Publications by authors named "Kyriakos Markides"

189 Publications

The role of testosterone replacement therapy and statin use, and their combination, in prostate cancer.

Cancer Causes Control 2021 May 26. Epub 2021 May 26.

Deparment of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.

Purpose: Previous studies have reported conflicting results in the associations of testosterone replacement therapy (TTh) and statins use with prostate cancer (PCa). However, the combination of these treatments with PCa stage and grade at diagnosis and prostate cancer-specific mortality (PCSM) and by race/ethnicity remains unclear.

Methods: We identified non-Hispanic White (NHW, N = 58,576), non-Hispanic Black (NHB, n = 9,703) and Hispanic (n = 4,898) men diagnosed with PCa in SEER-Medicare data 2007-2011. Pre-diagnostic prescription of TTh and statins was ascertained for this analysis. Multivariable-adjusted logistic and Cox proportional hazards models were used to evaluate the association of TTh and statins use with PCa stage and grade and PCSM.

Results: 22.5% used statins alone, 1.2% used TTh alone, and 0.8% used both. TTh and statins were independently, inversely associated with PCa advanced stage and high grade. TTh plus statins was associated with 44% lower odds of advanced stage PCa (OR 0.56, 95% CI 0.35-0.91). As expected, similar inverse associations were present in NHWs as the overall cohort is mostly comprised NHW men. In Hispanic men, statin use with or without TTh was inversely associated with aggressive PCa.

Conclusions: Pre-diagnostic use of TTh or statins, independent or in combination, was inversely associated with aggressive PCa, including in NHW and Hispanics men, but was not with PCSM. The findings for use of statins with aggressive PCa are consistent with cohort studies. Future prospective studies are needed to explore the independent inverse association of TTh and the combined inverse association of TTh plus statins on fatal PCa.
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http://dx.doi.org/10.1007/s10552-021-01450-0DOI Listing
May 2021

Independent and joint effects of testosterone replacement therapy and statins use on the risk of prostate cancer among White, Black and Hispanic men.

Cancer Prev Res (Phila) 2021 Apr 20. Epub 2021 Apr 20.

University of Texas McGovern Medical School.

The associations of testosterone therapy (TTh) and statins use with prostate cancer (PCa) remain conflicted. However, the joint effects of TTh and statins use on the incidence of PCa, stage and grade at diagnosis, and PCa-specific mortality (PCSM) have not been studied. We identified White (N=74181), Black (N=9157) and Hispanic (N=3313) men diagnosed with PCa in SEER-Medicare 2007-2016. Pre-diagnostic prescription of TTh and statins was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards models evaluated the association of TTh and statins with PCa, including statistical interactions between TTh and statins. We found that TTh (OR = 0.74, 95% CI: 0.68 - 0.81) and statins (OR = 0.77, 95% CI: 0.0.75 - 0.88) were inversely associated with incident PCa. Similar inverse associations were observed with high-grade and advanced PCa in relation to TTh and statins use. TTh plus statins was inversely associated with incident PCa (OR = 0.53, 95% CI: 0.48 - 0.60), high-grade (OR = 0.43, 95% CI: 0.37 - 0.49) and advanced PCa (OR = 0.44, 95% CI: 0.35 - 0.55). Similar associations were present in White and Black men, but among Hispanics statins were associated with PCSM. Pre-diagnostic use of TTh or statins, independent or combined, was inversely associated with incident and aggressive PCa overall and in NHW and NHB men. Findings for statins and aggressive PCa are consistent with previous studies. Future studies need to confirm the independent inverse association of TTh and the joint inverse association of TTh plus statins on risk of PCa in understudied populations.
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http://dx.doi.org/10.1158/1940-6207.CAPR-21-0040DOI Listing
April 2021

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

Gerontol Geriatr Med 2021 Jan-Dec;7:23337214211002724. Epub 2021 Mar 20.

University of Texas Medical Branch, Galveston, USA.

Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from Wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment ( < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.
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http://dx.doi.org/10.1177/23337214211002724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983470PMC
March 2021

Health and social correlates of dementia in oldest-old Mexican-origin populations.

Alzheimers Dement (N Y) 2020 16;6(1):e12105. Epub 2020 Dec 16.

LBJ School of Public Affairs and Department of Sociology The University of Texas at Austin Austin Texas USA.

Introduction: Substantial gaps in research remain across oldest-old ethnic populations while the burden of dementia increases exponentially with age among Mexican and Mexican American older adults.

Methods: Prevalence and correlates of dementia among individuals ≥82 years of age were examined using two population-based cohort studies: The Mexican Health and Aging Study (MHAS, n = 1078, 2012) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, n = 735, 2012-2013). The analytic MHAS and HEPESE samples had an average age of 86.4 and 88.0 years, 1.2 and 1.8 women to men, and 2.7 and 5.1 average years of education, respectively.

Results: We identified 316 (29.2%) and 267 (36.3%) cases of likely dementia in the MHAS and HEPESE cohorts, respectively. For Mexicans but not Mexican Americans, age-adjusted prevalence rates of likely dementia were higher in women than men. For both populations prevalence rates increased with age and decreased with education for Mexican Americans but not for Mexicans. In both populations, odds of likely dementia increased with age. Health insurance for the low-income was significantly associated with higher odds of likely dementia for Mexican American men and women and Mexican women but not men. Living in extended households increased the odds of likely dementia in women, but not in men for both studies. Multiple cardiovascular conditions increased the odds of likely dementia for Mexicans but not for Mexican Americans.

