Older Mexican Research Articles

Religious Involvement and Death Anxiety

The purpose of this study is to test a conceptual model that aims to clarify the relationship between religious commitment and death anxiety. This model contains the following hypotheses: (1) people who affiliate with Conservative Protestant congregations will be more likely to attend worship services; (2) people who go to church more often will be more likely to feel they belong in their congregations; (3) those who feel they belong in their congregations will be more deeply committed to their faith; (4) individuals who are more deeply committed to their faith will be more likely to forgive others; (5) people who forgive others are more likely to feel they have been forgiven by God; and (6) individuals who feel they are forgiven by God will experience less death anxiety. Data from a nationwide survey of older Mexican Americans provides support for each hypothesis.

Functional limitations and depressive symptoms: a longitudinal analysis of older Mexican American couples.

This study extends previous work on longitudinal patterns of spousal associations between functional impairments and psychological well-being in older couples in 3 important ways: By examining Mexican Americans, by considering a broader range of functional limitations, and by assessing the role of health status, social integration, and socioeconomic resources in these associations. Drawing on data from 6 waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993-2007), we employed growth curve models to investigate the implications of the spouse's functional limitations for the respondent's age trajectories of depressive symptoms in older Mexican American couples. Models were run separately for husbands and wives. The spouse's functional limitations were associated with higher levels of depressive symptoms in the respondent. Personal resources can both ameliorate and intensify the adverse implications of the spouse's functional limitations for the respondent's depressive symptomatology. The interplay among these factors can vary by gender and the type of the spouse's functional impairment. Future studies would benefit by examining caregiving patterns in older couples, by distinguishing between different dimensions of social support available to them, and by considering changes in couples' marital quality and social ties over time.

Depression, self-esteem, diabetes care and self-care behaviors among middle-aged and older Mexicans

AimsExamine the associations of depression and self-esteem on self-care activities and care received among Mexicans with diabetes. MethodsUsing data from the Mexican Nutrition and Health Survey 2012, logistic regression models were fit to test the associations between each self-care activity and diabetes care, and self-esteem and depression. ResultsPeople with low self-esteem were less likely to follow a diet, but no other associations were found. Contrary to what was expected, there were no relationships between depression and quality of care received or self-care behaviors. ConclusionCurrent findings support the importance of looking at mental health and emotional state among older adults with diabetes. Future studies should explore the relationship between different psychological barriers to proper diabetes management.

Loneliness among very old Mexican Americans: Findings from the Hispanic established populations epidemiologic studies of the elderly

Increasing numbers of researchers are finding that loneliness is a significant risk factor for morbidity and mortality, and several variables have been found to be closely related to the experience of loneliness among elders. However, much of the research has focused on the general older population, with no research to date focusing on minority populations. The objective of this study was to determine the prevalence and the correlates of loneliness among a community-dwelling older Mexican American population. This study used a three-item loneliness scale to determine the prevalence of loneliness. Pearson's correlation and linear regression analyses were used to determine the cross-sectional association between sociodemographic, interpersonal relationship and health variables with the scale. Data used came from the most recent wave (2011) of the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE). A total of 873 Mexican Americans completed the loneliness scale. The age range was from 80 to 102, with a majority (65%) female. The mean score on the scale was 4.05 (range 3–9), indicating relatively low levels of loneliness. Regression results indicate that depressive symptoms, cognitive status, and living alone were significantly associated with higher loneliness scores. Being married and having a confidante were significantly associated with lower loneliness. Age, number of close relatives and frequency of contact were not associated with loneliness. Findings suggest that among community-dwelling Mexican American older adults, loneliness has multiple determinants. Loneliness is a significant public health topic and clinicians should be aware of the various factors that can affect loneliness.

The Role of Religious Leaders in Health Promotion for Older Mexicans with Diabetes

Clergy in the Mexico play a major role in addressing the health care needs of their congregants. With qualitative semi-structured key-informant interviews, this study explored the views of ten male Mexican religious leaders (mostly Catholic) about their understanding of their role in diabetes health promotion. The major themes from the qualitative interviews emphasized the importance of open communication between church leaders and their parishioners, the role of the church in diabetes programs, and the unique position of religious institutions as a link between physical and spiritual aspects of health. Implications for diabetes interventions are discussed.

Work at Church and Church-Based Emotional Support Among Older Whites, Blacks, and Mexican Americans

This study aims to assess how social relationships form at church. The data are from older whites, older blacks, and older Mexican Americans. Our conceptual model proposes that: (1) conservative Protestants are more committed to their faith; (2) people who are more religiously committed attend worship services more often; (3) individuals who go to church more often perform more volunteer work; and (4) people who perform more work at church will receive more emotional support from their fellow church members. Support was found for these hypotheses. Several race differences emerged. The most important race difference suggests that the relationship between work at church and social support is strongest for older whites.

