Mexican American Older Adults Research Articles

Racial/Ethnic Differences in Self-Reported Upper Limb Limitations among U.S. Older Adults.

The development of disability related to activities of daily living (ADL) is of great concern in the aging population, particularly for Hispanic and Non-Hispanic (NH) Black older adults, where disability prevalence is greater compared to NH Whites. ADL-disability is typically measured across many functional tasks without differentiating upper- versus lower-limb limitations, hindering our understanding of disability burden. Despite the importance of the upper limbs for completing ADL and known age-related declines in function, racial/ethnic differences in upper limb function remain largely unknown. We identified 4,292 NH White, NH Black, and Mexican American older adults (≥65) from the 2011-2018 waves of the National Health and Nutrition Examination Survey (NHANES). We classified participants as having a limitation based on their ability to complete five upper limb tasks (preparing meals, eating, dressing, reaching overhead, grasping small objects) and compared limitation rates across racial/ethnic groups. Compared to NH Whites, NH Black older adults had significantly greater odds of reporting difficulties preparing meals (OR: 1.36, 95% CI: 1.01, 1.86) and dressing (OR: 1.55, 95% CI: 1.19, 2.02), while Mexican Americans had greater difficulty preparing meals (OR: 1.70, 95% CI: 1.12, 2.58), dressing (OR: 1.63, 95% CI: 1.12, 2.36), and grasping small objects (OR: 1.48, 95% CI: 1.06, 2.07). Our results demonstrate differences in self-reported upper limb ADL-disability across racial/ethnic groups, particularly for Mexican American older adults. Such findings underscore the need for routine monitoring of upper limb function throughout adulthood to identify limitations and target therapeutic interventions before independence is compromised.

Vision Impairment and Frailty Among Mexican American Older Adults: A Longitudinal Study.

We examined the relationship between vision impairment (VI) and new-onset frailty among non-frail Mexican American older adults (≥70years) at baseline and determined the differential impact of VI on each frailty criteria. Data were from an 18-year prospective cohort from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1998/1999, N = 1072 to 2016, N = 175). Frailty was defined as ≥3 criteria: unintentional weight loss of >10 pounds, weakness, exhaustion, low physical activity, and slowness. VI was defined as difficulty in recognizing a friend at arm's length's away, across the room, or across the street. We found that participants with VI (near or distant) and distant VI had greater odds of frailty (near or distant VI, OR = 1.89, 95% CI = 1.30-2.73 and distant VI, OR = 1.95, 95% CI = 1.34-2.86, respectively) after controlling for covariates over time. Early screening (optimal management) of VI may prevent or delay onset of frailty among older Mexican Americans.

Metabolic syndrome and arthritis among Mexican American older adults: findings from a 23-year follow-up.

To examine the sex differences in the relationship of metabolic syndrome (MetS) criteria with arthritis and symptomatic arthritis among Mexican American older adults aged ≥ 65 without self-reported arthritis at baseline over 23-years of follow-up. Participants (N = 1447) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). Measures included MetS criteria, arthritis defined as self-reported physician-diagnosed arthritis, socio-demographics, morbidities, depressive symptoms, pain on weight-bearing, cognitive and physical function, handgrip strength, mobility, and activities of daily living (ADLs) limitations. Symptomatic arthritis was defined as self-reported arthritis and having ≥ 1 of the following: pain, mobility limitation, or limited ADLs. At baseline, the mean age was 72.6years and 730 (50.5%) of our participants werefemales. Female participants with 2 and 3 MetS criteria had greater odds of arthritis [odds ratio (OR) = 1.77, 95% Confidence Interval (Cl) = 1.28-2.45 and OR = 2.68, 95% CI = 1.69-4.27, respectively) and symptomatic arthritis (OR = 1.74, 95% Cl = 1.24-2.44 and OR = 3.27, 95% CI = 2.04-5.26, respectively) after controlling for covariates. Male participants with 2 and 3 MetS criteria had greater odds of arthritis (OR = 1.65, 95% Cl = 1.14-2.39 and OR = 2.52, 95% CI = 1.51-4.19, respectively) and symptomatic arthritis (OR = 1.93, 95% Cl = 1.30-2.86 and OR = 2.98, 95% CI = 1.62-5.47, respectively) after controlling for covariates. Both females and males with pain on weight-bearing had greater odds of arthritis than those without pain. At 23-years of follow-up, Mexican American older adults with MetS have an increased risk of arthritis and symptomatic arthritis. Early MetS screening and management may reduce arthritis in this population at high risk of disability.

