Kerstin Gerst

Trends in Diabetes Prevalence and Diabetes-Related Complications in Older Mexican Americans From 1993–1994 to 2004–2005

OBJECTIVE Evidence has shown that Mexican Americans have a higher prevalence of diabetes and a greater risk for diabetes-related complications than non-Hispanic whites. However, no studies have described the changes in prevalence among older Mexican Americans. The purpose of this study was to expand on the current literature by examining the trends in diabetes prevalence and diabetes-related complications in Mexican Americans aged ≥75 years from 1993–1994 to 2004–2005. RESEARCH DESIGN AND METHODS The prevalences of self-reported diabetes and diabetes-related complications were estimated in the original cohort (1993–1994) and the new cohort (2004–2005) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (Hispanic EPESE) and were compared across the two surveys. RESULTS The prevalence of diabetes among Mexican Americans aged ≥75 years has nearly doubled between 1993–1994 and 2004–2005 from 20.3 to 37.2%, respectively (P < 0.001). The increase in the prevalence of diabetes was similar across all sociodemographic factors. Diabetes complications did not change significantly between the two cohorts. However, the prevalence of having any lower-extremity function disability did increase between the two cohorts. CONCLUSIONS The prevalence of diabetes in older Mexican Americans has increased dramatically. At the same time, there has been no improvement in diabetes-related complications as has been found in the general older population. These findings heighten the urgency for more effective public health interventions targeted to this population. As diabetes and obesity become more prevalent in older adults, physicians should encourage appropriate management in older patients, including early detection and glycemic control.

Immigration, Aging, and Health in the United States

Given the rising numbers of immigrants to the United States, in recent decades there has been increasing interest in better understanding the health status and the health care needs of immigrants and how they impact the host societies’ health and social service systems. Recent evidence has suggested the existence of a health advantage among immigrants, especially those from non-western origins, which has challenged our previous and often stereotypical notions regarding immigrants from poor countries. Early research in North America was almost exclusively focused on the negative impact of immigration on mental health (Malzberg 1967). The negative aspects of immigration were also the dominant theme of early studies in Europe (Friis et al. 1998). It is now commonly assumed that early research was often culturally biased, methodologically weak, and based on small numbers of immigrants (Friis et al. 1998; Markides 2001).

Protective Neighborhoods: Neighborhood Proportion of Mexican Americans and Depressive Symptoms in Very Old Mexican Americans

Research indicates that neighborhood context can have a significant effect on the health of older adults. The evidence suggests that there may be physical health benefits afforded to Mexican Americans living in ethnically homogenous neighborhoods, despite the relatively high economic risk in such neighborhoods, but few studies have considered the effect of neighborhood ethnic density on mental health outcomes in older adults. This study evaluated the association between neighborhoods with a high proportion of Mexican Americans and depressive symptoms in very old Mexican Americans. Hierarchical linear modeling was used to examine data from Wave 5 (2004/05) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Subjects included 1,875 community‐dwelling Mexican Americans aged 75 and older living in 386 neighborhoods in five states in the southwestern United States (Arizona, California, Colorado, New Mexico, Texas). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (α=0.88). Results showed that, in very old men, there was a significant negative association between percentage of Mexican Americans in the neighborhood and depressive symptoms (P=.01). In women, the direction of the association was the same, but the effect was not significant. These findings suggest that the proportion of Mexican Americans in the neighborhood matter more for very old Mexican American men than women. Further research may inform screening and treatment for depressive symptoms based on differences in neighborhood composition. Recommendations include culturally customized programs that offer older Mexican Americans greater mobility and access to programs and opportunities in culturally identifiable neighborhoods.

Patterns of Residential Crowding among Hispanics in Later Life: Immigration, Assimilation, and Housing Market Factors

OBJECTIVE We describe patterns of residential crowding among older Hispanics and non-Hispanic Whites. We also examine hypotheses about the relationship of residential crowding with assimilation (language and duration of residence) and housing market characteristics. METHODS We employ a multilevel research design, using data from the 2000 U.S. Census of Population. Hierarchical linear models are utilized to estimate the association between residential crowding and both individual and housing market factors. RESULTS Approximately one third of older Hispanics in metropolitan areas live in crowded housing compared with only one tenth of older non-Hispanic Whites. Foreign-born older persons report higher levels of crowding than U.S.-born older persons. Residential crowding differences between older Hispanics and non-Hispanics are not eliminated after controls are included. Older Hispanics who report better English language skills and a longer duration of residence in the United States live in less crowded housing. We do not find evidence for a relationship between crowding and residential segregation, but we find consistent evidence for an association between residential crowding and relative size of the Hispanic population. DISCUSSION The forces that shape household composition and access to housing among older Hispanics appear to result in higher levels of residential crowding for this population.

High depressive symptomatology among older community-dwelling Mexican Americans: The impact of immigration

Objectives: This analysis explores nativity differences in depressive symptoms among very old (75+) community-dwelling Mexican Americans. Design: Cross-sectional analysis using the fifth wave (2004–2005) of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE). Participants: The sample consisted of 1699 non-institutionalized Mexican American men and women aged 75 years and above. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Logistic regression was used to predict high depressive symptoms (CES-D score 16 or higher) and multinomial logistic regression was used to predict sub-threshold, moderate, and high depressive symptoms. Results: Results showed that elders born in Mexico had higher odds of more depressive symptoms compared to otherwise similar Mexican Americans born in the US. Age of arrival, gender, and other covariates did not modify that risk. Conclusion: The findings suggest that older Mexican American immigrants are at higher risk of depressive symptomatology compared to persons born in the US, which has significant implications for research, policy, and clinical practice.

