Association of frailty with the use of health services in older adults: a secondary analysis of the Mexican Health and Aging Study.

BACKGROUND: Frailty has been related to adverse outcomes, but evidence on its association with the use of health services is still scarce. OBJECTIVE: The purpose of this work was to determine the association of frailty with the use of health services in Mexican adults older than 60 years. MATERIAL AND METHODS: Analysis of the Mexican Health and Aging Study for the years 2015 (baseline) and 2018 (follow-up). Frailty was defined with the frailty index. The following outcomes were included: hospitalization, medical visits, major surgery, minor surgical procedures, and dental visits. Competing risk and count analyses (negative binomial regression) were performed. RESULTS: A total of 8,526 individuals were included, whose average age was 70.8%; 55.8% corresponded to the female gender. According to the results, hospitalization days and the number of minor procedures were associated with frailty. CONCLUSIONS: Frailty could be useful in the planning of health services for older adults. On the other hand, its evaluation would allow prioritizing care for those who are at higher risk of adverse outcomes.

ANTECEDENTES: La fragilidad se ha relacionado con desenlaces adversos, pero aún es escasa la evidencia sobre su asociación con el uso de servicios de salud. OBJETIVO: Evidenciar la asociación de la fragilidad con el uso de servicios de salud en adultos mexicanos mayores de 60 años. MATERIAL Y MÉTODOS: Análisis del Estudio Nacional sobre Salud y Envejecimiento en México para 2015 (basal) y 2018 (seguimiento). La fragilidad se definió con el índice de fragilidad. Fueron incluidos los siguientes desenlaces: hospitalización, visitas médicas, cirugía mayor, procedimientos quirúrgicos menores y visitas al dentista. Se utilizaron modelos de riesgos competitivos y de número de eventos (regresión negativa binomial). RESULTADOS: Se incluyeron 8526 individuos, cuya edad promedio fue de 70.8 %; 55.8 % correspondió al sexo femenino. De acuerdo con los resultados, los días de hospitalización y el número de procedimientos menores se asociaron a fragilidad. CONCLUSIONES: La fragilidad podría ser un parámetro útil en la planeación de los servicios de salud para los adultos mayores. Por otro lado, su evaluación permitiría priorizar la atención a quienes presenten mayor riesgo de desenlaces adversos.

Frailty indices based on self-report, blood-based biomarkers and examination-based data in the Canadian Longitudinal Study on Aging.

BACKGROUND: Frailty can be operationalised using the deficit accumulation approach, which considers health deficits across multiple domains. We aimed to develop, validate and compare three different frailty indices (FI) constructed from self-reported health measures (FI-Self Report), blood-based biomarkers (FI-Blood) and examination-based assessments (FI-Examination). METHODS: Up to 30,027 participants aged 45-85 years from the baseline (2011-2015) comprehensive cohort of the Canadian Longitudinal Study on Aging were included in the analyses. Following standard criteria, three FIs were created: a 48-item FI-Self Report, a 23-item FI-Blood and a 47-item FI-Examination. In addition a 118-item FI-Combined was constructed. Mortality status was ascertained in July 2019. RESULTS: FI-Blood and FI-Examination demonstrated broader distributions than FI-Self Report. FI-Self Report and FI-Blood scores were higher in females, whereas FI-Examination scores were higher in males. All FI scores increased nonlinearly with age and were highest at lower education levels. In sex and age-adjusted models, a 0.01 increase in FI score was associated with a 1.08 [95% confidence interval (CI): 1.07,1.10], 1.05 (1.04,1.06), 1.07 (1.05,1.08) and a 1.13 (1.11,1.16) increased odds of mortality for FI-Self Report, FI-Blood, FI-Examination and FI-Combined, respectively. Inclusion of the three distinct FI types in a single model yielded the best prognostic accuracy and model fit, even compared to the FI-Combined, with all FIs remaining independently associated with mortality. CONCLUSION: Characteristics of all FIs were largely consistent with previously established FIs. To adequately capture frailty levels and to improve our understanding of the heterogeneity of ageing, FIs should consider multiple types of deficits including self-reported, blood and examination-based measures.

Effect of poor glycemic control in cognitive performance in the elderly with type 2 diabetes mellitus: The Mexican Health and Aging Study.