Cardiovascular disease, depressive symptoms, and heart failure in Mexican American aged 75 years and older during 12 years of follow up

ObjectiveTo examine the relationship of cardiovascular disease (CVD) and high depressive symptoms (HDS) with heart failure (HF) among Mexican American older adults without HF at baseline over 12-years of follow-up. MethodsA 12-year prospective cohort study of 1,018 Mexicans Americans aged 75 and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004–2016). Measures included socio-demographics, CVD (heart attack or stroke), HDS, smoking status, body mass index, cognitive function, and HF. Participants were grouped into: CVD and HDS (n = 11), CVD only (n = 122), HDS only (n = 44), and no CVD or HDS (n = 841). Odds ratio (OR) and 95 % Confidence Interval (CI) of HF over time were estimated using the Generalized Estimating Equation. ResultsParticipants with CVD and HDS and those with HDS only had greater odds (OR=4.70, 95 %CI=1.98–11.2 and OR=3.26, 95 %CI=1.82–5.84, respectively) of HF over time, after controlling for all covariates. No significant association was found between CVD only and HF (OR=1.25, 95 %CI=0.90–1.76). ConclusionMexican American older adults with HDS only or both HDS and CVD were at high risk of HF. Appropriate management of CVD and depressive symptoms may reduce the onset of HF among this population.

Walking Activity and Physical Function Among Mexican American Older Adults Over 9 Years of Follow Up

Background: Walking activity has been associated with reduction in the development of chronic disease, cognitive and physical function impairment, disability, and mortality. The objective of this study was to examine the relationship between walking activity and physical function over 9 years of follow-up among Mexican Americans aged 78 years and older. Methods: Participants (N = 998) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2007–2016). Measures included walking activity duration and frequency, socio-demographics, body mass index, medical conditions, pain, depressive symptoms, limitation in activities of daily living, and the Mini-Mental State Examination. Low physical function was defined as scoring <7 on the Short Physical Performance Battery. At baseline, participants were grouped into nonwalkers (n = 653), walked <150 minutes/week (n = 144), and walked 150 minutes/week or more (n = 201). A Generalized Estimating Equation model was used to estimate the odds ratio and 95% CI of low physical performance as a function of walking activity status. Results: Compared with nonwalkers, participants walking < 150 minutes/week had lower odds (odds ratio = 0.66, 95% CI, 0.51–0.86) of low physical function over time, after controlling for all covariates, as did those walking ≥ 150 minutes/week (odds ratio = 0.54, 95% CI, 0.41–0.71). Conclusions: Mexican American older adults who engage in any walking activity are at reduced risk of low physical function, even those with disability. Interventions at the individual and community level are recommended to reduce physical function impairment, even in those with preexisting medical conditions or disability.

THE EFFECT OF FINANCIAL STRAIN AND LANGUAGE OF INTERVIEW ON DEPRESSIVE SYMPTOMS IN MEXICAN AMERICAN OLDER ADULTS

Abstract We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine the relationship of financial strain and interview language to high depressive symptoms among Mexican Americans aged ≥75 years without history of depressive symptoms at baseline over a 12-year period (2004/05-2016; N=1157). Participants scored < 16 in the Center for Epidemiologic Studies Depression Scale at baseline. Measures included age, marital status, years of formal education, body mass index, social isolation, church attendance, self-reported medical conditions, cognitive and physical function, pain, falls, disability, and hand grip strength. We used a generalized estimating equation model to estimate the odds ratio (OR) and 95% confidence interval (CI) of depressive symptoms as a function of financial strain and interview language over time, adjusting for all covariates. We found that participants experiencing financial strain and interviewed in Spanish had greater odds of experiencing high depressive symptoms (OR=2.48, 95% Cl=1.37-4.48) compared to those who were not experiencing financial strain and selected be interviewed in English. No significant association with depressive symptoms was found in participants with financial strain and interviewed in English or those without financial strain and interviewed in Spanish. In conclusion, Mexican American older adults were at a high risk for high depressive symptoms over time if they were experiencing financial strain and preferred be interviewed in Spanish. Early screening for depression may prevent or delay depressive symptoms for individuals in this population at high risk for depression.

