Factores que afectan el estado nutricional en personas mayores mexicanas: Enasem, 2018

OBJETIVO

Analizar los factores que afectan el estado nutricional en personas mayores mexicanas del Estudio Nacional de Salud y Envejecimiento en México 2018 (Enasem 2018). Material y métodos. Análisis transversal secundario de determinantes sociales, factores relativos a la salud y eventos estresantes de la vida con dos problemas nutricionales relevantes en personas mayores: 1) desnutrición y 2) exceso de peso considerando sobrepeso y obesidad, mediante regresión logística múltiple.

RESULTADOS

4 587 participantes. La prevalencia de desnutrición fue 16.1% y está relacionada con edad ≥80 años, sin pareja, sin escolaridad, sobrestimación de índice de masa corporal (IMC), dificultad motriz, dependencia funcional instrumental, hospitalización en año previo y caídas en los últimos dos años, autorreporte de fuerza prensil débil, reporte de desastre que afectó vivienda o accidente que afectó la salud. La prevalencia de exceso de peso fue 43.6%, relacionada con ser mujer, tener 60 a 79 años, percibirse sin sobrepeso u obesidad y subestimarlo contra IMC, tener ≥3 enfermedades, síntomas somáticos e inactividad física.

CONCLUSIONES

Los factores que afectan el estado nutricional hacia desnutrición o exceso de peso en las personas mayores requieren considerarse como áreas de intervención importante en el envejecimiento.

[Quality of life and caregiver burden in caregivers with patients with complications from type 2 diabetes mellitus]

Background

Chronic diseases with partial dependence, including type 2 diabetes mellitus, modify the way of life of the patient and his family, who adopt the role of caregiver having to reorganize, rethink their expectations and adapt their goals and objectives to the situation, this may generate a deterioration of the quality of life and an overload syndrome.

Objective

To identify the relationship between quality of life and caregiver overload in caregivers with patients with complications from type 2 diabetes mellitus assigned to the Family Medicine Unit No. 7.

Material and methods

Cross-sectional study, carried out with 138 caregivers with a patient with complications from type 2 diabetes mellitus. The sociodemographic profile instruments, the SF-36 health questionnaire, and the Zarit scale were used for data collection. The analysis was carried out through descriptive statistics and Spearman's correlation test, with a significance level of p≤0.05.

Results

It was identified that the health-related quality of life in caregivers with patients with complications from type 2 diabetes mellitus evaluated with the SF-36 questionnaire had a mean value of 74.8; with a score in the physical and mental components of 63.9 and 38.1 respectively. The best qualified dimensions were social function (84.9) and physical function, on the other hand, vitality obtained a lower qualification. It was observed that 5.05% of the caregivers present light overload and 5.05% intense overload. When performing the correlation between the global rating of the Zarit scale with the 8 dimensions of the SF-36 health questionnaire in caregivers of patients with complications of type 2 diabetes mellitus, a moderate negative correlation was observed between the dimensions of mental health, physical function, emotional role and vitality, as well as a weak negative correlation between the dimensions of social role and physical role.

Conclusions

The results show an inverse correlation between the caregiver's burden and the quality-of-life dimensions, that is, if one decreases, the other increases; It is important to carry out health promotion activities in this population to prevent caregiver overload.

La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores que viven en la comunidad

OBJETIVO

Determinar la asociación entre mala autopercepción de salud oral y fragilidad en personas mayores. Material y métodos. Estudio transversal en personas mayores de la Ciudad de México. La autopercepción de salud oral se midió con el Geriatric/General Oral Health Assessment Index (GOHAI) y la fragilidad con el fenotipo de Fried y colaboradores.

RESULTADOS

1 173 personas mayores, media de edad de 66.0 (5.7) años, mujeres 46.1% (n=541). La media (IC95%) de GOHAI-Sp fue de 49.2 (48.9-49.6). El 9.2% (n=108) presentaron fragilidad, 59.9% (n=703) prefrágil y 30.9% (n=362) no frágiles. La fuerza de asociación (RM) para mala autopercepción de salud oral y frágil fue RM 2.4 (IC95% 1.5,3.7) y RM ajustada RM 1.7 (IC95% 1.1,2.8), referencia no frágil. No existe asociación significativa para la mala autopercepción de salud oral y prefrágil. Conclusión. La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores.