BACKGROUND: Cognitive impairment is twice more frequent in elderly with type 2 diabetes mellitus (DM). This study was conducted to determine the association between glycemic control and cognitive performance among community-dwelling elderly persons in Mexico. METHODS: Cross-sectional study conducted in individuals aged 60 years or elderly participating in the 2012 Mexican Health and Aging Study. Type 2 DM participants were classified in 3 groups according to their glycated hemoglobin levels (HbA1c): < 7% (intensive control), 7-7.9% (standard control) or ≥ 8% (poor control), and cognitive performance: low (CCCE ≤44 points), intermediate (44.1-59.52 points), or high (≥59.53 points). Multinomial logistic regression models were constructed to determine this association. RESULTS: Two hundred sixteen community-dwelling adults aged 60 and older with type 2 diabetes were selected. Subjects in the low cognitive performance group were older (69.7 ± 6.6 vs 65.86 ± 5.18 years, p < .001) and had a lower educational level (2.5 ± 2.6 vs 7.44 ± 4.15 years, p < .000) when compared to the high cognitive performance participants. HbA1c ≥ 8% was associated with having low (Odds Ratio (OR) 3.17, 95% CI 1.17-8.60, p = .024), and intermediate (OR 3.23, 95% CI 1.27-8.20, p = .014) cognitive performance; this trend was not found for HbA1c 7.0-7.9% group. The multinomial regression analysis showed that the presence of HbA1c ≥ 8% (poor glycemic control) was associated with low (OR 3.17, 95% CI = 1.17-8.60, p = .024), and intermediate (OR 3.23, 95% CI = 1.27-8.20, p = .014) cognitive performance. After adjusting for confounding variables. CONCLUSIONS: Glycemic control with a HbA1c ≥ 8% was associated with worse cognitive performance.

Frailty, diabetes, and the convergence of chronic disease in an age-related condition: a population-based nationwide cross-sectional analysis of the Mexican nutrition and health survey.

AIMS: To describe the associations of frailty with diabetes mellitus and related conditions in older adults. METHODS: We conducted a cross-sectional analysis of a representative sample of older adults (n = 5379). We generated a 35-item frailty index (FI) and obtained information on diabetes and related conditions (peripheral neuropathy, lower limb amputation, diabetic coma, number of physician visits due to diabetes-related conditions, all-cause hospitalizations in the past year, years since diabetes diagnosis, and type of treatment). Logistic and Poisson regression models were used to determine the associations between frailty and diabetes and its complications. RESULTS: The mean age was 70.3 years (± 7.8); 54.7% were women. Those with an FI ≤ 0.082 composed the reference group. Multivariate analysis showed an OR of 2.32 (95% CI 1.93-2.73, p < 0.001) for the association between diabetes and frailty. People who were hospitalized for any cause during the previous year, those receiving both insulin and an oral compound to manage diabetes, and those with peripheral neuropathy showed ORs of 2.32 (95% CI 1.69-3.18, p < 0.001), 5.6 (95% CI 1.58-19.8, p = 0.008), and 2.02 (95% CI 1.42-2.86, p < 0.001), respectively, for being in the most frail group. CONCLUSIONS: People with diabetes have higher frailty scores. Furthermore, older adults with diabetes and higher burden of frailty have more diabetes-related complications.

Effect of a physical activity intervention and frailty on frailty trajectory and major mobility disability.

BACKGROUND: Physical activity (PA) interventions may reduce the burden of frailty and can prevent mobility disability for older adults. We explored whether a 2-year PA intervention would improve frailty trajectory, lead to clinically meaningful frailty changes (CMC), or impact major mobility disability (MMD) across baseline frailty levels. METHODS: We analyzed data for 1635 community-dwelling participants who were 70-89 years old (mean baseline age [SD]: 78.9 [5.2] years, 67.2% female) from the Lifestyle Interventions and Independence Study. Participants were randomized to either PA or health education (HE) intervention. A 44-item frailty index (FI) was constructed at baseline and 0.5, 1, 1.5, and 2 years after baseline. CMC was defined as change in FI of ≥0.03. MMD was the inability to complete a 400 m-walk within 15 min without assistance. Mixed-effects models were used to estimate frailty trajectory and CMC. Cox regression models were used to determine whether the effect of PA on the composite of MMD or death differed by baseline FI. RESULTS: Mean FI (SD) at baseline for both the PA and HE groups was 0.18 (0.10). Two years after baseline, mean FIs were 0.23 (0.12) for PA and 0.24 (0.12) for HE. The MMD rates were 30.1% (246/818) and 35.5% (290/817) for PA and HE, respectively. There was no time-by-intervention interaction for frailty trajectory or for CMC. Regarding the composite MMD and death, there was no FI-by-intervention interaction. Simple association analyses revealed that when baseline FI was centered at 0.15 or higher, the PA intervention was associated with lower risk of MMD or death compared to HE (HR [CI] range for FI ≥ 0.15: 0.65-0.81 [0.43-0.67, 0.90-0.98]). CONCLUSION: Participants in both groups showed similar frailty trajectories and CMC. Those who were frailer benefitted more from the PA intervention regarding MMD and death and may be a focus of recruitments for future PA program.

