Loss in Old Age: The Role of Sociodemographic and Cognitive Factors.

Asociación entre salud oral y deterioro cognitivo en personas mayores chilenas

Confirmatory factor analysis of the effect of daily-living on the happiness of community-dwelling older adults in Chile

The risk of mortality in old age is associated with marital status and living arrangements. There is still little knowledge about this in Latin America. Our objectives are to examine the association between marital status, living arrangements and mortality of older adults (>60 years) in Chile, and to test whether this association varies when demographic, socioeconomic and health factors are included. We used data from the Social Protection Survey, and mortality data were linked to the Civil Registry. We estimate a series of Poisson regression models. Our results show a clear association between marriage and longevity, since even controlling for demographic, socioeconomic and health factors, we found that separated or divorced, widowed, and unmarried people showed higher relative mortality compared to married people (IRR1.24, IRR1.33, IRR1.35, respectively). Considering only living arrangements, the results show that living alone, alone with children, with children and other relatives or in other arrangements is associated with higher mortality (IRR1.22, IRR1.27, IRR1.35, IRR1.35, respectively) compared to those living with their partners and children. However, considering marital status and living arrangements together, we find that survival among older adults was strongly associated with marital status. Marital status continues to be a direct measure of living arrangements among older adults in Chile.

Although both obesity and ageing are risk factors for cognitive impairment, there is no evidence in Chile on how obesity levels are associated with cognitive function. Therefore, the aim of the present study was to investigate the association between adiposity levels and cognitive impairment in older Chilean adults. This cross-sectional study includes 1384 participants, over 60 years of age, from the Chilean National Health Survey 2009-2010. Cognitive impairment was evaluated using the Mini-Mental State Examination. BMI and waist circumference (WC) were used as measures of adiposity. Compared with people with a normal BMI, the odds of cognitive impairment were higher in participants who were underweight (OR 4·44; 95% CI 2·43, 6·45; P < 0·0001), overweight (OR 1·86; 95% CI 1·06, 2·66; P = 0·031) and obese (OR 2·26; 95% CI 1·31, 3·21; P = 0·003). The associations were robust after adjustment for confounding variables. Similar results were observed for WC. Low and high levels of adiposity are associated with an increased likelihood of cognitive impairment in older adults in Chile.

Objective: The aim of this study was to determine the prevalence of use of hearing aids by older adults in Chile and the influence of some variables such as education level, income level and geographic area of residence on the prevalence of hearing aids. Design: A national cross-sectional survey which was carried out in 2009. Study sample: A representative sample of 4766 Chilean older adults aged 60 years and above. Results: The percentage of older adults in Chile who self-reported hearing problems and used hearing aids was 8.9%. Such prevalence increased for adults living in urban areas and for those who knew about the new Chilean programme of universal access to health services (AUGE). For older adults who did not know about this programme, significant associations between the use of hearing aids and the variables of age, geographic area of residence, and income level were found. Conclusions: People’s knowledge about AUGE programme may positively influence the use of hearing aids, although a direct effect cannot be attributed.

The risk factors for the development of cognitive impairment are not well known. To identify socio-demographic, lifestyle and health-related factors associated with cognitive impairment in older Chilean adults. Data analysis of 1,384 participants ≥ 60 years who participated in the National Health Survey of Chile 2009-2010. Sociodemographic, lifestyle and health-related factors were used as exposure variables of interest. Cognitive impairment was assessed using an abbreviated version of the Mini Mental test and defined as a score < 13 points of a maximum of 19. A logistic regression was used to identify factors associated with cognitive impairment. In this sample, the prevalence of cognitive impairment was 11.6 [95% confidence intervals (CI): 8.8; 15.2]. The factors associated with cognitive impairment were age (Odds ratio (OR) for > 76 years: 4.89, p < 0.01), male sex (OR: 2.42, p = 0.02), lower education (OR: 21.6, p < 0.01), physical inactivity (OR: 2.07, p = 0.02), sedentary behavior (OR: 2.23, p = 0.01), sleeping > 9/hours/day (OR: 2.98, p = 0.01), consumption of < 5 portions/day of fruit and vegetables (OR: 2.02, p = 0.05), having an unhealthy lifestyle (OR: 6.10, p = 0.0001), being underweight (OR: 3.67, p < 0.01), obesity (OR: 3.32, p = 0.03), having hearing impairment (OR: 2.26, p = 0.02), having a visual impairment (OR: 3.89, p < 0.01), a history of depression (OR: 3.03, p = 0.01) and having a physical disability (OR: 5.63, p < 0.01). We identified 14 factors associated with cognitive impairment. Although some of these factors were non-modifiable such as age and sex, most of them could be modified by implementing prevention programs aiming to improve lifestyle behaviors in older adults in Chile.

