Mexican Health And Aging Study Research Articles

Internet use and frailty in middle-aged and older adults: findings from developed and developing countries

BackgroundWith increasing trend of internet use in all age groups, whether internet use can prevent frailty in middle-aged and older adults remains unclear.MethodsFive cohorts, including Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), the Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Aging (ELSA), and Mexican Health and Aging Study (MHAS), were used in this study. Internet use, social isolation, and frailty status was assessed using similar questions. The Generalized estimating equations models, random effects meta-analysis, COX regression, and mediation analysis were utilized.ResultsIn the multicohort study, a total of 155,695 participants were included in main analysis. The proportion of internet use was varied across countries, ranging from 5.56% in China (CHARLS) to 83.46% in Denmark (SHARE). According to the generalized estimating equations models and meta-analysis, internet use was inversely associated with frailty, with the pooled ORs (95%CIs) of 0.72 (0.67,0.79). The COX regression also showed that participants with internet use had a lower risk of frailty incidence. Additionally, the association was partially mediated by social isolation and slightly pronounced in participants aged 65 and over, male, not working for payment, not married or partnered, not smoking, drinking, and not co-residence with children.ConclusionsOur findings highlight the important role of internet use in preventing frailty and recommend more engagements in social communication and activities to avoid social isolation among middle-aged and older adults.

Long-term inequalities in health among older Mexican adults: An outcome-wide analysis

The relationship between socioeconomic level and health outcomes in older people has been widely studied, but less information about health inequalities associated with gender and place of residence exists. Also, there is scarce evidence of longitudinal inequalities, particularly in countries from the global south. This study aimed to describe the longitudinal patterns of health inequalities associated with wealth, gender, and residence area among older Mexican adults. We used data from two longitudinal studies in Mexico: The Study on Global AGEing and Adult Health (SAGE) and the Mexican Health and Aging Study (MHAS). Three domains to characterize health inequities were used: wealth, gender, and rurality. We conducted an outcome-wide analysis with nine health indicators assessing older adults' physical and cognitive function. The Slope Index of Inequality and the Relative Index of Inequality were used as inequality measurements. Our results indicate that the greatest inequalities are observed in relation to wealth and gender. Older adults with lower socioeconomic status demonstrated higher rates of depression, sarcopenia, falls, and limitations in both basic and instrumental activities of daily living compared to their wealthier counterparts, with increasing trends in physical functionality over time. Furthermore, women experienced higher rates of depression, sarcopenia, frailty, and physical limitations compared to men. The only significant difference related to rurality was a lower rate of frailty among rural older adults. Longitudinal trajectories revealed an increase in the gap of inequality for various health indicators, especially in terms of wealth and gender. Health inequalities in old age are one of the greatest challenges facing health systems globally. Actions like universal coverage of health services for older people and the empowerment of individuals and their communities to have control over their lives and circumstances must be guaranteed.

Brain health index as a predictor of possible vascular dementia in the Mexican health and aging study 2012-2015.

To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012-2015. The MHAS is a longitudinal study of adults aged ≥ 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in ≥1 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 ±13.2 years, 35.8% were female, and the mean educational level was 5.8 ±5.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63-1.64, p< 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.

Diabetes, life course and childhood socioeconomic conditions: an empirical assessment for Mexico

BackgroundDemographic and epidemiological dynamics characterized by lower fertility rates and longer life expectancy, as well as higher prevalence of non-communicable diseases such as diabetes, represent important challenges for policy makers around the World. We investigate the risk factors that influence the diagnosis of diabetes in the Mexican population aged 50 years and over, including childhood poverty.ResultsThis work employs a probabilistic regression model with information from the Mexican Health and Aging Study (MHAS) of 2012 and 2018. Our results are consistent with the existing literature and should raise strong concerns. The findings suggest that risk factors that favor the diagnosis of diabetes in adulthood are: age, family antecedents of diabetes, obesity, and socioeconomic conditions during both adulthood and childhood.ConclusionsPoverty conditions before the age 10, with inter-temporal poverty implications, are associated with a higher probability of being diagnosed with diabetes when older and pose extraordinary policy challenges.