Cancer Mortality in Older Mexican Individuals (2000 – 2010)

Objective: Given the trends in aging worldwide, in Mexico, we determined trends in adjusted mortality rates due to cancer and 11 cancer subtypes in older individuals (>65 years) from 2000 to 2010. Methods: For this retrospective study, we collected data on mortality due to cancer from the registries of the National Institute of Statistics and Geography. Adjusted rates were calculated with a direct method based on the world standard population. Trend analysis was performed with a linear regression of the natural logarithm of the adjusted rate, and trends were evaluated with the Student´s t test. Results: During the studied period, the cancer mortality rates significantly declined from 51.90 to 47.19 (per 100,000 inhabitants) in the overall population. Similar declines were observed in women (from 45.19 to 40.36) and men (from 59.79 to 55.42). Significant declines in mortality rates were observed across several cancer subtypes, including esophageal, gastric, colorectal-anal, liver-biliary, pancreatic, and tracheal-bronchial-lung cancers. Significant increases in mortality rates were observed in colorectal and breast cancer, but no changes were observed in mortality rates due to prostate, ovarian, bladder, and non-Hodgkin lymphoma cancers. Conclusion: Mortality due to cancer in older Mexicans was lower than that observed in developed countries, and it significantly declined over the study period. Men had higher mortality rates than women. The highest mortality rates were due to breast and prostate cancer subtypes in older individuals.

Trust-Based Prayer Expectancies and Health Among Older Mexican Americans

This study assesses the health-related effects of trust-based prayer expectancies, which reflect the belief that God answers prayers at the right time and in the best way. The following relationships are evaluated in our conceptual model: (1) older Mexican Americans who attend worship services more often tend to develop a closer relationship with God; (2) people who feel close to God will be more likely to develop trust-based prayer expectancies; (3) people who endorse trust-based prayer expectancies will have greater feelings of self-esteem; and (4) higher self-esteem is associated with better self-rated health. The data support each of these relationships.

Church-based social support, religious commitment, and health among older Mexican Americans

Research indicates that social support that is provided by fellow church members is associated with better health. The goal of the current study is to contribute to this literature in three potentially important ways. First, the effects of received support are contrasted with a second measure of support–satisfaction with support received. Second, it is hypothesized that the effects of church-based support on self-rated health will depend upon the level of religious commitment. Third, these issues are examined with data from a nationwide survey of older Mexican Americans. The findings suggest that satisfaction with support, but not received support, is associated with better health. However, the results further reveal that these potentially important benefits are only evident among older Mexican Americans who are more committed to their faith.

Diabetes Risk in Older Mexican Americans: Effects of Language Acculturation, Generation and Socioeconomic Status

The effect of language acculturation, socioeconomic status (SES), and immigrant generation on development of diabetes among Mexican Americans was evaluated in the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE). HEPESE is a longitudinal cohort study of 3,050 non-institutionalized Mexican Americans aged 65 years at baseline (1993-1994) from 5 Southwestern states. Diabetes incidence was ascertained in 4 follow-up surveys to 2004-05 by respondent self-reported physician-diagnosis of diabetes, high blood glucose, or sugar in the urine. Language of interview, immigrant generation, gender, age, education, family history of diabetes, smoking status, alcohol use, health insurance type and self-reported height and weight were assessed. High socioeconomic status (SES) was defined by high school graduation and non-Medicaid insurance. Cox's proportional hazards models were fit to evaluate the effects of language acculturation, generation and SES on incident diabetes. 845 of 3,050 (27.7%) Mexican Americans had diabetes at baseline and were younger, more educated, and more likely to have health insurance than those without diabetes. Risk of developing diabetes increased for Spanish-speaking respondents with low SES from 1st to 3rd generation (HR = 1.76, 95% CI = 1.02-3.03) and from 2nd to 3rd generation (HR = 2.15, 95% CI = 1.20-3.84). Among English-speaking, high SES participants, generation had a protective effect on developing diabetes: HR = 0.45 (95% CI = 0.22-0.91) when comparing 3rd versus 1st generation. The effect of language acculturation and immigrant generation on incident diabetes is moderated by SES status in HEPESE participants.

