The Mex-Cog cognitive assessment battery: discriminant analysis of the cognitive performance profile in older adults

OBJECTIVE

To analyze the cognitive profile of a clinical sample using the Mex-Cog cognitive battery and establish which cognitive measures and domains contribute most to group separation.

MATERIALS AND METHODS

A group of 145 older adults previously diagnosed with dementia (n= 47), mild cognitive impairment MCI (n= 47), or as cognitively normal (n= 51) were assessed with the Mex-Cog cognitive battery. Six linear discriminant analyses (LDA) were estimated to compare dementia vs. cognitively normal, MCI vs. cognitively normal, and MCI vs. dementia, using ten individual measures and six cognitive domains. We used a leave-one-out cross-validation procedure to evaluate the predictive capacity of LDA models.

RESULTS

Discriminant functions using individual measures and domains distinguished correctly 100% of dementia and cognitively normal groups showing a memory and executive function profile. The predictive group membership for MCI versus cognitively normal varied between 82 and 85%, with a cognitive profile associated with attention-executive function followed by memory. Group separation between MCI and dementia was between 80 and 87%, characterized by orientation, memory, and visuospatial abilities.

CONCLUSIONS

The Mex-Cog cognitive battery is useful for identifying cognitive impairment in older adults.

World guidelines for falls prevention and management for older adults: a global initiative

BACKGROUND

falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present.

OBJECTIVES

to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries.

METHODS

a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting.

RECOMMENDATIONS

all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations.

CONCLUSIONS

the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Prevalence and Biological Correlates of Oropharyngeal Dysphagia in Outpatients of a Geriatric Evaluation Clinic: A Brief Report

BACKGROUND

Oropharyngeal dysphagia (OD) is a relevant disease among older adults and is associated with serious adverse health-related outcomes, such as malnutrition, sarcopenia, or frailty. Increasing its recognition and the related mechanisms will allow us to its prevention and treatment at different levels of care.

OBJECTIVES

This study aimed to determine the prevalence and biological correlates of OD in outpatient older adults.

METHOD

This is a cross-sectional study including 100 adults aged 60 or older from a geriatric clinic of a tertiary hospital in Mexico City. Health variables and geriatric syndromes were recorded. The Eating Assessment Tool-10 detection test and the volume-viscosity swallowing test were used to diagnose OD. Logistic regression models were performed to identify the factors associated with OD.

RESULTS

Mean age was 81.2 (±7.5) years and 21% had OD. The presence of xerostomia (p = 0.05) and a worst nutritional status (p = 0.035) were obtained.

CONCLUSIONS

The prevalence of OD among older adults was high. Inadequate nutrition status and the presence of xerostomia are more likely to be present with this swallowing disorder.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America

BACKGROUND

In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru.

METHODS

1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru.

FINDINGS

Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, ηp 2  = 0.031); while Blacks reported experiencing discrimination more often (p < .001, ηp 2  = 0.050). Blacks and Latinos reported more positive coping (p < .001, ηp 2  = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination.

INTERPRETATION

The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact.

FUNDING

Massachusetts General Hospital Department of Psychiatry.

Cognitive impairment among older adults living with HIV/AIDS and frailty

In 2014, 17% of newly diagnosed HIV infection cases in the United States were made in people over 50 years of age; actually, it is expected that in the near future this population group will be the most affected. This epidemiological change can be explained by the increased incidence of HIV infection in people over 50 years, but also by its higher prevalence due to treatment advances. As HIV infection has become a chronic one, new challenges have emerged. For instance, early-onset "geriatric syndromes," such as frailty, have been recognized in these patients. Frailty refers to a physiological state of vulnerability that increases the risk of adverse health-related outcomes. Frail individuals have higher risk of cognitive impairment; however, it is not known if early-onset frailty in those infected by HIV could also increase the risk of cognitive impairment in this already vulnerable population. The purpose of this review article is to describe, from an epidemiological point of view, the relationship between the changes promoted by HIV and the syndrome of frailty on cognitive function.