Insomnia Impairs Both the Pro-BDNF and the BDNF Levels Similarly to Older Adults with Cognitive Decline: An Exploratory Study

Sleep disorders, including insomnia, are common during aging, and these conditions have been associated with cognitive decline in older adults. Moreover, during the aging process, neurotransmitters, neurohormones, and neurotrophins decrease significantly, leading to the impairment of cognitive functions. In this sense, BDNF, the most abundant neurotrophic factor in the human brain, has been suggested as a potential target for the prevention and improvement of cognitive decline during aging; however, the current evidence demonstrates that the exogenous administration of BDNF does not improve cognitive function. Hence, in the present study, we quantified pro-BDNF (inactive) and BDNF (active) concentrations in serum samples derived from older individuals with insomnia and/or cognitive decline. We used linear regression to analyze whether clinical or sociodemographic variables impacted the levels of BNDF concentration. We observed that insomnia, rather than cognitive decline, is significantly associated with BDNF concentration, and these effects are independent of other variables. To our knowledge, this is the first study that points to the impact of insomnia on improving the levels of BDNF during aging and suggests that opportune treatment of insomnia may be more beneficial to prevent cognitive decline during aging.

[Answer to "Comment on article "Sleep disorders in older people. How do older people in Mexico City sleep?""]

The response of the authors of the article "Sleep disorders in older people. How do older people in Mexico City sleep?" is presented, in which they carry out pertinent clarifications.

The Relationship Between Social Isolation and Mortality Among Adults Aged 50 and Older in a 12-year Follow-Up Analysis in Mexico

Social relationships have a complex nature shaped mainly by two dimensions: structure and function. Previous research raised the importance of considering both features simultaneously given that they may operate differently. However, research on social relationships and mortality mainly refers to European and U.S. populations. This study examines structural and functional features of social relationships to understand social isolation among adults aged 50 and older in Mexico. In addition, we analyze that association with mortality, using panel data from a 12-year follow-up from the Mexican Health and Aging Study (2003-2015). Results reveal that structural and functional features of social relationships are intertwined, and social isolation was shaped by two aspects that we label lack of socialization and being alone and feeling lonely. After controlling for a series of sociodemographic and health variables, Cox proportional hazard regression models indicate that both aspects significantly increase mortality among older adults in Mexico.

[Sleep disorders in older people. How do older people from Mexico City sleep?]

BACKGROUND

Good sleep is essential for physical and mental health throughout life. However, there are few reports describing the sleep problems experienced by communitydwelling older people.

OBJECTIVE

To describe the prevalence of sleep disorders and their relationship with medical conditions in communitydwelling older people.

MATERIAL AND METHODS

Cross-sectional study with 1678 older people (60 years and over) from the Mexican Institute of Social Security (IMSS) in Mexico City. Sleep duration, sleep quality, daytime sleepiness, insomnia and risk of obstructive sleep apnea were evaluated, alongside with sociodemographic variables and medical conditions.

RESULTS

Participants self-reported an average sleep duration of 6.04 (± 1.5) hours per night, approximately half had poor sleep quality (49.1%), and 2 out of 10 experienced daytime sleepiness (19.1%); one third had insomnia (30.8%) and risk of obstructive sleep apnea (27.5%). A pattern of higher prevalence of sleep problems was observed in older adults with depression, with cognitive impairment, with difficulties in basic activities of daily living and in those taking medications for the nervous system.

CONCLUSIONS

This study showed that older people sleep few hours, have low sleep quality, and have a high prevalence of sleep disorders. The identification and treatment of sleep disordes in older people should be a priority in the IMSS.

Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort

Purpose

To identify factors associated with recovered functionality after a hip fracture in a sample of older adult patients.

Patients and Methods

Nested case-control study in a cohort. Older adults (60 years or older) with a hip fracture were recruited between May 2017 and October 2018. The Barthel scale was used to measure performance in activities of daily living (ADL). A questionnaire was applied to collect information about demographic, clinic, psychological and social variables, and anthropometric measurements were taken. A logistic regression model was built to analyze various factors related to recovered functionality.

Results

A total of 346 older adults with a hip fracture were studied (n=173 cases and n=173 controls); 69.4% (n=240) women and 30.6% (n=140) men. Mean age was 79.4 years (±8.7) overall; for cases, 77.4 (±7.9) years and for controls, 81.4 (±9.0). Mean schooling was 6.3 (± 4.3) years. Recovered functionality was associated with normal nutritional status (OR 4.81, 95% CI = 2.54–9.12), absence of heart disease (OR 4.08, 95% CI = 1.48–11.20), self-efficacy for ADL (OR 4.07, 95% CI = 2.15–7.72), absence of depressive symptoms (OR 2.99, 95% CI = 1.69–5.28), prior functionality (OR 2.83, 95% CI = 1.51–5.31), high socioeconomic level (OR 2.41, 95% CI = 1.24–4.65) and transcervical fracture (OR 2.34, 95% CI = 1.05–5.22).