Development of a Culturally Appropriate Food Frequency Questionnaire for Midlife and Older Mexican Americans

Development of a Culturally Appropriate Food Frequency Questionnaire for Midlife and Older Mexican Americans

Type 2 Diabetes and 10-Year Risk of Dementia and Cognitive Impairment Among Older Mexican Americans

OBJECTIVEType 2 diabetes has been linked with increased risk of dementia and cognitive impairment among older adults and with premature mortality in young and middle-aged adults. No studies have evaluated the association between diabetes and dementia among Mexican Americans, a population with a high burden of diabetes. We evaluated the association of diabetes with incidence of dementia and cognitive impairment without dementia (CIND) among older Mexican Americans while accounting for competing risk from death.RESEARCH DESIGN AND METHODSThis study included 1,617 participants 60–98 years of age from the Sacramento Area Latino Study on Aging followed up to 10 years from 1998. We evaluated the association between diabetes and dementia/CIND with competing risk regression models.RESULTSParticipants free of dementia/CIND at baseline (n = 1,617) were followed annually up to 10 years. There were 677 (41.9%) participants with diabetes, 159 (9.8%) incident dementia/CIND cases, and 361 (22.3%) deaths. Treated and untreated diabetes (hazard ratio 2.12 [95% CI 1.65–2.73] and 2.15 [1.58–2.95]) and dementia/CIND (2.48 [1.75–3.51]) were associated with an increased risk of death. In models adjusted for competing risk of death, those with treated and untreated diabetes had an increased risk of dementia/CIND (2.05 [1.41–2.97] and 1.55 [0.93–2.58]) compared with those without diabetes.CONCLUSIONSThese findings provide evidence that the association between type 2 diabetes and dementia/CIND among Mexican Americans remains strong after accounting for competing risk of mortality. Treatments that modify risk of death among those with diabetes may change future dementia risk.

Corrigendum

Aguila E, Escarce J, Leng M, Morales L. Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States. Journal of Aging and Health. 2013;25(1):136-158. (Original doi: 10.1177/0898264312468155 )

Handgrip Strength Predicts Functional Decline at Discharge in Hospitalized Male Elderly: A Hospital Cohort Study

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79–0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.

Border health in the shadow of the Hispanic paradox: issues in the conceptualization of health disparities in older Mexican Americans living in the Southwest.

Mexican Americans have demonstrated lower than what would be expected mortality rates and disease prevalence, given their overrepresentation among those living in poverty. However, Mexican Americans living along the US-Mexico border have been documented as carrying a higher burden of disease and disability that seems to contradict or at least challenge evidence in support of a "Hispanic Paradox". The purpose of this paper is to evaluate the concept of border health as it relates to the conceptualization and measurement of health outcomes in older Mexican Americans living in the Southwest United States. Data for this study comes from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (Hispanic EPESE) wave 1 and mortality files up to wave 5. Border residence was determined using La Paz Agreement county and distance from a port of entry classifications. Statistical analysis was conducted to assess border versus non-border differences in cause of death, disability, disease prevalence and premature mortality. Adjusted regression models were used to predict cause of death, disability and disease-free life expectancy and premature mortality (i.e. occurring before life expectancy). Interaction models between border/non-border and median income were also performed. Finally, distance from the US-Mexico border was used to determine the effect of distance to the US-Mexico border in border-residing participants. The findings from this study indicate that participants in the HEPESE were more likely to be alive at Wave 5 if they resided in a border county, however more likely to transition into ADL disability status. These findings were not explained by behaviors, duration in the US or sociocultural characteristics of where they lived. Additionally, Hispanic EPESE subjects that lived in the border region were more likely to have died from old age and were less likely to be lost to follow up. Interaction models revealed significant effects for diabetes as a cause of death. Moreover, distance from a US-Mexico port of entry was significant for being alive at wave 5 for border-residing participants. Relative to non-border residing participants, border residing Mexican Americans in the Hispanic EPESE did not carry a uniformly higher burden of disease, however had a significantly greater odds of 10 year survival. These findings bring up issues of measurement and the importance of geographic location when it comes to evaluating disease burden and mortality in Mexican Americans.

Normative data for the Mini-Mental State Examination, the Free and Cued Selective Reminding Test and the Isaacs Set Test for an older adult Mexican population: The Coyoacán Cohort Study

The Mini-Mental State Examination (MMSE), the Free and Cued Selective Reminding Test (FCSRT), and the Isaacs Set Test (IST) are useful instruments in the neuropsychological assessment of older individuals. Several versions of these tests exist in Spanish but normative data specifically set up for Mexican older adult population are missing although Mexico is the country containing the largest population of Spanish speakers and is undergoing a demographic transition with its aging population. Therefore, the aim of the present work was to produce age, educational level, and gender-adjusted normative scores for these tests for the population of older adults living in Mexico. Methods: Data were collected from a sample of 1047 subjects aged 70 years and over who participated in the Coyoacán cohort study, a population-based cohort study conducted in Mexico City. Results: Normative scores, presented in percentiles, were calculated according to age (70–79 and 80 years and over), educational level (0 years of schooling vs. 1–5 years of schooling vs. 6 and more years of schooling), and gender. Conclusion: This work provides norms for the MMSE, the FCSRT, and the IST which should be useful in clinical practice and helpful to better interpret the performances of Mexican older people consulting for memory troubles.

