Ivonne M. Berges

Frailty and 10-Year Mortality in Community-Living Mexican American Older Adults

Background: The older Hispanic population of the United States is growing rapidly. Hispanic older adults have relatively high-risk profiles for increased morbidity and disability, yet little is known about how the construct of frailty is related to health trajectories in this population. Objective: The purpose of this study was to examine the relationship between frailty and 10-year mortality in older community-dwelling Mexican Americans. Methods: Data were from the Hispanic Established Populations for Epidemiologic Studies of the Elderly and included 1,996 Mexican Americans, aged 65 and older, living in the southwestern US. Primary measures included mortality and a 5-item frailty index comprised of weight loss, exhaustion, walking speed, grip strength, and physical activity. Results: Mean baseline age was 74.5 years (SD 6.1) and 58.5% were women. Baseline frailty assessments yielded the following distribution: 44.9% non-frail, 47.3% pre-frail, and 7.8% frail. Overall, 892 (44.7%) participants died during the 10-year study period. Hazard ratios (HR), adjusted for sociodemographic, health, and medical factors, demonstrated increased odds for mortality in the pre-frail (HR = 1.25, 95% confidence interval, CI95%, 1.07–1.46) and frail (HR = 1.81, CI95% 1.41–2.31) groups compared to the non-frail cohort. Conclusion: The 5-item frailty index differentiated odds of 10-year mortality in older community-dwelling Mexican Americans. This clinical index has the potential to identify older minorities at risk for poor health outcomes and mortality.

Hypertension in Older Adults and the Role of Positive Emotions

Objective: Negative emotions have been linked to increases in blood pressure, but relations between positive emotion and blood pressure have not been investigated. Our aim was to test the hypothesis that high positive emotion would be associated with lower blood pressure in older adults. Methods: A cross-sectional study included 2564 Mexican Americans aged 65 or older living in one of five southwestern states. Primary measures included blood pressure and positive emotion score. Data analyses included descriptive and categorical statistics and regression and cumulative logit analysis. Results: The average age was 72.5 years, 52.8% were women, and 32.8% were on antihypertensive medication. For individuals not on antihypertensive medication, increasing positive emotion score was significantly associated with lower systolic (b = −0.35, standard error (SE) = 0.10) and diastolic (b = −0.56, SE = 0.07) blood pressure after adjusting for relevant risk factors; for those on antihypertensive medication, increasing positive emotion score was significantly associated with lower diastolic (b = −0.46, SE = 0.11) blood pressure, but not systolic blood pressure. Positive emotion was significantly associated with a four-level joint blood pressure variable. Each one-point increase in positive emotion score was associated with a 3% and 9% decreased odds of being in a higher blood pressure category for those on (odds ratio (OR) = 0.97; 95% confidence interval (CI) = 0.93–1.00) and not on (OR = 0.91; 95% CI = 0.89–0.93) antihypertensive medication, respectively. Conclusions: Findings indicate an association between high positive emotion and lower blood pressure among older Mexican Americans. Targeting the emotional health of older adults might be considered part of nonpharmacologic hypertension treatment programs or as part of adjunctive therapy for those on antihypertensive medication. BMI = body mass index; CES-D = Center for Epidemiologic Studies–Depression; CI = confidence interval; H-EPESE = Hispanic Established Population for the Epidemiologic Study of the Elderly; JNC = Joint National Committee; SD = standard deviation; SE = standard error.

Assessing Gait Speed in Acutely Ill Older Patients Admitted to an Acute Care for Elders Hospital Unit

