Influence of Type II Diabetes and High Depressive Symptoms on the Likelihood for Developing Activities of Daily Living (ADL) Disability and Mortality in Older Puerto Ricans

Association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China: the mediation effect of activities of daily living (ADL) disability

BACKGROUND

Depressive symptoms and sarcopenia, often observed among middle-aged and elderly individuals, are significant health concerns in China, particularly given the country's rapidly aging population. Depressive symptoms, characterized by persistent feelings of sadness and loss of interest, can significantly impact quality of life. Little is known about the underlying pathway connecting these two conditions.

METHODS

The data for this study were derived from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were evaluated using the Centre for Epidemiological Studies Depression (CSED) scale. Logistic regression analyses were employed to investigate the association between depressive symptoms, activities of daily living (ADL) disability, and sarcopenia, while adjusting for potential confounding factors. The selection of predictor variables, including social activity, chronic diseases, demographic factors, and lifestyle habits, was based on their known associations with mental health, physical functioning and sarcopenia. These variables were included to ensure a comprehensive adjustment for potential confounding factors and to provide a more accurate estimation of the relationship between depressive symptoms and sarcopenia. Additionally, mediation analysis was conducted to assess the mediating role of ADL disability in the relationship between depressive symptoms and sarcopenia.

RESULTS

A comprehensive study was conducted on a total of 8,238 participants aged 45 years and older, comprising 3,358 men and 4,880 women. Logistic regression analyses were conducted to identify significant associations between depressive symptoms (OR = 1.30, P = 0.0269,95%CI = 1.03-1.63), ADL disability (OR = 1.94, P < 0.001,95%CI = 1.37-2.75) and sarcopenia. The results revealed significant relationships among these variables. Furthermore, mediation effect analyses demonstrated that ADL disability partially mediated the association between depressive symptoms and sarcopenia (estimated indirect effect: 0.006, 95% CI: 0.003, 0.008, proportion of mediation effect: 20.00%).

CONCLUSIONS

The study underscores a significant association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China, with ADL disability acting as a mediator. These findings offer novel insights for targeted health interventions. Future interventions should effectively combat sarcopenia by integrating psychological support with muscle-strengthening exercise programs. By addressing both depressive symptoms and ADL disability, clinicians and public health professionals can enhance outcomes for this demographic. Collaborative efforts across disciplines are essential for providing comprehensive health management tailored to the needs of middle-aged and elderly individuals. Future research should longitudinally assess the impact of such integrated interventions on sarcopenia prevention and depressive symptom alleviation. Additionally, investigating the role of social and environmental factors in mediating this relationship is crucial for developing more effective health strategies for this vulnerable population.

The Role of Place of Birth and Residence in Puerto Rican Health Disparities: Evidence From Disability Prevalence Among Archipelago- Vs. Mainland-Born Puerto Ricans

Objectives: This paper provides new estimates of disability prevalence for the archipelago and mainland-residing Puerto Rican populations ages 40 and above and compares disability by place of birth and place of residence to investigate drivers of middle and older age health. Methods: Large nationally representative samples from 2013 to 2017 American Community Survey and Puerto Rico Community Survey data are used to estimate age-specific disability prevalence for archipelago-born/archipelago-residing, archipelago-born/mainland-residing, mainland-born/mainland-residing Puerto Ricans. Results: Mainland-born/mainland-residing Puerto Ricans have the lowest age-adjusted disability rates and archipelago-born/archipelago-residing Puerto Ricans have the highest rates. Differences in education explain part of this disparity. Discussion: Similarities in disability prevalence are strongest based on where one was born as opposed to current residence, pointing to early life as a critical period in the disablement process for later-life health. Early life socio-economic disadvantage on the archipelago may have an enduring impact on later-life disability prevalence for archipelago-born Puerto Ricans.

Healthcare utilization among pre-frail and frail Puerto Ricans

Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.

Health-related factors leading to disabilities in Korea: Survival analysis

The purpose of this study is to analyze (a) population and socioeconomic factors affecting disability, excluding the occurrence of disability due to accidents and congenital diseases, and (b) health-related behavioral factors and factors that can prevent and reduce the cause of disability due to disease in Korea. This study was a longitudinal research. Data were obtained from The 2018 Korean Health Panel (KHP) is a survey jointly conducted by the Korea Institute of Health and Social Affairs and the National Health Insurance Service. A total of 7, 372 (Mage = 52.14, SD = 21.39; Male = 47.52%) were analyzed in this study. People with Higher education attainments and more income levels were associated with lower hazard of developing new disabilities (all p < 0.05). In this study, the health factors that could be related to the occurrence of new disabilities were smoking, alcohol consumption, physical activity, and stress (all p < 0.0001). However, physical activity was negatively associated with the risk of developing a disability at all follow-ups (p < 0.05). Higher scores on the number of chronic diseases (valid scores = 0, 1, 2, 3, or more) represented a greater level of newly developing disability present at all follow-ups (all p < 0.0001). This longitudinal study confirmed the relationship between health-related factors and specific chronic diseases. Its findings can be used as a crucial foundation for establishing healthcare policies and services that can lower and prevent disability by preventing and reducing specific negative health behaviors and unhealthy behavioral factors, and alleviating chronic diseases in Korea.

