin and HOMA-IR in elderly men, which suggests a connection between bone and energy metabolism.

Introducción: diversos estudios sugieren que la osteocalcina (OC) contribuye no solo a la regulación del metabolismo óseo, sino también al metabolismo energético. El objetivo del trabajo fue evaluar la relación entre la concentración sérica de OC y los parámetros metabólicos y la densidad mineral ósea (DMO) en adultos mayores. Métodos: estudio transversal descriptivo en 122 hombres sanos mayores de 60 años. Se les determinó glucosa, lípidos, insulina, adiponectina y OC. La DMO se analizó por absorciometría de doble fotón. Resultados: el 42.8% de la muestra presentó síndrome metabólico (SM). Los niveles de OC no difirieron entre el grupo de pacientes con y sin SM. Se observó una correlación negativa entre la concentración de OC y el índice de masa corporal (IMC) (r = −0.226, p = 0.04), circunferencia de cintura (r = −0.261, p = 0.02), glucosa (r = −0.245, p = 0.03), insulina (r = −0.235, p = 0.03) y HOMA-IR (r = −0.211, p = 0.04). Los pacientes con DMO disminuida mostraron una concentración significativamente mayor de OC en comparación con aquellos con DMO normal. Conclusiones: la OC se asoció inversamente con el IMC, la obesidad abdominal, la glucosa, la insulina y la resistencia a la insulina en hombres mayores de 60 años. Lo anterior confirma la conexión que existe entre el tejido óseo y el metabolismo.

Oxidative stress in the elderly with diabetes mellitus or hypertension / Estrés oxidativo en adultos mayores con diabetes mellitus o hipertensión arterial

Background: Mexico City has the highest aging rate in the country, as well as a high prevalence of diabetes mellitus (DM) and hypertension (HT). It is known that each one of these conditions increase oxidative stress (OS) independently. Methods: With this study we described changes in OS of 18 patients without DM or HT (controls), 12 with DM, 23 with HT, and 18 with DM and HT, all of them members of the COSFAMM (Cohorte de Obesidad, Sarcopenia y Fragilidad en Adultos Mayores de México). OS was measured by the quantification of reactive oxygen species (ROS), by the oxidation of diclorofluorosceine, and by determination of lipid peroxidation by product malondialdehyde (MDA). Results: HT patients showed increased ROS levels, as did men with HT compared with the respective DM and HT groups. Also, women of control group showed higher levels of ROS compared with men. Conclusions: Generally, HT turned out to be the most influential factor for the increase of oxidative stress in the elderly while DM has no effect whatsoever.

Introducción: la Ciudad de México tiene el mayor índice de envejecimiento del país, así como una alta prevalencia de diabetes mellitus (DM) e hipertensión arterial (HTA). Se sabe que cada una de estas condiciones incrementa el estrés oxidativo (EO) de forma independiente. Métodos: en este estudio describimos los cambios en el EO de 18 pacientes sin DM ni HTA (controles), 12 con DM, 23 con HTA y 18 con DM y HTA, todos miembros de la Cohorte de Obesidad, Sarcopenia y Fragilidad en Adultos Mayores de México (COSFAMM). El EO fue medido por la cuantificación de especies reactivas de oxígeno (ERO) por la oxidación de la diclorofluorosceína (DCFH) y por determinación de peroxidación de lípidos por producto malondialdehído (MDA). Resultados: los pacientes con HTA mostraron niveles de ERO elevados, así como los hombres con HTA, comparados con los grupos correspondientes de DM y HTA. Asimismo, las mujeres del grupo control mostraron mayor cantidad de ERO que los hombres. Conclusiones: en general, la HTA en el adulto mayor resultó ser el factor que mayor contribución tiene en el incremento del estrés oxidativo, mientras que la DM no tiene efecto alguno.

Comparison of quality of life among community-dwelling older adults with the frailty phenotype.

PURPOSE: To compare the perception of the quality of life (QOL) of community-dwelling older adults with the phenotype of frailty. METHODS: Cross-sectional analysis of baseline data of the "Cohort of Obesity, Sarcopenia and Frailty of Mexican Older Adults" (COSFOMA). Operationalization of frailty was carried out using the phenotype as follows: weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness. QOL was measured using two scales: World Health Organization Quality of Life of Older Adults (WHOQOL-OLD), which is a specific instrument for the elderly population, and Short Form-36 Health Survey (SF-36), a generic instrument to evaluate the QOL related to health. One-way analyses of variance were conducted to assess the differences among the three phenotypes of frailty and QOL perception. RESULTS: There were 1252 older adult participants who were analyzed; 11.2% (n = 140) had frailty, 50.3% (n = 630) pre-frailty and 38.5% (n = 482) were not frail. The mean (±SD) total score of the WHOQOL-OLD according to the phenotype of frailty was 60.3 (13.9) for those with frailty, 67.4 (12.7) pre-frailty and 72.4 (11.2) not frail (ANOVA, p < 0.001). The mean (±SD) of the SF-36 of the physical and mental component measures the sum, 38.9 (9.9) and 41.9 (11.3) with frailty, 45.7 (9.1) and 46.6 (9.8) pre-frailty, and 49.6 (7.3) and 49.4 (7.9) not frail, respectively (ANOVA, p < 0.001). CONCLUSIONS: Frailty is observed in 1/10 community-dwelling older adults. Those with frailty and pre-frailty had a lower perception of QOL compared with those who were not frail.

Frailty in community-dwelling older adults: association with adverse outcomes.