Health, dependency and caregiving: barriers to economic activity among individuals aged 50 to 69 years in Mexico.

In Mexico, the economically active population aged over 50 years has been increasing in recent years. Due to their age, these workers may experience health deterioration and require some form of care. However, only formal employment is associated with better access to health services and pensions. At the same time, these workers may also need to care for children, sick partners or dependent older adults, which limits their time available for employment. This study examined the association between disability, receiving and providing care and access to health services, and economic activity among adults aged 50 to 69 in Mexico in 2015 and 2018. Multilevel modeling was conducted using data from the Mexican Health and Aging Study (MHAS). The MHAS is a longitudinal panel study of adults aged 50 years and older. The study sample included data from 8,831 observations from 2015 and 10,445 observations from 2018. Those living with some degree of disability and receiving care were found to be less likely to be economically active than those living with disability and not receiving care. Similarly, individuals who care for someone were also found to be less likely to be employed. Furthermore, the data suggested that individuals without access to health services were more likely to be economically active. For individuals aged 50 to 69 years, health and care issues were factors that limited economic activity status. In family-oriented societies with weak welfare states, the right to health is partial for the population and care is traditionally the responsibility of women, which exacerbates gender inequalities and has a differential impact on paid work for men and women.

A CROSS-NATIONAL COMPARISON OF RISK FACTORS ASSOCIATED WITH THE MOTORIC COGNITIVE RISK (MCR) SYNDROME

Abstract The Motoric Cognitive Risk (MCR) syndrome predicts risk of Alzheimer’s disease and vascular dementia. Cross-national comparisons of risk factors for MCR are important for identifying region-specific factors to design regionally tailored preventive interventions. We examined risk factors associated with MCR in 20,468 adults aged ≥65 years from the U.S Health and Retirement Study (HRS), English Longitudinal Study of Ageing (ELSA), Mexican Health and Aging Study (MHAS), China Health and Retirement Study (CHARLES), Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD), Survey of Health, Ageing and Retirement in Europe (SHARE) and Brazilian Longitudinal Study of Aging (ELSI-Brazil). MCR was defined as the presence of cognitive complaints and slow gait with no mobility disability and dementia. Associations between demographic [sex, education], medical [hypertension, diabetes, Parkinson’s, heart disease, stroke, obesity, depression, multiple falls], sensorimotor [grip strength, hearing] and behavioral factors [smoking, sedentariness, sleep quality], and prevalent MCR were examined using logistic models. Despite some overlap, cohort-specific risk factors for MCR were identified with relative risk ratios ranging as: 0.4-2.8 for education and multiple falls in HRS, 2.3-7.4 for poor hearing and sedentariness in ELSA, 2.3-2.6 for poor grip and diabetes in MHAS, 1.9-2.2 for depression and sedentariness in CHARLES, 0.5-5.3 for education and stroke in LASI-DAD, 0.3-2.4 for education and depression in SHARE and 2.4-4.0 for multiple falls and stroke in ELSI-Brazil. In this cross-sectional, cross-national comparison of 21 countries, MCR associated risk factors were region-specific, laying the foundation for tailored interventions to prevent MCR and subsequently dementia.

INTIMATE RELATIONSHIPS, SOCIAL ISOLATION, AND COGNITION

Abstract This symposium considers the cognitive impacts of a spectrum of social relationships, including both intimate partnerships and, in contrast, social isolation. Drawing on rich data from the Wisconsin Longitudinal Study (WLS), the Health and Retirement Study (HRS), the National Social Life, Health, and Aging Project (NSHAP), and the Mexican Health and Aging Study (MHAS), the papers showcase empirical linkages between older adults’ cognitive health with a set of exposures including marital status and relationship characteristics, social activities, and a lack of social connections. We begin with papers that examine the impact of particular marital relationship attributes and social behaviors on cognition and health. One paper employs the WLS to explore the impact of concordance and discordance in marital couples’ reports of similarity with and closeness to their spouse on cognition, while the second draws on NSHAP to consider the cognitive consequences of various domains of couples’ sexuality. The third paper uses the HRS to examine couples’ co-trajectories of physical, mental, and cognitive health, focusing particularly on how a spouse’s cognitive decline influences the other partner’s subsequent health trajectory. The fourth paper shifts our attention to variation by marital status in the cognitive impacts of leisure activities via data from MHAS, while the fifth focuses specifically socially-isolated older adults in the HRS and highlights variation in the relationship between social isolation and dementia by race and ethnicity. The symposium will conclude with a discussion of future directions for research on the cognitive consequences of relationships, social connections, and social isolation.