Discussion: Our study provides evidence of the high burden of dementia among oldest-old Mexicans and Mexican Americans and its association with health and social vulnerabilities.
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http://dx.doi.org/10.1002/trc2.12105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744026PMC
December 2020

Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia.

J Gerontol A Biol Sci Med Sci 2021 Feb;76(3):534-542

Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston.

Background: Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer's disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD.

Methods: Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis.

Results: The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43-1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27-1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80-0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82-0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant.

Conclusions: Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.
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http://dx.doi.org/10.1093/gerona/glaa236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907487PMC
February 2021

Depressive symptoms in child caregivers of very old Mexican Americans.

Aging Ment Health 2021 01 4;25(1):61-67. Epub 2020 Sep 4.

Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA.

Objective: To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers.

Methods: This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms.

Results: Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver.

Conclusions: In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.
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http://dx.doi.org/10.1080/13607863.2017.1423024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785680PMC
January 2021

Mobility but Not Balance Limitations Are Associated With Cognitive Decline among Older Hispanics.

Gerontol Geriatr Med 2020 Jan-Dec;6:2333721420947952. Epub 2020 Aug 13.

The University of Texas Medical Branch, Galveston, TX, USA.

Aging is associated with changes in lower-body functioning. The extent to which lower-body function is associated with cognitive changes over time is unclear, especially among older Hispanics, a high-risk population for declines in physical and cognitive functioning. We sought to determine if the association between lower-body functioning and cognitive decline over 9-years differentially varied with respect to balance, gait speed, lower-body strength (chair stands), or a summary score of the three measures. This retrospective cohort study used clinical performance data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE). Cognitive function was measured using the Mini-Mental Status Exam. Linear mixed modeling was used to investigate the association between lower-body function and cognitive decline, controlling for patients' demographic and health characteristics. We found that gait speed and timed chair stands but not balance were associated with accelerated cognitive decline in Mexican-Americans age 75 years and older. These parameters of lower-body function can be feasibly measured in any clinic. As limitations in lower-body functioning may be an early marker of cognitive decline, this suggests an opportunity for the development of interventions to slow cognitive and physical disablement and promote successful aging among persons older than 75 years.
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http://dx.doi.org/10.1177/2333721420947952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427021PMC
August 2020

Dual Trajectories of Dementia and Social Support in the Mexican-Origin Population.

Gerontologist 2021 04;61(3):374-382

Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston.

Background And Objectives: In the next few decades, the number of Mexican American older adults with Alzheimer's disease and related disorders will increase dramatically. Given that this population underutilizes formal care services, the degree of care responsibilities in Mexican American families is likely to increase at the same time. However, little is known about the changing need for assistance with instrumental day-to-day activities and emotional support by long-term patterns of cognitive impairment.

Research Design And Methods: We use 7 waves of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (1992/1993-2010/2011) and trajectory modeling to describe long-term patterns of perceived emotional and instrumental support, and dementia.

Results: Results revealed 2 latent classes of both emotional and instrumental support trajectories: low and high support. Specifically, those living alone were more likely to belong to the group with low support than to that with high support. Three latent classes for likely dementia were also revealed: likely dementia, increasing impairment, and no impairment. Those living alone were more likely to belong to the increasing impairment and likely dementia groups. The dual trajectory of emotional and instrumental support with likely dementia revealed that the probability of belonging to the low-support group was highest for those with increasing impairment.

Discussion And Implications: These findings highlight the risk and vulnerability of those who live alone concerning perceived social support and dementia. Implications of the findings for the potential dependency burden on Latino caregivers are discussed.
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http://dx.doi.org/10.1093/geront/gnaa100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023375PMC
April 2021

Health of Vietnamese Older Adults and Caregiver's Psychological Status in the United States: Result from the Vietnamese Aging and Care Survey.

Clin Gerontol 2020 Jun 16:1-9. Epub 2020 Jun 16.

University of Texas Medical Branch, Preventive Medicine and Population Health, Galveston, USA.

Objective: We examined the association between care recipient's physical, mental, and cognitive health conditions and caregivers' psychological distress in Vietnamese older care recipients and their caregivers.

Methods: The Vietnamese Aging and Care Survey was developed for care recipients, and adult-child and spousal caregivers, and inquired about their sociodemographics and health-related variables.

Results: Data were collected on 58 caregiver-care recipient dyads. Adult-child and spousal caregivers were on average 43 and 70 years-old respectively. The vast majority were female (76%) and born in Vietnam (97%). Adult-child caregivers reported more caregiver burden than spousal caregivers. Care recipients were on average 75 years-old. Care recipients of adult-child caregivers reported more depressive symptoms than care recipients of spousal caregivers and were more likely to have mild dementia. Care recipients' health had no effect on caregiver depressive symptoms but their educational attainment was associated with caregiver burden and depressive symptoms.

Conclusions: This study showed care recipients and caregivers' years of education were positively associated with caregivers' psychological distress. Vietnamese families lived in ethnic enclaves and shared caregiving responsibilities within the family. However, using available outside resources may alleviate psychological distress of not only caregivers but also families as a whole.

Clinical Implications: Healthcare professionals should encourage educated caregivers and educated care recipients to use outside resources to ease caregiving duties.
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http://dx.doi.org/10.1080/07317115.2020.1764157DOI Listing
June 2020

Frailty transitions predict healthcare use and Medicare payments in older Mexican Americans: a longitudinal cohort study.

