Older Mexican Research Articles

Hospital Versus Home Death: Results from the Mexican Health and Aging Study

Context Characterizing where people die is needed to inform palliative care programs in Mexico. Objectives To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. Methods We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. Results The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). Conclusion Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services.

Exploring health beliefs and care-seeking behaviors of older USA-dwelling Mexicans and Mexican-Americans

Objective. This study explored health beliefs and healthcare-seeking behaviors of older USA-dwelling Mexicans and Mexican-Americans using the Theory of Planned Behavior (TPB) as a conceptual guide. Design. A mixed-method cross-sectional design was utilized using semi-structured interviews to obtain detailed descriptions of 31 older (50 + ) participants' behavioral, normative, and control beliefs about health and healthcare utilization. An interview schedule consisting of open-ended and demographic questions and one standardized tool, the Bidimensional Acculturation Scale (BAS) for Hispanics, was used to collect data. Results. Several themes emerged for each belief area. Behavioral belief themes reflect participants' faith in, comfort with, and knowledge of traditional methods of care (e.g., herbs, teas, and use of curanderas) as well as their faith in the effectiveness of conventional care (e.g., medicine, technology, and use of physicians). Normative belief themes indicate that participants perceive that family and community contacts support participants' use of traditional methods and that family supports use of conventional methods. Control belief themes suggest that traditional methods are accessible and affordable but that conventional methods are not. BAS scored indicated that most (90.3%) participants adhered to Hispanic culture. Two (6.5%) participants adhered to non-Hispanic culture and one (3.2%) scored as bi-cultural. Conclusions. Themes from the data suggest that beliefs about healthcare impact the types of care utilized and the ways in which they are utilized. Clinicians and researchers striving to reduce health disparities and develop more culturally competent healthcare services for ethnic minority groups should work toward a better understanding of minority groups' belief systems about healthcare and its utilization. Utilization of the TPB allows for empirical model development that can better predict healthcare utilization behavior, further augmenting efforts to provide services that will help reduce health disparities for older Mexicans and Mexican-Americans and other populations.

Vitrification of oocytes from endangered Mexican gray wolves ( Canis lupus baileyi)

Careful genetic management, including cryopreservation of genetic material, is central to conservation of the endangered Mexican gray wolf. We tested a technique, previously used to vitrify human and domestic animal oocytes, on oocytes from domestic dogs as a model and from the endangered Mexican wolf. This method provided a way to conserve oocytes from genetically valuable older female Mexican wolves as an alternative to embryos for preserving female genes. Oocytes were aspirated from ovaries of 36 female dogs in December and March (0 to 65 oocytes per female) and from six female wolves (4 to 73 per female) during their physiologic breeding season, or following stimulation with the GnRH agonist deslorelin. Oocytes from dogs were pooled; half were immediately tested for viability and the remainder vitrified, then warmed and tested for viability. All oocytes were vitrified by being moved through media of increasing cryoprotectant concentration, placed on Cryotops, and plunged into liquid nitrogen. There was no difference in viability (propidium iodide staining) between fresh and vitrified, warmed dog oocytes (65.7 and 61.0%, respectively, P = 0.27). Oocyte viability after warming was similarly assessed in a subset of wolves (4 to 15 oocytes from each of three females; total 29 oocytes). Of these, 57.1% of the post-thaw intact oocytes were viable, which was 41.4% of all oocytes warmed. These were the first oocytes from a canid or an endangered species demonstrated to have maintained viability after vitrification and warming. Furthermore, our results demonstrated that vitrification of oocytes with the Cryotop technique was an option for preserving female gametes from Mexican wolves for future use in captive breeding programs, although in vitro embryo production techniques must first be developed in canids for this technique to be used.

Religion, Suffering, and Self-rated Health Among Older Mexican Americans

The purpose of this study is to examine the relationship between religiously based beliefs about suffering and health among older Mexicans. A nationwide survey of older Mexican Americans was conducted (N=1,005). Questions were administered to assess beliefs about finding positive outcomes in suffering, the benefits of suffering in silence, other dimensions of religion, and health. The findings suggest that older Mexican Americans who use their faith to find something positive in the face of suffering tend to rate their health more favorably. In contrast, older Mexican Americans who believe that it is important to suffer in silence tend to rate their health less favorably. Moving beyond measures of church attendance to explore culturally relevant beliefs about suffering provides important insight into the relationship between religion and health among older Mexican Americans.

