Michael J. Lichtenstein

The effect of medical conditions on the functional limitations of Mexican-American elderly

We examined the relationship of self-reported functional status to common medical conditions using a probability sample of 3050 noninstitutionalized Mexican-American men and women aged 65 or older and residing in the Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas). All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. The questionnaire obtained information on self-reported functional status and prevalence of arthritis, cancer, diabetes, stroke, heart attack, and hip fracture. The prevalence of medical conditions ranged from 4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven activities of daily living ranged from 5.4% for eating to 11.7% for bathing, while 25.1% could not walk up and down stairs, and 28.9% could not walk a half mile without help. In multiple logistic regression analyses, previous diagnoses of stroke and hip fracture were most predictive of functional limitations, though all conditions examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were independently associated with increased odds of impairment in some activities of daily living. In general, the odds for functional impairment associated with specific medical conditions were higher than those previously published for non-Hispanic white populations. The fact that Mexican-American elderly who live in the community and who have medical conditions, especially stroke and hip fracture, are at high risk for functional impairment probably reflects the low rate of institutionalization in this population and has implications for the provision of community-based long-term care services for Mexican-American elderly.

The Influence of Noncognitive Factors on the Mini-Mental State Examination in Older Mexican-Americans: Findings from the Hispanic EPESE

Mini-Mental State Examination data from the Hispanic Established Population for the Epidemiologic Study of the Elderly baseline survey, a population-based study of community-dwelling Mexican Americans aged 65 and older, were used to examine the relationship between cognitive impairment, sociodemographics, and health-related characteristics. The rate of cognitive impairment found in this group of older Mexican Americans, using the conventional cut point of 23/24 on the MMSE, was 36.7%. Using a more conservative cut point of 17/18 indicated an overall rate of severe cognitive impairment of 6.7%. Rates of impairment varied significantly with age, education, literacy, marital status, language of interview, and immigrant status and were associated with high and moderate levels of depressive symptoms, and history of stroke. Importantly, although education was strongly related to poor cognitive performance, it was not a significant predictor of severe cognitive impairment. Multivariate analyses further indicated that as a screen for cognitive impairment in older Mexican Americans, the MMSE is strongly influenced by these noncognitive factors. Scores may reflect test bias, secondary to cultural differences or the level of education in this population.

Effect of loss of balance on biomechanics platform measures of sway: Influence of stance and a method for adjustment

This paper describes a method for adjusting biomechanics platform measures of sway for loss of balance. Area and velocity measures of sway were determined in forty-seven elderly women, in double and single leg stance, first with their eyes open, then closed. Subjects were rarely able to complete 10 s trials during single leg stances. Therefore, a method was developed for eliminating data associated with loss of balance. Monitoring changes in vertical force and velocity by computer, those points exceeding trial specific thresholds associated with loss of balance were truncated. In double leg stances, loss of balance increased area measures by 0.3%, but did not effect velocity measures. In contrast, the loss of balance increased area measures by 0-3%, but did not effect velocity measures. In contrast, the loss of balance experienced by most subjects in single leg stance exaggerated area measures by 16-38%, and velocity measures by up to 10%. In double leg stances the correlations between unadjusted area measures and area measures adjusted for loss of balance ranged from 0.98 to 1.00. In single leg stances, the correlations for the area measures ranged from 0.69 to 0.89. The correlations between adjusted and unadjusted velocity measures were 1.00 and 0.93 for the double and single leg stances respectively. Although the question of which sway measure is best remains unanswered, this study provides useful data for future research. First, it demonstrates a method for modifying area representations of the center of pressure excursions for the effects of loss of balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Lower-extremity functioning in older Mexican Americans and its association with medical problems

OBJECTIVE: To describe lower‐extremity functioning in community‐dwelling older Mexican Americans and to examine its relationship with medical problems.

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: The hispanic EPESE study

OBJECTIVES: To determine the prevalence rates of prescription and over‐the‐counter (OTC) medication usage among community‐dwelling older Mexican Americans.

Screening for hearing impairment in the elderly - Rationale and strategy

TWENTY YEARS AGO, Archie Cochrane cited audiologic rehabilitation as an example of an underntilized service. 1 He noted that aural rehabilitation was underutilized because it was perceived as dull, unfashionable, and servicing the elderly. How has the situation changed in the past two decades? Hearing impairment remains one of the most common chronic health problems of older adults. 2s Approximately one-fourth of individuals over 65 years old report problems with their hearing; audiologically detectable hearing loss is present in more than one-third of individuals over 65.9-H Most are affected by presbycusis, a bilateral gradual or flat high-frequency sensorineural hearing loss that occurs with advancing age. At first examination, presbycustic hearing loss appears to be a prototypic condition for screening. It is common and slowly progressive. However, a detailed rationale for screening for this condition has not been critically evaluated, and a uniform method for screening has not been universally accepted. Specifically, the purposes of this review are: 1) to evaluate whether primary care health providers should screen for hearing impairment in aged adults and 2) to identify a feasible, accurate screening strategy for use in the primary care setting.