BMC Geriatr 2020 06 1;20(1):189. Epub 2020 Jun 1.

Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-1137, USA.

Background: Little is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans.

Methods: Longitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey data from five Southwest states linked to the Medicare claims files from the Centers for Medicare and Medicaid Services. Seven hundred and eighty-eight community-dwelling Mexican Americans 72 years and older in 2000/01 were studied. We used a modified Frailty Phenotype (unintentional weight loss, weakness, self-reported exhaustion and slow walking speed) to classify frailty status (non-frail, pre-frail or frail). Each participant was placed into one of 5 frailty transition groups: 1) remain non-frail, 2) remain pre-frail, 3) remain frail, 4) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail) and 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail). The outcomes for the one-year follow-up period (2000-2001) were: (a) healthcare use (hospitalization, emergency room [ER] admission and physician visit); and (b) Medicare payments (total payment and outpatient payment).

Results: Mean age was 78.8 (SD = 5.1) years and 60.3% were female in 1998/99. Males who remained pre-frail (Odds Ratio [OR] = 3.49, 1.13-10.8, remained frail OR = 6.92, 1.61-29.7) and transitioned to worse frail status (OR = 4.49, 1.74-11.6) had significantly higher hospitalization risk compared to individuals who remained non-frail. Males in the 'worsened' groups, and females in the 'improved' groups, had significantly higher Medicare payments than individuals who remained non-frail (Cost Ratio [CR] = 2.00, 1.30-3.09; CR = 1.53, 1.12-2.09, respectively].

Conclusions: Healthcare use and Medicare payments differed by frailty transition status. The differences varied by sex. Research is necessary to elucidate the relationship between frailty transitions and outcomes, sex difference and Medicare payment for older Mexican Americans living in the community.
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http://dx.doi.org/10.1186/s12877-020-01583-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268381PMC
June 2020

Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer's disease and related dementias.

PLoS One 2020 15;15(1):e0227681. Epub 2020 Jan 15.

University of Texas Medical Branch, School of Health Professions, Division of Rehabilitation Sciences, Galveston, Texas, United States of America.

Background: Older adults with Alzheimer's disease and related dementias (ADRD) are high-risk to experience hospitalizations and emergency room (ER) admissions. Mexican-Americans have a high prevalence of ADRD, but there is limited information on the healthcare use of older Mexican-Americans with ADRD. We used data from a cohort of older Mexican-Americans that has been linked with Medicare files to investigate differences in hospitalizations, ER admissions, and physician visits according to ADRD diagnosis. We also identify sociodemographic, health, and functional characteristics that may contribute to differences in healthcare utilization between Mexican-American Medicare beneficiaries with and without an ADRD diagnosis.

Methods And Findings: Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare Master Beneficiary Summary Files, Medicare Provider Analysis and Review files, Outpatient Standard Analytic files, and Carrier files. The final analytic sample included 1048 participants. Participants were followed for two years (eight quarters) after their survey interview. Generalized estimating equations were used to estimate the probability for one or more hospitalizations, ER admissions, and physician visits at each quarter. ADRD was associated with higher odds for hospitalizations (OR = 1.65, 95%CI = 1.29-2.11) and ER admissions (OR = 1.57, 95%CI = 1.23-1.94) but not physician visits (OR = 1.23, 95%CI = 0.91-1.67). The odds for hospitalizations (OR = 1.24, 95%CI = 0.97-1.60) and ER admissions (OR = 1.27, 95%CI = 1.01-1.59) were reduced after controlling for limitations in activities of daily living and comorbidities.

Conclusions: Mexican-American Medicare beneficiaries with ADRD had significantly higher odds for one or more hospitalizations and ER admissions but similar physician visits compared to beneficiaries without ADRD. Functional limitations and comorbidities contributed to the higher hospitalizations and ER admissions for older Mexican-Americans with ADRD.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227681PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961888PMC
April 2020

Vietnamese Adult-Child and Spousal Caregivers of Older Adults in Houston, Texas: Results from the Vietnamese Aging and Care Survey (VACS).

J Gerontol Soc Work 2020 Jan - Feb;63(1-2):5-18. Epub 2020 Jan 3.

University of Texas Medical Branch, Galveston, Texas, USA.

Vietnamese are the largest Asian ethnic group in Houston, Texas; however, research on this population is scarce. To address this dearth of knowledge, we developed the . The objective of the study was to explore the sociodemographic and health characteristics of Vietnamese adults aged 65 years and older (n = 132) and their family caregivers (n = 64). Adult-child caregivers (n = 41) were aged between 21 and 65 years old. The majority were married, working, female, and in good to excellent health. Spousal caregivers (n = 23) were between 57 and 82 years old, retired, female, and in fair to good health. Adult children received more caregiving-related help from others compared to spousal caregivers; however, they felt more caregiver burden, had more perceived stress, and were in challenging relationships with care recipients. Differences in life stages of adult-child versus spousal caregivers may contribute to these results. Implications are discussed.
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http://dx.doi.org/10.1080/01634372.2019.1707735DOI Listing
August 2020

The burden of health conditions across race and ethnicity for aging Americans: Disability-adjusted life years.

Medicine (Baltimore) 2019 Nov;98(46):e17964

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.

