Anne Lee

Development and validation of a brief dementia screening indicator for primary care.

Detection of “any cognitive impairment” is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

Association between chronic kidney disease detected using creatinine and cystatin C and death and cardiovascular events in elderly Mexican Americans: the Sacramento Area Latino Study on Aging.

Creatinine, the current clinical standard to detect chronic kidney disease (CKD), is biased by muscle mass, age and race. The authors sought to determine whether cystatin C, an alternative marker of kidney function less biased by these factors, can identify elderly Mexican Americans with CKD who are at high risk for death and cardiovascular disease.

A longitudinal analysis of cross-border ties and depression for Latino adults

Recent scholarship suggests a significant association between cross-border ties, or ties maintained with family and friends in countries and communities of origin, and the mental health of immigrants and their descendants. To date, this research has been exclusively cross-sectional, precluding conclusions about a causal association between cross-border ties and mental health outcomes. In the present study we undertake a longitudinal analysis of the relationship between cross-border ties and depression measured over a ten-year period for a sample of immigrant and U.S.-born Latinos. Data are from the Sacramento Area Latino Study on Aging (1998-2008), a population-based, prospective study of Latin American-origin adults 60 years and older. We find that cross-border ties reported at baseline were significantly associated with depression in subsequent study waves, even after controlling for the presence of depression at baseline, albeit with substantial differences by gender and nativity. Specifically, communication with family and friends in Latin America and travel to Latin America at baseline were each significantly associated with greater odds of depression for immigrant women, but with lower odds of depression for U.S.-born Latina women over the study period. Travel to Latin America at baseline was significantly associated with lower odds of depression for Latino men across the study. Across all models we control for depressive symptomatology at baseline to account for the reciprocal nature of depressive symptoms and engagement with social ties, including cross-border ties. Our findings suggest that cross-border ties may represent a unique source of both resilience and risk for the long-term mental health of immigrant Latinos and their descendants.

Impact of acculturation on cardiovascular risk factors among elderly Mexican Americans

PURPOSE Higher levels of acculturation among Latinos have been shown to be associated with a higher prevalence of cardiovascular (CV) risk factors in some studies of middle-age persons. The association of acculturation and prevalence of CV risk factors in elderly Latinos is less well established. METHODS Acculturation was measured using the validated bidimensional Acculturation Rating Scale for Mexican Americans-II. We conducted a cross-sectional analysis of the association of acculturation with prevalence of CV risk factors among 1789 elderly men and women from the Sacramento Area Latino Study on Aging using multivariate linear and logistic regression. We tested for the interaction of acculturation with risk factors by nativity status. RESULTS Median age was 69.8 years. Higher acculturation was associated with lower systolic blood pressure, lower low-density lipoprotein, higher high-density lipoprotein, and lower prevalence of CV disease after age and sex adjustment. Higher acculturation remained associated with lower level of low-density lipoprotein and higher level of high-density lipoprotein after full adjustment. Nativity status did not affect these results. CONCLUSIONS Contrary to other reports in middle-aged persons, higher levels of acculturation were associated with better lipid profiles and no significant differences in other CV risk factors by acculturation level in elderly Latinos.

Diabetes Mellitus as a Risk Factor for Development of Depressive Symptoms in a Population-Based Cohort of Older Mexican Americans

To determine whether diabetes mellitus increases depressive symptoms in older Latinos in a population‐based cohort.

Impact of Gender and Blood Pressure on Poststroke Cognitive Decline among Older Latinos

BACKGROUND Poststroke cognitive decline (PSCD) is an important consequence of stroke that may be more severe in women than in men. The existence of any gender differences in PSCD among Mexican Americans, and their potential mechanisms, such as blood pressure (BP), remain unknown. We assessed PSCD stratified on gender in older Mexican Americans and explored the influence of pre- and poststroke systolic BP on PSCD. METHODS Among 1576 nondemented, stroke-free adults 60 years of age or older when recruited between 1998 and 1999 in the Sacramento Area Latino Study on Aging (SALSA) cohort, we examined pre- and poststroke longitudinal changes in Spanish English Verbal Learning test scores (WL), a verbal memory test, and errors on the Modified Mini Mental State Examination (3MSE) scores, a global cognition test, stratified by gender, adjusting for baseline and time-varying covariates with linear mixed effects models. RESULTS We identified 151 adults (mean age 72 ± 8 years) with incident first-ever stroke during 10 years of follow-up. After adjustment for age, education, and time-varying depressive symptoms, 3MSE errors increased by 22% per year (95% confidence interval [CI] 6.8-36.7%) in men and 13.2% per year (95% CI 3.5-22.9%) in women over the poststroke period. Poststroke WL scores improved by 0.05 words per year (95% CI -0.24 to 0.33) in men and by 0.09 words per year (95% CI -0.16 to 0.34) in women. Results persisted after adjustment for time-varying systolic BP. CONCLUSIONS Among this population of older Mexican Americans, PSCD did not differ by gender. We found no evidence that systolic BP influenced PSCD in women or men.

Perceived Walking Speed, Measured Tandem Walk, Incident Stroke, and Mortality in Older Latino Adults: A Prospective Cohort Study.