Living Arrangements and Intergenerational Support in Puerto Rico: Are Fathers Disadvantaged?

OBJECTIVES

To examine how intergenerational support varies by parents' living arrangements and whether there are gender differences in received support in Puerto Rico.

METHODS

Data come from the 2006-2007 Puerto Rican Elderly and Health Conditions Project, a representative longitudinal study of adults aged 60 and older in Puerto Rico (n = 2,288). We examined the association between parents' living arrangements (alone, with spouse/partner only, with children) and their receipt of functional (help with errands/housework/transport) and health (help when sick) support from children, and whether parents' gender moderates the association.

RESULTS

Intergenerational coresidence was associated with higher odds of receiving functional and health support than living alone. Women were more likely than men to receive both forms of support. Parents' gender significantly moderated the association between living arrangements and receiving health support-men living with their partners were less likely to receive health support from children than women in similar living arrangements. These associations persisted when analyses were restricted to those with disability.

DISCUSSION

Our findings suggest that parents' receipt of support from children is conditioned upon their living arrangement and gender, even when their functional health is jeopardized. We discuss these results in relation to the heterogeneous influence of living arrangements for older adults' support needs and provide suggestions for policy and directions for future research in rapidly aging Puerto Rico.

Validation of the abbreviated Lubben Social Network Scale (LSNS-6) and its association with self-rated health amongst older adults in Puerto Rico

Social isolation is a well-established determinant of late-life well-being, and it may be particularly relevant for older adults in Puerto Rico following Hurricane María. The abbreviated Lubben Social Network Scale (LSNS-6) is a widely used measure of social isolation, but it has not been validated with Spanish-speaking older adults. The objectives of this study were to (1) assess the psychometric properties of a Spanish-language LSNS-6 and (2) examine its association with self-rated health (SRH) and psychological sense of community (PSOC). Data came from face-to-face survey interviews with a nonprobability sample of 154 community-dwelling older adults in Puerto Rico 2 years after Hurricane María. We assessed the LSNS-6's internal consistency reliability and convergent validity. We then conducted structural equational modelling consisting of (1) a measurement model using confirmatory factor analysis to test the factor structure of the LSNS-6 and (2) a structural model using path analysis to examine the direct effect of social isolation on SRH and to test the role of PSOC as a mediator in this relationship. The LSNS-6 demonstrated acceptable internal consistency reliability (α = 0.74) and convergent validity, r(151) = -0.33, p < 0.001. A correlated two-factor model (Family and Friends) provided the best fit (comparative fit index = 0.986, Tucker-Lewis index = 0.975, root mean square error of approximation = 0.082, standardised root mean squared residual = 0.033). Path model results show the Friends factor was negatively associated with SRH (β = -0.31, p = 0.045), whilst the Family factor was nonsignificant. The Friends factor had a statistically significant indirect effect on SRH through PSOC (β = 0.08, 95% CI [0.01, 0.29]). Our findings provide insight into the effect of social isolation on health amongst older adults in Puerto Rico and highlight the potential role of PSOC for assessment and intervention with older adults in post-disaster settings.

Pain associates with subjective memory problems and cognition in older Puerto Rican adults

This study examined whether pain is associated with subjective memory problems or cognition in Puerto Rican older adults. Participants came from the Puerto Rican Elderly Health Conditions (PREHCO) study, aged 60 and over (n = 2,144). Analyses examined concurrent and longitudinal associations of pain with subjective memory problems and cognition using a cognitive screener. Overall, participants with pain were more likely to report concurrent subjective memory problems than those without pain. Older adults with pain also exhibited slightly lower concurrent cognition. Novel pain was associated with cognitive decline and greater likelihood of incident subjective memory problems at follow-up. Persistent pain was only related to incident subjective memory problems at follow-up. Pain is associated with cognitive decline and subjective memory problems in older Puerto Ricans. Future studies should implement more in-depth neuropsychological assessments and examine the potential role of barriers to pain management in this population.