BACKGROUND Assessment of mobility in geriatric hospital units relies primarily on subjective observation or patient self-reports. We objectively examined the gait speed of hospitalized older patients. METHODS Prospective study of 322 patients 65 years or older admitted from the community to a geriatric hospital unit between March 2008 and October 2009. Associations of gait speed (in meters per second) and activities of daily living with length of stay and home discharge were examined in multivariable logistic and generalized linear regression models. RESULTS In total, 206 of 322 patients completed the gait speed walk, with a mean gait speed of 0.53 m/s. A strong association was found between faster gait speed and shorter length of stay. Patients unable to complete the walk and patients having gait speeds of less than 0.40 m/s had significantly longer lengths of stay by 1.9 and 1.4 days, respectively, compared with patients having gait speeds of at least 0.60 m/s. Similarly, patients unable to complete the walk (odds ratio, 0.03; 95% CI, 0.003-0.21) and patients having gait speeds of less than 0.40 m/s (odds ratio, 0.07; 95% CI, 0.001-0.63) had significantly decreased odds of home discharge compared with patients having gait speeds of at least 0.60 m/s. Activities of daily living were less robust than gait speed in discriminating the risk of length of stay or home discharge. CONCLUSIONS Gait speed is a clinically relevant indicator of functional status and is associated with important geriatric health outcomes, including length of stay and home discharge. Gait speed could be used to complement information obtained by self-reported activities of daily living.

Associations Between Positive Emotion and Recovery of Functional Status Following Stroke

Objective: Accumulating evidence indicates the beneficial effects of positive emotion on health and general well-being in older age. Less evidence is available on whether positive emotion supports improvement in functional status after an acute medical event such as stroke. This study examined the association between positive emotion at discharge from inpatient medical rehabilitation and functional status 3 months later in persons with stroke. Methods: A longitudinal study using information from the Stroke Recovery in Underserved Patients database. The study included 823 persons aged 55 years or older with stroke and admitted to an inpatient medical rehabilitation facility. Information was collected during inpatient medical rehabilitation stay and approximately 3 months after discharge. Results: The mean age of the sample was 72.8 years (SD = 9.5), 51.5% were women and 53.8% were married. The sample was mostly non-Hispanic white (79.2%), followed by non-Hispanic black (15.0%) and Hispanic (5.8%). The average length of stay was 20.1 day (SD = 10.1). In multivariate regression analyses, discharge positive emotion score was significantly associated with higher overall functional status (b = 0.70, SE = 0.21, p = .001) as well as with higher motor (b = 0.37, SE = 0.17, p = .003) and cognitive (b = 0.30, SE = 0.05, p = .0001) status at 3-month follow-up after adjustment for relevant risk factors. Conclusions: Our results indicate positive emotion is associated with gains in functional status after stroke. Findings have implications for stroke recovery programs and suggest the need to include measures of positive emotion inpatient assessments. CES-D = Center for Epidemiologic Studies-Depression; CMS = Centers for Medicare and Medicaid Services; FIM = Functional Independence Measure; IRF-PAI = Inpatient Rehabilitation Facilities-Patient Assessment Instrument; SE = standard error; SRUP = Stroke Recovery in Underserved Populations.

Higher church attendance predicts lower fear of falling in older Mexican-Americans.

Several studies have shown that involvement in religious activity appears to benefit health. To estimate the association between church attendance and fear of falling, we used a sample of 1341 non-institutionalized Mexican-Americans aged 70 and over from the third wave (1998–1999) of the Hispanic Established Population for the Epidemiological Study of the Elderly, followed until 2000–2001. Baseline potential predictors of fear of falling were church attendance, socio-demographics, history of falls, summary measure of lower body performance (tandem balance, eight-foot walk, and repeated chair stands), functional status, depressive symptoms, cognitive status, and medical conditions. Fear of falling at the two-year follow-up was measured as no fear, somewhat afraid, fairly afraid, and very afraid. Chi-square statistic and multiple logistic regression analysis were used to estimate associations between the outcome and the potential predictors. Multiple logistic regression analysis showed that frequent church attendance was an independent predictor of lower fear of falling (odds ratio = 0.73, 95% confidence interval 0.58–0.92, P = 0.008) two years later. Other independent predictors of fear of falling were female gender, poorer objective lower body performance, history of falls, arthritis, hypertension, and urinary incontinence. Frequent church attendance is associated with decreased fear of falling in older Mexican-Americans.

Attendance at religious services and physical functioning after stroke among older Mexican Americans.

The purpose of this study was to examine the association of attendance at religious services and change in physical functioning among older Mexican Americans who report residual physical limitations due to stroke. Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), generalized linear models were used to evaluate change in physical function over 3 years in persons with stroke aged 65 and older, controlling for demographics, medical conditions, health behaviors, and physical mobility. The results showed frequent attendees at religious services had significantly fewer declines in activities of daily living (ADLs) disability compared to infrequent attendees. The frequent attendance group also showed less decline in lower body function compared to the infrequent attendees. Findings are indicative that church attendance prestroke is associated with better physical function poststroke in older Mexican Americans.

