Carmen García-Peña

A frailty index to predict the mortality risk in a population of senior mexican adults

BackgroundFrailty in the elderly can be regarded as nonspecific vulnerability to adverse health outcomes, caused by multiple factors. The aim was to analyze the relationships between the frailty index, age and mortality in a two year follow up study of Mexican elderly.MethodsA frailty index was developed using 34 variables. To obtain the index, the mean of the total score for each individual was obtained. Survival analyses techniques were used to examine the risk ratios for the different levels of the frailty index. Kaplan-Meier estimates were obtained, adjusted for age and gender. Cox proportional hazards models were also built to obtain hazard ratio estimates.ResultsA total of 4082 participants was analyzed. Participants had an average age of 73 years and 52.5% were women. On average, participants were followed-up for 710 days (standard deviation = 111 days) and 279 of them died. Mortality increased with the frailty index level, especially in those with levels between .21 to .65, reaching approximately 17% and 21%, respectively. Cox proportional hazards models showed that participants with frailty index levels associated to increased mortality (.21 and higher) represent 24.0% of those aged 65-69 years and 47.6% of those 85 and older.ConclusionThe frailty index shows the properties found in the other studies, it allows stratifying older Mexican into several groups different by the degree of the risk of mortality, and therefore the frailty index can be used in assessing health of elderly.

Validation of a Modified Version of the Mini-Mental State Examination (MMSE) in Spanish

In order to validate the adapted version of the Mini-Mental State Examination (MMSE) in Spanish, 203 participants aged at least 60 years were interviewed and clinically evaluated. Factor analysis and ROC curves were used to evaluate the instrument. From the clinical evaluation, it was found that 34.5% of the participants were cognitively impaired. Spatial orientation, Orientation in time plus registration, Language plus attention and calculation, and Naming objects were the four components that explained 60.6% of the variance from the factor analysis. The ROC curve showed 23/24 as the optimal cut-off point, with a sensitivity of 0.97 and specificity of 0.88. Differences by number of years in education were also found, but adjusting the scoring for those individuals with a low level of education improved the performance of the instrument.

Frailty among community-dwelling elderly Mexican people: Prevalence and association with sociodemographic characteristics, health state and the use of health services

To estimate the prevalence of frailty phenotypes and their association with the sociodemographic characteristics, health state and the use of health services in the last 6 months among community‐dwelling elderly in Mexico City.

Role of depressive symptoms and comorbid chronic disease on health-related quality of life among community-dwelling older adults.

OBJECTIVE This study examined the influence of depressive symptoms on health-related quality of life (HRQOL) among community-dwelling older adults suffering from various categories of chronic comorbidity. METHODS A population-based survey in adults aged 60 years or more was conducted within a random sample of 1085 beneficiaries of the Mexican Institute of Social Security in Mexico City. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, and chronic comorbidity was determined with self-reports concerning prior medical diagnoses and the HRQOL Short Form-36 health survey. We carried out a stratified analysis by comorbidity category, evaluating the impact of depressive symptoms on HRQOL through an analysis of variance and modeling the independent association of depression symptoms with HRQOL using multiple linear regression analyses adjusted for comorbidity and other covariables. RESULTS HRQOL scores were low in the presence of depressive symptoms, while their impact increased when chronic diseases were also present. The group with the poorest HRQOL was older adults suffering from both depressive symptoms and two or more chronic diseases (P<.05). The stratified analysis by comorbidity and multivariate analysis, adjusted for covariables, indicated that depressive symptoms and comorbidity had cumulative negative effects on HRQOL. CONCLUSION The HRQOL of older adults deteriorated when depressive symptoms were present and decreased even further with the simultaneous occurrence of chronic illnesses. Identifying depression symptoms-either alone or along with chronic conditions-is crucial for implementation of measures aimed at improving elderly peoples HRQOL.

The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population.

BACKGROUND The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education. METHODS MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects. RESULTS Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model. CONCLUSION Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population

OBJECTIVES To evaluate the psychometric properties of the Geriatric/General Oral Health Assessment Index, Spanish version (GOHAI-Sp) and their relationship with the dentition status of an elderly Mexican population as a discriminatory validation. METHODS A cross-sectional study was conducted among persons over 60 years of age. A Spanish version the GOHAI-Sp validated in Spain in institutionalized geriatric patients was used. Clinical evaluation was done in order to determine experience with coronal and root caries. RESULTS Measurement of internal consistency of the GOHAI gave a Cronbach alpha coefficient of 0.77 for the 12 items. In factorial analysis, one factor alone was capable of explaining 30.6 percent of the total variance. The factor that was most apparent in the factorial analysis of the GOHAI had coefficients > 0.30 for the 12 items. The Kaiser-Meyer-Olkin measure of simple adequacy was 0.81 and the Bartletts sphericity test was 1,748.55 with 66 degrees of freedom (P < 0.001). There was a statistically significant difference in the GOHAI scores between the responses to self-perception of oral and general health (P < 0.001). Also, there was a statistically significant low correlation coefficient between the missing and filled components of the DMFT index and the number of healthy and functional teeth (P < 0.05). CONCLUSIONS The GOHAI has acceptable psychometric properties, discriminates between self-perception of oral health and self-perception of general health, and correlates with past caries experience measured by the DMFT index.

Self-perceived health status: an approach of the elderly in Mexico

OBJECTIVE To evaluate health status of the elderly in Mexico through their self-perception and to describe social, organizational and health-related factors. METHODS A study was carried out on secondary data from the 2000 National Health Survey in Mexico. Multiple logistic regression models were used. The dependent variable health status was measured through self-perception. The independent variables included were: sociodemographic characteristics, risk behaviors, accidents, disease diagnosis and clinical measures. RESULTS A total of 7,322 adults aged 60 years and older were studied, which represents 7% of the total population in that age group in Mexico. Of them, 19.8% reported poor or very poor health status. Factors found to be associated to poor health were age, female sex, having no social security, being divorced, homemaker, disabled, unemployed, tobacco consumption, having a health condition, accidents and diagnosed with chronic diseases. CONCLUSIONS The study allowed to identifying factors that may contribute to poor health status in the elderly. These findings could be taken into account in the development of actions and health care programs for this population in Mexico.

Health care utilization in the elderly Mexican population: Expenditures and determinants

BackgroundWorldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual).ObjectiveTo analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly.MethodsA secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age.ResultsHigher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were

Estado de la dentición y sus efectos en la capacidad de los ancianos para desempeñar sus actividades habituales

240.6 am dlls, whereas in households exclusively with elderly the expenditure was

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

308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization.ConclusionsThe conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this group requires immediate attention.