Despite evidence suggesting race and ethnicity are important factors in responses to environmental exposures, drug therapies, and disease risk, few studies focus on the health needs of racially- and ethnically-diverse aging adults.The objective of this study was to determine the burden of 10 health conditions across race and ethnicity for a nationally-representative sample of aging Americans.Data from the 1998 to 2014 waves of the Health and Retirement Study, an ongoing longitudinal-panel study, were analyzed.Those aged over 50 years who identified as Black, Hispanic, or White were included. There were 5510 Blacks, 3423 Hispanics, and 21,168 Whites in the study.At each wave, participants reported if they had cancer, chronic obstructive pulmonary disease, congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Disability-adjusted life years (DALYs) were calculated for each health condition by race and ethnicity. Ranked DALYs determined how race and ethnicity was differentially impacted by the burden of each health condition. Sample weights were utilized to make DALY estimates nationally-representative.Weighted DALY estimates (in thousands) ranged from 1405 to 55,631 for Blacks, 931 to 28,442 for Hispanics, and 15,313 to 295,623 for Whites. Although the health conditions affected each race and ethnicity differently, hypertension had the largest number of DALYs, and hip fractures had the fewest across race and ethnicity. In total, there were an estimated 198,621, 101,462, and 1,187,725 DALYs for older Black, Hispanic, and White aging adults.Our findings indicate that race and ethnicity may be influential on health and disease for aging adults in the United States. Monitoring DALYs may help guide the flow of health-related expenditures, improve the impact of health interventions, advance inclusive health care for diverse aging adult populations, and prepare healthcare providers for serving the health needs of aging adults.
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http://dx.doi.org/10.1097/MD.0000000000017964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867730PMC
November 2019

Pain as a predictor of frailty over time among older Mexican Americans.

Pain 2020 01;161(1):109-113

Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch (UTMB), Galveston, TX, United States.

The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were nonfrail at baseline. Data were from a prospective cohort study of 1545 community-dwelling Mexican Americans aged ≥67 years from the Hispanic Established Populations for the Epidemiological Study of the Elderly (1995/1996-2012/2013). Frailty was defined as meeting 2 or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, and slowness. The independent predictor was self-reported pain. Covariates included age, sex, marital status, education, comorbid conditions, body mass index, Mini-Mental State Examination, depressive symptoms, and limitation in activities of daily livings. General equation estimation was performed to estimate the odds ratio of frailty as a function of pain. A total of 538 participants (34.8%) reported pain at baseline. The prevalence of frailty among those with pain ranged from 24.4% in wave 3 to 41% in wave 8. The odds ratio of becoming frail over time as a function of pain was 1.71; 95% confidence interval: 1.41 to 2.09 after controlling for all covariates. Older age, hip fracture, high depressive symptoms, and activities of daily living disability were also associated with higher odds of becoming frail over time. Female participants and those with higher levels of education and high Mini-Mental State Examination scores were less at risk. In conclusion, pain was a significantly predictor of frailty. Early assessment and better management of pain may prevent early onset of frailty in older Mexican Americans.
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http://dx.doi.org/10.1097/j.pain.0000000000001711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923536PMC
January 2020

Caregiving Across Diverse Populations: New Evidence From the National Study of Caregiving and Hispanic EPESE.

Innov Aging 2019 May 9;3(2):igz033. Epub 2019 Sep 9.

Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston.

Background And Objectives: The current study employs population-based data to determine the extent to which stress and coping factors are related to self-rated health and distress for informal caregivers (CGs) from the 3 largest racial/ethnic groups in the United States (non-Latino White, African American, and Mexican American).

Research Design And Methods: Data on primary, informal CGs are obtained from the 2015 National Study of Caregiving (NSOC) ( = 667) and the 2016 Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE) CG supplement ( = 287). Logistic regression models of health are presented for all CGs and specifically for dementia CGs.

Results: Caregiving intensity is related to health for non-Latino White CGs and African American dementia CGs. Support from family and friends is related to better self-rated health, but only for African American dementia CGs. While better relationship quality is related to better health for African American CGs and White dementia CGs, formal support utilization is related to worse CG health for Mexican American dementia CGs.

Discussion And Implications: Findings emphasize the importance of earlier detection and intervention with CGs at the beginning in the caregiving career, the interplay of formal and informal support, and appropriate ways to intervene with dementia CGs. Culturally tailored home- and community-based care options are needed to supplement the low levels of CG support, especially for the Mexican American population.
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http://dx.doi.org/10.1093/geroni/igz033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733633PMC
May 2019

Validation of the Modified Frailty Phenotype Measure in Older Mexican Americans.

J Am Geriatr Soc 2019 11 15;67(11):2393-2397. Epub 2019 Aug 15.

Division of Rehabilitation, School of Health Professions, University of Texas Medical Branch, Galveston, Texas.

Objectives: Develop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies.

Design: Expert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure.

Setting: Five southwestern states.

Participants: A total of 1833 community-dwelling Mexican Americans aged 67 years or older.

Measurements: Frailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing "low physical activity" with "limitations in walking half a mile"). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13).

Results: The original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81-.86; weighted κ = .86; 95% CI = .84-.88; bootstrap κ = .84; 95% CI = .81-.86; bootstrap-weighted κ = .86; 95% CI = .84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants.

Conclusion: "Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019.
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http://dx.doi.org/10.1111/jgs.16104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6861608PMC
November 2019

Differences in hospitalizations, emergency room admissions, and outpatient visits among Mexican-American Medicare beneficiaries.

BMC Geriatr 2019 05 21;19(1):136. Epub 2019 May 21.

Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.

