Elderly Latinos Research Articles

Fraction of Total Plasma Vitamin B12 Bound to Transcobalamin Correlates with Cognitive Function in Elderly Latinos with Depressive Symptoms

The fraction of total plasma vitamin B(12) bound to transcobalamin (holoTC/B12 ratio) may reflect tissue levels of the vitamin, but its clinical relevance is unclear. We assessed associations between cognitive function and total B12, holoTC, and holoTC/B12 ratio in a cohort of elderly Latinos (n = 1089, age 60-101 years). We assessed cognitive function using the Modified Mini-Mental State Examination (3MSE) and a delayed recall test; we diagnosed clinical cognitive impairment by neuropsychological and clinical exam with expert adjudication; and we assessed depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D). We measured total B12 and holoTC using radioassays. HoloTC/B12 ratio was directly associated with 3MSE score (P = 0.026) but not delayed recall score. Interactions between holoTC/B12 and CES-D score were observed for 3MSE (P = 0.026) and delayed recall scores (P = 0.013) such that associations between the ratio and cognitive function scores were confined to individuals with CES-D >/=16. For individuals with CES-D > or = 16, the odds ratio for clinical cognitive impairment for the lowest holoTC/B12 tertile was 3.6 (95% CI 1.2-11.2) compared with the highest tertile (P = 0.03). We observed no associations between cognitive function and total B12 or holoTC alone, except between holoTC and 3MSE score (P = 0.021), and no interactions between holoTC or total B12 and CES-D score on cognitive function. HoloTC/B12 ratio is associated with cognitive function in elderly Latinos with depressive symptoms and may better reflect the adequacy of B12 for nervous system function than either holoTC or total B12 alone.

The gastric intrinsic factor polymorphism, A68G, modifies the association between the transcobalamin polymorphism, C776G, and vitamin B12 status

Gastric intrinsic factor (GIF) and transcobalamin (TC) are required for absorption of vitamin B12 across the ileal enterocyte. Polymorphisms in GIF (A68G) and TC (C776G) have been identified. Previously, we observed differences in plasma holoTC and homocysteine levels among individuals with the TC C776G polymorphism in a cohort of elderly Latinos (Sacramento Area Latino Study on Aging ‐ SALSA). Little is known about the effect of GIF A68G on indicators of B12 status, although the polymorphism has been linked to risk of pernicious anemia. In this study we investigated the prevalence of GIF A68G and its association with B12 status and TC genotype in the SALSA cohort (N=813, age 60–93y). The distribution of GIF genotypes was 94% wild‐type (AA) and 6% heterozygotes (AG), with 1 subject homozygous for the variant isoform (GG). No differences among the GIF genotypes were observed in total B12, holoTC, or homocysteine. However, interactions between GIF genotype and TC genotype were observed on total B12 (p=0.007) and holoTC (p=0.05) such that subjects with both the GIF 68G allele and TC 776G allele had lower total B12 and holoTC than all other allelic combinations. There was no interaction between the GIF and TC genotypes on homocysteine. The GIF A68G polymorphism is prevalent in elderly Latinos and combined with the TC C776G polymorphism may influence B12 absorption and status. NIH AG12975; USDA 00–35200–9073

Reflections on 30 Years of Advocacy, Thinking, and Writing About Elderly Latinos

SUMMARY The author reflects on over 30 years of thinking, writing, and advocating on behalf of elderly Latinos. Personal, cultural, and familial experiences are intertwined with implications for policy and practice. The impact of Latinos' generational socialization into American society is examined in relation to familial obligations to elderly relatives.

The Joint Effect of Poor Physical Function and Childcare on Psychological Distress Among Elderly Latinos

This study is based on the double jeopardy hypothesis that elderly people who have poor physical function and who provide childcare for their families are more likely to experience a greater sense of psychological distress than those with poor physical function who have no childcare responsibilities. We used a sample of 2160 elderly (age 65 or over) Latinos (including Puerto Ricans and those of Mexican, Cuban, or other Latin American origin or descent) from the National Survey of Hispanic Elderly People to test this hypothesis. Regression analysis was used, and the findings confirm that after controlling for age, gender, marital status, and education, the joint effect of physical function and childcare on psychological distress remains statistically significant. We further performed a sub-group analysis, also using regression analysis, to clarify the effect of poor physicalfunction on psychological distress in the sample of those who did provide and those who did not provide childcare. The findings clearly indicate that poor physical functioning has a greater effect on psychological distress in the group who provided childcare than in the group that did not. Implications for intergenerational practice and further research are discussed.

