Epidemiologic Studies Of The Elderly Research Articles

Body mass index and 12-year mortality among older Mexican Americans aged 75\u2009years and older

BackgroundThe role of obesity in mortality in the very old and old-oldest Hispanic population has not been studied. The objective of this study was to examine the effect of body mass index (BMI) on 12-year mortality among older Mexican Americans aged 75 years and older.MethodsTwelve year prospective cohort study consisting of a population-based sample of 1415 non-institutionalized Mexican American men and women aged 75 and older from 5 southwestern states: Arizona, California, Colorado, New Mexico, and Texas. Data was from Wave 5 of the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005–2016). Socio-demographics, body mass index (BMI), self-reported medical conditions, disability, depressive symptoms, falls, Mini-Mental-State-Examination (MMSE), and Short Physical Performance Battery (SPPB) were assessed at baseline during 2004–2005. BMI (Kg/m2) was classified as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obesity category I (30 to < 35), and obesity category II/morbid obesity (≥ 35). For assessment of mortality, deaths were ascertained through the National Death Index and report from relatives. Cox proportional hazards regression analysis was performed to estimate the hazard ratio (HR) of 12-year mortality as a function of BMI categories at baseline.ResultsThe mean BMI was 27.5 ± 1.7 with participants classified as 1.8% underweight, 30.8% normal weight, 39.2% overweight, 20.7% obesity category I, and 7.6% obesity category II/morbid obesity. Mexican Americans aged ≥75 years with overweight or obesity category I had a reduced HR of death (0.82, 95% CI = 0.70–0.96 and 0.75, 95% CI = 0.62–0.91, respectively) over 12-years of follow-up. The HR of death for underweight and obesity category II/morbid obesity participants was 1.59 (95% CI = 1.03–2.45) and 1.12 (95% CI = 0.85–1.46), respectively. Female participants and those with high scores in the MMSE and SPPB had decreased risk of death.ConclusionsThis study showed the protective effect of overweight and obesity on mortality in Mexican Americans above 75 years of age, which might have implications when treating older adults with overweight and obesity.

Physical Function Transitions and Healthcare Utilization Among Older Mexican Americans.

The aim of this study was to examine the relationship between 2-year physical function transitions and one-year healthcare utilization among Mexican American Medicare beneficiaries. The sample consisted of 429 Mexican Americans ≥75 years old from the Hispanic Established Population for the Epidemiologic Study of the Elderly linked with Medicare claims data from the Centers for Medicare and Medicaid Services. Short Physical Performance Battery (SPPB) from Wave 5 (2004/05) to Wave 6 was used to create physical function transition groups. The outcomes were physician visits (<6, 6-12, >12 visits), number of emergency room visits, and number of acute hospitalizations one-year after physical function transitions. Multinomial logistic regression and Generalized Estimating Equation with negative binomial distribution were used to estimate the odds ratio of healthcare utilization as a function of physical function transition groups, controlling for socio-demographics and comorbidities. Participants who improved or remained moderate-high physical function had lower odds ratio (OR) of being hospitalized (0.40, 95% Confidence Interval [CI]=(0.18, 0.90)) or visiting the emergency room (OR=0.52, 95% CI=0.32-0.84) one-year later compared to participants who remained in the low physical function group. No difference in physician visits across physical function transition groups was found. This study showed healthcare utilization differed by physical function transition groups among Mexican American Medicare beneficiaries. Physical function improvement or maintenance of moderate-high physical function should be targeted in older Mexican Americans, a population at great risk of developing disability, to reduce or delay dependency and healthcare burden.

Living Beyond 80: A Longitudinal Study of Cognitive and IADL Disablement Among the Oldest Mexican Americans

Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in IADL disability and tertiary outcomes of the IADL disablement for the oldest old. We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010-2011, 2012-2013, 2016, N=1,078) to investigate the longitudinal patterns of IADL decline using Latent Transition Analysis. Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

Documentation of Dementia as a Cause of Death Among Mexican-American Decedents With Dementia