Background: Few studies have investigated the healthcare utilization of Mexican-American Medicare beneficiaries. We used survey data that has been linked with Medicare claims records to describe the healthcare utilization of Mexican-American Medicare beneficiaries, determine common reasons for hospitalizations, and identify characteristics associated with healthcare utilization.

Methods: Data came from wave five (2004/05) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample included 1187 participants aged ≥75 who were followed for two-years (eight-quarters). Generalized estimating equations were used to estimate the probability of ≥1 hospitalization, emergency room (ER) admissions, and outpatient visits.

Results: The percentage of beneficiaries who had ≥1 hospitalizations, ER admissions, and outpatient visits for each quarter ranged from 10.12-12.59%, 14.15-19.03%, and 76.61-80.68%, respectively. Twenty-three percent of hospital discharges were for circulatory conditions and 17% were for respiratory conditions. Hospitalizations for heart failure and simple pneumonia were most common. Older age was associated with significantly higher odds for ER admissions (OR = 1.49, 95% CI = 1.21-1.84) but lower odds for outpatient visits (OR = 0.74, 95% CI = 0.57-0.96). Spanish language and female gender were associated with significantly higher odds for hospitalizations (OR = 1.53, 95% CI = 1.14-2.06) and outpatient visits (OR = 1.82, 95% CI = 1.43-2.33), respectively. Having a middle-school or higher level of education was associated with significantly lower odds for ER admissions (OR = 0.71, 95% CI = 0.56-0.91). Participants who were deceased within two-years had significantly higher odds for hospitalizations (OR = 6.15, 95% CI = 4.79-7.89) and ER admissions (OR = 3.63, 95% CI = 2.88-4.57) than participants who survived at least three-years.

Conclusion: We observed high healthcare utilization among Mexican-American Medicare beneficiaries. Forty percent of all hospitalizations were for circulatory and respiratory conditions with hospitalizations for heart failure and pneumonia being the most common. Older age, gender, education, language, and mortality were all associated with healthcare utilization. Continued research is needed to identify patterns and clusters of social determinants and health characteristics associated with healthcare utilization and outcomes in older Mexican-Americans.
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http://dx.doi.org/10.1186/s12877-019-1160-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528336PMC
May 2019

The burden of health conditions for middle-aged and older adults in the United States: disability-adjusted life years.

BMC Geriatr 2019 04 8;19(1):100. Epub 2019 Apr 8.

Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.

Background: Many adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.

Methods: Data from the 1998-2014 waves of the Health and Retirement Study were analyzed. At each wave, participants indicated if they were diagnosed with the following 10 conditions: cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Years lived with a disability and years of life lost to premature mortality were summed for calculating DALYs. Sample weights were utilized in the analyses to make the DALY estimates nationally-representative. Results for the DALYs were presented in thousands.

Results: There were 30,101 participants included. Sex stratified DALY estimates ranged from 4092 (fractured hip)-to-178,055 (hypertension) for men and 13,621 (fractured hip)-to-200,794 (hypertension) for women. The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 142,012 for cancer, 117,534 for diabetes, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. In total, there were an estimated 1,487,734 years of healthy life lost from the 10 health conditions examined over the study period.

Conclusions: The burden of these health conditions accounted for over a million years of healthy life lost for middle-aged and older Americans over the 16 year study period. Our results should be used to inform healthcare providers and guide health interventions aiming to improve the health of middle-aged and older adults. Moreover, shifting health policy and resources to match DALY trends may help to improve quality of life during aging and longevity.
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http://dx.doi.org/10.1186/s12877-019-1110-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454610PMC
April 2019

Erratum: A Comprehensive Analysis of Morbidity Life Expectancies Among Older Hispanic Subgroups in the United States: Variation by Nativity and Country of Origin.

Innov Aging 2018 Jun 19;2(2):igy019. Epub 2018 Jul 19.

Sealy Center on Aging, University of Texas Medical Branch, Galveston.

[This corrects the article DOI: 10.1093/geroni/igy014.][This corrects the article DOI: 10.1093/geroni/igy014.].
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http://dx.doi.org/10.1093/geroni/igy019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213940PMC
June 2018

Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions.

Innov Aging 2017 Sep 30;1(2):igx020. Epub 2017 Oct 30.

Department of preventive medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.

Background And Objectives: Hispanics are the most rapidly aging minority population in the United States. Our objective is to provide a summary of current knowledge regarding disability among Hispanics, and to propose an agenda for future research.

Research Design And Methods: A literature review was conducted to identify major areas of research. A life course perspective and the Hispanic Paradox were used as frameworks for the literature review and for identifying future areas of research.

Results: Four research areas were identified: (1) Ethnic disparities in disability; (2) Heterogeneity of the U.S. older Hispanic population; (3) Risk factors for disability; and (4) Disabled life expectancy. Older Hispanics are more likely than non-Hispanic whites to be disabled or to become disabled. Disability varied by country of origin, nativity, age of migration, and duration in the United States. Important risk factors for disability included chronic health conditions, depression, and cognitive impairment. Protective factors included positive affect and physical activity. Older Hispanics have longer life expectancy than non-Hispanic whites but spend a greater proportion of old age disabled. Future research should continue to monitor trends in disability as younger generations of Hispanics reach old age. Attention needs to be given to regional variation within the United States for disability prevalence, early-life risk factors, and factors that may contribute to variation in disabled life expectancy. There is also an urgent need for interventions that can effectively prevent or delay the onset of disability in older Hispanics.