THE ASSOCIATION OF AIR POLLUTION AND CLIMATE FACTORS WITH DEPRESSIVE SYMPTOMS AMONG OLDER MEXICAN AMERICAN ADULTS

Abstract Air pollution, drought, and extreme heat are associated with elevated depressive symptoms. Older Mexican American adults experience high levels of depressive symptoms compared to other demographic groups, but little is known about the role of environmental factors in depressive symptoms for this population. Mexican American adults are resilient to the harmful health effects of socioeconomic disadvantage, but it is unclear if this resilience extends to air pollution and climate change. This study uses data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) linked to air pollution and climate data from the Centers for Disease Control and Prevention, to assess the association of air pollution (PM2.5 and ozone) and climate factors (drought and extreme heat) with elevated depressive symptoms. We used data from the 2005 H-EPESE which includes Mexican American adults aged 75 and older. We used generalized estimation equations to test the association between air pollution and climate factors and depressive symptoms, adjusting for sociodemographic and health characteristics. Our sample (n=1,699) was 62.0% female with a mean age of 81.6 (standard deviation: 5.0). About 19% of participants reported elevated depressive symptoms. PM2.5 concentration was associated with higher odds of depressive symptoms (odds ratio: 1.11; 95% confidence interval: 1.04, 1.19). Ozone concentration, drought, and extreme heat were not associated with depressive symptoms. Our results suggest PM2.5 is a risk factor for elevated depressive symptoms. It is unclear if older Mexican American adults are resilient to the effects of environmental risk factors relative to other demographic groups.

Original Article: Liver disease, heart failure, and 13-year mortality among Mexican American older adults: Nativity differences

PurposeTo examine nativity differences of co-occurring liver disease (LD) and heart failure (HF) on 13-year mortality among Mexican American older adults. MethodsProspective cohort study of 1,601 Mexican Americans aged ≥75 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/05-2016). Participants were grouped into four groups: no LD and no HF (n=1,138), LD only (n=53), HF only (n=382), and both LD and HF (n=28). We used Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of death over time. ResultsThe HR of death, as a function of HF only, was 1.32 (95% CI=1.07-1.62) among US-born and 1.36 (95% CI=1.04-1.78) among foreign-born participants, vs. those with no LD and no HF. Among foreign-born participants, the HR of death as a function of LD and HF was 3.39 (95% CI=1.65-6.93) vs. those without either. LD alone was not associated with mortality in either group. Among US-born, co-occurring LD and HF was not associated with mortality. ConclusionsForeign-born participants with both LD and HF were at higher risk of mortality over 13 years of follow up.

37 Bilingualism does not modify the association between stroke and cognitive performance in Mexican American older adults

Objective:The Latinx population is rapidly aging and growing in the US and is at increased risk for stroke and dementia. We examined whether bilingualism confers cognitive resilience following stroke in a community-based sample of Mexican American (MA) older adults.Participants and Methods:Participants included predominantly urban, non-immigrant MAs aged 65+ from the Brain Attack Surveillance in Corpus Christi- Cognitive study. Participants were recruited using a two-stage area probability sample with door-to-door recruitment until the onset of the COVID-19 pandemic; sampling and recruitment were then completed via telephone. Cognition was assessed with the Montreal Cognitive Assessment (MoCA; 30-item in-person, 22-item via telephone) in English or Spanish. Bilingualism was assessed via a questionnaire and degree of bilingualism was calculated (range 0%-100% bilingual). Stroke history was collected via self-report. We harmonized the 22-item to the 30-item MoCA using published equipercentile equating. We conducted a series of regressions with the harmonized MoCA score as the dependent variable, stroke history and degree of bilingualism as independent variables, and age, sex/gender, education, assessment language, assessment mode (in-person vs. phone), and self-reported vascular risk factors (hypertension, diabetes, heart disease) as covariates. We included a stroke history by bilingualism interaction to examine whether bilingualism modifies the association between stroke history and MoCA performance.Results:Participants included 841 MA older adults (59% women; age M(SE) = 73.5(0.2); 44% less than high school education). Most (77%) of the sample completed the MoCA in English. 93 of 841 participants reported a history of stroke. In an unadjusted model, degree of bilingualism (b = 3.41, p < .0001) and stroke history (b = -1.98, p = .003) were associated with MoCA performance. In a fully adjusted model, stroke history (b = -1.79, p = .0007) but not bilingualism (b = 0.78, p = .21) was associated with MoCA performance. When an interaction term was added to the fully adjusted model, the interaction between stroke history and bilingualism was not significant (b= -0.47, p = .78).Conclusions:Degree of bilingualism does not modify the association between stroke history and MoCA performance in Mexican American older adults. These results should be replicated in samples of validated strokes, more comprehensive bilingualism and cognitive assessments, and in other bilingual populations.