There is lack of data on the frequency and correlates of dementia being documented as a cause of death in Hispanic populations. We investigated characteristics associated with dementia as a cause of death among Mexican-American decedents diagnosed with dementia. Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims files, and the National Death Index. Of the 744 decedents diagnosed with dementia before death, 26.9% had dementia documented as a cause of death. More health comorbidities (OR=0.38, 95% CI=0.25-0.57), older age at death (OR=1.05, 95% CI=1.01-1.08), and longer dementia duration (OR=1.09, 95% CI=1.03-1.16) were associated with dementia as a cause of death. In the last year of life, any ER admission with (OR=0.56, 95% CI=0.32-0.98) or without (OR=0.31, 95% CI=0.14-0.70) a hospitalization, more physician visits (OR=0.95, 95% CI=0.92-0.98) and seeing a medical specialist (OR=0.41, 95% CI=0.24-0.70) were associated with lower odds for dementia as a cause of death. In the last 30-days of life, any hospitalization with an ICU stay (OR=0.57, 95% CI=0.37-0.88) and ER admission with (OR=0.58, 95% CI=0.40-0.84) or without (OR=0.48, 95% CI=0.25-0.94) a hospitalization were associated with lower odds for dementia as a cause of death. Receiving hospice care in the last 30-days of life was associated with 2.09 (95% CI=1.38-3.16) higher odds for dementia as a cause of death. The possible under-documentation of dementia as a cause of death on death certificates may result in underestimation of healthcare resource need of dementia care for Mexican-Americans.

Dementia and Living Arrangements Among Mexicans and Mexican Americans

This study compares the living arrangements of adults 85 and older in Mexican-origin adults in Mexico and the United States. The study uses 475 Mexican-Americans in five southwestern states (Hispanic Established Population for the Epidemiologic Studies of the Elderly, H-EPESE) and 1,710 Mexicans from 32 states in Mexico (Mexican Health and Aging Study, MHAS) to examine living alone vs living with others based on the presence of dementia controlling for demographic, health, and financial correlates. In both countries, more than 20% of respondents living alone have dementia. Dementia is associated with household extension in both countries. Homeownership increases household extension in Mexico but not the U.S. The findings show that individuals with dementia are more likely to live alone in the U.S. than in Mexico. Older individuals with dementia may be at elevated risk of isolation in later life if families or formal organizations cannot provide on-going assistance.

Diabetes, Disability, and Dementia Risk: Results From the HEPESE

The relationship between cognitive function, diabetes and disability among the oldest-old remains largely unexplored, particularly in the Latino population. This study examines dementia risk and diabetes status in a Mexican-origin older adult sample. The data are drawn from eight waves (1993 -2013) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=3,039, mean age at baseline=73.6 (±6.8)). We use multivariable Cox proportional hazards models to predict the relation between diabetes and time to incident dementia (MMSE<24, 1+ IADL), with risk adjustment for age of migration, socioeconomic status, acculturation, and health. Diabetes prevalence at baseline was 27.8 %. Diabetes was associated with a higher risk of developing dementia (HR)=1.22, p<0.001). Foreign-born older adults who migrated at ages 20- 49 had a higher survival probability of being dementia-free (HR=0.84, p=0.001). Our results further highlight the importance of evaluating differences in the cognitive outcomes of Mexican origin older adults.

Frailty and Trajectories of Blood Pressure Among Older Mexican Americans Over Time

The objective of this study was to examine whether blood pressure (BP) trajectories differ by frailty status among older Mexican Americans. Data are from an 18-year prospective cohort study of 1,781 non-institutionalized Mexican American aged ≥ 67 years from the Hispanic Established Population for the Epidemiological Study of the Elderly (1995/96-2012/13). Frailty was defined as meeting three or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. General linear mixed models were used to estimate trajectories of systolic and diastolic BP over an 18-year period as a function of frailty status. All variables were analyzed as time-dependent covariates except for gender and education. At baseline, 46.3% participants were non-frail, 44.8% were pre-frail, and 9.0% were frail; and the mean of systolic and diastolic BP was 136.9 mmHg (SD=18.6) and 77.3 mmHg (SD=12.2), respectively. Frail participants had greater systolic and diastolic BP decline over time than non-frail (estimate=-3.94, SE=0.88, p-value=<0.0001 and estimate=-1.32, SE=0.54, p-value=0.0138, respectively); and pre-frail participants had greater systolic BP decline than non-frail (estimate=-1.51, SE=0.54, p-value=0.0049), after controlling for all covariates. Those with high body mass index and hypertension with and without treatment had increased levels of systolic and diastolic BP over time. Older age, female gender, arthritis, diabetes, and stroke had decreased levels of diastolic BP over time. This study showed progressive decline in systolic and diastolic BP in frail compared to non-frail older Mexican Americans, which might have implications when treating frail older adults with hypertension.