The Phenotype of Frailty Predicts Disability and Mortality among Mexican Community-Dwelling Elderly

BACKGROUND

Frailty represents a major public health priority in Western countries. Specific social and cultural factors may influence the prevalence and predictive value for negative health-related events of this syndrome.

OBJECTIVE

To determine the prevalence and predictive value of the phenotype of frailty among community-dwelling Mexican American older persons.

DESIGN, SETTING AND PARTICIPANTS

Two-year longitudinal study of 5,644 men and women aged 60 years and older participating in the Mexican Health and Aging Study.

MEASUREMENTS

The Frailty index used in the present study was a modified version of the operational definition proposed in the Cardiovascular Health Study (CHS). Frailty was defined by the presence of at least three of the four following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. The main outcomes were incident disability and mortality. Chi-square, ANOVA and multiple logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest.

RESULTS

The mean age of the study sample was 68.7 (SD 6.9) years. Thirty-seven percent of participants (n=2,102) met the definition of frailty. Frail subjects were significantly older, and more likely to be women than non-frail participants. They also presented lower education, more chronic diseases, lower income, and poorer self-reported health status. After adjusting for potential confounders, frailty was found to be a predictor of incident mobility disability (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.37-2.66), activities of daily living (ADL) disability (OR 9.33; 95%CI 3.37-25.82), and instrumental ADL (IADL) disability (OR 1.81, 95%CI 1.23-2.68). The risk of mortality among frail participants was almost three-fold higher than in non-frail ones.

CONCLUSION

The prevalence of frailty is higher in this elderly population than what previously reported in other cohorts. The phenotype of frailty was confirmed to be a predictor for adverse health-related outcomes (including mobility, ADL, and IADL disability). Further studies in Latin American countries are needed to identify frailty and develop adapted interventions for the prevention of adverse outcomes in older persons.

The Coyoacán Cohort Study: Design, Methodology, and Participants' Characteristics of a Mexican Study on Nutritional and Psychosocial Markers of Frailty

BACKGROUND

"Frailty" has emerged as a condition associated with an increased risk of functional decline among the elderly, which may be differentiated from aging, disability, and co-morbidities.

OBJECTIVE

The Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly has emerged to help answer many questions about frailty among the older adults. This report presents the design of the study and baseline data of its participants.

DESIGN

The "Coyoacan cohort" is a longitudinal observational study developed in Mexico City.

PARTICIPANTS

A representative sample of 1,294 non-institutionalized men and women aged 70 years and older were randomly recruited to undergo a face-to-face interview and a comprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009.

MEASUREMENTS

Data collected included socio-demographic and economic characteristics, medical history, oral health, drug use, cognitive function and mood, nutritional status, physical performance and functional status, physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 of the following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentional weight loss.

RESULTS

A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years, and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 blood samples were collected. The baseline prevalence of frailty was 14.1%.

CONCLUSIONS

Understanding the medical, biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the current research in the field.

Association between Self-Reported Health Status and Frailty in Community-Dwelling Elderly

BACKGROUND

The phenotype of frailty proposed by Fried et al. has been related with increased vulnerability for the development of adverse health-related outcomes. However, this phenotype is not often used in daily clinical practice. On the other hand, poor self-reported health status (SRHS) has been associated with similar adverse health-related outcomes.

OBJECTIVES

To determine the association between poor SRHS and frailty.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study of 927 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty.

MEASUREMENTS

SRHS was established by the question "How do you rate your health status in general?" Frailty was defined according to the phenotype proposed by Fried et al. The association between SRHS and frailty was determined through the construction of multinomial logistic regression models. Final analyses were adjusted by socio-demographic and health covariates, including depressive symptoms. Also, agreement between SRHS and the phenotype of frailty was explored.