Evaluation of Neighborhood-Level Disadvantage and Cognition in Mexican American and Non-Hispanic White Adults 50 Years and Older in the US

Understanding how socioeconomic factors are associated with cognitive aging is important for addressing health disparities in Alzheimer disease. To examine the association of neighborhood disadvantage with cognition among a multiethnic cohort of older adults. In this cross-sectional study, data were collected between September 1, 2017, and May 31, 2022. Participants were from the Health and Aging Brain Study-Health Disparities, which is a community-based single-center study in the Dallas/Fort Worth area of Texas. A total of 1614 Mexican American and non-Hispanic White adults 50 years and older were included. Neighborhood disadvantage for participants' current residence was measured by the validated Area Deprivation Index (ADI); ADI Texas state deciles were converted to quintiles, with quintile 1 representing the least disadvantaged area and quintile 5 the most disadvantaged area. Covariates included age, sex, and educational level. Performance on cognitive tests assessing memory, language, attention, processing speed, and executive functioning; measures included the Spanish-English Verbal Learning Test (SEVLT) Learning and Delayed Recall subscales; Wechsler Memory Scale, third edition (WMS-III) Digit Span Forward, Digit Span Backward, and Logical Memory 1 and 2 subscales; Trail Making Test (TMT) parts A and B; Digit Symbol Substitution Test (DSST); Letter Fluency; and Animal Naming. Raw scores were used for analyses. Associations between neighborhood disadvantage and neuropsychological performance were examined via demographically adjusted linear regression models stratified by ethnic group. Among 1614 older adults (mean [SD] age, 66.3 [8.7] years; 980 women [60.7%]), 853 were Mexican American (mean [SD] age, 63.9 [7.9] years; 566 women [66.4%]), and 761 were non-Hispanic White (mean [SD] age, 69.1 [8.7] years; 414 women [54.4%]). Older Mexican American adults were more likely to reside in the most disadvantaged areas (ADI quintiles 3-5), with 280 individuals (32.8%) living in ADI quintile 5, whereas a large proportion of older non-Hispanic White adults resided in ADI quintile 1 (296 individuals [38.9%]). Mexican American individuals living in more disadvantaged areas had worse performance than those living in ADI quintile 1 on 7 of 11 cognitive tests, including SEVLT Learning (ADI quintile 5: β = -2.50; 95% CI, -4.46 to -0.54), SEVLT Delayed Recall (eg, ADI quintile 3: β = -1.11; 95% CI, -1.97 to -0.24), WMS-III Digit Span Forward (eg, ADI quintile 4: β = -1.14; 95% CI, -1.60 to -0.67), TMT part A (ADI quintile 5: β = 7.85; 95% CI, 1.28-14.42), TMT part B (eg, ADI quintile 5: β = 31.5; 95% CI, 12.16-51.35), Letter Fluency (ADI quintile 4: β = -2.91; 95% CI, -5.39 to -0.43), and DSST (eg, ADI quintile 5: β = -4.45; 95% CI, -6.77 to -2.14). In contrast, only non-Hispanic White individuals living in ADI quintile 4 had worse performance than those living in ADI quintile 1 on 4 of 11 cognitive tests, including SEVLT Learning (β = -2.35; 95% CI, -4.40 to -0.30), SEVLT Delayed Recall (β = -0.95; 95% CI, -1.73 to -0.17), TMT part B (β = 15.95; 95% CI, 2.47-29.44), and DSST (β = -3.96; 95% CI, -6.49 to -1.43). In this cross-sectional study, aging in a disadvantaged area was associated with worse cognitive functioning, particularly for older Mexican American adults. Future studies examining the implications of exposure to neighborhood disadvantage across the life span will be important for improving cognitive outcomes in diverse populations.