RURAL–URBAN DISPARITIES IN COGNITIVE PERFORMANCE IN BRAZIL AND MEXICO

Abstract Latin America (LA) has the highest dementia burden globally among people 60 years or older, with a prevalence of 8.5%. However, there is little evidence of the disparities in cognitive performance in rural and urban areas in LA. We use nationally representative data from the two largest countries in LA, Brazil and Mexico, to assess if rurality is associated with cognitive impairment, and assess how education and country modify this relationship. The sample included 9,412 participants from the Brazilian Longitudinal Study of Aging (ELSI) and 14,779 participants from the Mexican Health and Aging Study (MHAS). Participants were classified as cognitively impaired or not impaired using cognitive performance scores and a regression-based approach. Logistic regression models were used to estimate the association between rural/urban residency and cognitive function. The modifying effect of education and country was investigated by adding an interaction term in the fully adjusted model. ELSI participants had a mean age 62.5±9.8 years, 54% were women, 13.3% were illiterate, and 6% had cognitive impairment. MHAS participants from had a mean age 64.8±9.7 years, 55% were women, 18% were illiterate, and 5% were cognitively impaired. In Mexico, those living in rural areas were more likely to have cognitive impairment than those in urban areas (OR=1.43, 95%CI=1.20;1.71), but this difference was not seen in Brazil (OR=1.10, 95%CI=0.87;1.36). The three-way interaction of rurality with country and education showed that rural residents of Mexico had lower odds of cognitive impairment compared to rural residents of Brazil with the same level of education (p&amp;lt;0.001).

GENDER DIFFERENCES IN INFORMANT REPORTS OF COGNITIVE FUNCTIONING IN MEXICO AND THE US

Abstract Background Increasingly, researchers are attempting to measure cognitive functioning in large population-based surveys using both direct measurement and informant reports, but little work examines how gender affects measurements. For example, the role of gender in the division of labor is different in the U.S. and Mexico so questions relating to household chores will overestimate functional impairment in Mexico relative to the U.S. Method: Data from the U.S. Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) will be used to examine disparities in how informants report cognitive change, measured by the total Community Screening Instrument for Dementia (CSI′D’) score, are related to gender of participants and informants. Result: Female participants in Mexico have higher CSID scores than men but not in the U.S. Conversely, female informants report higher CSID scores than male informants in the U.S. but not in Mexico. Conclusion Further analysis is needed to determine if national differences in the association of gender and reports of cognitive impairment are due to differences in how informants report impairment.

THE DUAL IMPACT OF EDUCATION AND OCCUPATION ON COGNITIVE FUNCTIONING IN OLDER MEXICAN ADULTS

Abstract Our research investigates the relationships among educational attainment, occupational mental demands, and cognitive functioning in Mexican adults aged 50 and older. We expand on prior studies demonstrating education’s link to cognitive function by examining how the complexity of one’s primary occupation also influences cognitive health. We hypothesize that cognitively demanding work, irrespective of education level, correlates positively with enhanced cognitive performance. Furthermore, we propose an additive effect, wherein high occupational mental demands amplify cognitive functioning beyond education’s influence. Our study uses data from 12,939 participants in the 2012 Mexican Health and Aging Study (MHAS) linked to an occupational database (Occupational Information Network O*NET). Employing generalized linear models to predict a summary cognition score, the findings unveil compelling insights. Both mental processes (β=0.17) and cognitive abilities (β=0.16) required in participants’ main occupations demonstrate positive correlations with cognitive scores (p&amp;lt;.01). Education emerges as a predictor of cognitive performance and had a stronger relationship with cognitive functioning compared to occupational mental demands (β=0.79, p&amp;lt;.01), highlighting the long-lasting effects of education in cognition emphasizing its role in shaping cognitive abilities throughout life. Adjusting for demographic and health factors reaffirms these associations. Moreover, our research introduces an innovative approach by creating an additive score for education and occupational mental demands. Our results reveal that the combined impact of education and mental demands is associated with higher cognitive scores (β=0.97, p&amp;lt;.01). In conclusion, our study presents a novel perspective by demonstrating that a combination of education and occupational mental demands may yield amplified cognitive benefits.