Potential Mediators of Ethnic Differences in Physical Activity in Older Mexican Americans and European Americans: Results from the San Antonio Longitudinal Study of Aging

Factors were examined that might explain reported ethnic differences in leisure time physical activity (LTPA) between Mexican Americans (MAs) and European Americans (EAs). Data were from a random sample of 749 community‐dwelling MAs and EAs, aged 65 and older, who participated in the San Antonio Longitudinal Study of Aging (SALSA) baseline examination. Variables examined included LTPA measured as kilocalories of energy expended per week, contextual variables (age, sex, socioeconomic status (SES), acculturation/structural assimilation), psychosocial measures (self‐esteem, mastery, perceived health control), lifestyle variables (fat avoidance, current alcohol drinker, years smoking, body mass index (BMI)), and presence of chronic diseases (diabetes mellitus, angina pectoris, myocardial infarction, stroke, hypertension, arthritis, chronic obstructive pulmonary disease, depression, mild cognitive impairment). Hierarchical multiple regression was used to examine potential mediators of the ethnic group–LTPA association. EAs expended almost 300 kcal/wk more energy than did MAs (1,287 kcal/wk vs 1,001 kcal/wk). SES and psychosocial (self‐esteem), lifestyle (fat avoidance, smoking, BMI), and disease (depression) factors that vary by SES explained this ethnic difference. In MAs, structural assimilation, but not acculturation, was significantly associated with LTPA independent of SES. Self‐esteem, BMI, and depression explained this association. Psychosocial resources, lifestyle behaviors, and depression explain differences in LTPA between older MAs and EAs. Interventions to increase LTPA in both ethnic groups should be targeted especially at women and persons who have low self‐esteem, smoke, and are obese or depressed. In MAs, additional emphasis should be focused on those who are less structurally assimilated into the broader American society.

Cross-Cultural Adaptation of the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S) for Use with Spanish-Speaking Mexican Americans

OBJECTIVE: To cross‐culturally adapt the Hearing Handicap Inventory for the Elderly‐Screening Version (HHIE‐S) for use with older Spanish‐speaking Mexican Americans.

Prevalence and Severity of Urinary Incontinence in Elderly Mexican-American Women

Objectives: To measure prevalence and characteristics of urinary incontinence in older Mexican‐American women.

A method for scoring the pain map of the McGill pain questionnaire for use in epidemiologic studies

Identifying and quantifying the location of pain may be important for understanding specific functional impairments in elderly populations. The purpose of the present analysis was two- fold: first, to describe the reliability of a scoring method for the McGill Pain Map (MPM), and second, to validate the method of scoring the MPM as a tool for assessing areas of body pain in an epidemiologic study. In interviews performed at the subjects’ homes, 411 community dwelling Mexican- American and non- Hispanic white subjects aged 65–74 from the San Antonio Longitudinal Study of Aging (SALSA) were asked to describe the location of their pain on the map of the human body included in the McGill Pain Questionnaire. The location of pain was scored by overlaying the survey figures with a MPM template divided into 36 anatomical areas. Inter- and intra- rater agreement among three raters was measured by calculating a kappa statistic for each of the body areas, and an intraclass correlation coefficient for the total number of painful areas (NPA). Internal validity was measured by Spearman’s rho between the NPA and the Present Pain Index (PPI) and Pain Rating Index (PRI) of the McGill Pain Questionnaire, and external validity by correlation between NPA and the Perceived Health (PH), Amount of Bodily Pain (APB), and Pain Interference with Work (PIW) items of the Medical Outcomes Study, and the Perceived Physical Health (PPH) question of the San Antonio Heart Study. Average inter- rater agreement for individual MPM areas was 0.92± 0.01, and average agreement for NPA was 0.96± 0.01. Intra- rater agreement for individual areas averaged 0.94± 0.01, and for NPA = 0.99± 0.001. Pain in one or more areas was present in 47.7% of the subjects. For the whole sample, correlations between NPA and the validation indices were: PPI (0.91), PRI (0.89), PH (0.25), ABP (0.64), PIW (0.49), and PPH (0.20). Among the 196 subjects with pain, correlations were: PPI (0.34), PRI (0.34), PH (0.19), ABP (0.21), PIW (0.38), and PPH (0.19) — p<0.01 for all correlations. In conclusion, we have developed a reliable method of scoring the MPM and have shown evidence of its validity in a community- based sample of elderly subjects. Patterns of painful body areas may be associated with specific diseases and functional impairments.