Life-space mobility and post-hospitalization outcomes among older Mexican American Medicare beneficiaries.

Older adults with limited mobility are at an increased risk of adverse health outcomes, an outcome inadequately investigated in older Mexican Americans. We explored whether pre-admission life-space mobility predicts post-hospitalization outcomes among hospitalized Mexican American Medicare beneficiaries. Life-space mobility, using the Life-Space Assessment (LSA), was analyzed using quartiles and 5-point intervals. Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Waves 7 and 8 data linked to Medicare claims data, 426 older Mexican Americans with at least 2 months of Medicare coverage who were hospitalized within 2 years of completing the LSA were included. Logistic and Cox Proportional regression analyses estimated the association of pre-admission LSA with post-hospitalization outcomes. Prior to hospitalization, 85.4% reported limited life-space mobility. Most patients (n=322, 75.6%) were hospitalized for medical reasons. About 65% were discharged to the community. Pre-admission LSA scores were not associated with community discharge (Odds Ratio [OR]=1.02, 0.95-1.10). Higher pre-admission LSA scores were associated with 30-day readmission (OR=1.11, 1.01-1.22). Patients in the highest pre-admission LSA quartile (i.e., greatest life-space mobility) were less likely to die within 2 years after hospital discharge (OR=0.61, 0.39-0.97) compared to those with lower pre-admission LSA scores. Among older Mexican American Medicare beneficiaries, greater pre-admission LSA scores were associated with an increased risk of 30-day readmission and a decreased risk of mortality within 2 years following hospitalization. Future work should further investigate the relationship between LSA and post-hospitalization outcomes in a larger sample of Mexican American older adults.

Hospitalizations and Emergency Room Admissions by Mexican American Older Adults with and without Dementia and Caregiver Mental Health.

Evidence from predominately non-Hispanic White populations indicates that emergency room (ER) admissions and hospitalizations by older adults with and without dementia are associated with caregiver stress and depressive symptoms. These results may not generalize to Hispanic populations because of cultural differences in caregiving roles, responsibilities, and perspectives about care burden. Investigate the association between ER admissions and hospitalizations by Mexican American older adults with and without dementia and symptoms of depression and stress among family caregivers. Data came from the 2010/11 wave of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and Medicare claims files. The final sample included 326 older adults and their caregivers. Negative binomial regression was used to model the association between hospitalizations and ER admissions by older adults in the previous two years and caregivers' depressive symptoms and stress in 2010/11. The number of older adult ER admissions and hospitalizations was not associated with caregiver depressive symptoms. Two or more ER admissions (incident rate ratio [IRR] = 1.26, 95% CI = 1.05-1.51) and two or more hospitalizations (IRR = 1.32, 95% CI = 1.07-1.61) were associated with significantly higher caregiver stress. Additionally, ER admissions and hospitalizations for a circulatory disease or injury and poisoning were associated with significantly higher caregiver stress. These associations were not modified by the care recipient's dementia status. Hospitalizations and ER admissions by older Mexican Americans were associated with greater caregiver stress but not depressive symptoms. These associations were similar for caregivers to older adults with and without dementia.

Vision Impairment and Falls among Older Mexican Americans

<h3>Research Objectives</h3> Objective: To examine vision impairment (VI) as predictor of falls among Mexican American older adults over time. <h3>Design</h3> Longitudinal survey of 16 years follow-up. <h3>Setting</h3> Community-dwelling setting. <h3>Participants</h3> 1,219 non-institutionalized Mexican Americans aged 70 years and older from the Hispanic Established Population Epidemiologic Study of the Elderly (2000-2016) residing in Arizona, California, Colorado, New Mexico, and Texas. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Main Outcome Measure: Falls were assessed with the following question: "During the past 12 months, how many times did you fall and land on the floor or ground?". Fall status was categorized as having no falls and having one or more falls. Covariates included socio-demographics, comorbidities, body mass index, Mini Mental State Exam (MMSE), depressive symptoms, smoking status, and hearing impairment. Self-reported VI was defined as difficulty in recognizing a friend across at arm's length's away the street, across the room, or across the street. General estimating equation models were performed to estimate the odds ratios of falls over time as a function of self-reported VI. <h3>Results</h3> Participants with falls ≥ 1 compared to those with no falls at baseline were significantly more likely to report VI (20.92% vs. 10.22%), be older (mean 79.14 ± SD 5.85 vs. mean 78.46 SD ± 4.77), female (68.46% vs. 56.64%), not married (56.52% vs. 46.89%), indicated living alone versus with family (79.57% vs. 24.56%), have decreased MMSE score (mean 21.88 ± SD 5.50 vs. mean 22.79 ± SD 5.13), high depressive symptoms (15.22% vs. 8.23%), and reported more comorbidities. Over time participants with VI had greater odds ratio of falls (OR=1.45, CI=1.00-2.10) than those without VI after controlling for all covariates. <h3>Conclusions</h3> Prevalence of vision impairment was high among older Mexican Americans who reported falls in the last 12 months. Addressing vision health disparities by health care providers will help reduce falls and increase health. <h3>Author(s) Disclosures</h3> None.