Thyroid stimulating hormone levels and geriatric syndromes: secondary nested case-control study of the Mexican Health and Aging Study.

PURPOSE: To determine the incidence of geriatric syndromes (GS) in community dwelling older adults with subclinical hypothyroidism. METHODS: This is an analysis from the Mexican Health and Aging Study, of a subsample of 2089 subjects with TSH determination. From this last subsample, we included 1628 individuals with TSH levels in the subclinical range (4.5-10 µU/ml). RESULTS: The multivariate analysis showed that when comparing data obtained from the 2012 wave with the 2015 wave results, there was a significant incidence of some GS such as falls (OR 1.79, CI 1.16-2.77, p = 0.0116), fatigue (OR 2.17, CI 1.40-3.38, p = 0.0348) and depression (OR 1.70, CI 1.06-2.71, p = 0.0246) among the subclinical hypothyroidism group. CONCLUSION: This study showed a greater incidence of GS in subjects 50 years and older with sub-clinical hypothyroidism, when compared to those with normal thyroid function.

Psychometric evaluation of a Spanish language version of the Screen for Caregiver Burden (SCB) in caregivers of patients with mixed, vascular and Alzheimer's dementia.

AIMS AND OBJECTIVES: To validate a Spanish language version of the Screen for Caregiver Burden, the full-length or long (25-item) and short (seven-item) versions in Mexican caregivers of patients with mixed, vascular and Alzheimer's dementia. BACKGROUND: Patients with dementia display impaired executive function and neuropsychiatric symptoms such as behavioural changes and sleep disturbances. These symptoms can make patients become more dependent. The experience of caregiving for patients under these conditions is burdensome. It is important to detect this burden to protect both the caregiver and the patient from negative outcomes. DESIGN: Survey. METHODS: Participants were 143 primary caregivers of patients with dementia and 30 caregivers of older adults without dementia in two hospitals in Mexico City. RESULTS: The internal reliability was Cronbach's α=0·89 and 0·82 for the 25-item and the seven-item versions, respectively. The item-total correlations for two Screen for Caregiver Burden versions were significant from r=0·26 to r=0·77 p<0·001. The test-retest was ICC=0·78 p<0·001; CI 95% (0·55-0·89) and ICC=0·72 p<0·001; CI 95% (0·41-0·86) for the 25-item and the seven-item, respectively. We found from non-significant to highly significant correlations between two Screen for Caregiver Burden versions and other measures ranged. Validity of known groups showed that the caregivers of demented patients experienced more burden than those caring for non-demented patients. CONCLUSIONS: Given these psychometric properties, both versions of the Screen for Caregiver Burden are valid tools and can be reliably used to assess the presence and level of caregiver burden in caregivers of demented patients. RELEVANCE TO CLINICAL PRACTICE: The Screen for Caregiver Burden in the Spanish Language can be used in clinical practice to detect caregiver burden in family members. We recommend using the long or full-length version when the objective is to assess the caregiver burden carefully and the short version (seven-item) as a screening method of caregiver burden that requires attention.

Polyvictimization and Recurrent Falling in Older Ecuadorian Adults: The Mediation Role of Depressive Symptoms.

Objective: To assess depressive symptoms as a mediator in the association between polyvictimization and recurrent falling. Methods: Using data from the Salud, Bienestar y Envejecimiento (Health, Well-being, and Aging) Ecuador Study, we analyzed community-dwelling adults 60 years and older (n = 5227). Recurrent falling was determined as ≥2 falls during the prior 12 months. Polyvictimization was determined as a history of ≥2 types of abuse. The mediator was depressive symptoms. Mediation analyses were based on the VanderWeele method. Results: Polyvictimization was significantly associated with higher odds of recurrent falling, and odds ratio (OR) = 1.45 (95% confidence intervals [CI] 1.20-1.76). Higher depressive symptoms increase the odds for recurrent falling (OR = 1.09 and 95% CI 1.07-1.11). Moreover, depressive symptoms were a significant mediator between polyvictimization and recurrent falling. The mediating effect was 28.4%. Discussion: Polyvictimization was associated with higher odds of recurrent falling, and this association was mediated by depressive symptoms.