Conclusion

In older adults who have suffered a hip fracture, clinical, psychological, and demographic characteristics are associated with recovered functionality. These factors should be considered as a priority in the care of older adults who have experienced hip fractures.

Sleep duration and incident frailty: The Rural Frailty Study

Background

The association between sleep duration and frailty remains unconclusive since most of the studies have been cross-sectional. Therefore, this study aimed to analyze the association between sleep duration, sleep complaints, and incident frailty.

Methods

A community-based cohort study from rural areas in Mexico with 309 older adults aged 70 and over. Data from waves two and three of the Rural Frailty Study were used. We operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive waves. Sleep duration was classified as: ≤ 5 h, 6 h, 7–8 h, and ≥ 9 h; and the self-reported sleep complaints as a dichotomous variable. Analyses were performed using Poison regression models.

Results

The average age was 76.2 years and 55.3% were women; the incidence of frailty was 30.4%; 13.3% slept ≤5 h, and 38.5% ≥ 9 h. Compared with the group that slept 7–8 h, the risk of frailty at 4.4 years of follow-up was significantly higher among those who slept ≤5 h (adjusted RR 1.80, 95% CI: 1.04–3.11) and among those who slept ≥9 h (adjusted RR 1.69, 95% CI: 1.10–2.58). Sleep complaints were not associated with incident frailty (adjusted RR 1.41, 95% CI: 0.94–2.12).

Conclusions

Our results show that short and long sleep duration are associated with the incidence of frailty. Studies that objectively evaluate sleep duration are needed to clarify whether meeting the recommended hours of sleep decreases frailty incidence.

Sex Differences in the Association Between Risk of Obstructive Sleep Apnea, Insomnia, and Frailty in Older Adults

PURPOSE

To analyze the association between risk of obstructive sleep apnea (OSA), insomnia, sleepiness and self-assessed sleep duration with frailty in older adults.

PATIENTS AND METHODS

Cross-sectional study with 1643 older adults (60 to 97 years old) who participated in round 6 (2019) of the Cohort of Obesity Sarcopenia and Obesity in Older Adults of the Mexican Institute of Social Security. The Berlin Questionnaire was used to assess risk of OSA, the Athens Insomnia Scale for insomnia, the Epworth Scale for sleepiness, and sleep duration by self-report. Frailty was assessed with the frailty criteria proposed by Fried. Sociodemographic and health variables were also collected. Statistical analysis was performed with logistic regression and was stratified by sex.

RESULTS

This study included 1643 participants (823 men and 820 women). Mean age was 67.1 ± 5.9 years. The percentage of frail older adults was 10.5% (n = 172), with risk of OSA 26.1% (n = 429), with insomnia 30.3% (n = 497) and with sleepiness 18.9% (n = 310). In all participants, risk of OSA and insomnia were associated with frailty. In the stratified analysis by sex, the association between risk of OSA and frailty was observed in women (odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.05, 3.22), but not in men (OR = 1.19, 95% CI: 0.65, 2.19). Insomnia was significantly associated with frailty in women (OR = 2.38, 95% CI: 1.35, 4.20) and in men (OR = 1.88, 95% CI: 1.01, 3.52). Neither sleepiness nor sleep duration was associated with frailty.

CONCLUSION

In community-dwelling older adults, both the risk of OSA and insomnia conferred greater odds of presenting frailty in women. It is required to implement strategies aimed at improving sleep hygiene and detecting patients with OSA and insomnia.

Insomnia, low sleep quality, and sleeping little are associated with frailty in Mexican women

OBJECTIVE

To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults.

SUBJECTS & METHODS

Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty.

RESULTS

Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men.

CONCLUSION

In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.

Decreased Autonomy In Community-Dwelling Older Adults

Purpose

The present study aims to explore characteristics associated with low perception of autonomy among community-dwelling older adults.

Patients and methods

This original research was derived from a cross-sectional study based on the study COSFOMA with information from 1,252 (60 years and older) community-dwelling older adults whose data was obtained through a questionnaire that included sociodemographic characteristics, as well as different scales of geriatric assessment. The perception of autonomy was evaluated with the autonomy sub-scale of the Quality of Life Scale of Older Adults from the World Health Organization (World Health Organization Quality of Life of Older Adults, WHOQOL-OLD).