The association between bilingual semantic fluency and episodic memory among bilingual Mexican American older adults.

AbstractBackgroundBilingualism is increasingly common in older adults in the US and may impact the expression and course of Alzheimer’s Disease and related dementias (ADRD). Optimal methods for assessing cognition in population‐based studies of bilingual older adults are not established. Given that declines in semantic fluency are associated with declines in episodic memory in ADRD, we examined the degree to which animal naming in English and Spanish is associated with memory performance in a sample of bilingual Mexican American (MA) older adults.MethodThe Brain Attack Surveillance in Corpus Christi‐Cognitive study is a population‐based study of cognition in MA and non‐Hispanic white adults 65+ in south Texas. We included US‐born, bilingual MA participants who completed in‐person neuropsychological assessment in their preferred language (English) with the Harmonized Cognitive Assessment Protocol. We added a Spanish animal naming trial to the standard animal naming trial in English. We used the delayed recall score from a word list as the indicator of memory performance. We performed a series of regression analyses with delayed recall as the dependent variable and the English and Spanish animal naming scores as the independent variables, with age, sex, years of education, and a self‐reported bilingualism index score to account for level of bilingualism (range 0–1; 0 indicates monolingual Spanish; 1 indicates monolingual English) as covariates.ResultNinety‐six participants were included (Mage = 73yrs±6; Meducation = 11±4; 60% women; Table 1). In separate regression models including covariates, English animal naming (b = 0.25, p&lt;.0001) and Spanish animal naming (b = 0.20, p &lt;.05) were each associated with delayed recall. When considered together, English animal naming (b = 0.24, p = &lt;.0001) and not Spanish animal naming (b = 0.03, p = .69) was associated with delayed recall, after accounting for age, sex, years of education, and level of bilingualism (Table 2). Results were consistent when the analysis was restricted to balanced bilinguals (Table 3).ConclusionSemantic fluency in English and Spanish were each related to episodic memory among bilingual MA older adults assessed in English, although the Spanish trial did not add unique information in its association with episodic memory. Future studies should evaluate how bilingual semantic fluency is associated with longitudinal cognitive decline in ADRD.

Body mass index and physical frailty among older Mexican Americans: Findings from an 18-year follow up.

The relationship between body mass index (BMI) and frailty in older Mexican Americans has not been previously studied. The objective of this study was to examine the relationship between BMI and frailty among non-frail older Mexican Americans at baseline over 18 years of follow up. Longitudinal population-based study of 1,648 non-institutionalized Mexican Americans aged ≥ 67 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13). Frailty phenotype 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. BMI (kg/m2) was classified as underweight (<18.5), normal weight (18.5-<25), overweight (25-< 30), obesity category I (30-<35), and obesity category II/morbid obesity (≥35). Covariates included socio-demographics, comorbidities, cognitive function, and depressive symptoms. Generalized Estimating Equation models were performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of frailty as a function of BMI category. Participants with underweight or obesity category II/ morbid obesity had greater odds of frailty over time compared to those with normal weight (OR = 2.39, 95% CI = 1.29-4.44 and OR = 1.62, 95% CI = 1.07-2.44, respectively) after controlling for all covariates. Participants with BMIs in the overweight or category I obesity were at lower odds of frailty over time. Mexican American older adults with BMIs in the underweight or obesity category II/morbid obesity were at higher odds of frailty over time. This indicates that maintaining a healthy weight in this population may prevent future frailty.