The ratio of holotranscobalamin to total B12 is associated with cognitive impairment in elderly Latinos with elevated depression scores

The ratio of holotranscobalamin to total B12 is associated with cognitive impairment in elderly Latinos with elevated depression scores

Metabolic Syndrome and Cognitive Decline in Elderly Latinos: Findings from the Sacramento Area Latino Study of Aging Study

To investigate the effect of metabolic syndrome on cognitive function in an elderly Latino population and to determine whether inflammation modifies this association. A longitudinal cohort study. Sacramento area and the surrounding California counties from 1998 to 1999. One thousand six hundred twenty-four Latinos aged 60 and older who participated in the Sacramento Area Latino Study of Aging. Baseline metabolic syndrome was calculated using the Third Adult Treatment Panel of the National Cholesterol Education Program. Cognitive function was measured using the Modified Mini-Mental State Examination (3MS) and the Delayed Word-List Recall (DelRec), a verbal memory test. The effect of metabolic syndrome on cognitive change scores was examined using random effects models; in addition, the effect of the individual components of the syndrome on cognitive change was examined. Of the 1,624 participants, 718 (44%) had metabolic syndrome at baseline. Those with metabolic syndrome had worse 3-year change scores on 3MS (P=.04) and DelRec (P=.03). Multivariate adjustment attenuated the results for DelRec but not for 3MS. This association was especially pronounced in participants with a high serum level of inflammation, resulting in an average 3MS score 0.64 points lower per year (P=.03) for those with metabolic syndrome. Individual components of metabolic syndrome were not associated with cognitive decline except for elevated glucose on the DelRec (P=.02) and high blood pressure on 3MS (P=.05). Metabolic syndrome and inflammation may both contribute to cognitive decline in older people of diverse backgrounds. The results also suggest that, in elderly Latinos, the composite measure of metabolic syndrome is a greater risk for cognitive decline than its individual components.

Predictors of institutionalization in Latinos with dementia.

The present study identified predictors of time to institutionalization among elderly Latinos suffering from dementia, and determined how these predictors varied when compared to Caucasians and African-Americans. The sample included 324 Latino, 701 African-American, and 7,100 Caucasian dementia patients and their caregivers recruited from eight catchment regions in the U.S. and were assessed over a 3-year period. Potential predictors considered in the event history analyses included context of care and indicators of care recipient cognitive and functional status, caregiver stress and depression, and caregiving resources. Cox proportional hazards models revealed that various indicators of sociodemographic context, caregiver well-being, and community-based service utilization influenced time to institutionalization among Latinos. Cross-ethnic/racial comparisons also identified statistical variations in site, living arrangement, intensity of informal care provision, caregiver depression, and adult day service use across the Latino, Caucasian, and African-American samples when predicting time to nursing home placement. The findings emphasize the need to explore time to institutionalization across racial and ethnic contexts, and suggest future variables to consider when analyzing nursing home placement in diverse situations.

Elderly Latinos of Langley Park: Understanding Retirement Issues

This paper will argue, first, that the intersections between aging and immigration are poorly understood and, second, that this knowledge gap has important implications for research, program planning, and policy making in the United States. There are two patterns that illustrate aging Latino in the U.S.: aging in place and immigration in late life. The intersections between the service structure, belief systems, and policy will be examined in this paper with reference to an ethnographic study of Latino elderly in Langley Park. Two study populations were selected in Langley Park. While the first population was composed of elderly Latino, the second consisted of health and social care service providers. Health was perceived by the informants as the most important need affecting the Latino elderly, both as individuals and as a population. Yet service providers identified health as the fourth most important need. The implications of this lack of congruence between the informants and the service providers regarding both need assessment and need prioritization are discussed.

