Kyriakos S. Markides

Emotional Well-Being Predicts Subsequent Functional Independence and Survival

OBJECTIVE: To determine whether positive affect has an independent effect on functional status, mobility, and survival in an older Mexican American sample.

The association between emotional well-being and the incidence of stroke in older adults

Objective Individuals with high levels of depressive symptoms have an increased risk of many illnesses, including stroke. Measures of depressive symptoms include questions about the presence of negative affect, such as sadness, as well as the absence of positive affect, such as happiness and optimism. We assessed whether positive or negative affect, or both, predicted risk of stroke. Methods Data were from a 6-year prospective cohort study of a population-based sample of 2478 older whites and blacks from five counties in North Carolina who reported no history of stroke at the baseline interview. Baseline, in-person interviews were conducted to gather information on sociodemographic, psychosocial, and health-related characteristics of subjects. Thereafter interviews were conducted annually for 6 years. Results Increasing scores on the modified version of the Center for Epidemiological Studies Depression Scale (CES-D) were significantly associated with stroke incidence for the overall sample (relative risk [RR] = 1.04 for each one-point increase, 95% confidence interval [CI] = 1.01–1.09) over the 6-year follow-up period after adjusting for sociodemographic characteristics, blood pressure, body mass index, smoking status, and selected chronic diseases. Positive affect score demonstrated a strong inverse association with stroke incidence (RR = 0.74, 95% CI = 0.62–0.88). Conclusions Increasing scores on the modified CES-D are related to an increased risk of stroke, whereas high levels of positive affect seem to protect against stroke in older adults.

Measuring social support among older adults.

The purpose of this study is to introduce a measure of natural supportive behaviors for use in studies that examine the relationship between stress, social support, and health among older adults. The index improves on existing measures in three ways: it avoids problems arising from confounding potentially supportive relationships with support that is actually received; the scale also assesses variations in individual support needs; and it measures four distinct dimensions of social support (informational support, tangible help, emotional support, and integration). Based on data from a random community survey of 351 older adults, the basic psychometric properties and the factor structure of the scale are explored. The predictive validity of the scale is demonstrated by showing that the dimensions of support buffer the stressful effects of bereavement on depressive symptoms.

Handgrip Strength and Mortality in Older Mexican Americans

OBJECTIVES: To examine the association between handgrip strength and mortality in older Mexican American men and women.

Onset of Frailty in Older Adults and the Protective Role of Positive Affect

The aim of this study was to examine the longitudinal association between positive affect and onset of frailty for 1,558 initially nonfrail older Mexican Americans from the Hispanic Established Populations for Epidemiological Studies of the Elderly database. The incidence of frailty increased 7.9% during the 7-year follow-up period. High positive affect was found to significantly lower the risk of frailty. Each unit increase in baseline positive affect score was associated with a 3% decreased risk of frailty after adjusting for relevant risk factors. Findings add to a growing positive psychology literature by showing that positive affect is protective against the functional and physical decline associated with frailty.

Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period

Background and aims: Little is known about muscle strength as a predictor of disability among older Mexican Americans. The aim of this study was to examine the association between hand grip strength and 7-year incidence of ADL disability in older Mexican American men and women. Methods: A 7-year prospective cohort study of 2493 non-institutionalized Mexican American men and women aged 65 or older residing in five south-western states. Maximal hand grip strength test, body mass index, cognitive function, activities of daily living, self-reports of medical conditions (arthritis, diabetes, heart attack, stroke, cancer, hip fracture), and depressive symptoms were obtained. Results: In a Cox proportional regression analysis, there was a linear relationship between hand grip strength at baseline and risk of incident ADL disability over a 7-year follow-up. Among non-disabled men at baseline, the hazard ratio of any new ADL limitation was 1.90(95% CI 1.14–3.17) for those in the lowest quartile, when compared with men in the highest hand grip strength quartile, after controlling for age, marital status, medical conditions, high depressive symptoms, MMSE score, and BMI at baseline. Among non-disabled women at baseline, the hazard ratio of any new ADL limitation was 2.28 (95% CI 1.59–3.27) for those in the lowest quartile, when compared with women in the highest hand grip strength quartile. Conclusions: Hand grip strength is an independent predictor of ADL disability among older Mexican American men and women. The hand grip strength test is an easy, reliable, valid, inexpensive method of screening to identify older adults at risk of disability.