Frailty, Mortality, and Health‐Related Quality of Life in Older Mexican Americans

To determine the effect of health-related quality of life (HRQOL) on the relationship between frailty status and survival in older Mexican-American adults. Prospective analysis of participants in the Hispanic Established Populations for Epidemiologic Study of the Elderly. Urban and rural areas of five southwestern states: Arizona, California, Colorado, New Mexico, and Texas. One thousand eight Mexican-American adults aged 74 to 101 interviewed between 2005 and 2006. Trained interviewers collected information on patient demographics, health conditions, frailty status, HRQOL, and survival. Frailty was associated with a greater odds of death (odds ratio = 2.72, 95% confidence interval = 1.5-5.1) over a period of 2 to 3 years. After adjusting for the physical component of HRQOL, being frail (as opposed to prefrail or nonfrail) was no longer significantly associated with mortality. The mental health component of HRQOL did not affect the relationship between frailty and mortality. Older Mexican Americans identified as frail experienced poorer survival in this sample than their prefrail or nonfrail counterparts. Adjusting for the physical component of HRQOL attenuated poorer survival in persons categorized as frail.

Lower Frailty Incidence in Older Mexican Americans than in Older European Americans: The San Antonio Longitudinal Study of Aging

To directly compare frailty incidence of older Mexican American (MA) and European American (EA) adults. Longitudinal, observational cohort study. Socioeconomically diverse neighborhoods in San Antonio, Texas. Three hundred one older MA and 305 older EA adults in the San Antonio Longitudinal Study of Aging (SALSA) who were nonfrail at baseline. Frailty was assessed at baseline, and three follow-ups conducted over an average of 9.9 years using well-established criteria from the Cardiovascular Health Study. Covariates were baseline age, sex, socioeconomic status (SES), prefrailty status, diabetes mellitus, and comorbidity. The adjusted ethnic odds (MA vs EA) of incident frailty were estimated using generalized estimating equations. There was no ethnic difference in the unadjusted incidence of frailty over the three follow-up examinations (odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.62-1.52), even though baseline SES was significantly lower in MAs than EAs. After covariate adjustment, the odds of incident frailty were significantly lower for MAs than EAs (OR = 0.40, 95% CI = 0.23-0.72). Other significant predictors of frailty in the adjusted model were pre-frailty (present vs absent OR = 3.19, 95% CI = 1.86-5.47), education (1-year increment OR = 0.89, 95% CI = 0.83-0.96), and income (1-year increment OR = 0.88, 95% CI = 0.79-2.04). These findings lend support to the Hispanic Paradox and suggest that MAs who live to older ages are less likely than similarly aged EAs to become frail. Further research is needed to identify the underlying biological and social mechanisms that explain this finding to enhance the development of interventions for the prevention and treatment of this clinical geriatric syndrome.

ASSOCIATION BETWEEN ANOREXIA OF AGING AND DISABILITY IN OLDER COMMUNITY‐DWELLING MEXICANS

ASSOCIATION BETWEEN ANOREXIA OF AGING AND DISABILITY IN OLDER COMMUNITY‐DWELLING MEXICANS

Religion and Health Among Older Mexican Americans: Exploring the Influence of Making Mandas

A manda is a religious quid pro quo whereby an older Mexican American promises to perform a religious act if the Virgin or one of the saints grants a request. The purpose of this study is to see whether making mandas is associated with health among older Mexican Americans. Findings from the study model suggest that making mandas is associated with a greater sense of personal control, and more personal control is associated, in turn, with better health.