RESULTS

Prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as "poor". The unadjusted regression analyses demonstrated that fair and poor SRHS were significantly associated with prefrail and frail status. After adjustment for multiple covariates, the association remained statistically significant. However, in the final adjustment for depressive symptoms, only the association between poor SRHS and frail status continued to be statistically significant. Fair agreement between poor SRHS and frail status was also found.

CONCLUSION

Poor SRHS shares common correlates as well as health-related adverse outcomes with frailty syndrome, and remains associated with it even when possible confounders are taken into account. Therefore, poor SRHS could be further explored as an option for frailty syndrome screening.

Frailty Is Associated with Disability and Recent Hospitalization in Community-Dwelling Elderly: The Coyoacan Cohort

BACKGROUND

The phenotype of frailty proposed by Fried et al has shown to predict several adverse health-related outcomes in elderly populations worldwide; however, the description of such associations in Latin America is still scarce.

OBJECTIVE

To describe the association between frailty and recent hospitalization, disability for basic (ADL) and instrumental activities of daily living (IADL).

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study of 1,124 community-dwelling adults aged 70 and older participating in the Coyoacán cohort.

MEASUREMENTS

Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. Multiple regression analyses were used to test the association between frailty and the outcomes of interest, adjusting for potential confounders.

RESULTS

Mean age was 78.2 (SD ±6.1) years. Prevalence of frailty was 14.1%. Adjusted multivariate models showed that frail status was associated with ADL disability (OR 3.06, 95%CI 1.52-6.17), IADL disability (OR 17.02, 95%CI 6.16-47.01), and recent hospitalization (OR 3.21, 95%CI 1.31-7.8).

CONCLUSION

Among Mexican community-dwelling elderly, frailty is associated with ADL and IADL disability as well as with recent hospitalizations. Moreover, frailty's prevalence in this population appears to be greater compared to what has been reported elsewhere. Social and cultural traits should be further studied as correlates of frailty in diverse populations.

Association between employee benefits and frailty in community-dwelling older adults

AIM

The phenotype of frailty has been associated with an increased vulnerability for the development of adverse health-related outcomes. The origin of frailty is multifactorial and financial issues could be implicated, as they have been associated with health status, well-being and mortality. However, the association between economic benefits and frailty has been poorly explored. Therefore, the objective was to determine the association between employee benefits and frailty.

METHODS

A cross-sectional study of 927 community-dwelling older adults aged 70 years and older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty was carried out. Employee benefits were established according to eight characteristics: bonus, profit sharing, pension, health insurance, food stamps, housing credit, life insurance, and Christmas bonus. Frailty was defined according to a slightly modified version of the phenotype proposed by Fried et al. Multinomial logistic regression models were run to determine the association between employee benefits and frailty adjusting by sociodemographic and health covariates.

RESULTS

The prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as "poor." Multinomial logistic regression analyses showed that employee benefits were statistically and independently associated with the frail subgroup (OR 0.85; 95% CI 0.74-0.98; P = 0.027) even after adjusting for potential confounders.

CONCLUSIONS

Fewer employee benefits are associated with frailty. Supporting spreading employee benefits for older people could have a positive impact on the development of frailty and its consequences. Geriatr Gerontol Int 2016; 16: 606-611.

Association between high serum estradiol levels and delirium among hospitalized elderly women

BACKGROUND

Delirium is a common and serious disorder among hospitalized elderly individuals. We investigated the association between serum estradiol levels and incident delirium.

METHODS

Longitudinal study of 141 women ≥ 70 years old admitted to a tertiary care hospital in Mexico City. All participants underwent a comprehensive geriatric assessment. Blood samples for cortisol and estradiol determination were obtained at hospital admission. Incident delirium was investigated until participants were discharged. Multivariate models were run to test the independent association between estradiol levels and incident delirium.

RESULTS

Twenty-three (16.3%) participants developed delirium. Estradiol levels were higher among women with incident delirium compared with non-affected women. Multivariate logistic regression analysis showed that serum estradiol levels were associated with incident delirium even after adjusting for multiple confounding covariates, including cortisol levels (OR: 1.93; 95% CI: 1.28-2.92).