BackgroundDifferent factors are associated with late life depression and diagnosis, including gender. It has also been reported that depression among older people is underdiagnosed. As a result, the mental health needs of this group are insufficiently met. The aim of this study was to explore gender differences in the factors associated with positive screens for depression and self-reported diagnosis among older adults in Chile.MethodsData from 3786 older adults who participated in the Social Protection Survey in 2016 were analysed. PHQ-9 was used to identify screen-positive cases. Self-reported diagnosis of depression was used to determine the proportion of people with a screen-positive result who had received a diagnosis of depression. Logistic regression models were used to determine sociodemographic and health factors associated with depression and underdiagnosis in older men and women.ResultsThe prevalence of a screen-positive result was 20.91% (5.83% major depressive disorder) among men, and 36.38% (12.43% major depressive disorder) among women. 18.77% of men and 34.11% of women with a positive depression screening had received a diagnosis. More educated men were more likely to receive a diagnosis. Older age was associated with a lower probability of diagnosis among older women.ConclusionsOur results suggest that depressive disorders are undiagnosed in a high proportion of older adults in Chile. Gender is a relevant factor in the underdiagnosis of depression in this group. Further research is needed to understand the factors involved in these gaps, to improve detection and provide timely support and treatment.

BackgroundConfinement during the COVID-19 pandemic has placed great stress on older adults, which may be affecting their quality of life. Thus, this study aims to describe the changes in mental and physical health, isolation and loneliness, residence and socioeconomic resources in a national cohort of Chilean older adults before and during the COVID-19 outbreak. It also analyzes the changes in depressive symptoms by changes in the other quality of life indicators before and during the COVID-19 outbreak. Possible methodological biases of telephone surveys in older adults living in non-developed countries are also discussed.MethodsBetween June and September 2020, a random subsample of 720 people who had participated in the face-to-face V National Survey on Quality of Life in Older Adults in Chile conducted at the end of 2019 was followed up by telephone. Descriptive bivariate analyses were performed using t-test and non-parametric tests for independent variables, comparing the baseline sample with the current 2020 follow-up sample during the peak of the pandemic outbreak in Latin America. Furthermore, descriptive bivariate analysis through t-test and non-parametric test for paired samples compared the follow-up subsample at baseline with the not-included sample, examining possible biases of the telephone interview compared with the face-to-face interview.ResultsIn the panel, there was no variation in self-rated health. The health symptoms that worsened were memory, stomach, and mood problems. Depressive symptoms and anxiety increased; similarly, smartphone users, social contacts, intergenerational co-residence and resilience increased. The telephone follow-up sample had a higher educational level and greater smartphone use than those not included in the subsample.ConclusionsAlthough some physical and mental health indicators have worsened during the pandemic, older adults mobilized resources that could allow them to maintain their quality of life, such as improved resilience. Thus, these findings can guide future research and the development of efficient strategies to improve these resources among older adults to ensure wellbeing.

To better establish the value of vaccination against influenza viruses, we estimated vaccine-averted influenza illnesses among young children and older adults in Chile, Guyana, and Paraguay. We gathered country- and target population-specific data on monthly influenza hospitalizations, vaccine coverage, and vaccine effectiveness from surveillance records and immunization registries during 2013-2018. We applied a static compartmental model to estimate differences in the number influenza-associated respiratory disease events (symptomatic nonhospitalized illnesses, medically attended illnesses, hospitalizations) in the presence and absence of influenza vaccination programs. Between 2013 and 2018, vaccinating 68% of children aged 6-23 months in Chile averted an annual mean of 14 617 nonhospitalized, 9426 medically attended, and 328 hospitalized influenza illnesses; vaccinating 28% of children aged 6-23 months in Paraguay averted 1115 nonhospitalized, 719 medically attended, and 25 hospitalized influenza illnesses. Vaccinating 59% of older adults in Chile averted an annual mean of 83 429 nonhospitalized, 37 079 medically attended, and 1390 hospitalized influenza illnesses; vaccinating 36% of older adults in Paraguay averted an annual mean of 3932 nonhospitalized, 1748 medically attended, and 66 hospitalized influenza illnesses. In Guyana, a hypothetical campaign vaccinating 30% of children aged <5 years could have prevented an annual 1496 nonhospitalized, 971 medically attended, and 10 hospitalized influenza illnesses. Vaccinating 30% of adults aged ≥65 years could have prevented 568 nonhospitalized, 257 medically attended, and 10 hospitalized influenza illnesses. Influenza vaccination averted tens of thousands of illnesses and thousands of hospitalizations in Chile and Paraguay; influenza vaccination could have had a proportional benefit in Guyana.

The aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. Additionally, we attempt to provide a cognitive profile for T2DM group. A cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Student's t-tests and MANOVA. Among all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%, p < 0.001). The risk of CI was 2.8 times higher in older people with T2DM compared to older people without the diagnosis. Multiple regression analysis, adjusted for age and gender, demonstrated that age, education, presence of dyslipidemia, and T2DM duration were the predictor variables significantly associated with CI. T2DM group performed worse on global cognitive performance, attention, language, verbal memory, visual memory, visual constructional ability, and executive function. After adjusting for significant covariates from multiple regression analysis, a relationship between "cognition" and T2DM is still observed. Amnesic multi-domain impairment was the specific cognitive identified pattern for T2DM group. The present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile.

