Beatriz Eugenia Alvarado

Cognitive decline is related to education and occupation in a Spanish elderly cohort

Background and aims: The type of education and occupation can sensibly influence cognitive decline. The aim of this study was to examine their impact on cognitive function in a longitudinal study of community-dwelling Spanish people over 65 with low levels of formal education and predominantly unskilled occupations. Methods: Cognitive function was assessed in 1993 and 1997 using a simple scale including items of memory and orientation that has been previously validated for populations with low levels of formal education. Cognitive score in 1997 and cognitive decline over 4 years (1993–1997) were used as outcomes. Education and occupation were analyzed as determinants of cognitive function using multiple linear regression, and of cognitive decline using logistic and multinomial regressions. Results: Of the 557 subjects who completed the follow-up in 1997, 11% had experienced severe decline and 20.6% mild decline. Overall and mild cognitive decline were predicted by low education and being a farm worker (OR: 2.36, CI 95%: 1.16–4.81 and OR: 2.37, CI 95%: 1.05–5.37) after controlling for age. Conclusions: Cognitive decline in the elderly is partially explained by early life events, such as education, and living in a deprived environment over a long period of time. We cannot ascertain whether these effects are direct or mediated by other associated conditions but sample attrition does not account for our results.

Inequalities in breast and cervical cancer screening among urban Mexican women

OBJECTIVEnTo examine the equity of screening for breast and cervical cancer among women aged 50 and over living in Mexico City according to the Andersen behavioural model.nnnMETHODSnLogistic regressions were used to analyze the associations of predisposing factors, enabling resources and health needs with mammography and Pap testing among 1323 women aged 50 and over living in Mexico City. The data were taken from SABE, a survey conducted in Latin American and Caribbean cities in 1999-2000.nnnRESULTSnReferring to the previous two years, use of mammography was less frequent (14.8%) than Pap testing (53.7%). Higher education and having private health insurance were associated with receiving both procedures. Being married was associated with receipt of Pap testing, while being unmarried was associated with mammography. Younger women were more likely to receive a Pap test. Other cancer prevention behaviours were strong predictors of mammography and Pap test use.nnnCONCLUSIONSnThere are inequities in access to cancer screening services among women aged 50 and over in Mexico. Cancer prevention programs need to implement strategies that guarantee free and accessible services independently of social conditions or type of health insurance. The observed clustering of screening services suggests that packaging screening programs for gynaecological cancer could be used to increase coverage.

Life course socioeconomic disadvantage and cognitive function among the elderly population of seven capitals in Latin America and the Caribbean.

Objectives: To examine the influence of life course socioeconomic disadvantages (SED) on cognitive function in later life. Method: Data originate from a survey of people 60 and older living in seven Latin American and Caribbean cities. Cognitive function was measured with a modified Mini-Mental State Examination and the Pfeffer Scale of Functional Capacity. Homogeneity tests were used to pool data. Associations between cognitive function and SED were evaluated, fitting logistic regressions. Results: Cognitive impairment (CI) prevalence ranged from 0.3% to 6.5% in men and 1.2% to 10.1% in women. Childhood rural living, poor childhood health, illiteracy, housewife or farmer occupation, and insufficient income were associated with CI in all seven cities. The odds of CI increase with cumulative exposure to disadvantages along life course. Conclusions: Life course SED is related to cognitive function later in life. Difficulty in properly distinguishing cognitive function from test performance remains an issue.

Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population

Background and aims: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. Methods: We used the São Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and co-morbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. Results: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32–3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41–2.38 in women; OR= 3.42; 95% CI 2.41–4.86 in men). Conclusions: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.

Social networks and depressive symptoms among elderly women and men in Havana, Cuba

Objectives: To examine the main and the stress-buffering effects of social networks on depressive symptoms among elderly Cuban men and women living in La Havana. Method: Information was gathered from a representative sample of the elderly population in Havana (n = 1905), as part of the SABE (Salud, Bienestary Enuejecimiento) study. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. The structure and function of social networks were studied. Gender-specific multivariate logistic regressions were fitted to test the main (independent of stressors) and the stress-buffering effects (in the presence of financial strain or disabilities) on depressive symptoms. Results: Social ties were associated with a lower prevalence of depressive symptoms in women and men independently of the presence of stressors. Women who were or had been married, lived in an extended family, and enjoyed balanced exchanges with relatives and children reported low prevalence of depressive symptoms. Men were less likely to report depressive symptoms if they were currently married, and did not live alone. Social networks buffered the effect of financial strain on depression, but not in the event of disability. Conclusion: In Cuba, networks centered on children and extended family were associated with low frequency of depressive symptoms, ruling contrary to common findings in developed societies. These living arrangements have an important role in buffering the impact of financial strain on depressive symptoms.