HEALTH AND AGING AMONG LATIN AMERICAN OLDER ADULTS: FINDINGS FROM STUDIES IN BRAZIL, CHILE, COLOMBIA, AND MEXICO

Abstract Aging in Latin America is occurring rapidly, in a context of high levels of poverty, low education and limited knowledge on the health conditions of older adults. This symposium is focused on heath-disparities found in some of Latin America’s largest middle-income countries, Mexico, Brazil, Chile, and Colombia. The symposium explores various health-related topics associated with aging, that may have significant implications for longevity, overall health, and disease risk. The papers in this symposium examine a variety of health-related dimensions and disparities among older Latinos that include major chronic health conditions, such as diabetes, hypertension, cardiovascular diseases and cognition. Using data from the Brazilian Longitudinal Study of Aging, Farina examines the relationship between childhood conditions and older adult health. Using the Mexican Health and Aging Study (MHAS) and the Health and Retirement study (HRS), Cantu compares cognitive measures and their association with gender in Mexico and the US. Using mortality data, Sandoval studies how healthy life expectancy varies among the largest indigenous group in Chile compared to non-indigenous populations. Lastly, Osuna uses data from the Colombian Survey of Health, Well-Being, and Aging to examine how diseased life expectancy varies from self-reported data compared to measured data among older Colombians. Results underline what populations in Latin American have increased risk of experiencing poorer health outcomes and disparities that may exist. The findings highlight the importance of understanding the conditions under which Latin American older adults are aging and the implications this can have in the future.

The association of English‐Spanish and Indigenous‐Spanish bilingualism with cognition among older adults in the Mexican Health and Aging Study (MHAS)

AbstractBackgroundWhile several studies have reported a “bilingual advantage” in cognition among older adults, others have not. Most studies of bilingualism and cognitive aging are in urban settings among high income countries, limiting the generalizability among bilinguals residing in lower‐and middle‐income countries, such as Mexico. Additionally, the association of bilingualism and cognition among indigenous populations is unknown. In Mexico, there are almost 7 million speakers of indigenous languages, residing primarily in rural areas, and over 15 million people that report speaking English, predominantly in urban settings. To account for sociocultural factors confounding the type of bilingualism (i.e., English‐Spanish, Indigenous‐Spanish), we evaluated whether bilingualism was associated with better cognitive functioning among adults across urban and rural regions in Mexico.MethodAnalyses included participants from the Mexican Health and Aging Study (MHAS) aged 55 and older in urban (N = 1053, 12% Spanish‐English bilinguals) and rural (N = 814, 20% Spanish‐Indigenous bilinguals) areas. Participants reported speaking English and/or an indigenous language in addition to Spanish. Participants completed comprehensive cognitive testing assessing memory, language, executive function, and visuospatial domains. General linear models stratified by region evaluated bilingualism on cognitive domain performance covarying for sociodemographic factors.ResultSociodemographic characteristics differed by region and language group. English‐Spanish bilinguals in urban areas were younger, predominantly men, with higher education, less likely illiterate, and with greater U.S. migration history compared to monolinguals. In rural areas, Indigenous‐Spanish bilinguals were younger, with less education, higher prevalence of illiteracy, and less likely to have U.S. migration history compared to monolinguals. In urban settings, English‐Spanish bilingualism was not associated with performance on any cognitive domain (p&gt;0.05). In rural settings, Indigenous‐Spanish bilingualism was associated with worse performance across all cognitive domains (p&lt;0.01).ConclusionThere was no evidence of a bilingual cognitive advantage among older adults residing in urban and rural regions in Mexico. While indigenous bilinguals demonstrated the lowest cognitive test performance, further work is required to understand the socioeconomic and environmental factors associated with bilingualism among indigenous populations in Mexico. Greater characterization of their bilingualism (i.e., age and context of acquisition, proficiency, frequency of use) across all languages can help elucidate the association between bilingualism and cognitive test performance.