Cognitive Impairment and Decline in Physical Function Among Older Mexican Americans Over 20 Years

The aim of this study was to examine cognitive function as a predictor of physical function decline over a 20-year follow-up period among older Mexican Americans who were non-disabled and were able to complete the Short Physical Performance Battery (SPPB) at baseline. The sample consisted of 2,232 Hispanics 65 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly. Measures included socio-demographics, self-reported medical conditions, body mass index (BMI), disability, depressive symptoms, limitations in activities of daily living, Mini-Mental State Examination (MMSE), and SPPB. General linear mixed models were used to estimate changes in SPPB over time as a function of MMSE. At baseline, 11% of the participants had cognitive impairment (MMSE < 21) and the average SPPB score for those with and without cognitive impairment was 7.16 + 2.75 and 7.81 + 2.36, respectively. Mixed model analysis showed that those with cognitive impairment (MMSE < 21) experienced a decline in the SPPB of 0.34 points per year (Standard Error = 0.09, p-value = 0.0002) after controlling for all covariates. Other significant predictor factors of decline in the SPPB were older age, depressive symptoms, diabetes, any assistance with activities of daily living, having had a hip fracture, and high BMI. Cognitive impairment predicted decline in physical function among older Mexican Americans who were non-disabled at baseline. These findings underscore the need of developing interventions to maintain cognitive and physical function to delay or prevent disability in this underserved population with high rates of disability.

Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older

Older adults with dementia and cognitive impairment often experience neuropsychiatric symptoms (NPS). Few studies have investigated the presence of NPS among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients aged 85 years and older, along with their caregivers. The 12-item Neuropsychiatric Inventory (NPI-12) was administered to measure behavioral and psychiatric symptoms among the care recipients. Cognitive impairment was defined as a score of 18 or less on the Mini Mental Status Exam (MMSE). Care recipients with a diagnosis of dementia as reported by the caregiver were also classified as cognitively impaired. Overall, 259 (68.0%) participants had one or more NPS. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p<0.01). The predicted probability of having one or more NPI symptoms was 0.25 percentage points (95% CI=0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of older Mexican American adults, particularly in those with cognitive impairment. Future research could also investigate sociodemographic correlates of NPS.

Understanding Transitions in IADL and Their Consequences for Cognitive Impairment Among Older Mexican Americans

Mexican Americans tend to live longer lives than other ethnic groups, but it remains unclear how this trend influences the trajectory of disability and its consequences for cognitive frailty. Building on previous research, we assess transitions in IADL among the oldest old. We use data from three waves of the Hispanic Established Population of the Epidemiologic Study of the Elderly (H-EPESE) to investigate trajectories of IADL disability as individuals’ age into their 80s and 90s, a period of the life course with much higher rates of morbidity and decreasing socioeconomic resources. The H-EPESE is a benchmark longitudinal cohort study based on an original sample of 3,050 Mexican-Americans aged 65 and older in the Southwestern United States. Our modeling approach estimates transitions in patterns of IADL employing the Latent Transition Analysis (LTA). Results revealed three heterogeneous latent classes: high IADLs, difficulty in transportation and mobility, and low IADLs. Those with high IADLs tended to remain in the same class over time. Individuals having difficulty in transportation and mobility tended to stay in the same class or transfer to high IADLs, whereas those with overall low IADLs transferred to either the same class or to difficulty in transportation and mobility. Additional analysis revealed that cognitive impairment was a significant predictor of instrumental disability over time. Furthermore, females were more likely than males to belong to difficulty in transportation or mobility class than to the low IADL class. Our results highlight the long term consequences of cognitive decline on IADL limitations.