Aging and the Left Behind: Puerto Rico and Its Unconventional Rapid Aging

Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10th highest in the world. Unlike most locales, Puerto Rico's aging is driven by both (a) the culmination of long-running fertility and mortality trends and (b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico's unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico's unique history and political relationship with the United States present challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country's aging society.

Psychometric testing of the Brief Sense of Community Scale with older adults in Puerto Rico

The Brief Sense of Community Scale (BSCS) is a well-validated measure of psychological sense of community (PSOC), but it has yet to be tested with Spanish-speaking older adults. The current study uses data from face-to-face interviews with a non-probability sample of 154 community-dwelling older adults in Puerto Rico. We used confirmatory factor analysis (CFA) to test three competing factor structures. We also tested internal consistency reliability and convergent validity. CFA results show the second-order four-factor model was the best fit (χ² (16) = 20.78, p = 0.187; CFI = 0.997, TLI = 0.995, SRMR = 0.026, RMSEA = 0.044, 90% CI [<0.001, 0.092]). The BSCS showed good reliability (α = 0.85) and was correlated in the expected direction with social network size (r = 0.34, p < 0.001) and loneliness (r = -0.27, p < 0.001). These findings indicate that the BSCS comprises the four domains (membership, needs fulfillment, emotional connection, and influence) from the original PSOC theory. These results inform theory development and can aid program planning, policy, and practice with older adults in Puerto Rico.

Correlation between functional disability and quality of life among rural elderly in Anhui province, China: a cross-sectional study

Objective

We aimed to explore the correlation between functional disability and quality of life (QoL). And exploring the interaction of functional disability, basic demographic characteristics and health-related information on QoL among the rural elderly in Anhui Province.

Methods

This study used multi-stage stratified cluster sampling in rural Anhui Province from January to July 2018 to conduct a cross-sectional survey of older adults who met the inclusion criteria. The Five-Dimensional European Quality Of Health Scale (EQ-5D) and the WHO Disability Assessment Schedule (WHODAS2.0) scale were used to evaluate the QoL and functional disability, and the basic demographic characteristics of the survey subjects were also collected. Using binary logistic and Classification and regression tree model (CART) models to analyze the data, explore the relationship between functional disability and QoL in the elderly.

Results

A total of 3491 older adults were included in the survey, and 3336 completed the entire survey, with an effective response rate of 95.56%. After adjusting for covariables, those who had limited in dimension of mobility (AOR=2.243, 95%CI: 1.743-2.885), getting along (AOR=1.615, 95%CI: 1.173-2.226), life activities (AOR=2.494, 95%CI:1.928-3.226), and social participation (AOR=2.218, 95%CI: 1.656-2.971) had a lower QoL. However, the dimension of cognition (AOR=0.477, 95%CI: 0.372-0.613) is a protective factor for QoL. Additionally, we also observe that 96.3% of those who were unemployed and limited in both mobility and life activities dimensions had a lower QoL, but among those who were robust in both mobility and social participation dimensions and not suffer from chronic diseases, 56.3% had a higher QoL.

Conclusions

Our findings indicate that special attention should be paid to the elderly who are unemployed, have limited in cognition, getting along, social participation, mobility, life activities and cognition robust to improve their QoL. This research is of great significance for formulating targeted strategies and measures to improve the QoL for rural elderly.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12363-7.

Bidirectional relationship between depressive symptoms and physical performance in community-dwelling older people with subjective memory complaints

PURPOSE

This study examined the bidirectional relationship between depressive symptoms and physical performance in community-dwelling older people with subjective memory complaints.

METHODS

Secondary analyses using data from the Multidomain Alzheimer Preventive Trial (MAPT) study were performed. The participants were 1679 subjects (female, 64.8%; mean age, 75.3 ± 4.4 years). The outcome measures were depressive symptoms assessed by the 15-item Geriatric Depression Scale (GDS) and physical performance assessed by the Short Physical Performance Battery (SPPB) and handgrip strength (HGS). All measurements were performed at baseline and at 6, 12, 24, and 36 months. The bidirectional relationships of GDS with SPPB and HGS were examined using mixed-effect regression analysis.

RESULTS

Baseline physical performance was significantly associated with a decreased GDS score (SPPB score: β = - 0.210, 95% confidence interval [CI], - 0.283 to - 0.137; HGS: β = - 0.038, 95% CI - 0.056 to - 0.019). The baseline GDS score was significantly associated with decreased physical performance (SPPB score: β = - 0.082, 95% CI - 0.107 to - 0.056; HGS: β = - 0.261, 95% CI - 0.370 to - 0.152).

CONCLUSION

Since depressive symptoms and physical performance had a bidirectional relationship, prevention or improvement of decreased physical performance could play a role in reducing depressive symptoms, and addressing depressive symptoms may play a role in improving physical performance.