Church service roles and anticipated support among older Mexican Americans

The purpose of this study is to see how feelings of anticipated support arise in church. Anticipated support refers to the belief that coreligionists will provide assistance in the future if the need arises. This model contains the following hypothesis: (1) people who affiliate with conservative Protestant congregations will be more deeply committed to their faith, (2) individuals who are more committed to their faith will attend church more frequently, (3) people who go to church more often will be more likely to occupy church service roles, (4) those who occupy church service roles will feel more highly valued by their coreligionists, (5) individuals who feel they are valued highly by fellow church members will receive more emotional support from them, and (6) people who receive more emotional support at church will have stronger anticipated support beliefs. Data from a nationwide survey of older Mexican Americans support these hypotheses.

Early childhood experiences, cultural beliefs, and oral health of Mexican American women.

This qualitative article examines how financial resources, cultural beliefs, and early childhood experiences affect perceptions of oral health and dental utilization of middle-aged and older Mexican American women. Fourteen in-depth qualitative interviews were conducted. The women's ages range from 49 to 87 years. Most had not visited the dentist in more than 2 years. Most women's early childhood experiences did not include dental visits or dental instruction. Some believed tooth loss was a normal aging process. Misconceptions regarding preventive care, the belief that dental visits were only necessary when experiencing pain, and finances were the primary reasons for not visiting the dentist. The results lend insight into the oral health, self-care practices, and dental utilization of middle-aged and older immigrant Mexican American women.

Church-Based Social Support and a Sense of Belonging in a Congregation among Older Mexican–Americans

Research suggests that people with a strong sense of belonging in a congregation tend to rate their health in a more favorable way. However, relatively little is known about how a sense of belonging arises in a congregation. The purpose of the current study is to see if five different dimensions of church-based social support are associated with a sense of belonging in a congregation. In the process, an effort is made to contribute to the literature in two potentially important ways. First, the relationship between church-based support and belonging is evaluated with data from a nationwide survey of older Mexican–Americans. Second, tests are conducted to see if there are gender differences in the relationship between church-based support and belonging. The findings suggest that for the sample as a whole, receiving more of each type of church-based social support is associated with a stronger sense of belonging. Moreover, the results reveal that the relationship between all five types of church-based support and belonging is stronger for older Mexican–American men than for older Mexican–American women.

Comparison of the diet quality of young and older Mexican‐ American sedentary women enrolled in community‐based social support physical activity interventions

The Healthy Eating Index (HEI) 2005 was calculated to assess diet quality of Mexican‐American sedentary women enrolled in 2 community‐based social support physical activity interventions: Mujeres en Accion (Mujeres; n = 124 older women; 53±12 y; BMI = 32.9±7.4 kg/m2) and Madres para la Salud (Madres; n = 139 postpartum women; 28±5 y; BMI = 29.6±3.5 kg/m2), using baseline data. Older Mujeres participants had higher mean scores (0 to 5) for total fruit (3.9±0.5 vs. 2.6±0.2, p=0.017), whole fruit (5.0±0.3 vs. 3.3±0.2, p=0.001), total vegetables (3.9±0.3 vs. 2.7±0.1, p=0.001), and dark green/orange vegetables (3.2±0.4 vs. 1.8±0.2, p=0.007), but had a lower score for whole grains (3.3±0.3 vs. 5.0±0.05, p<0.001) than Madres participants. Mujeres participants also had a lower score (0 to 10) for % of energy (%E) from saturated fat (5.5±0.5 vs. 7.3±0.3, p=0.008). Both groups had low scores for sodium (1.4±0.5 vs. 2.0±0.4 out of 10, n.s.) and % E from solid fat/alcohol/added sugar (11.5±0.8 vs. 9.9±0.5 out of 20, n.s.). There were no differences in overall HEI score (63.9±2.4 [Mujeres] vs. 61.5±1.4 [Madres], n.s.) or scores for total grains, milk, meat/beans, and oils. In conclusion, despite differences in some of the individual HEI components, the overall score (below an ideal value of 80) suggests that both groups of Mexican‐ American women would benefit from dietary quality improvement. Supported by NIH 3R01NR010356–02S1.