Older Mexican Adults Research Articles

Older Portuguese And Mexican Adults And Sexual Well-Being? A Cross-Cultural Qualitative Study

Objectives: Sexual well-being (SWB) refers to the subjective emotional and cognitive evaluation of the quality of the individual's sexuality, it plays a relevant role in quality of life and health promotion on old age and has cross-cultural implications. The aim of this study is to analyse comparatively the perspectives of older adults on their SWB in Portugal and Mexico. Methods: Data were collected from 86 Portuguese and 80 Mexican community-dwelling participants aged 65 years and older, using a semi-structured interview protocol. Older adults were inquired about their perceptions on what contributes to their sexual well-being. Socio-demographic data were also enquired. Content analysis was used to identify key themes. Results: Outcomes indicated eight themes: eroticism, supportive relationship, positive self-concept, health and self-care, romance, active life, tenderness and care, and no pain and no pregnancy restrictions, for both samples. Eroticism was the most frequent theme reported by Portuguese participants (31.4%) and health and self-care were the most frequent theme reported by Mexican participants (26.5%). Conclusions: The empirical results of this study indicated that SWB is strongly influenced by socio-cultural and psychosocial values. This cross-cultural comparison between Portugal and Mexico contributes to understand this concept in old age with different perspectives and place a scenario for future culture-adapted interventions and comprehensive policies. Keywords: Mexican, older adults; Portuguese; qualitative study; sexual well-being

Association of frailty with cognitive impairment in Mexican older adults from the open population

AbstractBackgroundFrailty and mild cognitive impairment are highly prevalent and disabling conditions in the older adult population, which can coexist. Since fragility represents wear and tear of multiple systems that put the subject in a condition of physical, cognitive, and social vulnerability,MethodThis report contains information from an observational cohort design study, the inclusion criteria included adults older than 65 years or older at the beginning of follow‐up, who completed the baseline evaluations and three years of follow‐up, within the protocols of the GID 10 / 66. Data from 1,823 adults older than 65 years without dementia were analyzed in the initial evaluation. Frailty was evaluated by modified Fried criteria (excluding grip strength), the presence of 3 of the 4 remaining criteria was considered fragility. They were considered for the analysis of variables such as sex, age, education, marital status, occupation, diabetes, hypertension, depression, anxiety, and cognitive impairment level in the initial evaluation. The incidence of cognitive impairment was determined by the presence of MCI or dementia at the follow‐up evaluation.ResultThe prevalence of frailty in the baseline evaluation was reported in 6.1%. Frailty was more prevalent in older ages. The occupation was also found to be associated with frailty, more prevalent in unemployed older adults. Comorbidities such as diabetes, a history of cerebral vascular disease, depression, and anxiety were found to be associated with frailty. The incidence of cognitive impairment in the total sample was 14.6%, in the group with frailty in the baseline evaluation it was 30.0%, which translates into a risk ratio of 2.2, which is reduced to 1.8 when adjusted for risk variables for incident cognitive impairment such as age, schooling, diabetes, depression, and anxiety.ConclusionIn older adults from the open population, frailty is associated with the incidence of cognitive impairment independently of some of the known risk factors for dementia and mild cognitive impairment.

Evidence of Validity and Reliability of the Lasher and Faulkender Anxiety about Aging Scale in Mexican Older Adults.

Anxiety about aging is an important mediating factor in attitudes and behavior toward elderly individuals as well as a mediating factor in the adjustment to one’s own aging processes. The aim of this study was to analyze the factor structure, internal consistency and factorial invariance by sex of the Lasher and Faulkender Anxiety about Aging Scale. The sample consisted of 601 Mexican older adults, 394 women and 207 men, with a mean age of 70.69 ± 8.10 years. The factor structure of the questionnaire was analyzed using confirmatory factor analysis. Analyses show that a four-factor structure is feasible and adequate. The four-factor structure (fear of the elderly, psychological concerns, physical appearance and fear of loss), according to statistical and substantive criteria, showed adequate reliability and validity indicators. However, the obtained model does not fully coincide with that proposed by the questionnaire authors, although it continues to support the multi-factor component of anxiety about aging. On the other hand, the factor structure, the factor loadings and the intercepts are considered invariant in the two populations (men and women); however, there are differences between populations on the means of the physical appearance and fear of loss factors.