TRIAL REGISTRATION NUMBER

NCT01513252.

Risk factors associated with mortality in young and long-lived older adults in Florianópolis, SC, Brazil

This article aims to investigate risk factors associated with mortality in young (< 80 years) and long-lived (≥ 80 years) older adults in Florianópolis. A longitudinal population-based study of 1702 older adults participants of the EpiFloripa Ageing Study. Deaths were identified through searches in the Mortality Information System. The probability of survival was estimated using the Kaplan-Meier and Log-Rank methods. The effect of risk factors for mortality was evaluated using Cox Regression models, adjusted for gender, family income, leisure physical activity, depressive symptoms, functional disability, falls, smoking, cardiovascular disease, stroke, and diabetes mellitus. The overall survival probability was 89.9% and 52.6% for the young and long-lived older adults, respectively. For younger older adults, the risk of death was higher for males, ex-smokers and those with moderate/severe disability. For the long-lived older adults, only those with depressive symptoms had a higher risk of death. These results reveal different risk profiles of death among younger and older adults and the need for a differentiated look in the health care of this population.

Relationship between Individual Social Capital and Functional Ability among Older People in Anhui Province, China

This study aimed to explore the relationship between individual social capital and functional ability, with a focus on whether there is an interactive relationship that exists among social capital related to functional ability among older people in Anhui province, China. We conducted a cross-sectional study with a multi-stage stratified cluster random sampling method from July to September 2017. Data were collected through questionnaire including demographic characteristics, individual social capital status, and functional capability status. Binary logistic regression analysis model and classification and regression tree model (CART) were utilized. Overall, this study included 1810 elderly people, 43% of whom had functional disability. After the adjustment, subjects with lower social participation (AOR = 1.60; 95% CI: 1.26–2.03) and lower social connection (AOR = 1.74; 95% CI: 1.34–2.25) had an increased risk of functional disability. However, social support (AOR = 0.73; 95% CI: 0.57–0.94) was inversely related to functional ability. We also observed interactive relationship of social capital associated with functional ability, which indicated that special attention and efforts should be paid to older adults with less educational attainment, with multimorbidity, with advanced age, and with lower level of social participation, cohesion for the purpose of maintaining sound functional ability. Our findings may be of salient relevance for devising more targeted and effective interventions to prevent the onset of functional limitations among community-dwelling older adults.

The risk of mortality among people with type 2 diabetes in Latin America: A systematic review and meta-analysis of population-based cohort studies

Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and cause-specific mortality in population-based cohort studies in LA. Systematic review and meta-analysis: inclusion criteria were (1) men and women 18 years old and above with T2DM; (2) study outcomes all-cause and/or cause-specific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS-I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta-analysis (N = 416 821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I² ] = 85.7%, p < 0.001; 95% confidence interval [CI], 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I²  = 93.9%, p < 0.001; 95% CI, 1.36-3.74). The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I²  = 59.2%; p < 0.061; 95% CI, 1.99-3.82) and for renal mortality 15.85 (I²  = 0.00%; p < 0.645; 95% CI, 9.82-25.57). Using available population-based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death.

Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions

BACKGROUND AND OBJECTIVES

Hispanics are the most rapidly aging minority population in the United States. Our objective is to provide a summary of current knowledge regarding disability among Hispanics, and to propose an agenda for future research.

RESEARCH DESIGN AND METHODS

A literature review was conducted to identify major areas of research. A life course perspective and the Hispanic Paradox were used as frameworks for the literature review and for identifying future areas of research.

RESULTS

Four research areas were identified: (1) Ethnic disparities in disability; (2) Heterogeneity of the U.S. older Hispanic population; (3) Risk factors for disability; and (4) Disabled life expectancy. Older Hispanics are more likely than non-Hispanic whites to be disabled or to become disabled. Disability varied by country of origin, nativity, age of migration, and duration in the United States. Important risk factors for disability included chronic health conditions, depression, and cognitive impairment. Protective factors included positive affect and physical activity. Older Hispanics have longer life expectancy than non-Hispanic whites but spend a greater proportion of old age disabled. Future research should continue to monitor trends in disability as younger generations of Hispanics reach old age. Attention needs to be given to regional variation within the United States for disability prevalence, early-life risk factors, and factors that may contribute to variation in disabled life expectancy. There is also an urgent need for interventions that can effectively prevent or delay the onset of disability in older Hispanics.

DISCUSSION AND IMPLICATIONS

Considerable research has examined disability among older Hispanics, but continued research is needed. It is important that research findings be used to inform public policies that can address the burden of disability for older Hispanic populations.