Asociación de la fragilidad con el uso de servicios de salud en adultos mayores. Un análisis secundario del Estudio Nacional sobre Salud y Envejecimiento en México / Association of frailty with the use of health services in older adults. A secondary analysis of the Mexican Health and Aging Study

Resumen Antecedentes: La fragilidad se ha relacionado con desenlaces adversos, pero aún es escasa la evidencia sobre su asociación con el uso de servicios de salud. Objetivo: Evidenciar la asociación de la fragilidad con el uso de servicios de salud en adultos mexicanos mayores de 60 años. Material y métodos: Análisis del Estudio Nacional sobre Salud y Envejecimiento en México para 2015 (basal) y 2018 (seguimiento). La fragilidad se definió con el índice de fragilidad. Fueron incluidos los siguientes desenlaces: hospitalización, visitas médicas, cirugía mayor, procedimientos quirúrgicos menores y visitas al dentista. Se utilizaron modelos de riesgos competitivos y de número de eventos (regresión negativa binomial). Resultados: Se incluyeron 8526 individuos, cuya edad promedio fue de 70.8 %; 55.8 % correspondió al sexo femenino. De acuerdo con los resultados, los días de hospitalización y el número de procedimientos menores se asociaron a fragilidad. Conclusiones: La fragilidad podría ser un parámetro útil en la planeación de los servicios de salud para los adultos mayores. Por otro lado, su evaluación permitiría priorizar la atención a quienes presenten mayor riesgo de desenlaces adversos.

Abstract Background: Frailty has been related to adverse outcomes, but evidence on its association with the use of health services is still scarce. Objective: The purpose of this work was to determine the association of frailty with the use of health services in Mexican adults older than 60 years. Material and methods: Analysis of the Mexican Health and Aging Study for the years 2015 (baseline) and 2018 (follow-up). Frailty was defined with the frailty index. The following outcomes were included: hospitalization, medical visits, major surgery, minor surgical procedures, and dental visits. Competing risk and count analyses (negative binomial regression) were performed. Results: A total of 8,526 individuals were included, whose average age was 70.8%; 55.8% corresponded to the female gender. According to the results, hospitalization days and the number of minor procedures were associated with frailty. Conclusions: Frailty could be useful in the planning of health services for older adults. On the other hand, its evaluation would allow prioritizing care for those who are at higher risk of adverse outcomes.

Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE).

OBJECTIVES: The aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. STUDY DESIGN: Data were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007-2010). Nationally representative samples of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). MAIN OUTCOME MEASURES: Educational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. RESULTS: People in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1-6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7-1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. CONCLUSIONS: Substantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.

Association of Healthy Habits Beliefs and Mortality in Older Adults: A Longitudinal Analysis of the Mexican Health and Aging Study.

OBJECTIVE: The aim of this article is to establish the association between beliefs about healthy habits and mortality in a group of Mexican older adults. METHOD: This is an 11-year follow-up secondary analysis of the Mexican Health and Aging Study. RESULTS: There was a significant difference ( p < .001) in survival rate between those participants who believed that healthy habits have the potential to improve health compared with those who did not. After adjustment for confounders, Cox regression models showed a hazard ratio (HR) of 0.17 (95% confidence interval [CI] [0.07, 0.38], p < .001) for the group that believed in healthy habits. DISCUSSION: Although the mechanism is not completely clear, according to our results, believing that healthy habits can improve health was associated with lower rates of mortality. Further research should elucidate potential strategies for changing beliefs in older adults with the goal of improving their overall health.

Edentulism and its relationship with self-rated health: secondary analysis of the SABE Ecuador 2009 Study.