Trajectories of frailty and related factors of elderly people in Mexico.

Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it. Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.

Etiology of Anemia in Older Mexican Adults: The Role of Hepcidin, Vitamin A and Vitamin D.

Anemia in older adults is a growing public health issue in Mexico; however, its etiology remains largely unknown. Vitamin A deficiency (VAD) and vitamin D deficiency (VDD) have been implicated in the development of anemia, though by different mechanisms. The aim of this study is to analyze the etiology of anemia and anemia-related factors in older Mexican adults. This is a cross-sectional study of 803 older adults from the southern region of Mexico in 2015. The anemia etiologies analyzed were chronic kidney disease (CKD), nutritional deficiencies (ND), anemia of inflammation (AI), anemia of multiple causes (AMC) and unexplained anemia (UEA). VAD was considered to be s-retinol ≤ 20 μg/dL, and VDD if 25(OH)D < 50 nmol/L. IL-6 and hepcidin were also measured. Multinomial regression models were generated and adjusted for confounders. Anemia was present in 35.7% of OA, independent of sex. UEA, CKD, AI and ND were confirmed in 45%, 29.3%, 14.6% and 7% of older adults with anemia, respectively. Hepcidin and log IL-6 were associated with AI (p < 0.05) and CKD (p < 0.001). VAD was associated with AI (p < 0.001), and VDD with ND and AMC (p < 0.05). Log-IL6 was associated with UEA (p < 0.001). In conclusion, anemia in older adults has an inflammatory component. VAD was associated to AI and VDD with ND and AMC.

Supportive care needs among older Mexican adults with metastatic cancer.

198 Background: Supportive care (SC) in oncology includes the prevention and management of cancer- and treatment-related symptoms and adverse effects. Previous studies have shown that SC needs may differ depending on clinical stage, patients’ gender, comorbidities, and chronological age. The goal of this study was to describe the SC needs of older adults with metastatic cancer enrolled in a SC patient navigation program at Instituto Nacional Ciencias Medicas Salvador Zubiran, an academic, public hospital in Mexico City, and to compare them with those of their younger counterparts. Methods: This was a secondary analysis of a prospective study which included adult patients with newly diagnosed metastatic solid tumors. The patients’ SC needs and symptoms were assessed by a patient navigator using validated questionnaires, and then a multidisciplinary team created a personalized SC plan to address those needs. Potential SC interventions included pain management, physical therapy, geriatric assessment/intervention, mitigation of caregiver burden, depression/anxiety management, and nutritional assessment/intervention. Patients were divided into two age groups (≥65 and &lt; 65 years), and differences in SC needs between groups were compared using Chi square, Student’s T and Mann-Whitney tests. Results: Out of 337 patients with metastatic solid tumors included between April 2018 and October 2020 (median age 64 years, range 19-94 years), 164 (48%) were aged ≥65 years. Among older patients (≥65 years), 130 (79%) had an abnormal geriatric screening and were referred for a comprehensive geriatric assessment. Older adults were more likely than younger patients to report malnutrition needing nutritional assessment/intervention (81 vs. 65%, p &lt; 0.01) and to experience fatigue needing a referral to physical therapy (77 vs. 66%, p = 0.03). We found no differences in moderate/severe pain (45 vs 47%, p = 0.79), depression/anxiety (69 vs 77%, p = 0.09), caregiver burden (42 vs 34%, p = 0.12) or sleep disturbances (54 vs 64%, p = 0.07) between groups. However, the total number of SC needs was significantly higher for older adults than for their younger counterparts (4.9 vs. 3.9, p &lt; 0.01). Conclusions: The results of this study show that older adults with metastatic solid tumors have more SC needs and require more symptom management interventions than their younger counterparts. The need for nutritional interventions and physical therapy was significantly higher among older patients, thus, these components should be considered an essential part of geriatric oncology multidisciplinary programs. Oncologists treating older adults with advanced cancer should screen for SC needs among older patients in order to provide targeted interventions.

Longitudinal association of sarcopenia and mild cognitive impairment among older Mexican adults.