Education and cognitive function among older adults in Brazil and Mexico

AbstractBackgroundEducation is a protective factor against cognitive impairment. Research on education and cognitive function has focused on high‐income countries, where education is higher. Thus, it is important to investigate this association in a context of lower education levels, such as the one in middle‐income countries. We use nationally representative data from the two largest countries in Latin America, Mexico and Brazil, to assess the benefits of education for cognitive function, and assess how sex and country modify this relationship.MethodsThe sample included adults 50 years or older from the 2015 waves of the Brazilian Longitudinal Study of Aging (ELSI) (n = 9,412) and the Mexican Health and Aging Study (MHAS) (n = 14,779). Participants were classified as cognitively impaired or not impaired using cognitive performance scores and a regression‐based approach. Education was categorized as 0, 1‐4, 5‐8, or &gt;8 years of education. We used logistic regression models to estimate the association of education with cognitive function adjusted for sociodemographic variables, chronic diseases, and health behaviors. We also investigated the modifying effec of sex and country by adding an interaction term in the fully adjusted model.ResultsParticipants of the ELSI had mean age 62.5±9.8 years, 54% were women, 13.3% had no formal education, and 6% were categorized as cognitively impaired. Participants of the MHAS had mean age 64.8±9.7 years, 55% were women, 18% had no formal education, and 5% were categorized as cognitively impaired (Table 1). Individuals with at least one year of education were less likely to have cognitive impairment than those with no formal education in both countries, with the highest reduction in the &gt;8 years category, followed by the 1‐4 and the 5‐8 education categories (Table 2). We found a three‐way interaction effect of education with country and sex (p&lt;0.001). Men in the MHAS had lower odds of cognitive impairment than men in the ELSI at all levels of education, but there was no difference for women (Figure 1).ConclusionHigher educational level was associated with lower odds of cognitive impairment in both countries. Men in Brazil had higher odds for cognitive impairment compared with men in Mexico.

Association of APOE with Alzheimer’s disease in Mexico, Caribbean‐Hispanics, Peruvian and Mexican Americans

AbstractBackgroundThe Apolipoprotein E (APOE) ε4 allele is the strongest genetic risk factor for Late Onset Alzheimer’s disease (LOAD). However, its genetic effect is heterogeneous across different ethnicities. We investigated the association of APOE with LOAD in five different Hispanic studies: Mexicans in the Mexican Health and Aging Study (MHAS), Caribbean Hispanics in the Washington Heights Inwood Aging project (WHICAP), Peruvians in the Genetics of Alzheimer’s disease In Peruvian Populations (GAPP) and Mexican Americans from The Health &amp; Aging Brain among Latino Elders (HABLE) and the Texas Alzheimer’s Research and Care Consortium (TARCC).MethodA total of 7,832 participants were included in the analysis. APOE genotypes were generated by direct genotyping or imputation. SNPs associations with LOAD were assessed using multivariate logistic regression models in PLINK. Analyses were adjusted for age (≥60 years old), sex, and education. Global ancestry proportions, Native Americans, European, African were estimated with ADMIXTURE software using the Human Genome Diversity Project as the reference panel. Genetic ancestry specific secondary analyses were conducted using the same models.ResultThe genetic ancestral composition was significantly different across cohorts. Peruvians and Mexicans showed a predominant native ancestry, Caribbean‐Hispanics appeared to have a major contribution of European ancestry, and Mexican Americans exhibited similar proportions of both European and Native ancestries. We observed a significant association with e4 allele dosage in all the cohorts, except for MHAS. The genetic effect of at least one copy of the e4 allele on LOAD risk was very similar in GAPP and HABLE (OR = 3.42, SE = 0.39 and OR = 3.33, SE = 0.33, respectively), while attenuated in TARCC (OR = 2.81, SE = 0.28) and WHICAP (OR = 1.82, SE = 0.16). Among MHAS participants with a predominant European ancestry, APOE association achieved statistical significance with an increased disease risk (OR = 3.42, SE = 0.55) for homozygous carriers. Within the native‐prevalent ancestry subsample, the increased LOAD risk among APOE_ e4 heterozygous carriers were similar in both GAPP and HABLE cohorts (OR = 3.61, SE = 0.44 and OR = 3.64, SE = 0.43, respectively).ConclusionOur results showed a differential risk for LOAD from the APOE_ e4 allele across populations with admixed genetic ancestry.