Association Between Frailty and Development of Alzheimer's Disease–Related Dementias

Frailty is associated with an increased risk for Alzheimer’s disease and related dementias (ADRD). However, this association has not been investigated in older Mexican Americans; a population that is high-risk for frailty and ADRD. This study investigated the association between frailty and the development of ADRD over 9-year period. We analyzed 860 Mexican Americans ≥76 years old of the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) who have been linked with Medicare claims data. Survey data from Wave 6 (2007/08) was used to categorize participants as frail (either pre-frail or frail) or non-frail according to the Fried phenotype. The main outcome was ADRD diagnosis after Wave 6 interview. ADRD status was determined using the Chronic Conditions Segment of the Master Beneficiary Summary File. We estimated ADRD disease-free probability during 2007-2016 using midpoint of interval data method stratified by frailty status. Mean age of the study sample was 83.2 years (SD=4.4) and 59.3% were female. We found individuals who were frail had less ADRD-free months (46.5; SD= 36.5-52) compared to those who were non-frail (66.0; SD= 47.5-120). Individuals with a score of less than 21 points on the Mini Mental Status Exam had greater risks of ADRD development (Odds Ratio=1.35, 95% CI= 1.05-1.74) compared to their counterpart, after controlling mortality as a competing risk. Our results suggest being pre-frail, frail or cognitively impaired are risk factors for ADRD in community-dwelling older Mexican Americans.

Likely Dementia and Its Implication for Support Among the Oldest-Old in Mexico and the United States

This study examines sources of vulnerabilities to dementia in low resource populations in two specific contexts—Mexico and the United States. Data are drawn from comparable waves of the Mexican Health and Aging Study (MHAS) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) in 2012, which include representative samples of the oldest-old (82 and over), the fastest growing segment of the populations worldwide. Likely dementia prevalence is 30.9% (±0.46SD) for Mexicans in Mexico and 36.3% (±0.48SD) for Mexicans in the U.S. Odds of likely dementia in both populations were increased by age, living in extended households, depressive symptoms, and Seguro Popular and Medicaid receipt. Being female and having comorbid cardiovascular conditions were also associated with likely dementia but only for older Mexicans. There is a need to strengthen the caregiving capacity of memory care services in low resource communities in Mexico and the U.S.

Body Mass Index and 12-year Mortality Among Older Mexican Americans Aged 75 Years and Older

The objective of this study was to examine the effect of body mass index (BMI) on 12-year mortality among older Mexican Americans aged 75 years and older. Data are from wave 5 (N=1,367) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005-2016). Measures included socio-demographics, self-reported medical conditions, body mass index (BMI), disability, Mini-Mental-State-Examination (MMSE), short physical performance battery (SPPB), high depressive symptoms, and falls. BMI was classified as underweight (< 18.5), normal weight (18.5 to < 25), overweight (25 to < 30), obesity type I (30 to <35), and morbid obesity (≥ 35).Cox proportional hazards regression analysis was performed to estimate the hazard ratio of 12-year mortality as a function of BMI categories at baseline. The average of the sample was 81.2 years, 17.2% were underweight, 22.7% were normal weight, 27.4% were overweight, 31.9% were obesity type I, and 38.6% were morbid obesity. Mexican Americans aged ≥75 years with overweight or obesity Type I had a reduced hazard ratio (HR) of death (HR=0.80, 95% CI=0.68-0.93 and HR=0.73, 95% CI=0.60-0.88, respectively) over 12-years of follow-up. The HR of death for underweight and morbid obesity participants was 1.78 (95% CI=1.13-2.80) and 1.03 (95% CI=0.79-1.36), respectively. Female participants and those with high scores in the MMSE and SPPB had decreased risk of death. This study confirmed the protective effect of overweight and obesity on mortality seen in this population at a younger age, which might have implications when treating older adults with overweight and obesity.