BackgroundRecent evidence from cross‐sectional and longitudinal studies supports the hypothesis that sarcopenia is associated with worsening cognitive function. However, primary evidence largely comes from high‐income countries, whereas in low‐ and middle‐income countries, this association has been underexplored. This study aimed to estimate the longitudinal association between sarcopenia and mild cognitive impairment in a sample of older Mexican adults.MethodsData come from the three waves of the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) in Mexico (2009, 2014, 2017). Four hundred ninety‐six older adults, aged ≥50, were included. Sarcopenia was defined as having low muscle quantity and either/both slow gait speed and weak handgrip strength. Mild cognitive impairment was determined based on the recommendations of the National Institute on Aging‐Alzheimer's Association. Cognitive function was evaluated by a composite cognitive score of five different cognitive tests: immediate and delayed recall, forward and backward digit span and semantic verbal fluency. Three‐level mixed‐effects models (logistic and linear) were used to estimate the longitudinal associations between sarcopenia, mild cognitive impairment and cognitive function.ResultsThe prevalence of mild cognitive impairment (8.9%, 12.9%, 16.0%) and sarcopenia (10.5%, 20.7%, 23.3%) showed a significant temporal increase for Waves 1, 2 and 3 (P‐value < 0.01, respectively). The presence of sarcopenia was significantly associated with mild cognitive impairment (OR = 1.74; CI95% 1.02, 2.96; P = 0.04) and worse cognitive function (β = −0.57; CI95% ‐0.93, −0.21; P < 0.01). We observed significant associations between sarcopenia and immediate verbal recall (β = −0.14; CI95% −0.28, −0.01; P = 0.04), delayed verbal recall (β = −0.12; CI95% −0.23, −0.01; P = 0.03) and semantic verbal fluency (β = −0.17; CI95% −0.28, −0.05; P = 0.01). The prevalence of mild cognitive impairment increased at an annual rate of 0.8% for non‐sarcopenic older adults, but nearly 1.5% for sarcopenic adults.ConclusionsSignificant longitudinal associations were observed between sarcopenia, mild cognitive impairment and cognitive function among older Mexican adults. Public health strategies, including policy research and clinical interventions, must be implemented in low‐ and middle‐income countries in order to reduce or delay the onset of sarcopenia and thus improve population‐level cognitive health among older adults.

Screening intrinsic capacity and its epidemiological characterization: a secondary analysis of the Mexican Health and Aging Study.

ABSTRACTObjective.To describe the levels of intrinsic capacity and those factors related to its decline in Mexican older adults, using the Mexican Health and Aging Study.Methods.This is a cross-sectional secondary analysis of the 2015 data of the Mexican Health and Aging Study, including adults aged 50 years and above. Selected questions were included to represent each domain of intrinsic capacity screening: cognition, depression, hearing, vision, anorexia, weight loss, and mobility. Sociodemographic characteristics, psychosocial factors, and health conditions were included to assess their association with intrinsic capacity. Further categories were established to assess not only individual characteristics but also different groupings. Along with descriptive statistics, multinomial regression models were performed.Results.From a total of 12 459 adults aged 50 years and above, 54.7% were women and the average age was 71.2 years; 87.8% of the individuals had at least one intrinsic capacity domain affected, and mobility had the highest frequency (47.6%). All domains showed a trend of increasing with age and were higher among women. Self-rated health, chronic diseases, number of visits to a physician in the last year, and ≥2 affected activities of daily living were consistently associated with more intrinsic capacity domains affected.Conclusions.Decreased levels of intrinsic capacity in Mexican older people are associated with less schooling, self-rated health, chronic diseases, visits to a physician, and activities of daily living.

Family help received by Mexican older adults across socioeconomic strata: changes over a critical decade.

ABSTRACTObjective.To identify how patterns of family economic support help alleviate the cumulative effects of inequality, with focus on the financial support that children give their elderly parents.Methods.This paper uses data from two cross-sections, 2001 and 2012, of the Mexican Health and Aging Study for the 50 years and older population. Analysis includes descriptive statistics to estimate differences in economic support based on family and individual characteristics; and a multinomial probit regression model, in each cross-section, to analyze the amount of money received for economic help and the associated characteristics.Results.Economic help received was significantly reduced, both in proportion, from 20% to 10% between 2001 and 2012, and in the amount received, with differences by income quintile. In 2001, 14.9% of those in the lowest quintile (Q1) would move to Q4–Q5 with children’s help; in 2012, this was 9.1%. The adjusted probability of receiving any amount of money from children decreased from 0.511 in 2001 to 0.340 in 2012.Conclusions.In Mexico, economic inequality in the 50 years and older population remains a constant. Economic help received from children varied by income quintile and plays an important role for those in the lowest income groups. More research is needed to understand the patterns of intergenerational exchanges as these cohorts of older adults continue to age and as future cohorts are entering old age with more pronounced changes than the current cohorts experienced over this critical decade.