Food Insecurity and Executive Function among Older Mexican Adults: Indirect Effects through Depressive Symptoms

AbstractBackgroundRecent work has linked food insecurity with worse cognitive outcomes, with executive function being a domain affected most consistently. The mechanisms underlying this association are largely unknown and few have investigated how changes in food insecurity over time (never food insecure, newly food insecure, formerly food insecure, or chronically food insecure) relate with cognitive outcomes. Food insecurity is also related with worsening depressive symptoms, which may impact executive function. This study evaluates how changes in food insecurity in late‐life relate with executive function, and whether this association is mediated by depressive symptoms among older adults in Mexico.MethodData includes the 2012‐2015 Mexican Health and Aging Study (MHAS) and 2016 Mex‐Cog subsample of the MHAS (n = 1,581 age 55+). Food insecurity was classified as never food insecure (not food insecure in 2012 or 2015), newly food insecure (food insecure in 2015 but not 2012), formerly food insecure (food insecure in 2012 but not 2015), or chronically food insecure (food insecure in 2012 and 2015). Executive function and depressive symptoms (CES‐D) were obtained from the Mex‐Cog. Direct/indirect (through depression) effects of food insecurity were tested using structural equation modeling with bootstrap confidence intervals controlling for demographic and socioeconomic confounders.ResultApproximately half of the sample were never food insecure, 16% were newly food insecure, 15% were chronically food insecure, and 18% were formerly food insecure. SEM results indicated partial mediation. Significant direct effects were observed, with chronic and former food insecurity related with 0.12 and 0.11 standard deviations lower executive function, respectively, compared to the never food insecure. Both chronic and former food insecurity exhibited significant indirect effects via depressive symptoms with indirect effects making up 21% and 15% of the total effects of chronic and former food insecurity on executive function.ConclusionFood insecurity may represent an important modifiable risk factor for poorer executive function outcomes. Although food insecurity had a direct impact on executive function, part of its detrimental effect was through worsening depressive symptoms. This study highlights the importance of considering experiences of food insecurity over time and the co‐existence of both food insecurity and depressive symptoms.

Return Migration and Disability by Life Course Stage of Return: Evidence Against the Salmon Bias.

Life course theory points to unique characteristics among older immigrants that may differentiate older age return migration from return at younger ages in terms of health. To investigate how the health of returnees may differ by age-at-return, this analysis compares disability between 3 groups of Mexican adults with a history of migration to the United States: those who return to Mexico before age 50, those who return at 50 and older, and those who remain in the United States at age 50 and older. Data from two nationally representative data sets, the U.S. Health and Retirement Study and the Mexican Health and Aging Study, are combined to create a data set representing Mexicans 50 and older with a history of migration to the United States. Adopting a life course perspective, activity of daily living (ADL) difficulty is compared by return status and age-at-return to account for differential selection into return by life stage. Mexican immigrants who remain in the United States past age 50 have a higher probability of at least 1 ADL compared to those who return to Mexico, regardless of life course timing of return. The immigrant disadvantage persists after adjusting for differences in demographic, childhood, and adult characteristics between groups. These findings are noteworthy because they stand in opposition to hypotheses based on life course and health-selective return migration theories and because they mean that Mexican immigrants remaining in the United States into midlife and older adulthood may be vulnerable to heightened prevalence of disability.