Gender Differences in Lower Extremity Function in Latin American Elders Seeking Explanations From a Life-Course Perspective

Objective: The authors examined the contribution of life-course exposures to gender differences in mobility in later life. Method: Data originate from a survey of persons aged 60 and older living in six Latin American and Caribbean cities (n = 10,661). Lower extremity limitations (LEL) were defined as the presence of three or more reported difficulties with five activities: lifting and carrying 10 lb, walking several blocks, climbing a flight of stairs, kneeling/ stooping/crouching, and getting up from a chair. Data were pooled after testing homogeneity of effects across cities. A multivariate model was fitted using logistic regression analysis. Complete data analyses were performed on 8,166 (72%) participants. Results: Prevalence of LEL varies across cities (9.3—23.7% in men, 23.3—42.9% in women). Intervening life-course and health factors explained a small proportion of the gender difference in LEL (odds ratio = 2.39; 95% confidence interval = 2.04—2.79). Childhood hunger was predictive of LEL in women, and a stronger association between depression and LEL was found in men than in women. Little education and insufficient income were associated with LEL for both men and women. Discussion: Life-course exposures predict mobility, but further research is needed to identify intervening factors relating gender to mobility in old age.

Validation of food security and social support scales in an Afro-Colombian community: application on a prevalence study of nutritional status in children aged 6 to 18 months

We conducted a cross-sectional study on 193 mothers of children 6 to 18 months of age in an African-Colombian community, with the objectives: (1) to adapt and validate the Community Childhood Hunger Identification Project scale, the DUKE-UNC-11 social support scale, and the Quebec Longitudinal Study of Child Development (QLSCD) partner support scale, and (2) to identify any existent relationship between nutritional status in infancy and both food insecurity and social support. We determined construct validity using factor analysis and theoretical models-based non-parametric correlations. Length-for-age and weight-for-length Z-results were calculated. Factor analyses reduced the hunger scale to one factor, the DUKE-UNC-11 scale to two factors, and the QLSCD scale to one factor. The Cronbachs alpha test ranged between 0.70 and 0.90. Both food insecurity and social support scales were correlated with mothers social conditions, and social support was positively associated with social networks and mothers self-perceived health status. Food insecurity, emotional-social support, and partners negative support were associated with lower height-to-age and therefore a higher ratio of chronic malnutrition. The study supports the appropriateness of the instruments to measure the expressed concepts.

Life course socioeconomic adversity and age at natural menopause in women from Latin America and the Caribbean.

Objective: The aim of this study was to assess the association between life course socioeconomic adversity and age at menopause in Latin America and the Caribbean. Methods: Data from 4,056 women aged 60 to 79 years randomly selected from seven cities in Latin America and the Caribbean were analyzed. Cox proportional hazards models were used to estimate the probability of age at menopause by indicators of life course socioeconomic adversity. Results: Median age at menopause was 50 years. The following life course socioeconomic indicators were associated with earlier age at menopause: low education (hazard ratio [HR], 1.16; 95% CI, 1.07-1.26) and manual occupation/housewives (HR, 1.12; 95% CI, 1.03-1.20). Other factors associated with earlier age at menopause were current smoking (HR, 1.14; 95% CI, 1.03-1.27), nulliparity (HR, 1.14; 95% CI, 1.02-1.28), and multiparity (five children or more; HR, 1.15; 95% CI, 1.06-1.24). There was a cumulative effect of socioeconomic adversities across the life course. The median age at menopause was lower for women with six indicators of life course socioeconomic adversity compared with women with no adversities (HR, 1.40; 95% CI, 1.10-1.77). Conclusions: Median age at menopause occurs several years earlier in women from Latin America and the Caribbean compared with women from high-income countries. The results support the association between life course socioeconomic adversity and age at menopause.

Early life adversity and C-reactive protein in diverse populations of older adults: a cross-sectional analysis from the International Mobility in Aging Study (IMIAS)

BackgroundRecent studies suggest potential associations between childhood adversity and chronic inflammation at older ages. Our aim is to compare associations between childhood health, social and economic adversity and high sensitivity C-reactive protein (hsCRP) in populations of older adults living in different countries.MethodsWe used the 2012 baseline data (nu2009=u20091340) from the International Mobility in Aging Study (IMIAS) of community-dwelling people aged 65–74 years in Natal (Brazil), Manizales (Colombia) and Canada (Kingston, Ontario; Saint-Hyacinthe, Quebec). Multiple linear and Poisson regressions with robust covariance were fitted to examine the associations between early life health, social, and economic adversity and hsCRP, controlling for age, sex, financial strain, marital status, physical activity, smoking and chronic conditions both in the Canadian and in the Latin American samples.ResultsParticipants from Canadian cities have less adverse childhood conditions and better childhood self-reported health. Inflammation was lower in the Canadian cities than in Manizales and Natal. Significant associations were found between hsCRP and childhood social adversity in the Canadian but not in the Latin American samples. Among Canadian older adults, the fully-adjusted mean hsCRP was 2.2 (95xa0% CI 1.7; 2.8) among those with none or one childhood social adversity compared with 2.8 (95xa0% CI 2.1; 3.8) for those with two or more childhood social adversities (pu2009=u20090.053). Similarly, the prevalence of hsCRPu2009>u20093xa0mg/dL was 40xa0% higher among those with higher childhood social adversity but after adjustment by health behaviors and chronic conditions the association was attenuated. No associations were observed between hsCRP and childhood poor health or childhood economic adversity.ConclusionsInflammation was higher in older participants living in the Latin American cities compared with their Canadian counterparts. Childhood social adversity, not childhood economic adversity or poor health during childhood, was an independent predictor of chronic inflammation in old age in the Canadian sample. Selective survival could possibly explain the lack of association between social adversity and hsCRP in the Latin American samples.