Factors Associated with Nonattendance to a Geriatric Clinic among Mexican Older Adults

Introduction: Outpatient appointment nonattendance (NA) represents a public health problem, increasing the risk of unfavorable health-related outcomes. Although NA is significant among older adults, little is known regarding its correlates. This study aimed to identify the correlates (including several domains from the geriatric assessment) of single and repeated NA episodes in a geriatric medicine outpatient clinic, in general and in the context of specific comorbidities. Methods: This is a cross-sectional study including data from 3,034 older adults aged ≥60 years with ≥1 scheduled appointments between January 1, 2016, and December 31, 2016. Appointment characteristics as well as sociodemographic, geographical, and environmental information were obtained. Univariate and multivariate multinomial regression analyses were carried out. Results: The mean age was 81.8 years (SD 7.19). Over a third (37.4%) of participants missed one scheduled appointment, and 14.4% missed ≥2. Participants with a history of stroke (OR 1.336, p = 0.041) and those with a greater number of scheduled appointments during the study time frame (OR 1.182, p < 0.001) were more likely to miss one appointment, while those with Parkinson’s disease (OR 0.346, p < 0.001), other pulmonary diseases (OR 0.686, p = 0.008), and better functioning for activities of daily living (ADL) (OR 0.883, p < 0.001) were less likely to do so. High socioeconomic level (OR 2.235, p < 0.001), not having a partner (OR 1.410, p = 0.006), a history of fractures (OR 1.492, p = 0.031), and a greater number of scheduled appointments (OR 1.668, p < 0.001) increased the risk of repeated NA, while osteoarthritis (OR 0.599, p = 0.001) and hypertension (OR 0.680, p = 0.002) decreased it. In specific comorbidity populations (hypertension, type 2 diabetes mellitus, and cancer), better ADL functioning protected from a single NA, while better mobility functioning protected from repeated NA in older patients with hypertension and cancer. Discussion/Conclusion: Identifying geriatric factors linked to an increased probability of NA may allow one to anticipate its likelihood and lead to the design and implementation of preventive strategies and to an optimization of the use of available health resources. The impact of these factors on adherence to clinical visits requires further investigation.

How Do Older Portuguese and Mexican Adults Experience Their Sexual Well-Being? A Cross-Cultural Qualitative Study.

Sexual well-being (SWB) refers to the subjective emotional and cognitive evaluation of the quality of the individual's sexuality. SWB plays a relevant role in quality of life and health promotion on old age and has cross-cultural implications. In addition to the scarcity of in-depth qualitative studies in this area and studies with cross-cultural samples, no studies have compared perceptions of SWB among Portuguese and Mexican older adults. The aim of this study was to comparatively analyze perspectives on SWB among older adults residing in Portugal and Mexico. Data were collected from 86 Portuguese and 80 Mexican community-dwelling participants aged 65years and older, using a semi-structured interview protocol. Older adults were asked about factors that significantly contribute to their SWB. Sociodemographic data were also gathered. Content analysis was used to identify key themes. Eight themes were identified across both studied samples: eroticism, supportive relationship, positive self-concept, health and self-care, romance, active life, tenderness and care, and no pain and no pregnancy restrictions. Eroticism was most pertinent to Portuguese participants (31.4%). Health and self-care was most frequently reported by Mexican participants (26.5%). The findings of this study indicate that SWB is strongly influenced by sociocultural and psychosocial values. Cross-cultural comparisons between older Portuguese and Mexican people provide a broader understanding of SWB in older age and suggest a scenario for future culture-adapted interventions and comprehensive policies.