3 Harmonized Memory and Language Function in the Harmonized Cognitive Assessment Protocol (HCAP) Across the United States and Mexico

Objective:Cross-national neuropsychological research is needed to understand the social, economic, and cultural factors associated with cognitive risk and resilience across global aging populations. Memory and language have been shown to be sensitive to age-related cognitive decline and pathological cognitive aging processes and may be more sensitive to subtle cognitive decline than measures of global cognitive function. Thus, we aimed to derive and validate harmonized cognitive domain scores for memory and language across population-based studies in the US and Mexico.Participants and Methods:Data came from the Health and Retirement Study (HRS) Harmonized Cognitive Assessment Protocol (HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We used confirmatory factor analysis methodology to create statistically co-calibrated cognitive domains of memory and language. We performed differential item functioning (DIF) analysis to evaluate measurement differences across studies, using a cultural neuropsychological approach to identify comparable items across studies (i.e., cross-study anchors). We evaluated harmonized scores by examining their relationship to age and education in each study.Results:We included 3347 participants from the HRS-HCAP study [Mage=76.6(7.5), 60% female] and 2042 participants from the Mex-Cog study [Mage=68.1(9.0), 59% female]. Education was classified according to the International Standard Classification of Education in the following categories (HRS-HCAP and Mex-Cog, respectively): none or early childhood education: (0.7%; 50.5%), primary education (4.1%; 22.3%), lower secondary education (7.1%; 15.7%), upper secondary education (41.1%; 3.0%), and any college (47.1%; 8.5%). DIF analyses revealed that 5 out of the 7 memory items and 1 out of the 12 language items demonstrated statistical evidence of measurement differences across studies, meaning that these items measured each underlying cognitive construct differently across studies. After adjusting for DIF by not allowing the items with DIF to be cross-study anchors, harmonized memory and language scores showed generally the expected associations with age and education in each study. Increasing age was associated with lower memory (r=-0.40 in HRS-HCAP; r=-0.44 in Mex-Cog) and language (r=-0.31 in HRS-HCAP and r=-0.67 in Mex-Cog) scores. Increasing years of education was associated with better memory and language scores, with mean scores ranging from z=-0.86 and z=-0.29 among those with a primary education or lower to z=0.33 and z=0.90 among those with any college, for HRS-HCAP and Mex-Cog, respectively.Conclusions:A cultural neuropsychology approach to statistical harmonization facilitates the generation of harmonized measures of cognitive functioning in cross-national studies. Future work can utilize these harmonized cognitive scores to investigate determinants of late-life cognitive decline and dementia in the US and Mexico.

On the comparability of frailty scores under the accumulation of deficits approach.

While the cumulative deficit model is arguably the most popular instrument for population-level frailty screening, several questions remain unanswered regarding the comparability of the resulting scores across subpopulations. Based on data from the five waves of the Mexican Health and Aging Study (MHAS) we draw upon the alignment method to test for measurement invariance of frailty scores as per the accumulation of deficits approach. Our results show that adjusting for measurement non-invariance not only improves predictive validity of our frailty measures, but resulting scores are more consistent with what is theoretically expected from them in longitudinal research. There are clear potential benefits of measurement invariance testing as a general analytical framework from which to tackle with issues of comparability in frailty research.

Assigning lifetime occupation domains for older Mexicans: MHAS-O*NET linkage protocol.

We developed a MHAS (Mexican Health and Aging Study) and O*NET (Occupational Information Network) linkage to allow global researchers using MHAS data to assign lifetime occupation domains for older Mexicans. Three bilingual raters independently matched 440 records with 132 unique occupation codes from the 2012 MHAS. We used a modified Delphi technique to reach agreements. To assess reliability, we compared the distribution of observations between the MHAS file and the MHAS-O*NET linked file across five job categories (upper white collar, lower white collar, upper blue collar, low blue collar, and agriculture/fishing/forestry). The Institutional Review Board at the University of Texas Medical Branch reviewed and approved the research (IRB # 21-0268). Using the developed 1:1 MHAS-ONET linkage, consistency between MHAS and ONET was 97.4% across the five job categories. This MHAS-O*NET linkage will allow researchers to analyze the association between lifetime occupation and multiple dimensions of health, functionality, and retirement determinants for a low-middle income country with a large proportion of workers in the informal sector.

20 years of the Mexican Health and Aging Study

The Mexican Health and Aging Study (MHAS) is a longitudinal study using a national sample of approximately 15,000 community-dwelling adults aged 50 years old and older in Mexico. Spanning over 20 years (2001-2021), six waves of data collection establish the MHAS as the leading data platform for the study of aging in Latin America.