Pain, obesity, and physical function in Mexican American older adults during 20 years of follow-up.

Pain remains largely undertreated in older adults irrespective of health care setting. Mexican American adults in the United States have a high age-adjusted prevalence of obesity. However, the association of pain and obesity with physical function is understudied in this population. To examine the association of co-occurring pain and obesity with physical function over 20 years of follow-up in a cohort of older Mexican Americans who scored ≥7 (moderate to high) in the Short Physical Performance Battery (SPPB) test and were nondisabled at baseline. Longitudinal population-based study. Community-dwelling older adults from Southwestern United States. Mexican American adults age 65 years and older. Not Applicable. Physical function was assessed with the SPPB test (standing balance, timed 8-ft walk, and five repeated timed chair stands). Participants at baseline were divided into four groups: no pain-no obesity (n= 869), obesity only (n= 282), pain only (n= 216), and pain-obesity (n= 159). Generalized Estimating Equation models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of lower performance in physical function over 20 years as a function of pain-obesity grouping. Participants with pain only (OR=1.61, 95% CI=1.34-1.95) and with co-occurring pain and obesity (OR=2.32, 95% CI=1.83-2.95) had significantly greater odds of physical function impairment over those with no pain-no obesity or obesity only, after controlling for all covariates. Older Mexican American adults were at high risk for physical function impairment over time if they had pain or co-occurring pain and obesity. Early assessment and proper pain management as well as maintaining a healthy weight may reduce declines in physical function in older Mexican American adults.

Vision Impairment and Frailty among Older Mexican Americans: Findings from the Hispanic Established Population Epidemiologic Study of the Elderly

<h3>Research Objectives</h3> To examine distant vision impairment (DVI) as predictor of frailty among non-frail Mexican American older adults overtime. <h3>Design</h3> Longitudinal survey of 14 years follow-up. <h3>Setting</h3> Community setting. <h3>Participants</h3> 1,100 non-institutionalized Mexican Americans aged 70 years and older from the Hispanic Established Population Epidemiologic Study of the Elderly (1998-2013) residing in Arizona, California, Colorado, New Mexico, and Texas. At the end of follow-up, 292 participants were re-interviewed in person, 119 were lost to follow-up, and 689 were confirmed dead through the National Death Index and report from relatives. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> 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. Covariates included socio-demographics, comorbidities, body mass index, and depressive symptoms. Self-reported DVI was defined as difficulty in recognizing a friend across the street or across the room. General estimating equation models were performed to estimate the odds ratios of the frailty over time as a function of self-reported DVI. <h3>Results</h3> Non-frail participants with DVI at baseline were more likely to be older (mean 78.63 ± SD 5.85), have decreased MMSE score (mean 20.80 ± SD 4.97), and reported more comorbidities than those without DVI. Over time participants with DVI had increased odds ratio of frailty (OR=2.05, CI=1.36-3.09) than those without DVI after controlling for all covariates. <h3>Conclusions</h3> This study fills a research gap that currently exists with DVI and frailty among Older Mexican Americans. Knowledge gained from this study will increase awareness among policy makers and health care providers related to vision health disparities. <h3>Author(s) Disclosures</h3> None.

Improving Diabetes Education in Mexican American Older Adults.

Lack of culturally sensitive, age-specific diabetes education in Mexican American older aged people may contribute to deficits in diabetes knowledge, self-management, and glycemic control. This quality improvement initiative applied evidence-based, culturally competent, age-specific education to improve health outcomes. A one-group, pretest/posttest design guided this project in a primary care community clinic. Mexican American adults >60 years, with type 2 diabetes mellitus (T2DM; N = 12) received 3 months of biweekly innovative classes including: healthy Mexican foods; family involvement; Spanish interpreter using simultaneous earphone technology; and interactive, bilingual, large-print materials. Paired sample t tests compared diabetes knowledge, self-management, and A1C levels. There was a significant improvement in preeducation and posteducation outcomes: knowledge, t(11) = -7.969, p = .000; d = 2.32, self-management, t(11) = -7.930, p = .000; d = 2.43, and A1C levels, t(11) = 6.434, p = .000; d = 0.78. Culturally competent, language-friendly innovation, age-specific T2DM education can positively impact knowledge, self-management behaviors, and glycemic values in older aged Mexican American people.

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

Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status 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 ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. 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. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14–0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.

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.