Background Walking speed is associated with functional status and all-cause mortality. Yet the relationship between walking speed and stroke, also a leading cause of disability, remains poorly understood, especially in older Latino adults who suffer from a significant burden of stroke. Methods A total of 1,486 stroke-free participants from the Sacramento Area Latino Study on Aging, aged 60 and older at baseline in 1998-1999, were followed annually through 2010. Participants reported their usual walking speed outdoors which was classified into slow, medium, or fast. We also assessed timed tandem walk ability (unable or eight or more errors vs less than eight errors). We ascertained three incident stroke endpoints: total stroke, nonfatal stroke, and fatal stroke. Using Cox proportional hazards models, we estimated hazard ratios (HRs) for stroke at different walking speed and timed tandem walk categories. Results Over an average of 6 years of follow-up (SD = 2.8), the incidence rate of total strokes was 23.2/1,000 person-years for slow walkers compared to 15.6/1,000 person-years for medium walkers, and 7.6/1,000 person-years for fast walkers. In Cox models adjusted for sociodemographics, cardiovascular risk, cognition and functional status, and self-rated health, the hazard of total stroke was 31% lower for medium walkers (HR: 0.69, 95% confidence interval [CI]: 0.47, 1.02) and 56% lower for fast walkers (HR: 0.44, 95% CI: 0.24, 0.82) compared with slow walkers. We found similar associations with timed tandem walk ability (fully adjusted HR: 0.66, 95% CI: 0.45, 0.98). Conclusions Our findings suggest perceived walking speed captures more than self-rated health alone and is a strong risk factor for stroke risk in Latino older adults.

Gender Differences in the Combined Effects of Cardiovascular Disease and Osteoarthritis on Progression to Functional Impairment in Older Mexican Americans

BACKGROUND Comorbidity (COM) is an important issue in aging. Cardiovascular disease (CVD) and osteoarthritis separately and together may modify the trajectories of functional decline. This analysis examines whether specific and unrelated COMs influence functional change differently and vary by gender. METHODS A cohort study of 1,789 (aged 60 years and older) Mexican Americans was followed annually for up to 10 years. We created four groups of COM (CVD alone, lower body osteoarthritis alone [OA], neither, or both). We employed mixed effects Poisson models with Instrumental Activities of Daily Living (IADL) as the outcome. We tested whether the association between COM and decline in functional status differed by gender. RESULTS IADL impairments in those with CVD, OA, or both were significantly higher at baseline and increased more rapidly over time compared to those with neither condition. Compared to women with no COM, the number of IADL impairments in women with CVD alone were 1.36 times greater, with OA were 1.35 times greater, and both conditions were 1.26 times greater. Compared to men with no COM, IADL impairments in men with CVD alone were 1.15 times greater, OA alone were 1.12 times greater, and both were 1.26 times greater. CONCLUSIONS Over time, the influence of COM on functional decline differs by specific combinations of COM and by gender. Aggregate COM scales obscure the biological and temporal heterogeneity in the effects of COM. Time-dependent-specific COMs better assess the development of impairment. Women experience a higher burden of functional impairment due to COM than men.

The Impact of Neighborhood Socioeconomic Position on Prevalence of Diabetes and Prediabetes in Older Latinos: The Sacramento Area Latino Study on Aging.

Diabetes is a leading cause of morbidity and mortality in Latinos, but few studies of disease risk in this subpopulation examine both area-level socioeconomic position (SEP) and its association with individual-level risk factors. This study sought to examine the cross-sectional relationship between neighborhood socioeconomic position (NSEP) and prevalent diabetes and prediabetes status among older Latinos. Longitudinal health data were collected from 1,789 participants in the Sacramento Area Latino Study on Aging (SALSA). Among SALSA participants, higher NSEP was associated with lower diabetes prevalence (p = .001). Adjustment for body mass index and other individual-level factors did not affect this relationship. No association was observed between NSEP and prediabetes in both unadjusted and adjusted models. Neighborhoods with higher SEP had a lower prevalence of diabetes. This study highlights the importance of considering neighborhood factors that may place older Latinos at high risk for this disease.

Cross-border ties, nativity, and inflammatory markers in a population-based prospective study of Latino adults

Even after migration, immigrants and their descendants may continue to have ties to family and friends who remain in places of origin. Recent research suggests that these cross-border social ties have implications for health, although this scholarship has been limited to self-reported outcomes. Using data from the Sacramento Area Latino Study on Aging (SALSA), we estimate associations between cross-border social ties and inflammatory biomarkers among Latino adults (n = 1786). We find that immigrants who maintained any cross-border connection to family and friends in Latin America had significantly lower levels of baseline interleukin-6 (IL-6) and C-reactive protein (CRP) compared to their US-born counterparts with no cross-border ties. These results held for values of CRP at five-year follow-up for men only. In contrast, US-born women with cross-border ties to family and friends in Latin America had both significantly higher levels of CRP and significantly lower levels of tumor necrosis factor-alpha (TNF-α) at five-year follow-up relative to their US-born counterparts with no cross-border ties. We find descriptively that men who have cross-border ties are also less likely to be socially isolated within local contexts. Considering place-of-origin social connections may contribute critical nuance to studies of immigrant health, including disparities in inflammatory markers that may serve as indicators of underlying chronic disease.