Edentulism is related to a number of conditions in older adults, impacting their overall health status and thus their quality of life and relationship with the environment. At the same time, self-rated health has been shown to be an accurate marker of overall health status. However there is little information on how edentulism relates to self-rated health in older adults of Hispanic origin. The aim of this study was to evaluate the impact of edentulism on self-rated health in older adults. We analyzed data from SABE Ecuador 2009, a cross-sectional study that included a probabilistic representative sample of 5, 235 community-dwelling older adults aged 60 years or older. The dependent variable was self-rated health and the independent variable was edentulism, with age, sex and comorbidities as confounding variables. In order to test the independent association of edentulism with self-rated health, a logistic regression model was fitted. Out of the whole sample, 77. 13% of older adults reported having fair/poor self-rated health. We found an independent association between edentulism and self-rated health with incremental risk according to number of missingteeth, ranging from OR 1. 35 (CI 95% 0. 75 - 2. 43) p 0. 32 for less than 4 missing teeth to OR 1. 88(1. 06 - 3. 32) p 0. 029for more than half of teeth missing. Even though oral health has long been considered separately from the rest of the body and mind, it is clear from our results that oral health is a very important component of global health status in the elderly.

El edentulismo se ha asociado con una gran variedad de condiciones en los adultos mayores afectando el estado general de su salud. Por lo tanto, afecta la calidad de vida de la persona y su relación con el medio ambiente. Por otro lado, la autoevaluación de la salud ha demostrado ser un marcador preciso del estado general de la salud. Sin embargo, hay escasa información sobre cómo estas dos condiciones se relacionan entre sí en adultos mayores de origen hispano. El objetivo de este estudio fue evaluar el impacto del edentulismo en la autoevaluación de la salud en adultos mayores. Se analizaron los datos de SABE Ecuador 2009, un estudio transversal que incluyó una muestra probabilística y representativa de 5. 235 personas de 60 anos de edad o más. La variable dependiente fue la salud autoevaluada y edentulismo fue la variable independiente, teniendo edad, sexo y comorbilidades como variables de confusión. Con el fin de probar la asociación independiente de edentulismo con la auto-evaluación de la salud un modelo de regresión logística se ajustó. De la muestra entera, un 77, 13% de los adultos mayores reportaron tener salud auto-evaluada regular / pobre. Se encontró una asociación independiente entre edentulismo y salud autoevaluada con un riesgo incremental dependiendo del número de dientes ausentes de OR 1, 35 (IC 95% 0, 75 - 2, 43) p 0, 32, en adultos mayores con menos de 4 dientes ausentes hasta OR 1, 88 (1, 06 - 3, 32) p 0, 029, con más de la mitad de dientes ausentes. La salud oral se ha considerado de forma independiente del resto del cuerpo y la mente, es claro por nuestros resultados que la salud oral es un componente muy importante del estado de salud global en las personas mayores.

Effect of single infusion of ketamine on depressive symptoms in elderly patients undergoing ophthalmological surgery: a randomized controlled trial / Efecto de una sola infusión de ketamina sobre síntomas depresivos en pacientes geriátricos sometidos a cirugía oftalmológica: ensayo controlado aleatorizado

Abstract: Introduction: Depressive symptoms are common in elderly surgical patients and are associated with negative outcomes. Although medication can relieve symptoms, only 50% of patients achieve remission using conventional treatments. Recently, ketamine has been shown to improve depression rapidly. However, its use and tolerability in elderly patients has not been widely studied. Material and methods: We conducted a randomized, double-blind, comparative study in patients aged 60 and over who required ophthalmological surgery. Experimental group received 0.5 mg/kg ketamine, whereas the control group received NaCl solution at 0.9%. Both groups received a standardized regimen of conscious sedation. Depressive symptom severity was assessed using the Geriatric Depression Scale-Short Form (GDS-SF) before and after exposure to ketamine infusion; tolerability was also evaluated. A repeated univariate analysis of variance (ANOVA) model examined the direction of changes in depressive symptom severity among groups. Results: 90 patients were randomized. A significant reduction in symptom severity was observed after ketamine infusion (mean change from baseline: -1.6 vs -0.3 in the control group; p = 0.003). No differences emerged between groups in the presence of adverse effects with ketamine infusion. Conclusions: A single infusion of ketamine in elderly patients undergoing ophthalmological surgery is associated with improved depressive symptoms in the first 24 hours of exposure to the drug with a good tolerability profile.