CONCLUSIONS

Elderly women with high serum estradiol levels at hospital admission had an increased risk for incident delirium. Serum estradiol may be a biomarker for increased risk of delirium.

The Phenotype of Frailty and Health-Related Quality of Life

BACKGROUND

Frailty is a multidimensional problem in the elderly, but there is little information about its implications on health-related quality of life (HRQoL).

OBJECTIVES

To determine the association between frailty and HRQoL as well as the association between each component of the phenotype of frailty and the physical (PCS) and mental (MCS) components summaries of QoL.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study of 496 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty.

MEASUREMENTS

Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. QoL and both of its components were assessed through the SF-36. The association of each component of frailty with the PCS and the MCS of QoL was determined through the construction of multivariate lineal regression models. Final analyses were adjusted by socio-demographic characteristics and by the remaining four components of frailty as covariates.

RESULTS

Mean age of participants was 78.0 (SD ± 6.2), 49.4% were women, and 12.7% were frail. Multivariate lineal regression analysis showed that frail and prefrail participants had lower scores for the PCS (P < .001) and the MCS (P < .001) of QoL in comparison with non-frail subjects. Weight loss (P < .001) and exhaustion (P < .001) had an independent inverse association with the MCS of QoL while gait speed (P < .001) and grip strength (P < .001) were also inversely associated with the PCS score.

CONCLUSION

Frailty is independently associated with lower scores in the MCS and the PCS of QoL. The finding that different components of frailty were associated with both dimensions of QoL reflects the need for individualized treatment of frail elderly.

The severity of urinary incontinence decreases health-related quality of life among community-dwelling elderly

BACKGROUND

Urinary incontinence (UI) is an important geriatric syndrome that has been associated with a wide range of health-related outcomes. However, UI severity has rarely been examined in the context of a comprehensive geriatric assessment. Therefore, the aim of this study is to examine the association between UI severity and health-related quality of life (QoL) when frequent geriatric issues are taken into account.

METHODS

We performed a cross-sectional study of 1,124 participants aged 70 y and older. UI was diagnosed when difficulty with urinary continence was reported, and its severity was assessed through a modified version of the Sandvik Index. Health-related QoL was measured using the SF-36, including its physical and mental component summaries. Multivariate linear regression was performed to determine the association between UI severity and health-related QoL.

RESULTS

Prevalence of UI was 18%, and it was severe in 29.3% of cases. Severely incontinent subjects were older and had worse self-perceived health status, greater disability, and more depressive symptoms in comparison with continent participants or with those affected to a lesser degree. Multivariate regression analysis showed a significant inverse association between the physical component summaries and moderate (B = -4.54) as well as severe UI (B = -6.72). The mental component summaries showed similar results (B = -1.44 and -4.43, respectively).

CONCLUSIONS

UI severity is associated with lower QoL scores in both its components. This association appears to be more important as severity increases. UI severity must be evaluated thoroughly in the elderly because of its potential adverse effects on physical and mental health.

Cognitive impairment and low physical activity are the components of frailty more strongly associated with disability

OBJECTIVE

To determine the association of the five frailty criteria from the Cardiovascular Health Study, as well as cognitive impairment, with prevalent disability for the instrumental (IADL) and basic activities of daily living (ADL).

DESIGN

Cross-sectional study of 475 community-dwelling subjects aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty.

MEASUREMENTS

Six probable frailty criteria were considered: weight loss, poor endurance, low physical activity, slowness, weakness, and cognitive impairment. The association of each component of frailty for IADL and ADL disability as main outcomes was determined constructing multivariate logistic regression analyses. Final models were adjusted by socio-demographic factors and the presence of the other five frailty components as covariates.