Discussion And Implications: Considerable research has examined disability among older Hispanics, but continued research is needed. It is important that research findings be used to inform public policies that can address the burden of disability for older Hispanic populations.
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http://dx.doi.org/10.1093/geroni/igx020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177050PMC
September 2017

Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans.

Aging Ment Health 2019 10 24;23(10):1405-1412. Epub 2018 Nov 24.

a Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston , TX , USA.

Impaired cognition and pre-frailty are associated with poor health outcomes. However, research has not examined the combined impact of cognitive impairment and pre-frailty on future frailty and mortality among older Mexican Americans. Data for this analysis came from the 2006-2007 and 2010-2011 waves of the Hispanic EPESE. The final sample included 639 Mexican Americans aged ≥77 years who were non-frail or pre-frail in 2006-2007. Frailty measure included weight loss, exhaustion, weakness, and slow walking speed. Participants were classified as non-frail (0 criteria) and pre-frail (1 criterion) at baseline. Cognitive impairment was defined as <21 points on the MMSE. At baseline, participants were grouped as: cognitively intact non-frail, cognitively intact pre-frail, cognitively impaired non-frail, and cognitively impaired pre-frail. Logistic and hazard regression models were used to evaluate the odds of being frail in 2010-2011 and risk for 10-year mortality. Cognitively impaired pre-frail participants were more likely to become frail (OR = 4.82, 95% CI = 2.02-11.42) and deceased (HR = 1.99, 95% CI = 1.42-2.78). Cognitively impaired non-frail participants had significantly higher risk for mortality (HR = 1.55, 95% CI = 1.12-2.19) but not frailty (OR = 1.29, 95% CI = 0.50-3.11). Being cognitively intact and pre-frail at baseline was not significantly associated with being frail at follow-up (OR = 1.62, 95% CI = 0.83-3.19) or mortality (HR = 1.29, 95% CI = 0.97-1.71). Comorbid cognitive impairment and pre-frailty is associated with future frailty and mortality in older Mexican Americans. Screening for cognitive impairment may be effective for identifying pre-frail Mexican Americans who are at the highest risk of frailty and mortality.
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http://dx.doi.org/10.1080/13607863.2018.1493719DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534489PMC
October 2019

The Healthy Immigrant Effect and Aging in the United States and Other Western Countries.

Gerontologist 2019 03;59(2):205-214

Kent School of Social Work, University of Louisville, Kentucky.

The rising number of immigrants to the United States and other western countries has been accompanied by rising interest in the characteristics of immigrants including their mortality risk and health status. In general, immigrants to the United States, Canada, and Australia enjoy a health advantage over the native populations, which has been coined the healthy immigrant effect. The purpose of this review is to summarize findings on aging and the immigrant health effect in the 3 most common immigrant destinations the United States, Canada, Australia, as well as in Europe. Much of the research in the United States has focused on the so-called Hispanic Paradox or the favorable health of Hispanics relative to non-Hispanic whites despite lower average socioeconomic status as well as other risk factors, with recent research beginning to pay attention to dietary and genetic factors. In all 3 countries, there is evidence of a health convergence of immigrants relative to the native-born population over approximately 10-20 years. By the time they reach old age, immigrants experience high rates of comorbidity and disability. Immigrant health selection appears to be the key reason explaining the immigrant health advantage. Immigrants to Europe also appear to be health selected but not as consistently as in the United States, Canada, and Australia. Immigrant enclaves appear to confer health advantages in the United States among older Hispanics but appear to have negative consequences in Europe. More attention needs to be given to the health and health care needs of the rising numbers of refugees to Europe as well as refugees in the Middle East, Africa, and elsewhere.
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http://dx.doi.org/10.1093/geront/gny136DOI Listing
March 2019

Cohort Differences in Cognitive Impairment and Cognitive Decline Among Mexican-Americans Aged 75 Years or Older.

Am J Epidemiol 2019 01;188(1):119-129

Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.

Research suggests that the prevalence and incidence of cognitive impairment among older adults is decreasing. This analysis used data from 9 waves (1993-2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess cognitive status and cognitive decline for 2 cohorts of Mexican-Americans aged ≥75 years in 1993-1994 versus 2004-2005. Logistic regression, joint longitudinal survival models, and illness-death models for interval-censored data were used to examine cohort differences in the odds of prevalent cognitive impairment, trajectories of cognitive decline, and the risk of 10-year incident cognitive impairment, respectively. Results indicated that compared with the 1993-1994 cohort, the 2004-2005 cohort had higher odds for prevalent cognitive impairment (odds ratio = 2.51, 95% confidence interval (CI): 1.92, 3.29), particularly among participants with <4 years of education (odds ratio = 2.99, 95% CI: 2.14, 4.18). Conversely, the 2004-2005 cohort exhibited significantly slower rates of cognitive decline (βˆ = 0.50, 95% CI: 0.39, 0.62) and had a significantly lower risk of incident cognitive impairment (hazard ratio = 0.75, 95% CI: 0.62, 0.91) compared with the 1993-1994 cohort. This analysis provides mixed results for cohort trends in the cognitive health of older Mexican-Americans. Continued research is needed to identify risk factors that contribute to these population-level trends.
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http://dx.doi.org/10.1093/aje/kwy196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321807PMC
January 2019

A Comprehensive Analysis of Morbidity Life Expectancies Among Older Hispanic Subgroups in the United States: Variation by Nativity and Country of Origin.