Oral health condition and development of frailty over a 12-month period in community\u2010dwelling older adults

BackgroundTo determine the association between oral health condition and development of frailty over a 12-month period in community-dwelling older adults.MethodsPopulation-based, case-cohort study derived from the Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults (COSFOMA) study, including data from years 2015 and 2016. Using latent class analysis, we determined the oral health condition of older adults with teeth (t0), i.e., functional teeth, presence of coronal caries, root caries, periodontal disease, dental calculus, dental biofilm, root remains, xerostomia, and need for dental prosthesis. Edentulous was considered as a separate class. Criteria of the Frailty Phenotype (t1) by Fried et al. were used: weight loss, self-report of exhaustion, walking speed, decreased muscle strength, and low physical activity. The presence of three or more criteria indicated a frail condition. The strength of the association (odds ratio, OR) between oral health condition and development of frailty was estimated through bivariate analysis. Multiple logistic regression was used to adjust for the other variables of study: sociodemographic data (sex, age, marital status, level of education, paid work activity, and living alone), comorbidities, cognitive impairment, depressive symptoms, nutritional status, and use of oral health services.Results663 non-frail older adults were evaluated, with a mean age of 68.1 years (SD ± 6.1), of whom 55.7% were women. In t0, a three-class model with an acceptable value was obtained (entropy = 0.796). The study participants were classified as: edentulous persons (6.9%); Class 1 = Acceptable oral health (57.9%); Class 2 = Somewhat acceptable oral health (13.9%); and Class 3 = Poor oral health (21.3%). In t1, 18.0% (n = 97) of participants developed frailty. Using Acceptable oral health (Class 1) as a reference, we observed that older adults with edentulism (OR 4.1, OR adjusted 2.3) and Poor oral health (OR 2.4, OR adjusted 2.2) were at an increased risk of developing frailty compared to those with Acceptable oral health.ConclusionOlder adults with edentulism and poor oral health had an increased risk of developing frailty over a 12-month period.

Prevalence and incidence of possible vascular dementia among Mexican older adults: Analysis of the Mexican Health and Aging Study.

Vascular dementia is the second most common cause of dementia. Physical disability and cognitive impairment due to stroke are conditions that considerably affect quality of life. We estimated the prevalence and incidence of possible vascular dementia (PVD) in older adults using data from the Mexican Health and Aging Study (MHAS 2012 and 2015 waves). The MHAS is a representative longitudinal cohort study of Mexican adults aged ≥50 years. Data from 14, 893 participants from the 2012 cohort and 14,154 from the 2015 cohort were analyzed to estimate the prevalence and incidence of PVD. Self-respondents with history of stroke were classified as PVD if scores in two or more cognitive domains in the Cross-Cultural Cognitive Examination were ≥ 1.5 standard deviations below the mean on reference norms and if limitations in ≥ 1 instrumental activities of daily living were present. For proxy respondents with history of stroke, we used a score ≥3.4 on the Informant Questionnaire on Cognitive Decline in the Elderly. Crude and standardized rates of prevalent and incident PVD were estimated. Prevalence of PVD was 0.6% (95% CI, 0.5-0.8) (0.5 with age and sex- standardization). Rates increased with age reaching 2.0% among those aged 80 and older and decreased with educational attainment. After 3.0 years of follow-up, 87 new cases of PVD represented an overall incident rate of 2.2 (95% CI, 1.7-2.6) per 1,000 person-years (2.0 with age and sex- standardization). Incidence also increased with advancing age reaching an overall rate of 9.4 (95% CI, 6.3-13.6) per 1,000 person-years for participants aged >80 years. Hypertension and depressive symptoms were strong predictors of incident PVD. These data provide new estimates of PVD prevalence and incidence in the Mexican population. We found that PVD incidence increased with age. Males aged 80 years or older showed a greater incidence rate when compared to females, which is comparable to previous estimates from other studies.

Last Year of Life, Frailty, and Out-of-Pocket Expenses in Older Adults: A Secondary Analysis of the Mexican Health and Aging Study.

To determine the association of frailty with out-of-pocket expenses (OOPEs) during the last year of life of Mexican older adults. Cross-sectional secondary analysis of the Mexican Health and Aging Study (MHAS), a representative population-based cohort study. Health care expenses were estimated, and a probit model was used to estimate the probability that older adults had OOPE. A general linear model was applied to explain OOPE magnitudes. A total of 55.8% of individuals reported having OOPE with a mean of 3,261 USD. Average OOPE for hospitalization during the last year of life was 7,011.9 USD. Older adults taking their own medical decisions during the last year of life expended less than those who did not. No affiliation to health services, frailty, and health decision-making by others increased the probability of OOPE. The magnitude is determined by age, hospitalization, medical visits, affiliation, frailty, and health decision-making by others.

Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study.

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

Design guidelines and usability for cognitive stimulation through technology in Mexican older adults

ABSTRACT To develop software to stimulate cognitive functions of attention, memory, reasoning, planning, language, and perception in Mexican older adults, and to evaluate the usability of software based on system utility, information quality, and interface quality. For the development of the cognitive stimulation software, an inductive-deductive methodology was used in three stages: Analysis (system requirements), design and coding (cognitive stimulation software), evaluation (usability results). The usability of the software was assessed in 89 older adults between the ages of 60 and 84 years, through a usability questionnaire with evidence of reliability and validity. Eight exercises about attention, seven on memory, three on reasoning, one about planning and language, and two on perception were developed. We evaluated the usability of the developed software using the Computer System Usability Questionnaire, obtaining medium-high usability in 76.2% of the participants regarding the system utility, in 77.7% concerning the information quality and, in 84.2% in the interface quality. The software was developed considering aspects of usability and based on changes and losses associated with aging, as well as on the stimulation of cognitive functions related to instrumental activities of daily living, including exercises based on traditional pencil-paper exercises.

Factors associated with cognitive performance in residents of long-term care facilities in Northeast Mexico.

Objective: To investigate factors associated with cognitive impairment (CI) in institutionalized Mexican older adults. Material and methods: Cross-sectional study of residents of three long-term care facilities in the metropolitan area of Monterrey, Mexico. A medical history, Mini-Mental State Examination (MMSE), Barthel index, geriatric depression scale, and a nutritional screening were performed. CI was defined as MMSE ≤24. Results: Of 280 octogenarian residents (72.1% females) 61.1 % had a MMSE ≤24. Older age (OR=1.047), functional dependence (OR=10.309), malnutrition (OR=2.202), urinary incontinence (OR=2.588), and history of fracture (OR=1.764) were directly associated to CI. While higher education level (OR=0.583) and the use of antihypertensives (OR=0.521), antihistamines (OR=0.322), antiprostatic hypertrophy (OR=0.219), and lipid-lowering drugs (OR=0.575) were inversely associated. Conclusions: The evaluation of cognitive performance and its associated factors is essential for institutionalized patients in order to implement a management program aimed at reducing the progression of CI and its possible complications.

Factors associated with cognitive performance in residents of long-term care facilities in Northeast Mexico.

Objective: To investigate factors associated with cognitive impairment (CI) in institutionalized Mexican older adults. Material and methods: Cross-sectional study of residents of three long-term care facilities in the metropolitan area of Monterrey, Mexico. A medical history, Mini-Mental State Examination (MMSE), Barthel index, geriatric depression scale, and a nutritional screening were performed. CI was defined as MMSE ≤24. Results: Of 280 octogenarian residents (72.1% females) 61.1 % had a MMSE ≤24. Older age (OR=1.047), functional dependence (OR=10.309), malnutrition (OR=2.202), urinary incontinence (OR=2.588), and history of fracture (OR=1.764) were directly associated to CI. While higher education level (OR=0.583) and the use of antihypertensives (OR=0.521), antihistamines (OR=0.322), antiprostatic hypertrophy (OR=0.219), and lipid-lowering drugs (OR=0.575) were inversely associated. Conclusions: The evaluation of cognitive performance and its associated factors is essential for institutionalized patients in order to implement a management program aimed at reducing the progression of CI and its possible complications.

Multidimensional assessment of the financial toxicity (FT) of cancer among older Mexican adults and their families: A mixed methods study.