RESULTS

Mean age of participants was 78.1 (SD=6.2). The unadjusted results showed that each of the components of frailty, except weight loss, was associated with both IADL and ADL disability. However, after adjustment, only low physical activity [Odds ratio (OR) =3.27; 95% CI=1.56 to 6.85] and cognitive impairment (OR=2.06; 95% CI=1.04 to 4.06) remain independently associated with IADL disability. Regarding ADL disability, only a lower physical activity (OR=7.72; 95% CI=1.28 to 46.46) was associated with this outcome, whereas cognitive impairment was marginally associated but was not statistically significant (OR=5.45; 95% CI=0.91 to 32.57).

CONCLUSIONS

Cognitive impairment and low physical activity are the main contributing factors of frailty phenotype to disability. Better understanding the independent contribution of each frailty subdimension to the different adverse-health outcomes may help to provide a more adequate management of frail elderly.

[Diabetes and changes in functional status of the elderly: a reality?]

Diabetes mellitus (DM) is a common disease in the elderly population. The concept of autonomy is linked to a balance between the impairments observed in the daily activities and the availability of resources to compensate these incapacities. In the evolution of the DM, micro and macro vascular complications are commonly observed. The burden of these complications is usually proportional to the duration of the disease and the quality of glycaemic control. Visual alteration and progressive kidney failure requiring haemodialysis have significant impact on the functional status on the elderly diabetic patient living at home. Alterations of cardiac function and peripheral vascular disease which can ultimately lead to lower limb amputation also result in a dramatic alteration in the capacity of elderly patient to carry routine activities of daily living. The presence of DM seems to be a risk factor for cognitive decline and dementia. This article will review the usual complications of DM and link these complications to functional changes in the elderly population.

[Pharmacological treatment of diabetes in the elderly]

Diabetes mellitus (DM) is a highly prevalent disease in the geriatric population. The elderly are at increased risk for adverse drug reactions (hypoglycemia) compared with the young due to physiological changes associated with age, high number of comorbidities and polypharmacy usually present, causing changes in drugs pharmacokinetics and pharmacodynamics. At present, there are wide therapeutic options to treat DM, so it is important to know the different drug families and their potential side effects. As a general principle, metformin remains an appropriate option for the management of DM in the elderly, first-generation sulfonylureas (chlorpropamide) is preferable not to use due the high risk of hypoglycemia. Some thiazolidinediones have been associated with heart failure, as their use in the elderly is controversial. About the new drugs that act on the DPP-4, results are promising with a low risk profile of adverse reactions. We must consider the use of human insulin or insulin analogues in the elderly when not achieved with other hypoglycaemic agents. At the start of therapy is important to establish the most appropriate management goals based on patient comorbidities and their life expectancy.

[Pharmacological treatment of diabetic neuropathy in the elderly]

Diabetic neuropathy is the third most common complication of diabetes mellitus. When this neuropathy is accompanied by pain, it requires a specific treatment. In the elderly patient, the pain has an enormous impact on quality of life, as it is associated with anxiety, depression and sleep disorders, leading to a direct impact on the functionality of the patient. Likewise, there are a number of changes at the central and peripheral nervous system, which contribute to the chronicity of painful processes, and eventually also affect and impact on the quality of life of elderly patients. It is fundamental before initiating treatment, to know of all aspects related to drug pharmacokinetics and pharmacodynamics, especially those related to aging, because this will allow you to select the best drug for each patient. This article aims to review the pathophysiological concepts related to diabetic neuropathy in the elderly and the best treatment options.