Innov Aging 2018 Jun 18;2(2):igy014. Epub 2018 Jun 18.

Sealy Center on Aging, University of Texas Medical Branch, Galveston.

Background And Objectives: Although a clear advantage in mortality has been documented among older Hispanic subgroups, particularly the foreign-born, research examining health selectivity in morbidity life expectancies among older Hispanics are scarce. Differences in sociocultural characteristics among Hispanic subgroups may influence racial/ethnic and nativity disparities in morbidity. Research examining the heterogeneity among older Hispanic subgroups may further our understanding of why some Hispanics are able to preserve good health in old age, while others experience a health disadvantage. Thus, the primary goal of this analysis is to examine racial/ethnic, nativity, and country of origin differences in morbidity life expectancies among older adults in the United States.

Research Design And Methods: We used individual-level data (1999-2015) from the National Health Interview Survey to estimate Sullivan-based life tables of life expectancies with morbidity and without morbidity by gender for U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, foreign-born Cubans, and whites in mid-life (age 50), and late-life (age 65).

Results: Hispanics are heterogeneous in morbidity life expectancies. Among females, U.S.-born Mexicans, foreign-born Mexicans, and island-born Puerto Ricans spent more late-life years with morbidity than whites. For men, U.S.-born Puerto Ricans were the only Hispanic subgroup disadvantaged in the number of years lived with morbidity. Conversely, foreign-born Cubans exhibited the healthiest outcomes of all groups, regardless of gender.

Discussion And Implications: Reducing the risk for late-life morbidity must be informed by a comprehensive understanding of a wide range of factors that shape health among older adults. Research should avoid pan-ethnic groupings that overlook important differences in chronic disease risk profiles among Hispanic subgroups. Recognizing the various sociocultural and environmental processes that underlie Hispanic subpopulations is important for development and implementation of social and public health policies aimed at ameliorating negative health outcomes of late-life morbidity among minority and immigrant groups.
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http://dx.doi.org/10.1093/geroni/igy014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004785PMC
June 2018

Frailty and diabetes among Mexican American older adults.

Ann Epidemiol 2018 07 26;28(7):421-426.e1. Epub 2018 Apr 26.

Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston.

Purpose: Progressive physical frailty in older adults is associated with increased risk of falls, disability, institutionalization, and mortality. Although associations between diabetes and frailty have been observed, the impact of diabetes on frailty in older Hispanics is largely unexplored. We examine the association of diabetes on the odds of frailty among older Mexican Americans.

Methods: Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly from 1995 until 2012, frailty was assessed by slow gait, weak hand grip strength, exhaustion, and unexplained weight loss (n = 1327).

Results: Logistic regression showed a large magnitude of effect of diabetes on the odds of frailty (odds ratio 1.47, 95% confidence interval 1.14-1.90). Other contributors to frailty included arthritis, heart attack, and hip fracture. Positive and negative effects had significant and opposing associations. Ordinal logit models assessed the odds of frail compared to nonfrail and prefrail. In these models, diabetes was associated with a 32% increase in the odds of a higher level of frailty.

Conclusions: Diabetes is a significant contributor to increased frailty in older Mexican Americans. Interventions to reduce frailty rates should focus on mitigating the effects of diabetes and shifting away from negative and toward positive effect.
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http://dx.doi.org/10.1016/j.annepidem.2018.04.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211192PMC
July 2018

Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients.

Prev Chronic Dis 2018 05 3;15:E51. Epub 2018 May 3.

Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas.

Introduction: Older Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations.

Methods: We analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3).

Results: Care recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34-2.94), self-care limitations (OR = 2.53; 95% CI, 1.70-3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28-3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26-2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05-5.24) than those with just arthritis and hypertension.

Conclusion: MCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.
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http://dx.doi.org/10.5888/pcd15.170358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951156PMC
May 2018

Early frailty transition predicts 15-year mortality among nondisabled older Mexican Americans.

Ann Epidemiol 2018 06 12;28(6):362-367.e3. Epub 2018 Apr 12.

Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch (UTMB), Galveston, USA. Electronic address:

Purpose: To investigate the effect of early frailty transitions on 15-year mortality risk.

Methods: Longitudinal data analysis of the Hispanic Established Populations for the Epidemiological Study of the Elderly involving 1171 community-dwelling Mexican Americans aged ≥67 years and older. Frailty was determined using the modified frailty phenotype, including unintentional weight loss, weakness, self-reported exhaustion, and slow walking speed. Participants were defined at baseline as nonfrail, prefrail, or frail and divided into nine transition groups, during a 3-year observation period.

Results: Mean age was 77.0 years (standard deviation [SD] = 5.3) and 59.1% were female. Participants who transitioned from prefrail to frail (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.23-2.28), frail to prefrail (HR = 1.54, 95% CI = 1.05-2.28); or who remained frail (HR = 1.72, 95% CI = 1.21-2.44), had significant higher 15-year mortality risk than those who remained nonfrail. Participants transitioning from frail to nonfrail had a similar 15-year mortality risk as those who remained nonfrail (HR = 0.96, 95% CI = 0.53-1.72). Weight loss and slow walking speed were associated with transitions to frailty.

Conclusions: An early transition from frail to nonfrail in older Mexican Americans was associated with a 4% decrease in mortality compared with those who remained nonfrail, although this difference was not statistically significant. Additional longitudinal research is needed to understand positive transitions in frailty.
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http://dx.doi.org/10.1016/j.annepidem.2018.03.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971136PMC
June 2018

Physical Performance Trajectories and Mortality Among Older Mexican Americans.