e18827 Background: FT associated with cancer care damages patients’ quality of life and increases symptom burden. Developing countries lack public insurance programs to protect the growing population of older adults with cancer from catastrophic expenses. In this cross-sectional mixed methods study, we evaluated FT among a Mexican older adults with cancer and their relatives. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months (mo) of diagnosis at two public hospitals in Mexico City, and their relatives. For the quantitative component, patients and relatives answered the CFPB Financial Well-Being Scale (range 0-100 points, lower scores represent worse financial well-being), the COST-FACIT cancer-related financial burden scale (range 0-44 points, scores &lt; 26 represent FT), and a 3 mo self-reported expense diary. For the qualitative component, focused interviews were used to describe the individual experience of selected patients and their relatives. Results: 96 patients (mean age 72.1 years, SD 6.1; 59.4% male) were included for the quantitative component. The most common tumor types were prostate (33%), colon (14%), breast (14%), and lung (10%); 45% had stage IV disease; and a third had no healthcare coverage. Mean COST-FACIT score was 16.4 (95% CI 14.8-17.9), with 9% reporting no FT (score ≥26), 52% mild FT (14-25), 39% moderate FT (1-13), and 0% severe FT (0). Mean CFPB Financial Well-Being Scale score was 45.2 (95% CI 43.3-47.1); with 78% reporting poor financial well-being (score ≤50). Median expenses in the previous 3 mo were $3225 USD ($23-$55,000), of which most were associated with purchasing medications, including chemotherapy (median $735, $0-$13425). Average monthly patient income was only $123/mo ($0-$2000). Focused interviews were done for 25 patient-relative dyads. While most had no debt before cancer, a significant proportion of patients and their relatives (mainly their sons, daughters, or siblings) acquired multiple debts from banks, retail stores offering high-interest sub-prime credits, and/or relatives to pay for cancer-related costs . A common theme related to FT was the long interval (up to 1 year) between first symptoms and diagnosis, during which they paid for several private consultations and diagnostic tests. In many cases patients had to travel up to 180 miles to find cancer care. Conclusions: 91% of older Mexican adults with cancer had FT, compared to 18% reported by older patients with advanced cancer in the USA. Likewise, 78% had scores ≤50 in CFPB, in contrast with 24% in the US. Our results show high out-of-pocket expenses, limited healthcare coverage, and a deleterious effect of FT on the economic stability, productivity, and income of entire families and generations. Financial protection schemes are needed to protect older adults with cancer living in developing countries.

Concerns and difficulties associated with the COVID-19 pandemic among older adults with cancer in Mexico.

12042 Background: The COVID-19 pandemic has impacted the well-being of people not only due to the disease but also because of stay-at-home orders, social distancing, unemployment, and different kinds of loses. Older adults have particularly suffered during the pandemic, with increased health-related concerns and anxiety leading to increased vulnerability. However, little is known about the effects of the pandemic on older adults with cancer living in developing countries. They are facing issues related to their diagnosis and treatment, as well as the effects of the pandemic on their care and on the well-being of their families. To improve care for this vulnerable population, we studied the concerns and difficulties associated with COVID-19 among older Mexican adults with cancer. Methods: We included patients age ≥65 with the 10 most common tumors in Mexico according to GLOBOCAN and within 3-24 months of cancer diagnosis at two public hospitals in Mexico City. Patients were contacted telephonically and asked to complete a survey reporting the difficulties encountered during the COVID-19 pandemic and to rate their concerns associated with cancer care management using a 0-10 Likert-type scale, with higher ratings meaning increased concerns. Focused interviews were used to describe the individual experience of selected patients and their relatives related to COVID-19 and cancer care. Results: Between April 20, 2020 and December 1, 2021, 67 patients (mean age 71.9, min 65, max 90; 35.8% female; 62.7% living with a partner) were included. The most common tumors were prostate (43%), colon (16%), and lung (12%). 46% had Stage IV disease, and 61% had a life expectancy of more than a year. Twenty-five percent of patients reported encountering at least one difficulty in obtaining cancer care due to the COVID-19 pandemic. 43% of the patients reported difficulties with accessing follow-up cancer care; 39% reported issues with obtaining medications, including chemotherapy; and 34% reported problems obtaining medical care in general, including oncology visits. Regarding concerns, 33% of the patients reported being “very worried” or “extremely worried” about the COVID-19 pandemic. The most relevant concerns were related to getting infected with COVID-19 (or having a family member who became infected) (mean rating 7.9, SD 2.9); not being able to pay for cancer treatments or medical care (mean rating 6.9, SD 3.5); and worsening of cancer due to delayed care during the pandemic (mean rating 6.6, SD 3.7). Conclusions: A significant proportion of older adults with cancer in Mexico faced difficulties obtaining cancer treatment and follow-up care during the COVID-19 pandemic. Their most relevant concerns included getting infected, financial losses, and progression of disease. Creating systems to provide continued cancer care for vulnerable populations in developing countries is essential to face the COVID-19 pandemic.