The ratio of holotranscobalamin to total B12: associations with transcobalamin genotype, methylmalonic acid, and homocysteine

A common polymorphism, C776G, in the plasma B12 transport protein, transcobalamin (TC), encodes for either proline or arginine at codon 259. In a previous study, we demonstrated that individuals homozygous for the arginine isoform (RR) had a lower percentage of total plasma B12 bound to TC (holoTC/total B12 ratio) than those homozygous for the proline isoform (PP). In the present study, we investigated TC genotype and the potential significance of the holoTC/total B12 ratio in a cohort of elderly Latinos (N=833, age 60-93y) participating in the Sacramento Area Latino Study on Aging (SALSA). The distribution of TC genotypes was 40.6% homozygous for the proline isoform (PP) and 11.6% homozygous for the arginine isoform (RR). Consistent with our previous study, the RR genotype was associated with a lower median holoTC/total B12 ratio than the PP genotype (0.27 vs. 0.23, p=0.002). In multiple regression analyses controlling for age, sex, creatinine, and folate, the holoTC/total B12 ratio was inversely associated with the functional indicators of B12 status, methylmalonic acid (p=0.001) and homocysteine (p<0.001). These data indicate that for a given level of total B12, the percentage of the total on TC is a strong determinant of functional B12 status, and TC genotype is an important determinant of that percentage. Further studies are needed to determine if TC genotype and the holoTC/total B12 ratio contribute to the increased risk of vascular disease and dementia associated with hyperhomocysteinemia. NIH AG12975; USDA 00-35200-9073

Low folate status is associated with impaired cognitive function and dementia in the Sacramento Area Latino Study on Aging

Low folate status is associated with poor cognitive function and dementia in the elderly. Since 1998, grain products in the United States have been fortified with folic acid, which has reduced the prevalence of folate deficiency and hyperhomocysteinemia. We investigated whether folate status is associated with cognitive function and dementia in a cohort of elderly Latinos (aged >or= 60 y; n = 1789) exposed to folic acid fortification. Global cognitive function was assessed by the Modified Mini-Mental State Examination (3MSE) and specific cognitive functions by cross-culturally validated neuropsychological tests. Dementia was diagnosed according to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised, and California Alzheimer Disease Diagnostic and Treatment criteria. Red blood cell (RBC) folate was measured by automated chemiluminescence and total plasma homocysteine by HPLC. The prevalence of folate deficiency (RBC folate <or= 160 ng/mL) was <1%. After control for confounding by homocysteine, vitamin B-12, creatinine, demographic variables, and depressive symptom score, RBC folate was directly associated with 3MSE (P = 0.005) and delayed recall (P = 0.007) scores. In addition, adjusted odds ratios for low 3MSE score (<or=78) and dementia diagnosis per unit increase in RBC folate were significantly below unity (P <or= 0.008), which indicated that the relative risks of cognitive impairment and dementia decreased with increasing RBC folate concentration. In contrast, adjusted odds ratios for low 3MSE score and dementia diagnosis per unit increase in homocysteine were not significant. RBC folate is directly associated with cognitive function scores and is inversely associated with dementia in elderly Latinos despite folic acid fortification.

Meeting the Mental Health Needs of Elderly Latinos Affected by Depression: Implications for Outreach and Service Provision

Meeting the Mental Health Needs of Elderly Latinos Affected by Depression: Implications for Outreach and Service Provision

Chapter 7: Ahora le Voy a Cuidar Mis Nietos

SUMMARY The abuse of alcohol and other substances has long been the source of disruption in family structures and lifestyles. Yet, the impact on Latino grandparent-headed households in rural communities has received little attention to date. Health and social services agencies can reach out to rural elderly Latinos by involving community representatives in the intervention process and making culturally sound recommendation for practice and program development.

Meeting the Mental Health Needs of Elderly Latinos Affected by Depression: Implications for Outreach and Service Provision

Latinos are one of the fastest growing segments of the older population and are known to have a high prevalence of depression, as well as a greater likelihood of risk factors for this condition such as poor comorbid physical health, distressed economic circumstances, and social isolation that leads to a de facto homebound status. Thus, long-term care providers are likely to encounter increasing numbers of older Latinos suffering from depression in both community and institutional settings. This article discusses current empirical and conceptual studies on mental health issues facing older Latinos, as well as outreach, clinical practice, and policy recommendations for working with this population.

