Health and Social Care System Preparedness for Dementia Care in Mexico: Current Status and Recommendations to Achieve Optimal Care

In this article, we summarise the findings of the situational analysis of dementia care generated as part of the STRiDE: Strengthening responses to dementia care in developing countries project, including a desk review, a SWOT analysis and views from relevant stakeholders. In addition, the article incorporates the experience of 4 years of work within the STRiDE project of FEDMA, Mexico's Federation of Alzheimer's and other dementias and its allied Associations in presenting specific recommendations to optimise dementia care in the country. All the information gathered brings together a detailed understanding of the current dementia care systems of diagnosis, treatment, and support in general and what is lacking, allowing for the generation of general recommendations to enhance the isolated efforts currently available and amplify their impact, as well as strategies to generate new services currently unavailable, but urgently needed.

Introducing a multicomponent staff training intervention to reduce antipsychotic medication: Care home management pre and post intervention views of systemic impact, and preliminary RE-AIM evaluation

OBJECTIVES

We explored views of care home managers when introducing PROCUIDA-Demencia a mixed-methods two-arm cluster randomised controlled pilot and clinical outcomes study aiming to optimise dementia care by introducing psychosocial interventions to reduce antipsychotic medication in care homes.

METHOD

We undertook secondary analysis of pre and post in-depth interviews conducted in summer 2018 with not-for-profit care home managers in Mexico who were allocated to the intervention group. Transcribed data were thematically analysed. Themes were mapped out with RE-AIM quality appraisal framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) as preliminary evaluation to identify practice and future intervention development and evaluation.

RESULTS

Two pre- and three post-intervention themes were constructed. Participants reported measurable positive impact; one home built a new specialist dementia care unit and others hired a psychologist and psychiatrist to sustain the changes. Antipsychotic medication was reduced for some participating residents which also minimised cost burden on family members.

CONCLUSION

Funding, systemic working across families, clinical and social teams and effective systems of governance are urgently required to sustain models like PROCUIDA-Demencia. The RE-AIM preliminary evaluation outlined care home managers' long-term sustainable practice and positive impact on the dementia care system. These findings might inform staff retention strategies and care home systemic care practices. This evaluation is contributing to the Mexican Alzheimer's and other dementias plan.

Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps

Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.

Life Course Education, Health, and Ageing Well: A Short Inter-Academic Report

After the first wave of the COVID-19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the inhabitants, the authors of this paper initiated a literature review of educational trajectories, health, and ageing well. The findings strongly demonstrate that alongside genetics, the affective and educational family environment, as well as the general environment, greatly interact starting from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease [DOHAD] in the first 1,000 days of life as well as in the characterization of gender. Other factors such as socio-economic level, parental education, schooling in urban or rural areas, also play a major role in the differential acquisition of health literacy. This determines adherence (or lack thereof) to healthy lifestyles, risky behaviours, substance abuse, but also compliance with hygiene rules, and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes), which promote cardiovascular and kidney damage, and neurodegenerative diseases, explaining that the less well educated have shorter survival and spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of this inter-academic group propose specific educational actions at three levels: (1) teachers and health professionals, (2) parents, (3) the public, emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities.

Optimizing Dementia Care for Mexicans and Mexican-Origin U.S. Residents

In this article, we report on the recommendations of a bi-national conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment and care management require additional knowledge and skills of general and specialized staff in the healthcare workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for bi-national dementia care policy and practice.

Non-contributory pension programs and frailty of older adults: Evidence from Mexico

Non-contributory pension programs in the developing world seek to provide older adults with an income that may improve their health and wellbeing in old age by enabling access to health care and better nutrition. There is no previous evidence of the effects of non-contributory pensions on frailty, a comprehensive measure of health and well-being of the oldest old. We aimed to estimate the effects of non-contributory pension programs on frailty of older adults in the state of Yucatan, Mexico. We use rich panel data, including objective markers and self-reported assessments of health and well-being, for 944 adults at least 70 years of age in two communities of Yucatan, Mexico. The first wave was collected in 2008; the second wave was collected in 2010, 18 months after implementation of a monthly state pension in one community and 12 months after a federal pension paid every two months in the other. We found the state pension led to a statistically significant decrease in the severity of frailty for women, but the federal pension was associated with an increase. We found no statistically significant change in the frailty index for men in either community. Among explanations for these findings are monthly payments being more likely to be spent on health care, medicines, and more regular food expenditures, enabling women who previously lacked independent means of support to increase their longer-term health. The federal program paid every two months led to irregular patterns of food expenditure and increased ownership of durable goods but had no effects on health care utilization, subsequently leading to deterioration in longer-term health for women.

Household Composition and Longitudinal Health Outcomes for Older Mexican Return Migrants

Mexican return migrant population is increasing, yet our knowledge about their lives after resettlement in Mexico remains fragmentary. Using 2001-2012 longitudinal data from the Mexican Health and Aging Study, we investigate difference in household composition for older migrants who returned from the United States compared to nonmigrants. Furthermore, we fit a Cox proportional hazards model to assess the relationship between household composition and health and functional trajectories of return migrants and nonmigrants. The results indicate that return migrants with long duration of U.S. stay have different household composition than nonmigrants or short-term migrants: On average, they have smaller household size, including fewer females who may be available to offer assistance to older adults. Presence of middle-age females in the household has positive effects on health and functional trajectories. We highlight implications of this research for policy makers in Mexico and the United States.

Introduction

The population of Mexico today has more adults aged 60 and older than children younger than five. Even so, the proportion of older adults as a share of the total population is significantly lower in Mexico than in high income countries. However, Mexico and other countries in the region of Latin America are ndergoing a period of accelerated aging that is partly due to the fast pace at which mortality rates dropped after 1930, and partly to the more-recent sudden drop in fertility rates. In the last 20 years, research on aging has accelerated as well and the scientific community has benefitted from having new sources of information and databases.