Results

The mean (SD) age of the 1,252 community-dwelling older adults participating in the study was 68.5 (7.2) years. The average perception of autonomy was 65.3 (18.2) points out of 100. In the final logistic regression model, schooling <6 years (Odds Ratio, OR = 2.1, 95% Confidence Interval, CI = 1.5-2.9), low social support (OR = 1.6, 1.2-2.2), low spirituality (OR = 2.6, 95% CI = 1.9-3.4), presence of cognitive impairment (OR = 1.9, 95% CI = 1.4-2.5), anxiety (OR = 1.7, 95% CI = 1.2-2.5), and limitation in activities of daily living (ADL) (OR = 1.6, 95% CI = 1.1-2.2) were statistically associated with the presence of low autonomy in older adults.

Conclusion

The perception of autonomy among community-dwelling older adults is moderate. Social support and spirituality, as well as cognitive impairment, anxiety, and limitations in ADL, play a significant role for degree of perceived autonomy in this population. Health professionals can use this information to promote participation in decision-making processes through programs that improve quality of life.

The impact of poor oral health on the oral health-related quality of life (OHRQoL) in older adults: the oral health status through a latent class analysis

Background

Determine the impact of poor oral health on the oral health-related quality of life (OHRQoL) in community-dwelling older adults.

Methods

Cross-sectional study of community-dwelling older adults in Mexico City. Sociodemographic characteristics were obtained and assessed their OHRQoL according to the Geriatric/General Oral Health Assessment Index (GOHAI). Clinical evaluation of their oral health: painful chewing, use of dentures, dry mouth, xerostomia, plaque, calculus, coronal and root caries, tooth loss and gingival bleeding. Finally, we determined the oral health of participants through Latent Class Analysis (LCA), excluding totally edentulous. The strength of association was determined (Odds Ratio [OR] and 95% confidence interval [95% CI]) through logical regression between the oral health categories (latent classes) and OHRoL in older adults, adjusted with the other variables included in the study: age, sex, marital status, living arrangements (lives alone), educational level, paid work status, comorbidity, cognitive deterioration, depression and use of medical and dental services in the previous 12 months.

Results

The mean (SD) GOHAI score for the 228 older adults to 46.5 (8.7), number of classes to characterize oral health through LCA was three (entropy 0.805). The GOHAI mean for Class 3 (57.0%), acceptable oral health was 50.1 (7.1); totally edentulous (9.6%), 47.9 (8.4); for Class 2 (16.7%), regular oral health, 43.8 (9.3); and for Class 1 (16.7%), poor oral health, 42.2 (9.7). Significant differences were observed among means (p < .001). Using Class 3 an as a reference, the strength of association between the GOHAI scores and low OHRQoL (GOHAI 25th percentile = 24.0) was OR = 0.7, 95% CI = 0.2–3.3 for totally edentulous; OR = 3.0, 95% CI = 1.2–7.6 for Class 2 and OR = 5.0, 95% CI = 2.1–12.1 for Class 1.

Conclusion

Poor oral health was associated with a negative impact on the OHRQoL of community-dwelling older adults.

Clinical relevance

It is essential to design and implement oral health care policies specifically targeted at improving the quality of life in this older adult population.

Does poor sleep impair cognition during aging? Longitudinal associations between changes in sleep duration and cognitive performance among older Mexican adults

Alterations in sleep patterns are common among older adults; further, short and long sleep durations have been linked with impaired cognitive performance in older individuals. Yet most research examining these relationships has been cross-sectional, limited to high-income nations, and has failed to consider how changes in sleep duration may impact cognitive decline. The present longitudinal study uses nationally-representative data to test whether changes in sleep length among "healthy" baseline sleepers are associated with reduced cognitive function in older Mexican adults (>50 years old) at follow-up. Data were drawn from the first and second waves of the World Health Organization's Study on global AGEing and adult health. Self-report data captured sleep duration over two nights, and five cognitive tests (immediate and delayed verbal recall, forward and backward digit span, and verbal fluency) were used to measure various cognitive domains and create a composite z-score of cognitive performance. Linear regressions were performed to assess associations between sleep length changes and cognitive decline, controlling for relevant lifestyle and health factors. Increased sleep durations at follow-up among individuals who reported intermediate sleep durations (6-9 h/night) at baseline were significantly associated with greater rates of decline in overall cognitive function. Longer sleepers also trended toward greater rates of decline for attention/working memory and executive function. This study suggests that long sleep durations are a risk factor for certain types of impaired cognition among older adults living in a middle-income country. These findings are clinically important given the growing rates of dementia and aging populations globally.