Frailty transitions predict healthcare use and Medicare payments in older Mexican Americans: a longitudinal cohort study

BackgroundLittle is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans.MethodsLongitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey data from five Southwest states linked to the Medicare claims files from the Centers for Medicare and Medicaid Services. Seven hundred and eighty-eight community-dwelling Mexican Americans 72 years and older in 2000/01 were studied. We used a modified Frailty Phenotype (unintentional weight loss, weakness, self-reported exhaustion and slow walking speed) to classify frailty status (non-frail, pre-frail or frail). Each participant was placed into one of 5 frailty transition groups: 1) remain non-frail, 2) remain pre-frail, 3) remain frail, 4) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail) and 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail). The outcomes for the one-year follow-up period (2000–2001) were: (a) healthcare use (hospitalization, emergency room [ER] admission and physician visit); and (b) Medicare payments (total payment and outpatient payment).ResultsMean age was 78.8 (SD = 5.1) years and 60.3% were female in 1998/99. Males who remained pre-frail (Odds Ratio [OR] = 3.49, 1.13–10.8, remained frail OR = 6.92, 1.61–29.7) and transitioned to worse frail status (OR = 4.49, 1.74–11.6) had significantly higher hospitalization risk compared to individuals who remained non-frail. Males in the ‘worsened’ groups, and females in the ‘improved’ groups, had significantly higher Medicare payments than individuals who remained non-frail (Cost Ratio [CR] = 2.00, 1.30–3.09; CR = 1.53, 1.12–2.09, respectively].ConclusionsHealthcare use and Medicare payments differed by frailty transition status. The differences varied by sex. Research is necessary to elucidate the relationship between frailty transitions and outcomes, sex difference and Medicare payment for older Mexican Americans living in the community.

Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample

ObjectivesFocus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample. DesignLongitudinal study, analyses included descriptive statistics and repeated measures proportional hazards. Setting/ParticipantsCommunity-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years. MeasuresData included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status. ResultsOver 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size. Conclusions/ImplicationsMaintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed.

Religious attendance, depressive symptoms, and sleep disturbance in older Mexican Americans

ABSTRACT Although numerous studies have shown that religious involvement is associated with better health across the life course, researchers have virtually ignored possible links between religious involvement and sleep-related outcomes. Building on previous work, we tested whether religious attendance is inversely associated with sleep disturbance among older Mexican Americans. We also assessed whether depressive symptoms mediate the association between religious attendance and sleep disturbance. Our mediation model was tested using ordinary least squares regression and conditional process analysis of cross-sectional data from the original cohort of the Hispanic Established Population for the Epidemiologic Study of the Elderly. Regression models show that religious attendance is inversely associated with depressive symptoms and sleep disturbance. Mediation analyses indicate that depressive symptoms mediate the association between religious attendance and sleep disturbance. These findings contribute to previous work by showing that religious attendance may protect against sleep disturbance by promoting mental health among older Mexican Americans.

THE RELATIONSHIP OF THE TRAJECTORY OF COMORBIDITY ON FUNCTIONAL STATUS IN A COMMUNITY SAMPLE OF ELDERS

The Duke Established Populations for the Epidemiologic Study of the Elderly (EPESE) study is a 1:7 random sample elderly over 65YO at baseline living in the Piedmont NC, followed yearly for 10 years beginning in1986. There were 4162 participants at baseline of which slightly over 1100 were still alive and responding at year 10. The participants self-reported on 5 comorbidities (cancer, high BP, diabetes, stroke and heart attack) at each year, as well as 4 functional scales - Katz, Rosow-Breslau, Nagi, and IADL scales. Using Mixed Models, the slope (trajectory) and intercept (level) of comorbidity over 10 years was estimated for each person, and correlated with the function scales in the final year. Correlations of the final comorbidity trajectory with the 4 functions levels ranged between 0.12 and 0.18, the trajectory with function ranged between 0.15 and 0.27. All p-values<0.0001. The first Canonical Correlate of function with comorbidity was 0.28 (p<0.0001). Slope and intercept were related jointly to each outcome and multivariately (p<0.001 for the joint effects, controlling for race, gender, age, and years of education. The multimorbidity relationship with function differed by race (omnibus p-value for the raceXmultimorbidity interaction p=0.03 (by Wilk’s Lambda), controlling for the demographics). This method is an example of combining longitudinal and cross-sectional outcomes and shows that the change in number of comorbidities is associated with functional status level.