Introduction: The effect of two physical training methods on older adults should be investigated in greater depth and its results shared with the community. Objective: To determine the effects of two types of physical training on the functional features associated with the cognitive state and the effect on a physiological mediator of growth hormone (IGF-1) in older women. Material and Methods: Quasi-experimental study that included 12 weeks of training in two groups divided into resistance and aerobic training. The study included a population of 113 women aged 69.39 ± 6.48 years from Talcahuano, Chile. All participants were randomly assigned to either group. The MINIMENTAL test was used to examine the executive functions of cognitive state and blood concentration of IGF-1, which was also used to examine neurotrophic factors. For the assessment of physical condition, an indirect test was used for the maximum mass displaced in one repetition (1RM) by the limbs and the TM6 test to estimate maximal oxygen consumption. Results: Significant differences between the groups with respect to the total score obtained in the MINIMENTAL test (EG1 = 28.13 ± 2.26; EG2 = 28.57 ± 1.83 and CG = 23.47 ± 2.80; ANOVA; p = 0.000) were observed. A post hoc analysis revealed no significant differences when examining executive functions individually between groups (Bonferroni; p > 0.05). An increase in the neurotrophic factor IGF-1 was also recorded in the training groups (EG1 p = 0.014 and EG2 p = 0.005). The pre- and post-test showed large differences in magnitude in the resistance training group (ES = 0.9; 20.41% change). Conclusion: Both workouts produce an overall improvement in the functions associated with cognitive status and increase blood concentrations of IGF-1 in older adults.

Analysis of cognitive impairment in the elderly by age, sex and self-perception of memory using the National Health Survey (ENS 2016-2017). Analytical cross-sectional study. The data comes from the National Health Survey (ENS 2016-2017). A n = 2,030 adults over 60 years of age are included. Variables such as age, sex, self-perception of memory and cognitive ability measured with the "Mini-Mental" Test were considered. A Pearson correlation was made between the results of the Mini-Mental and age by sex and by level of self-perception of memory and Spearman's correlation between age and level of self-perception. A Logistic Regression analysis considered a binary variable due to suspicion of cognitive impairment (CD) and predictors, age, level of self-perception of memory, and sex. The evaluation was completed by 63.69% (n = 1,293) women and 36.31% (n = 737) men. The mean age was 71.02 ± 7.9 years. Age was significantly higher in the group with suspected DC (p=0.00). While Age and negative self-perception independently increase the risk of DC (OR= 1.1027 CI95%; 1.0392-1.1719 and OR = 1.4974 CI95%; 0.4091-5.5725) respectively. A significant percentage of older adults reported a fair to poor (self-perceived) memory. Age was the most significant variable in relation to the suspicion of CD. In other words, the older the age, the greater the cognitive deterioration without significant differences by sex. However, women presented less cognitive impairment.

BackgroundAlthough about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown.ObjectiveTo estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile.MethodDisability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan’s method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile.ResultsNon-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively).ConclusionsThis is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.

The study was aimed to explore social representations of older adults among Chilean people aged 70 or more, living in three cities with differences in historical, geographic, and sociodemographic characteristics and to explore the importance of the local context on their shaping. Multiple correspondence analysis was employed to analyze the terms produced through free-word association technique, by 741 people. The two first dimensions explained 62.4% of the inertia and showed that the contribution of city of residence was several times higher than the average; the contribution of gender and educational level was higher than average as well. The northern city representations were characterized by positive terms, whereas more negative contents were characteristic of the city of the center, and terms without an explicitly positive or negative assessment were associated to the southern city. These findings reinforce the relevance of the local sociocultural context in shaping social representations of old age and stress the importance of considering particular regional features in the design of policies and interventions aimed to recognize and integrate older adults in Chile.

Introduction: dementia is a growing problem throughout the world, and Chile is no exception. With a greater impact among elderly people. Objective: discover how a multimodal intervention can benefit older people in preventing dementia. Methodo: study with pre-diagnosis and post-evaluation. Strategies are combined to address the problem comprehensively: cognitive therapies, adapted physical exercise, emotional and social support, among others. Participants 20 older people with no history of cognitive impairment from a commune in the Araucanía region. Results: limited knowledge about dementia prevention and concern about future cognitive decline. The most frequently expressed risk factors for dementia are alcohol abuse, not playing mind games, having depression, and not doing physical exercise. Categories emerge from the qualitative phase; Knowledge of dementia, Knowledge of dementia prevention, Community culture of dementia care, Experience in the intervention and Satisfaction of the experience. Conclusions: highlights the urgent need for specific preventive and educational interventions and implement programs. These programs must be adapted to the specific needs and characteristics of the population, considering cultural, socioeconomic and access to health care factors. It is important to provide the community with practical tools and resources to maintain cognitive health and reduce the risk of developing the disease.