[Sleep disturbances are associated with frailty in older adults]

BACKGROUND

Sleep plays a vital role in good health. Since sleep disturbances have been linked to a series of adverse physical health outcomes, the objective was to analyze the association between sleep disturbances and the frailty criteria in Mexican older adults from Mexico City.

METHODS

The study design was cross-sectional. A total of 1252 people aged 60 years or older were assessed according to Fried criteria for defining frailty. Sleep disturbances (sleeping without rest, sleeping more than usual and having trouble sleeping) were collected by self-report through a face to face questionnaire. The association between sleep disturbances and frailty was estimated with ordinal logistic regression controlled by covariates.

RESULTS

It was found that 6.9% of older people reported sleeping more than usual, 18.9% slept without rest and 16.3% had trouble sleeping. There was a statistically significant association between sleeping more than usual (OR = 1.96, 95% CI: 1.23-3.12) and having trouble sleeping (OR = 1.53, 95%CI: 1.09-2.17) with frailty.

CONCLUSION

Sleeping more than usual or having trouble sleeping contribute to increase frailty in older people from Mexico City.

Factores asociados con el aislamiento social en una muestra de adultos mayores con seguridad social

Señor editor: El aislamiento social en adultos mayores (AM) es un asunto trascendental, no sólo por su prevalencia, que se estima entre 7 y 49%, sino porque además afecta la salud y el bienestar de los individuos. México ha experimentado diversos cambios poblacionales que han debilitado la estructura y la dinámica de las redes familiares y de amigos, por lo que los AM son susceptibles a sufrir aislamiento social. Conocer los factores que determinan el aislamiento social en la población envejecida tiene importantes implicaciones en términos sociales y de la práctica clínica...

Multidimensional social support is associated with healthcare utilization among older Mexican adults

In this study, we aimed to estimate the association between social support and healthcare utilization among older Mexican adults. We conducted a prospective study with 4027 older adults aged 65-74 in rural areas in seven Mexican states. Data were collected at baseline (2007) and 14 months later (2009). Healthcare utilization was defined as number of visits to a physician for preventive or curative purposes in the last 6 months. Multidimensional social support was operationalized into two components: structural (living arrangements, marital status and network size) and functional (perceived availability of support; and perceived support across emotional, instrumental, economic and information domains). Mixed-effects regression models were used to estimate the probability of healthcare use and to examine the association between social support and the number of visits to a physician. Results showed that perceived availability of social support was associated with the probability of visits to a physician (OR 1.44; p < .01). Meanwhile, the following domains of functional component of social support were associated with the probability of visits to a physician: instrumental (OR 1.55; p < .01), economic (OR 1.19; p = .03) and informational (OR 1.39; p < .01); and also with the number of visits to a physician: instrumental (e ^β  = 1.27; p < .01), economic (e ^β  = 1.14; p = .01) and informational (e ^β  = 1.12; p < .10). Our findings suggest that a significant association exists between social support, measured from a multidimensional viewpoint, and healthcare utilization, in which greater social support was related to a greater extent of use of health services.

Frailty and Social Vulnerability in Mexican Deprived and Rural Settings

OBJECTIVE

To estimate the prevalence of frailty in a sample of rural elderly living in socially vulnerable circumstances as well as to determine its correlates.

METHOD

Cross-sectional study of 558 rural elderly participating in a prospective study conducted in Mexico. Frailty was defined using the Fried criteria. Ordinal logistic regression model was used to identify the correlates of frailty levels.

RESULTS

Prevalence of frailty was 8.6%. Disability in basic activities of daily living and illiteracy increase the probability of being pre-frail and/or frail (odds ratio [OR] = 2.72, p < .01; OR = 1.45, p = .05, respectively), while living in households with higher socioeconomic status reduces this probability (OR = 0.85, p < .01).

DISCUSSION

A high prevalence of frailty was found among these young elderly, who did not yet fully show adverse health events. Also the social vulnerability of rural elderly is associated with frailty status. These findings highlight the health needs of socially and economically vulnerable elderly population.

Impact of the non-contributory social pension program 70 y más on older adults' mental well-being

Background

In 2007, a non-contributory pension program was launched in rural areas of Mexico. The program consisted in a non-conditional cash transfer of US$40 monthly to all older adults (OA) aged 70 and over. We evaluate the effect of the program on mental well-being of its beneficiaries.