J Gerontol A Biol Sci Med Sci 2019 01;74(2):233-239

Department of Preventive Medicine and Community Health, Galveston.

Background: We sought to identify distinct trajectory classes of physical performance in Mexican Americans aged 75 years and older and to examine whether these trajectories predict mortality.

Methods: We used four waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data for adults 75 years and older from 2004-2005 to 2013. Latent growth curve analysis was used to identify distinct trajectory classes. Multinomial logistic regression analysis was used to examine the association between baseline characteristics and the newly constructed trajectories. Cox proportional hazards regression models examined the hazard of mortality as a function of Short Physical Performance Battery (SPPB) trajectories.

Results: The study follow-up period was approximately 9.5 years. One thousand four hundred and eleven adults were successfully classified into three (low-declining, high-declining, and high-stable) physical performance trajectory classes. Depressive symptoms (relative risk ratio = 1.94, 95% confidence interval [CI] = 1.17-3.22), diabetes (relative risk ratio = 2.44, 95% CI = 1.63-3.65), number of other comorbid health conditions (relative risk ratio = 1.40, 95% CI = 1.16-1.68), and obesity (relative risk ratio = 2.83, 95% CI = 1.67-4.80), increased the relative risk of classification into the low, relative to high-stable trajectory class. Male gender and foreign-born status significantly reduced risk of classification in the low-declining and high-declining trajectory classes. We observed a statistically significant association between low-declining (hazard ratio = 3.01, 95% CI = 2.34-3. 87) and high-declining (hazard ratio = 1.64, 95% CI = 1.32-2.03) trajectories and increased risk of mortality.

Conclusions: Differences in mortality across physical performance trajectory classes suggest that these physical performance classes represent differences in underlying disease progression, and thus differences in mortality risk among older Mexican Americans, which warrants additional research to better understand differential physical performance trajectories and their effects on morbidity and mortality in heterogeneous aging populations.
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http://dx.doi.org/10.1093/gerona/gly013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333933PMC
January 2019

Complexity of Work and Incident Cognitive Impairment in Puerto Rican Older Adults.

J Gerontol B Psychol Sci Soc Sci 2019 06;74(5):785-795

Department of Psychology, University of Alabama at Birmingham.

Objective: We investigated complexity of work in main occupation in relation to incident cognitive impairment in older Puerto Ricans.

Method: A population-based sample of 1,673 adults age 60+ for the Puerto Rican Elderly: Health Conditions (PREHCO) study was used. Cognition was measured at baseline and 4 years later using the Mini-Mental Cabán (MMC), with scoring 1.5 SD below the MMC score adjusted for age, education, gender, and reading ability comprising cognitive impairment. Complexity scores were derived from the 1970 U.S. Census, 1977 and 2000 Dictionary of Occupational Titles, and 2001 O*Net.

Results: Controlling for baseline age, gender, childhood economic hardship, adult money problems, depressive symptoms, and self-reported health, greater scores for most work complexity measures were associated with significantly lower risk of cognitive impairment (ps < .05), with significant odds ratios ranging between 0.74, reflecting 26% reduction in risk for every extra standard deviation of complexity, and 0.81. Controlling for education reduced these effects slightly but also reduced most associations to nonsignificant. The results were stronger for those with less childhood economic hardship or education (ps < .05).

Discussion: Complexity of work may reduce risk of cognitive impairment in Puerto Rican older adults, especially when combined with favorable childhood economic conditions and higher educational attainment.
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http://dx.doi.org/10.1093/geronb/gbx127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594295PMC
June 2019

HPV Vaccination Among Foreign-Born Women: Examining the National Health Interview Survey 2013-2015.

Am J Prev Med 2018 Jan 23;54(1):20-27. Epub 2017 Oct 23.

Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, Texas; Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.

Introduction: Human papillomavirus vaccination is less prevalent among foreign-born than U.S.-born women and may lead to disparities in human papillomavirus-related cancers in the future. There is limited research on factors associated with vaccination uptake between these two groups. This study examined the association between place of birth and human papillomavirus vaccine uptake, and what determinants of vaccination attenuate this relationship.

Methods: The 2013-2015 National Health Interview Survey data on women was analyzed in 2016, to determine differences in prevalence of human papillomavirus vaccination between foreign- and U.S.-born women. Multivariate binary logistic regression analysis was used to examine the association between foreign-born status and human papillomavirus vaccine initiation, after controlling for health insurance status, having a usual source of care, obstetrician/gynecologist visits, Pap tests, length of U.S. residency, and citizenship.

Results: Human papillomavirus vaccination prevalence varied significantly among women born in different regions of the world. European and South-American women had the highest vaccination rates among all foreign-born women. Compared with U.S.-born women, foreign-born women were significantly less likely to report human papillomavirus vaccine initiation. This relationship was partially attenuated after adjusting for the covariates. Among foreign-born women, Asians were significantly less likely to report human papillomavirus vaccination uptake than white women. Additionally, living in the U.S. for >5 years was significantly associated with vaccine initiation, but attenuated by U.S. citizenship status.

Conclusions: Public health interventions to improve human papillomavirus vaccination need to be developed to address multicultural audiences with limited access to health insurance and health care.
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http://dx.doi.org/10.1016/j.amepre.2017.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736418PMC
January 2018