Mobility Activity and Its Value as a Prognostic Indicator of Survival in Hospitalized Older Adults

To objectively assess total steps and minutes active in the first and last 24 hours of hospitalization and to examine associations with survival after discharge in hospitalized older adults.

Change in positive emotion and recovery of functional status following stroke.

OBJECTIVES To investigate change in positive emotion over a 3-month follow-up period and determine whether this change is associated with recovery of functional status in persons with stroke. DESIGN A longitudinal study using information from the Stroke Recovery in Underserved Patients (SRUP) database. Positive emotion and functional status were assessed within 72 hours of discharge from an in-patient medical rehabilitation facility and at 3-month follow-up using established measurement instruments. PARTICIPANTS The study included 840 adults 55 years old or older with a first-time stroke and admitted to one of eleven in-patient medical rehabilitation facilities in the United States. RESULTS The mean age was 72.9 (SD = 9.52) years, 78.6% were non-Hispanic white and 51.7% were women. The average length of stay was 20.2 (SD =10.1) days and the most prevalent type of stroke was ischemic (75.0%). Positive emotion increased for 35.6% of the sample, decreased for 29.2%, and 35.2% reported no change. Increases in positive emotion change score compared to no change (b = -3.2, SE = 1.5, p = .032) or a decline (b = -8.9, SE = 1.4, p = or <.001) was significantly associated with improved functional status at the 3-month follow-up after adjusting for sociodemographic and clinical variables as well as depressive symptoms. CONCLUSION Positive emotion is a dynamic process and can change over time. In persons with stroke, increases in positive emotion over a 3-month period was significantly associated with an increasing likelihood of recovery of functional status compared to no change or a decline in positive emotion. Understanding factors that influence both increases and decreases in positive emotion has implications for stroke rehabilitation programming and quality of life post-hospital discharge.

Sex Differences in Mortality among Older Frail Mexican Americans

OBJECTIVE To examine the association between frailty and 10-year mortality among older men and women of Mexican American origin. METHODS Data were collected from 1995-1996 through 2004-2005 among community-dwelling Mexican Americans aged >or=65 years as part of the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE). A standardized frailty measure based on weight loss, exhaustion, grip strength, walking speed, and physical activity was computed. Data were collected on sociodemographics and health characteristics, comorbidities, and performance-based functional measure. RESULTS The sample was 59% female, and mean baseline age was 74.5 years of (SD 6.06) at baseline. Hazard ratios (HR) indicated an increased mortality risk in frail men (HR = 3.04, 95% CI 2.16-4.28) compared with frail women (HR = 1.92, 95% CI 1.39-2.65). CONCLUSIONS Frailty is an independent predictor of mortality among older men and women of Mexican American origin. This association was found to be stronger among men after adjusting for age, marital status, education, body mass index (BMI), health behaviors, and medical conditions.

Perceived pain and satisfaction with medical rehabilitation after hospital discharge

Objective: To examine the association between pain and satisfaction with medical rehabilitation in patients with hip or knee replacement approximately 90 days after discharge from inpatient medical rehabilitation. Design: A cross-sectional design. Participants: The sample included 2507 patients with hip or knee replacement using information from the IT Health Track medical outcome database. Main outcome measure: Satisfaction with medical rehabilitation. Results: The average age was 70.2 years, 66.5% were female, and 88.5% were non-Hispanic white. Pain scores were significantly and inversely associated with satisfaction with medical rehabilitation after adjustment for possible confounding factors. In patients with hip replacement each one-point increase in pain score was associated with a 10% decreased odds ratio (OR) of being satisfied with medical rehabilitation (OR 0.90, 95% confidence interval (CI) 0.84, 0.96). In patients with knee replacement, each one-point increase in pain score was associated with a 9% decreased odds ratio (OR 0.91, 95% CI 0.87, 0.96) of being satisfied with medical rehabilitation. Conclusion: Our data indicate that postoperative pain from hip or knee replacement is associated with reduced satisfaction with medical rehabilitation. Better postoperative pain control may improve a patients level of satisfaction.