HEALTHY LIFE EXPECTANCY OF OLDER HISPANICS: THE INFLUENCE OF NEIGHBORHOOD CHARACTERISTICS

Research consistently shows a survival advantage among Hispanics, despite a worse health profile. The goal of this study was to calculate disability free life expectancy for older Hispanics in the United States, and to explore any difference by neighborhoods. We used data from the Wave 5 (2004-5) of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE), linked to vital status data through 2016. We used Sullivan’s method to create disability free life expectancy (DFLE) estimates, and to calculate the ratio of life expectancy without disability to life expectancy with disability. These estimates were compared across neighborhood characteristics using Census FIPS data. All neighborhood characteristics were cut into tertiles and significance testing compared high versus low. The average age of the sample was 82 (range 75-109), a majority female (62%), non-married (57.5%), and born in the US (56%). Results showed that neighborhood Hispanic density, poverty, and percent linguistically isolated were not statistically significant for disability free life expectancy estimates. However, disability free life expectancy was higher in neighborhoods with higher density of immigrants, compared to neighborhoods with lower density of immigrants. This was statistically significant for all age groups 75 until age 88. These results suggest that for very old Mexican Americans living in the southwest, neighborhood effects are not significant predictors of disability free life expectancy. The exception is for the neighborhood immigrant density. This suggests that the healthy immigrant effect may maintain even in older ages. Policy and practice implications will be discussed.

NATIVITY AND DISABILITY TRAJECTORIES AMONG TWO COHORTS

Nativity is an important characteristic in the context of disability in older adults, as it may influence attitudes and behaviors that can delay or accelerate the disability process. This study aims to assess trajectories of disability (defined as lower-body functional limitations, limitations in daily and instrumental activities of daily living, and gross mobility) in foreign-born and US-born Mexican Americans between 1993 and 2013. We used eight waves (1993 -2013) from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N=3050, mean age at baseline=73.6 (±6.8). Disability was assessed using self-reported limitations in activities of daily living (ADL /IADL). Nativity and age-at-migration were collected by self-report. We used linear and quadratic growth curve models to evaluate the trajectory of ADL/IADL disability over a period of 20 years and assessed variations by nativity status while adjusting for potential confounders. Approximately 19% of foreign-born and 17% of US-born reported having at least one ADL, while 51.5% natives and 58.7% of foreign-born had at least one IADL. Our results showed that after controlling for age at baseline, sex, marital status, self-reported health, chronic conditions, and education, foreign-born older adults were less likely to have ADL/IADL disability at baseline, but exhibited a faster rate of increase in disability over time (β =0.31 for ADL, β=0.07 for IADL). Our findings show that foreign-born older adults are accumulating disability at faster compared with their native peers, highlighting the importance of evaluating nativity differences in the health outcomes of Hispanic population at old age.

SEX DIFFERENCE IN EARLY FRAILTY TRANSITIONS, HEALTHCARE USE, AND MEDICARE PAYMENT IN OLDER MEXICAN AMERICANS

This study investigated sex difference in early frailty transitions on one-year follow-up healthcare utilization and Medicare payment. We used the linked Medicare claims data and the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey, using longitudinal analyses for 789 older Mexican Americans ≥70 years old in 1998/99. Participants were divided into five transition groups: 1) remain non-frail, 2) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail), 3) remained pre-frail, 4) remained frail, 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail) based on their frailty status between Wave 3 (1998/99) and Wave 4 (2000/01). Main outcomes were: (a) healthcare utilization (hospitalization, emergency room admission, physician visit) and (b) Medicare payment (total and outpatient payments) from 2000/01 to 12 months after. Mean age was 78.8 (SD=5.1) and 60.3% were female in 1998/99. We found sex had significant interaction effects on one-year follow-up hospitalization and Medicare outpatient payment. Compared to the remained no-frail group, males who remained pre-frail (Odds Ratio [OR]= 3.62, 95% CI=1.18-11.2), remained frail (OR= 7.59. 95% CI= 1.74-33.1) and worse (OR=4.54, CI=1.74-11.8) had higher risk for hospitalization. Males in the worse group also had significantly higher Medicare outpatient payment (OR=2.58, CI=1.46-4.56). Same associations were not observed in females. However, both genders used similar frequency and type of outpatient services, as the top services were evaluation and management services. Our results suggested research is needed to examine balance between sex differences, frailty improvements, resources needed and total care expenditure in this population.