Methods and Findings

Quantitative and qualitative methods were used. For the quantitative component, we used the selection criteria established by the program (age and locality size) to form the Intervention (OA aged 70–74 residing in rural localities, <2500 inhabitants) and Control groups (OA aged 70–74, in localities with 2501–2700 inhabitants). Baseline data collection was conducted in 2007 where 5,465 OA were interviewed. The follow-up survey was conducted in 2008, and it was possible to interview 5,270 OA, with a response rate of 96%. A difference-in-difference linear probability model with individual fixed effect was used to estimate the impact of the program on mental well-being indicators. In 2009 a qualitative component was designed to explore possible causal pathways of such effect.

Results

After a year of exposure, the program had a significant effect on reduction of depressive symptoms (β = −0.06, CI_95% −0.12; −0.01) and an increase in empowerment indicators: OA participated in important household decisions (β = 0.09, CI_95% 0.03;0.15); and OA participated in household decisions pertaining to expenses (β = 0.11, CI_95% 0.05;0.18). Qualitative analysis found a strong trend showing a reduction of sadness, and feeling of increasing empowerment.

Conclusions

These results suggest that a non-conditional transfer in older ages have an impact beyond the economic sphere, impacting even the mental well-being. This effect could be explained because the pension produces feelings of safety and welfare. It is recommendable that governments should invest efforts towards universalizing the non-contributory pension programs in order to ensure a basic income for the elderly.

Short-term effect of physical activity and obesity on disability in a sample of rural elderly in Mexico

Objetivo. Estimar el efecto de la actividad física (AF) y la obesidad sobre la incidencia acumulada de discapacidad en actividades básicas de la vida diaria en adultos mayores (AM). Material y métodos. Estudio longitudinal. La muestra procede del estudio de evaluación de impacto del Programa 70 y más; seleccionamos 2477 AM de 65-74 años sin discapacidad en la medición basal. La AF, el índice de masa corporal y otras covariables se midieron en el estudio basal. Resultados. La incidencia acumulada de discapacidad, a 14 meses de seguimiento, fue de 10.1%. Después de ajustar por covariables, la AF alta disminuyó el riesgo de discapacidad (RM=0.64; IC95% 0.43-0.95). La obesidad se asoció marginalmente con el riesgo de discapacidad (RM=1.36; IC95% 0.96-1.95). Conclusión. Se requiere incorporar la valoración funcional de los adultos mayores en los niveles primarios de atención para identificar sujetos con dependencia funcional y fomentar la actividad física para mantener la masa muscular y así disminuir la incidencia de la discapacidad.

Does food insecurity compromise maternal dietary zinc or energy intake in favor of her child, in rural poor Mexican households?

OBJECTIVE

To analyze quantitative indicators of food insecurity (FI), and estimate if FI modifies the association between maternal and child Zinc and energy intake as evidence for maternal dietary compromise in favor of her child.

MATERIAL AND METHODS

Cross-sectional study (n=2 563), data derived from baseline impact evaluation of the Mexican Programa de Apoyo Alimentario. Quantitative indicators of FI were:Household food storage, maize and/or bean production, food expenditure, and spatial access to food markets. We evaluated percentage adequacy of energy (PAE) and Zinc (PAZn) intake. Multiple linear regression model was fitted to estimate the association between maternal and child PAE and PAZn.

RESULTS

Child PAE and PAZn were positively associated with those of their mothers. None of the FI indicators modified the association between maternal and child PAE and PAZn.

CONCLUSIONS

No evidence of maternal dietary compromise in favor of her child was observed using four quantitative indicators of FI in central-southern rural Mexican househods.

[Functional dependency and falls in elderly living in poverty in Mexico]

OBJECTIVE

To determine the prevalence of functional dependency (FD) on Mexican elderly living in extreme poverty conditions and to estimate the association between falls and FD.

MATERIAL AND METHODS

A survey was conducted with three stages for selection, stratified by type of locality (rural or urban) and nationally representative of the 2006 Oportunidades Program. The target population was composed of individuals 70 years of age and older who were beneficiaries of the Oportunidades Program.

RESULTS

A total of 30.9% of the elderly presented FD. The gender stratified logistic regression model resulted in an odds ratio (OR) for women of 1.25 (I.C:1.13-1.39) for the association between the increase in the number of falls and FD and OR=1.12 (I.C:0.97-1.29) for men.

CONCLUSIONS

Given the vulnerable conditions in which these older adults live, specific interventions need to be implemented to prevent falls in order to reduce the risk of functional dependency.