Self-Reported Urge Urinary Incontinence (UUI) Among Older Mexican–American Men: Risk Factors and Psycho-Social Consequences

Extant literature on Urge Urinary Incontinence (UUI) focuses on women and non-Hispanic Whites and little is known about ethnic minority men. We analyzed 700 Mexican-American men aged 75 and older from the fifth Wave (2004/5) of the Hispanic Established Population for the Epidemiologic Study of the Elderly. Logistic regression analyses examined risk factors for self-reported UUI and the impact of UUI on mental health and social support. Twenty-nine percent reported having difficulty holding their urine until they could get to a toilet. Men with more co-morbid conditions and men with prostate problems were more likely to report UUI symptoms. Men with UUI were less likely to report having a confidant and had a higher risk of high depressive symptoms. This study is the first to examine risk factors for and consequences of self-reported UUI among older Mexican-American men using a large community-based survey.

Comparative Analyses of Functional Reaches of Older Mexican American Adults

Older Mexican American adults have greater difficulty in performing activities of daily living (ADL) compared to other older adult groups. Differences in functional upper extremity anthropometry measures may help explain higher incidences of ADL difficulties among older Mexican American adults. Hence, as a first step, the objectives of this study were to compare baseline limiting outer fingertip and grip reaches of older Mexican Americans with published and available functional anthropometry data from other older adult groups. Older Mexican American females and males, aged 60–85+, recruited from Senior Centers in the City of El Paso, participated in the study. Stature, vertical fingertip and grip reaches, and horizontal fingertip and grip reaches, among other dimensions, were measured. Summary statistics, percentiles, and correlations between dimensions were generated for elderly Mexican American females and males. For overall comparison of Mexican American older adult anthropometry with other older adult groups, data available from several other studies in the Older Adult Data compendium was used. Overall comparisons of weighted means of available reach dimensions between older Mexican Americans and other older adult groups showed significant differences in most functional reach dimensions. Older Mexican American adults were found to have significantly different functional anthropometry than other groups.

Test-Retest Reliability of Functional Anthropometry and OARS Survey among Older Mexican American Adults

The aim of this study is to assess test-retest reliability of functional anthropometry measures and the Older American Resources and Services (OARS) survey among older Mexican American adults. A healthy sample of 30 Older Mexican American adults was selected from senior recreation centers. For functional anthropometry 20 variables were measured in the participants, and the participants were also asked to fill the OARS survey. All the participants responded to both the test again after two weeks and helped to assess the test-retest reliability of functional anthropometry measures and the OARS Survey. Pearson correlation analysis of the results indicates that the results of the anthropometric test and the OARS survey for the first administration and second administration were significantly positively correlated.

Trends in Hypertension Prevalence, Awareness, Treatment and Control in Older Mexican Americans, 1993–2005

To describe trends in hypertension prevalence, awareness, treatment, and control among older Mexican Americans living in the Southwestern United States from 1993-1994 to 2004-2005. This study is a comparison between two separate cross-sectional cohorts of non-institutionalized Mexican Americans 75 years of age or older from the Hispanic Established Population for the Epidemiological Study of the Elderly (919 subjects from the 1993-1994 cohort and 738 from the 2004-2005 cohort). Data were collected on self-reported hypertension, measured blood pressure, medications, as well as sociodemographic and other health-related factors. Hypertension prevalence increased from 73.0% in the period 1993-1994 to 78.4% in 2004-2005. Cross-cohort multivariate analyses showed that the higher odds of hypertension in the 2004-2005 cohort was attenuated by adding diabetes and obesity to the model. There was a significant increase in hypertension awareness among hypertensives (63.0% to 82.6%) and in control among treated hypertensives (42.5% to 55.4%). Cross-cohort multivariate analyses showed that the higher odds of control in 2004-2005 cohorts were accentuated by adding diabetes to the model. There were no significant changes in treatment rates (62.2% to 65.6%) Hypertension prevalence in very old Mexican Americans residing in the Southwestern United States was higher in 2004-2005 than in 1993-1994 and was accompanied by a significant increase in awareness and control rates.