Aging and Ethnicity

The purpose of this book is to attempt to synthesize social gerontological literature on Americas major ethnic groups in order to make it more accessible to scholars and students. Chapters are included on demographic and socioeconomic characteristics mortality and health and family structure and family relations. (EXCERPT)

Neighborhood context and self-rated health in older Mexican Americans

PURPOSE To determine whether neighborhood characteristics are associated with self-rated health in older Mexican Americans. METHODS Epidemiologic data on 3050 older Mexican Americans residing in the southwestern United States during 1993 and 1994 were merged with 1990 US Census data. All subjects were matched to one of 210 census tracts (neighborhoods). Multilevel ordinal logit models were used to examine relationships between self-rated health and individual- and neighborhood-level variables. RESULTS After adjusting for individual characteristics, older Mexican Americans were more likely to rate their health poorer if they lived in neighborhoods that were economically disadvantaged, less populated by other Hispanics, or located within 50 miles of the US-Mexico border. In addition, residence in a border community moderated the relationship between self-rated health and neighborhood economic disadvantage. The effect of neighborhood economic disadvantage on poorer self-rated health was two to three times stronger for subjects living near the border region than subjects living further away from the border. CONCLUSIONS This study demonstrates the importance of considering several dimensions of neighborhood context, especially for Mexican Americans. Residence in a border community and neighborhood economic disadvantage were important predictors of poorer self-rated health status. In addition, older Mexican Americans experience a health benefit from living in neighborhoods populated with other Hispanics.

Acculturation and alcohol consumption among Mexican Americans: a three-generation study.

Data from a three-generation study of Mexican Americans conducted in the San Antonio, Texas area are utilized to examine the influence of acculturation into the larger society on alcohol consumption. Acculturation was not related to alcohol consumption in the older generation. In the middle generation, it was related to lower alcohol consumption among men, as well as among women. In the younger generation, acculturation was related to more drinking among women, but not among men. Within-family analysis showed that the alcohol consumption of members of the younger generation was associated with the consumption of their parents, particularly in the case of younger women.

Depressive symptoms and mortality in older Mexican Americans.

PURPOSE We examined the prevalence of comorbid depressive symptomatology and leading chronic medical conditions, and their influence on death rates in older Mexican Americans. METHODS Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) were used. Differences in death rates across sociodemographics, self-ratings of health, and health conditions were examined with analysis of variance statistics. Logistic regression models were used to examine main effects and interaction effects of each medical condition separately and in conjunction with depressive symptomatology. RESULTS Bivariate analyses indicated that death rates were substantially higher when a high level of depressive symptoms was comorbid with diabetes (OR = 3.84, 95% CI = 2.55-5.78), cardiovascular disease (OR = 4.04, 95% CI = 2.36-6.91), hypertension (OR = 2.27, 95% CI = 1.57-3.27), stroke (OR = 3.00, 95% CI = 1.44-6.15), and cancer (OR = 4.46, 95% CI = 2.48-8.01). Multivariate analyses indicated a synergistic effect for comorbid diabetes and depressive symptoms such that the odds of having died among diabetics with high levels of depressive symptoms (OR = 4.03, 95% CI = 2.67-6.11) were three times that of diabetics without high levels of depressive symptoms (OR = 1.36, 95% CI = 0.89-2.06). CONCLUSIONS High levels of depressive symptoms concomitant with major chronic medical conditions elevate the risk for death among older Mexican Americans. Given the fact that depression is often unrecognized and undertreated in the elderly, awareness of the potential for loss of life as well as the potential for treatment may help to improve this situation not only for older Mexican Americans, but for older adults in general.