Vitamin B12 deficiency is the dominant nutritional cause of hyperhomocysteinemia in a folic acid-fortified population

Prevalence rates for folate deficiency and hyperhomocysteinemia have been markedly reduced following the introduction of folic acid fortification in the United States. We report the prevalence of hyperhomocysteinemia in a population of community-dwelling elderly Latinos in the post-folic acid fortification era. We measured homocysteine, total vitamin B12, holotranscobalamin, red blood cell folate, and serum creatinine in 1096 subjects aged > or =60 years. Hyperhomocysteinemia (>13 micromol/L) was observed in 16.5% of the subjects. The population attributable risk percentages for hyperhomocysteinemia were 29.7% for total B12 <148 pmol/L, 36.4% for holotranscobalamin <35 pmol/L, and 41.4% for creatinine >115 micromol/L. In contrast, the population attributable risk percentage for hyperhomocysteinemia was only 0.3% for red blood cell folate <365 nmol/L. We conclude that in the post-folic acid fortification era, low vitamin B12 status has become the dominant nutritional determinant of hyperhomocysteinemia. Steps to either reduce the prevalence of vitamin B12 deficiency or to identify and treat individuals with vitamin B12 deficiency could further reduce the prevalence of hyperhomocysteinemia.

Plasma folate concentrations are associated with depressive symptoms in elderly Latina women despite folic acid fortification

A relation between low folate status and depression has been recognized since the 1960s. Since 1998, flour in the United States has been fortified with folic acid, and the prevalence of folate deficiency has decreased dramatically. We investigated whether, in this era of folic acid fortification, low folate status is a determinant of depressive symptoms in a cohort of elderly Latinos (aged >/=60 y) participating in the Sacramento Area Latino Study on Aging (SALSA). In a cross-sectional logistic regression analysis of data from SALSA (n = 627 M, 883 F), odds ratios (ORs) were ascertained for elevated depressive symptoms [Center for Epidemiologic Studies Depression Scale (CES-D) score >/=16] among tertiles of plasma folate. Depressive symptoms were assessed by using the CES-D. Plasma folate concentrations were determined by radioassay. The prevalence of folate deficiency (plasma folate </= 6.8 nmol/L) in the SALSA population was <1%. For men, no significant association between folate tertile and high CES-D score was observed. The adjusted OR for high CES-D score in women in the lowest tertile of folate was 2.04 (95% CI: 1.38, 3.02), which was significantly different from that in women in the highest tertile of folate (P < 0.001). These data indicate that, despite folic acid fortification, low folate status is associated with depressive symptoms in elderly Latina women (but not elderly Latino men).

Neuropsychiatric symptoms in Latino elders with dementia or cognitive impairment without dementia and factors that modify their association with caregiver depression.

The purpose of this study was to determine neuropsychiatric symptom frequency and intensity in demented and cognitively impaired but not demented Latino elderly persons, evaluate whether overall neuropsychiatric symptom intensity is associated with higher levels of caregiver depression, and identify factors that modify the relationship between neuropsychiatric symptoms and caregiver depression. Ninety-five elderly Latinos with dementia or cognitive impairment but not dementia (CIND), all of whom were identified through an ongoing epidemiological cohort study, and their informal caregivers participated in the study. Caregivers were interviewed in their homes, in either Spanish or English. The Neuropsychiatric Inventory was used to assess neuropsychiatric disturbances. For most neuropsychiatric symptoms, prevalence and intensity were significantly higher in the demented group compared with the CIND group. The overall neuropsychiatric symptom intensity score was significantly associated with caregiver depression. The strength and direction of the association of neuropsychiatric symptoms with caregiver depression was found to vary by three factors: whether the caregiver was the care recipient's spouse, whether the care recipient had dementia or CIND, and the care recipient's age. Neuropsychiatric symptoms may play a significant role in caregiver depression among Latino families. However, the impact of neuropsychiatric disturbances on Latino caregivers may differ depending on characteristics of both the caregiver and care recipient. The adverse impact of neuropsychiatric symptoms on caregivers of elderly persons with CIND has not been previously reported and deserves further study.

Plasma Vitamin B-12 Concentrations in an Elderly Latino Population Are Predicted by Serum Gastrin Concentrations and Crystalline Vitamin B-12 Intake