Trends in Diabetes Medication Use and Prevalence of Geriatric Syndromes in Older Mexican Americans from 1993/1994 to 2004/2005

New diabetes medications introduced over the last decade have led to changes in diabetes treatment recommendations for the increasing number of elderly patients with diabetes. It is, however, not clear whether these changes are accompanied by changes in prevalence of comorbid geriatric syndromes. To determine whether changes in diabetes treatment between 1993/1994 and 2004/2005 were accompanied by changes in prevalence of geriatric syndromes in Mexican Americans aged 75 years and older. Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used. Participants aged 75 years and older with diabetes in 1993/1994 (n = 284) and in 2004/2005 (n = 324; new cohort added in 2004/2005) were included in the analyses. Medication use and geriatric syndromes prevalence rates were estimated and compared using descriptive and univariate statistics for continuous variables and contingency tables (chi(2)) for categorical variables. Older Mexican Americans with diabetes in 2004/2005 were more likely to be taking 2 or more oral diabetes medications than were those in the 1993/1994 cohort; most of the drugs taken by the 2004/2005 cohort were the newly introduced oral diabetes medications. Use of insulin as sole diabetes therapy decreased from 20.3% in the 1993/1994 cohort to 7.5% in the 2004/2005 cohort. The 2004/2005 cohort reported longer diabetes duration and higher prevalence of obesity and hypertension; they were also more likely than the 1993/1994 cohort to have more geriatric syndromes: pain, arthritis, incontinence, and self-reported activities of daily living disability. No significant differences exist between the 2 cohorts in objective measures of cognitive and physical function. Older Mexican Americans with diabetes in 2004/2005 used more of the newer diabetes medications and less insulin compared to the 1993/1994 cohort. The prevalence rates of geriatric syndromes were higher in the 2004/2005 cohort. Our findings suggest that screening for and treating comorbid geriatric syndromes is increasingly important for optimal geriatric diabetes care.

Cognitive Status and Future Risk of Frailty in Older Mexican Americans

Because cognitive impairment and frailty share common risk factors (eg, high proinflammatory cytokines), we examined whether poor cognition predicts subsequent risk of frailty in initially nonfrail Mexican Americans aged 67 years and older. Frailty was defined as meeting one or more of the following components: (a) unintentional weight loss of >10 pounds, (b) weakness, (c) self-reported exhaustion, and (d) slow walking speed. Sociodemographic factors, Mini-Mental State Examination, medical conditions (stroke, heart attack, diabetes, arthritis, cancer, and hypertension), and depressive symptoms were obtained. Main outcome measure was risk of becoming frail over 10 years. Out of 942 participants who were nonfrail at baseline (1995-1996), 57.8% were women and the mean age was 73.7 years (SD = 5.3). In general estimation equation models testing the relationship between Mini-Mental State Examination (<21 vs. ≥21) and the risk of becoming frail over a 10-year period, there was a significant association (odds ratio = 1.09, 95% confidence interval = 1.00-1.19; p = .0310)] between the cognition-by-time interaction and odds of becoming prefrail or frail over time. This association was independent of age, sex, marital status, education, time, and medical conditions, indicating that nonfrail participants with poor cognition had a 9% odds per year of becoming frail over time compared with those with good cognition. Low Mini-Mental State Examination score was independently associated with increased risk of frailty over a 10-year period in older Mexican Americans. Low Mini-Mental State Examination score may be an early marker for future risk of frailty.

Physician‐Assisted Suicide Attitudes of Older Mexican‐American and Non‐Hispanic White Adults: Does Ethnicity Make a Difference?

Little is known about attitudes toward physician-assisted suicide (PAS) in various ethnic groups. This study compares attitudes held by older Mexican Americans and non-Hispanic whites and examines subject characteristics that may influence their responses. A convenience sample of 100 older Mexican Americans and 108 non-Hispanic whites (n=208) aged 60 to 89 were recruited from four primary care community-based practice sites in San Antonio, Texas. Interview items measured attitudes toward PAS, cognitive status, functional status, and religiosity. Older Mexican Americans (52.7%) reported stronger agreement than non-Hispanic whites (33.7%) with PAS. Male sex (odds ratio (OR)=2.62, 95% confidence interval (CI)=1.09-6.35) predicted agreement with legalization in Mexican Americans, whereas lower religiosity scores (OR=0.84, 95% CI=0.75-0.94) were predictive of agreement in older non-Hispanic whites. This study is the first to find positive attitudes among community-dwelling older Mexican Americans toward PAS that are higher than those of older non-Hispanic white adults. Sex and religious views were important determinants of positive attitudes toward PAS. Larger, more-generalizable studies should be conducted to confirm the attitudinal patterns that have been identified in this study.