BACKGROUND: The study of frailty is important to identify the additional needs of medical long-term care and prevent adverse outcomes in community dwelling older adults. This study aimed to determine the prevalence of frailty and its association with adverse outcomes in community dwelling older adults. METHODS: A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 older adults (≥60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD). RESULTS: Frailty was identified in 20.6% (n=258), pre-frailty in 57.6% (n=721), and not frail in 21.8% (n=273). The association between frailty and limitations in ADL was odds ratio (OR) =2.3 (95% confidence interval [CI] 1.7-3.2) and adjusted OR =1.7 (95% CI 1.2-2.4); falls OR =1.6 (95% CI 1.2-2.1) and adjusted OR =1.4 (95% CI 1.0-1.9); admission to emergency services OR =1.9 (95% CI 1.1-3.1) and adjusted OR =1.9 (95% CI 1.1-3.4); low quality of life OR =3.4 (95% CI 2.6-4.6) and adjusted OR =2.1 (95% CI 1.5-2.9). CONCLUSION: Approximately 2 out of 10 older adults demonstrate frailty. This is associated with limitations in ADL, falls, and admission to emergency rooms during the previous year as well as low quality of life.

Frailty among community-dwelling elderly Mexican people: prevalence and association with sociodemographic characteristics, health state and the use of health services.

AIM: To estimate the prevalence of frailty phenotypes and their association with the sociodemographic characteristics, health state and the use of health services in the last 6 months among community-dwelling elderly in Mexico City. METHODS: The present study included 1933 elderly individuals from Mexico City. We estimated the prevalence of the frailty phenotype based on Fried and Walston. Household interviews were carried out to collect information on sociodemographics (sex, age, education, marital status, live alone, paid job), health state (activities of daily living, cognitive function, depression, comorbidity, nutritional status) and the use of health services in the last 6 months. RESULTS: The estimated prevalence of frailty was 15.7%, pre-frailty at 33.3% and non-frailty at 51.0%. The statistically relevant associations in the pre-frail elderly were female (OR 0.83), older age (OR 2.48), single (OR 1.03), living alone (OR 1.23), no paid work (OR 0.82), limitations in the basic activities of daily living (OR 2.11) and instrumental activities of daily living (OR 2.10), cognitive impairment (OR 1.49), depression symptoms (OR 3.82), underweight/malnourished (OR 1.89), overweight/obesity (OR 0.80), moderate comorbidity (OR 2.05), and use of health services (OR 1.04) using the non-frail phenotype as the comparison category. Frailly is associated with female (OR 1.05), older age (OR 10.32), less educated (OR 2.51), single OR 1.39), living alone (OR 0.86), no paid work (OR 1.16), limitations in the basic activities of daily living (OR 7.66) and instrumental activities of daily living (OR 8.42), cognitive impairment (OR 3.02), depression symptoms (OR 11.23), underweight/malnourished (OR 1.49), overweight/obesity (OR 0.49), moderate comorbidity (OR 3.55), and use of health services (OR 1.99) using the non-frail phenotype as the comparison category. CONCLUSIONS: The results suggest that older age, disability, comorbidity, cognitive impairment and depression could have an influence role in frailty.

Value of EQ-5D in Mexican city older population with and without dementia (SADEM study).

BACKGROUND: The EuroQoL-5D (EQ-5D) is a brief, multi-attribute, preference-based health status measurement. The objective of this study was to assess the validity and reliability of EQ-5D in older adults with and without dementia in Mexico City. METHODS: The Study on Aging and Dementia in Mexico (SADEM) was a survey of 3101, Mexican adults (60 + years old). An in-home face-to-face interview was administered. EQ-5D using ranking to rate states on a 100-point visual analogue scale; Daily Living Activities (ADL), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE), Short Form of the quality of life survey (SF-36), and Charlson comorbility index were used for comparison. The validity and reliability of EQ-5D were tested. We identified states of health for direct valuation; state 11111 ("no problems") had to be included because it was essential to the reseating (onto a 0-1 scale) of the visual analogue scale data. We included all plausible combinations of levels across each of the five EQ-5D dimensions and evaluated any significant interaction effects and factorial designs, based on balanced complete blocks. RESULTS: The EQ-5D was applied to 3101 older people, of whom 109 (3.4%) had dementia. The general reliability of EQ-5D for cases was 0.80 and for controls 0.76, for each dimension. We had a total of 103 combinations for controls and 45 for cases. The percentage for the state of health "no problems" (11111) for controls was 30.4%, and had the highest percentage of cases (8.8%). CONCLUSION: The resulting valuations form the basis for clinical use and facilitate the interpretation and evaluation of health care.

Prevalence of mild cognitive impairment and its subtypes in the Mexican population.

BACKGROUND/AIM: To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes, taking into account education and health status. METHODS: This is the first report of our Study on Aging and Dementia in Mexico. This study included 2,944 elderly individuals 60 years old or more with in-home assessment for cognitive impairment. The prevalence of MCI was based on Petersen criteria. MCI was classified as amnestic of single domain (a-MCI-s) or multiple domain (a-MCI-md) or nonamnestic of single domain (na-MCI-s) or multiple domain (na-MCI-md). In addition to a battery of neuropsychological measures, a self-report depression measure and a medical history including history of stroke, heart disease and other health conditions were recorded. RESULTS: The global estimated prevalence of MCI in the Mexican population was 6.45%. Of these subjects, 2.41% met criteria for a-MCI-s, 2.56% for a-MCI-md, 1.18% for na-MCI-s and 0.30% for na-MCl-md. Women showed a higher prevalence of MCI than men (63.7 vs. 36.3%, respectively). The analysis showed that heart disease [odds ratio (OR) 1.5], stroke (OR 1.2) and depression (OR 2.1) were associated with an increased risk of MCI. CONCLUSIONS: The prevalence of MCI in Mexico is similar to that in other countries. The results suggest that stroke, heart disease and depression may have an important role in the etiology of MCI.