[Specific needs in the care of elderly with diabetes mellitus]

The management of diabetes mellitus (DM) in the elderly is a complex process. In the perspective of improving glycemic control and postponing complications, lifestyle changes (diet and exercise) are often prescribed. Pharmacologic intervention is common and must be accompanied with adequate teaching on drug and hypoglycaemia management. Ideally, this process is multidisciplinary and objectives must be shared by all members of the diabetic team. The transmission and application of diabetic management strategies must be adapted to each individual in the context of his limits and capacities. Even in presence of interventions to control glycaemia, blood pressure and lipids, the micro and macro vascular complications are still very frequent in elderly patients with DM. Vascular interventions such as percutaneous arterial angioplasty and/or arterial bypass are frequently proposed even in very old diabetic patients. These patients are still at high risk of lower limb amputation with subsequent dramatic alteration in functional status and mortality. We will attempt to make a brief overview of the very diverse needs observed in older diabetic patients.

The metabolic syndrome, diabetes, and Alzheimer's disease

BACKGROUND

The metabolic syndrome (MS) is a cluster of metabolic abnormalities that has been controversially associated with Alzheimer's disease (AD), so the purpose of this report was to investigate the association between these two chronic diseases a sample of older persons.

METHODS

Case-control study of 90 consecutive outpatients with AD and 180 non-demented controls from a dementia clinic at a tertiary care hospital in Mexico City. Probable or possible AD was diagnosed according to the guidelines of the Consortium to Establish a Registry for Alzheimer's Disease, whereas control participants where those classified as normal by the same instrument. MS was defined according to the World Health Organization criteria. Patients were matched 1:2 by age, sex, and years of education. Conditional regression analysis was used to test the association between MS and AD.

RESULTS

Compared to controls, MS was more frequent among AD patients (72.2% vs. 23.3%; P < 0.01). While all components of MS were more frequent among cases than control patients, only diabetes was statistically significant, whereas hypertriglyceridemia and low HDL cholesterol were marginally associated. Conditional regression analysis showed that among AD participants, the probability of having MS was about sevenfold higher than for their non-demented counterparts (OR 6.72, 95% CI 3.72-12.13; P < 0.01).

CONCLUSIONS

The MS is a clinical entity that encompasses a diverse range of chronic diseases, which could be a better risk indicator than any individual MS component for adverse health outcomes, like AD. Our findings underscore the harmful role of MS in the health status of the elderly.

Hypertension as a risk factor for developing depressive symptoms among community-dwelling elders

OBJECTIVE

To determine whether hypertension (HTA) is an independent predictor of depressive symptoms (DS) in a sample of elderly Mexican community-dwelling persons.

MATERIAL AND METHODS

Two-year longitudinal study of 3,276 community-dwelling persons aged 60 years and older, participating in the Mexican Health and Aging Study. Subjects that self-reported both having or not having HTA while denying DS at baseline were included. Two-year follow-up data were analyzed, and multiple regression analyses were used to test whether HTA is an independent predictor of incident DS after adjusting for many potential confounders.

RESULTS

Mean age of participants was 68.4 +/- 6.9 years. Prevalence of HTA was 36.6%. At follow-up, 28.7% developed DS. After adjusting for multiple covariates (age, sex, education level, relationship status, self-reported health and economic status, diabetes, arthritis, stroke, ischemic cardiopathy, falls, pain, hearing impairment, visual impairment, urinary incontinence, cognitive impairment, smoking, alcohol use, and baseline disability), HTA was an independent predictor of DS at two years followup (Adjusted Odds Ratio = 1.18; 95% confidence interval = 1.01-1.40).

CONCLUSIONS

Hypertension is an independent risk factor for the development of depressive symptoms. Programs to support early treatment of cardiovascular disease and hypertension should be implemented in order to prevent late-onset of depressive symptoms.

[Frailty, an enigmatic and controversial concept in geriatrics. The biological perspective]

Frailty is a controversial, complex and enigmatic concept. Because the world's population is aging, it has been possible to assess the impact of frailty over patients themselves as well as on their relatives, community and mainly on their caregivers. Health care personnel must be able to identify and understand this entity and its components. In addition during the 80's frailty was understood as synonymous with disability, chronic illness, or extreme aging; this perspective must be modified. The literature on frailty has increased exponentially in the last years. However, there is still not a well defined and universally recognized description or definition. The purpose of this review was to understand frailty and its consequences based on the most recent advances in the field of aging. Frialty is a multifactorial phenomenon and for purposes of this review, only biological characteristics are discussed.