Resumen: Introducción: Los síntomas depresivos son comunes en pacientes quirúrgicos de edad avanzada y se asocian con resultados negativos. Aunque la medicación pueda aliviar los síntomas, sólo el 50% de los pacientes que están envejeciendo alcanzan la remisión usando tratamientos convencionales. Se ha demostrado que la ketamina mejora rápidamente la depresión, sin embargo, su uso y tolerabilidad en pacientes mayores no ha sido estudiada ampliamente. Material y métodos: Se realizó un estudio aleatorizado, doble ciego, comparativo en pacientes de 60 años o más que requirieron cirugía oftalmológica. Un grupo experimental recibió 0.5 mg/kg de ketamina, mientras que el grupo control recibió solución de NaCl al 0.9%. Ambos grupos recibieron un régimen estandarizado de sedación consciente. La severidad de los síntomas depresivos fue evaluada usando la versión acortada de la escala de depresión geriátrica (GDS-SF) antes y después de la exposición a la infusión de la ketamina, la tolerabilidad también fue evaluada. Un modelo de análisis de varianza univariada de medidas repetidas (ANOVA) examinó la dirección de los cambios en la gravedad de los síntomas depresivos entre los grupos. Resultados: 90 pacientes fueron aleatorizados. Se observó, una reducción significativa en la severidad de los síntomas después de la infusión de la ketamina (cambio de la media desde el valor basal: -1.6 versus -0.3 en el grupo de control; p = 0.003). No surgieron diferencias entre los grupos en la presencia de efectos adversos con la infusión de ketamina. Conclusiones: Una sola infusión de ketamina en pacientes geriátricos sometidos a cirugía oftalmológica se asocia con la mejoría de síntomas depresivos en las primeras 24 horas de exposición al fármaco con un buen perfil de tolerabilidad.

Assessing the Validity of Self-Rated Health with the Short Physical Performance Battery: A Cross-Sectional Analysis of the International Mobility in Aging Study.

OBJECTIVE: The aim of this study was to explore the validity of self-rated health across different populations of older adults, when compared to the Short Physical Performance Battery. DESIGN: Cross-sectional analysis of the International Mobility in Aging Study. SETTING: Five locations: Saint-Hyacinthe and Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). PARTICIPANTS: Older adults between 65 and 74 years old (n = 1,995). METHODS: The Short Physical Performance Battery (SPPB) was used to measure physical performance. Self-rated health was assessed with one single five-point question. Linear trends between SPPB scores and self-rated health were tested separately for men and women at each of the five international study sites. Poor physical performance (independent variable) (SPPB less than 8) was used in logistic regression models of self-rated health (dependent variable), adjusting for potential covariates. All analyses were stratified by gender and site of origin. RESULTS: A significant linear association was found between the mean scores of the Short Physical Performance Battery and ordinal categories of self-rated health across research sites and gender groups. After extensive control for objective physical and mental health indicators and socio-demographic variables, these graded associations became non-significant in some research sites. CONCLUSION: These findings further confirm the validity of SRH as a measure of overall health status in older adults.

Lack of Energy and Negative Health-Related Outcomes in Nursing Home Residents: Results From the INCUR Study.

OBJECTIVE: "Lack of energy" or anergia is a common complaint associated with adverse outcomes in older people. There is a lack of knowledge on this symptom in the nursing home (NH) setting. The aim of this study was to investigate whether lack of energy was associated with hospitalization and mortality in NH residents. DESIGN: Longitudinal observational cohort study. SETTING AND PARTICIPANTS: A total of 575 NH residents (72% women) in 13 French NHs from the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study cohort. MEASUREMENTS: Lack of energy was measured at the baseline visit as part of the 10-item Geriatric Depression Scale. Unadjusted and adjusted Cox proportional hazard regression models were performed to test the association of lack of energy with hospitalization events and mortality over 12 months of follow-up. RESULTS: The mean age of the study sample was 86.3 (SD = 7.5) years. At the baseline, 250 (43.5%) residents complained about lack of energy. Overall, 192 (33.4%) individuals experienced at least 1 hospitalization event and 98 (17.0%) died during the 12-month follow-up. Lack of energy was significantly associated with a higher risk of hospitalization (HR 1.35; 95% CI 1.02-1.80; P = .03), even after adjustment for potential confounders (HR 1.41; 95% CI 1.04-1.91; P = .02). No statistically significant association was found between lack of energy and 12-month mortality. CONCLUSION: Lack of energy is a predictor of hospitalization in older people living in NHs. It may be considered a relevant clinical feature for identifying individuals at risk of adverse health outcomes, thus potentially serving as a screening tool for subsequently conducting a comprehensive geriatric assessment in this highly vulnerable and complex population.

Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study.

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79-0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.