The prevalence of vitamin B-12 deficiency increases with age, probably resulting from malabsorption of food-bound B-12 secondary to gastric atrophy. On the basis of this assumption, the Institute of Medicine (IOM) recommends those aged >50 y consume crystalline vitamin B-12. There is limited information on the prevalence of gastric atrophy in the elderly and whether the IOM recommendation would be effective. The objective of this study was to assess predictors of vitamin B-12 status and their interactions in free-living elderly. Individuals (n = 57) with deficient plasma vitamin B-12 (p-B12 < 148 pmol/L) were compared with 68 individuals with marginal p-B12 (148-221 pmol/L) and 52 with normal p-B12 (>221 pmol/L) in a cross-sectional sample (n = 1546) of elderly (>60 y) Latinos in California. Associations were examined among p-B12 and serum gastrin, vitamin B-12 intake from food and crystalline sources, and medications that putatively affect vitamin B-12 absorption. Serum gastrin was elevated, indicating gastric atrophy, in 48% of participants with deficient p-B12, 23% with marginal p-B12 and 21% of normal p-B12 participants, and was a significant predictor of deficient p-B12 and high plasma homocysteine (p-tHcy). Median total vitamin B-12 intake exceeded recommendations and was similar among status groups. Crystalline vitamin B-12 intake in the normal p-B12 group was higher than in the deficient p-B12 group (P < 0.01), and tended to be higher than the marginal group (P = 0.07). When serum gastrin was elevated, p-B12 was predicted by crystalline vitamin B-12, but not by intake of vitamin B-12 from food. Elevated serum gastrin was highly prevalent and predicted vitamin B-12 depletion. Crystalline vitamin B-12 intake predicted p-B12 in individuals with elevated serum gastrin, supporting IOM recommendations to increase consumption of crystalline vitamin B-12.

Homocysteine and cognitive function in the Sacramento Area Latino Study on Aging

Elevated plasma homocysteine (hyperhomocysteinemia), an independent risk factor for vascular disease, has been reported to be inversely correlated with objective measures of cognitive function in patients with Alzheimer disease and in community-dwelling older adults. We evaluated the cross-sectional relation between total plasma homocysteine concentration and cognitive function in elderly Latinos (aged > or = 60 y; n = 1789) participating in the Sacramento Area Latino Study on Aging. Global cognitive function was assessed by using the Modified Mini-Mental State Examination, and specific cognitive functions were assessed by using 6 instruments developed for cross-cultural and multilingual neuropsychological evaluation of older persons. Associations between the cognitive function scores and total plasma homocysteine concentrations were then measured by multiple regression analysis with control for potential confounding by nutrient status (red blood cell folate, plasma vitamin B-12), kidney function (serum creatinine), demographic variables (age, sex, education, acculturation), and depressive symptoms. Modest inverse associations were found between homocysteine concentrations and several indexes of cognitive function, including the global Modified Mini-Mental State Examination assessment and the picture-association, verbal attention-span, and pattern-recognition tests (P < or = 0.05). Demographic variables, particularly age and education, were more strongly associated with cognitive function scores than was homocysteine. Homocysteine is a modest independent predictor of cognitive function in community-dwelling elderly Latinos. Reducing plasma homocysteine concentrations by administering B-vitamin supplements may provide some protection against cognitive decline in this and other elderly populations, but the effect may be limited.

Elderly Latinos in the U.S.: What Do They Know and Think About HIV/AIDS?

ABSTRACT Previous research on efforts to change health related behaviors indicates that such change may be affected by an individual's knowledge and attitudes, sense of self-efficacy and of susceptibility, and the norms of his or her reference group. This paper presents results from analysis of responses to the National Health Interview Survey's questions about AIDS knowledge, attitudes, susceptibility and behavior, comparing older Latinos both to older non-Latino Americans and to younger Latinos. Data from the NHIS 1994 survey is analyzed; questions on AIDS knowledge and attitudes are investigated and the effects of age and ethnicity are compared. The results demonstrate significant differences by ethnicity and age. While substantial majorities of all groups know the basic information about HIV transmission, of the four, older Latinos have the highest proportion of people with some inaccurate information.

Culturally Competent Practice with Elderly Latinos

This chapter describes a framework for culturally competent practice with elderly Latinos. The poverty rate was estimated at 20.6 percent, twice the rate for white elderly cohorts. Health reasons and low-paying jobs have also resulted in many elderly leaving the workforce before retirement age, thereby dramatically reducing their income security and pension benefits upon retirement. A starting point for culturally competent practice begins with an understanding of three broad fields of study known as the sociology, biology and psychology of aging which represent the foundation for gerontological social work practice. The sociology of aging , also referred to as the non-physical aspects of aging, focuses on the social forces and theories of aging. Social work knowledge is based on a range of perspectives and content areas derived from various schools of thought. Ethnicity is an equally significant concept in the ecological perspective with multiple definitions and relevance to service providers.