[Depression: clinical features and consequences among the elderly]

Among geriatric syndromes, chronic and recurrent depression is salient due to its ravaging effects. Depression is a predisposing factor for chronic diseases and decreases functional status. In the United States, depression alone represents a forty three billion dollar annual expense. Although the prevalence of depression may vary depending on the population studied and the methodology applied, its range is between 10 to 27%. Fatigue, insomnia, and anorexia, in a cyclical fashion, are the milestone symptoms of depression among the elderly. Nevertheless, these symptoms have poor diagnostic specificity, mainly because they may be observed among healthy elders; thus the importance of using reliable screening tools that allow early detection. In order to shed light on this disease, the present article reviews its clinical course and consequences, and describes the use of the geriatric depression scale as the most popular screening instrument for this patient population.

[Relationship between determining factors for depressive symptoms and for dietary habits in older adults in Mexico]

OBJECTIVE

To determine the factors that are commonly associated with both the dietary habits of older adults living in the community and depressive symptoms in this group.

METHODS

Secondary analysis of data on Mexico City obtained by means of the multicenter study on Health, Well-being, and Aging (Salud, Bienestar y Envejecimiento, SABE) that was carried out in 1999 and 2000. The following variables were examined: presence or absence of depressive symptoms, according to Yesavage's Geriatric Depression Scale (GDS); mental status, as reflected by the score obtained on a modified, shortened version of Folstein's Mini-mental State Examination (MMSE); and functional capacity, as measured by Katz' Index of Independence in Activities of Daily Living. Those whose score on the shortened MMSE was 12 points or less were asked to respond to the Pfeffer Functional Activities Questionnaire, which was used to assess their ability to perform the basic activities of daily living. Information was obtained through self-report on the material, physical, psychological, and social aspects of purchasing, preparing, and consuming food products and of oral health status during the most recent 12-month period. Variables that were significantly associated with the results obtained on the GDS were included in a multivariate regression analysis; several statistical models were created, and variables that were shown to be statistically significant in the stepwise multivariate linear regression were used to determine the best-fitting explanatory model for the results obtained on the GDS.

RESULTS

The average age of study participants was 64.4 +/- 8.6 years, and the prevalence of depressive symptoms was 66%. The score obtained on the GDS showed a significant association with the presence of arterial hypertension (P < 0.01), but not with the self-reported presence of diabetes, neoplasia, stroke, lung disease or heart disease. However, the use of dental prostheses (P < 0.01), urinary incontinence (P < 0.01), and falls (P < 0.01) were significantly associated with the results on the GDS. The intake of milk products, meat, fish, fowl, fruit, and vegetables was significantly lower in the group that had depressive symptoms. An inverse correlation was detected between the score obtained on the GDS on the one hand, and the number of complete meals consumed during the day (P < 0.01) and total fluid intake (P < 0.01) on the other. The determining factors that were most closely associated with these results were, in addition to the presence of arterial hypertension, the presence of cognitive impairment (P < 0.01), difficulty performing the basic activities of daily living (P = 0.03) and the instrumental activities of daily living (P < 0.01), poor mobility (P < 0.01), difficulty using the telephone (P < 0.01), and the self-perception of having poor memory (P < 0.01), of having insufficient resources with which to live (P < 0.01), and of having poor oral health (P < 0.01). These variables explained 31% of the variance seen in the R2 values linked to the SDG variables that were incorporated into the final explanatory model.

CONCLUSION

A number of determining factors for depressive symptoms and the results obtained on the GDS resemble the factors that determine poor dietary habits among older adults. The potential existence of common causative mechanisms calls attention to the need for designing interventions aimed at preventing both types of problems and their negative consequences. These results confirm the need to take dietary habits and other parameters into account when studying depression in older adults.