The rural-urban divide: health services utilization among older Mexicans in Mexico.

Mexico. Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health services" of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.

The Relationship Between Education Level and Mini-Mental State Examination Domains Among Older Mexican Americans

To study the effect of education and language of response at the interview on performance in the Mini-Mental State Examination (MMSE) domains, we studied 2861 Mexican Americans aged 65 and older from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) followed from 1993 to 1994 until 2004 to 2005. The MMSE was examined as total score (0-30) or divided into 2 global domains: (1) no-memory (score 0-24): Orientation, attention, and language; and (2) memory (score 0-6): working and delayed memory. Mean age and total MMSE were 72.7 years and 24.6 at baseline, and 81.7 years and 20.5 at 11 years of follow-up. Spanish-speaking participants had less education (4.1 vs 7.4 years, P < .0001), they had significantly higher adjusted mean scores for memory, no-memory, and total MMSE compared with English-speaking participants. In multivariate longitudinal analyses, participants with more years of education performed better than those with less education, especially in total MMSE and no-memory domain. Spanish-speaking participants with 4 to 6 years of education had higher memory scores than those speaking English (estimate 0.40, standard error [SE] = 0.14, P < .001), 7 to 11 (estimate 0.27, standard error = 0.13, P < .01) or 12+ (estimate 0.44, standard error = 0.13, P < .001). Results suggest that cultural factors and variables related to preferred language use determined variations in MMSE performance. Because the memory domain of the MMSE is less affected by education, it may be used along with other cognitive tests for early detection of cognitive decline in older populations with low education.

Validación de un instrumento para medir el efecto de la salud bucal en la calidad de vida de adultos mayores mexicanos

Translate, culturally adapt, and validate a new Spanish version of the Oral Health Impact Profile (OHIP) for older persons in Mexico City, Mexico. A validation study of the new version of OHIP-Mx-49 was carried out through interviews and clinical examinations of people aged 60 or older in the southern area of Mexico City. The following variables were analyzed: sociodemographic (age, sex, marital status, level of schooling, and whether the subject lived alone), clinical (current number of teeth, coronal and root caries, dental hygiene, and the use of removable prostheses and dentures), and self-perception (of the need for dental and general health care). The OHIP-Mx-49 value was calculated as the sum of the scores in seven dimensions: functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The internal consistency (Cronbach's alpha coefficient), replicability (intraclass correlation coefficient), and convergent and discriminant validity (Mann-Whitney and Kruskal-Wallis tests) were assessed. Of the 131 people interviewed (average age: 73.8 +/- 8.3 years), 77.9% were women. High internal consistency values were obtained for the OHIP-Mx-49 (0.96) and the dimensions (0.79-0.86), and replicability in the instrument (0.877) and all the dimensions except social disability (0.176). The average OHIP-Mx-49 score was 37.1 +/- 35.3; higher scores were observed in people with 1-9 teeth (P = 0.02), people who did not have coronal caries (P = 0.02), and people who perceived a need for dental care (P = 0.01). The OHIP-Mx-49 is a reliable and valid instrument that can be used with older Mexicans.

High depressive symptomatology among older community-dwelling Mexican Americans: The impact of immigration

Objectives: This analysis explores nativity differences in depressive symptoms among very old (75+) community-dwelling Mexican Americans. Design: Cross-sectional analysis using the fifth wave (2004–2005) of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE). Participants: The sample consisted of 1699 non-institutionalized Mexican American men and women aged 75 years and above. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Logistic regression was used to predict high depressive symptoms (CES-D score 16 or higher) and multinomial logistic regression was used to predict sub-threshold, moderate, and high depressive symptoms. Results: Results showed that elders born in Mexico had higher odds of more depressive symptoms compared to otherwise similar Mexican Americans born in the US. Age of arrival, gender, and other covariates did not modify that risk. Conclusion: The findings suggest that older Mexican American immigrants are at higher risk of depressive symptomatology compared to persons born in the US, which has significant implications for research, policy, and clinical practice.

Tooth Loss and Dental Healthcare Coverage in Older Rural Mexican Adults Living in Poverty

Tooth Loss and Dental Healthcare Coverage in Older Rural Mexican Adults Living in Poverty