Homeownership Among Mexican Americans in Later Life

While more about the homeownership characteristics of Mexican Americans in the early and middle stages of the adult life course has recently been learned, far less is known about homeownership among Mexican Americans in later life. The well-being of older persons, including immigrant elders, has been linked to homeownership, in part because ownership imparts many advantages not available to nonowners. This study investigated homeownership among older Mexican Americans with a conceptual model based on economic, assimilation, social capital, and place stratification perspectives. Data from the 2000 U.S. census were employed to examine individual and contextual effects using multilevel models. The authors found support for several hypotheses drawn from their conceptual framework. The authors also showed that both citizenship status of target individuals and citizenship makeup of households were associated with the likelihood of homeownership. The findings are discussed relative to existing research and as they applied to housing policy.

The Impact of Physical Activity on Disability Incidence among Older Adults in Mexico and the United States.

Evidence suggests that transitions among older adults towards healthy habits, such as physical activity, appear underway in developed countries such as the USA but not in developing countries such as Mexico. However, little is known about the potential benefit of physical activity in preventing disability among elders in countries at different stages of epidemiological transition. We explore the impact of physical activity on the disablement process among elders in Mexico compared to the USA. Data are from two waves of the Mexican Health and Aging Study and the Health and Retirement Study. We examine the impact of exercise on the transition from no disability to ADL limitations two years later. Findings indicate that exercise is more common in the U.S. than in Mexico. There is a positive effect of exercise on negative outcomes in both countries. However, the protective effect of exercise is stronger in the U.S. than in Mexico.

Self-Reported Urge Urinary Incontinence (UUI) Among Older Mexican–American Men: Risk Factors and Psycho-Social Consequences

Extant literature on Urge Urinary Incontinence (UUI) focuses on women and non-Hispanic Whites and little is known about ethnic minority men. We analyzed 700 Mexican–American men aged 75 and older from the fifth Wave (2004/5) of the Hispanic Established Population for the Epidemiologic Study of the Elderly. Logistic regression analyses examined risk factors for self-reported UUI and the impact of UUI on mental health and social support. Twenty-nine percent reported having difficulty holding their urine until they could get to a toilet. Men with more co-morbid conditions and men with prostate problems were more likely to report UUI symptoms. Men with UUI were less likely to report having a confidant and had a higher risk of high depressive symptoms. This study is the first to examine risk factors for and consequences of self-reported UUI among older Mexican–American men using a large community-based survey.

BMI and Transitions to Disability Among Older Adults in Mexico and the United States

As national populations across the world age at an unprecedented rate, disability rates are also increasing (World Health Organization, & The World Bank. (2011). World report on disability, from http://whqlibdoc.who.int/publications/2011/9789240685215_eng.pdf). Prevalence of disability varies greatly by country, however, ranging from 43.4% among persons 60 and older in lower income countries to 29.5% in higher income countries (World Health Organization, & The World Bank. (2011). World report on disability, from http://whqlibdoc.who.int/publications/2011/9789240685215_eng.pdf). High rates of disability can impact individuals’ quality of life and contribute to the health burden of society. This is particularly the case in developing countries, where access to rehabilitation services and treatment programs may be limited (Al Snih, S., Graham, J. E., Kuo, Y., Goodwin, J. S., Markides, K. S., & Ottenbacher, K. J. (2010). Obesity and disability: Relation among older adults living in Latin America and the Caribbean. American Journal of Epidemiology 171(12):1282–1288).

Protective neighborhoods: Neighborhood proportion Mexican American and depressive symptoms among very old Mexican Americans

Research indicates that neighborhood context can have a significant effect on the health of older adults. The evidence suggests that there may be physical health benefits afforded to Mexican Americans living in ethnically homogenous neighborhoods, despite the relatively high economic risk in such neighborhoods, but few studies have considered the effect of neighborhood ethnic density on mental health outcomes in older adults. This study evaluated the association between neighborhoods with a high proportion of Mexican Americans and depressive symptoms in very old Mexican Americans. Hierarchical linear modeling was used to examine data from Wave 5 (2004/05) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Subjects included 1,875 community‐dwelling Mexican Americans aged 75 and older living in 386 neighborhoods in five states in the southwestern United States (Arizona, California, Colorado, New Mexico, Texas). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (α=0.88). Results showed that, in very old men, there was a significant negative association between percentage of Mexican Americans in the neighborhood and depressive symptoms (P=.01). In women, the direction of the association was the same, but the effect was not significant. These findings suggest that the proportion of Mexican Americans in the neighborhood matter more for very old Mexican American men than women. Further research may inform screening and treatment for depressive symptoms based on differences in neighborhood composition. Recommendations include culturally customized programs that offer older Mexican Americans greater mobility and access to programs and opportunities in culturally identifiable neighborhoods.