Association between the risk of malnutrition and sarcopenia at 4.2 years of follow-up in community-dwelling older adults

Introduction

Currently, there is only scarce evidence of a causal association between risk of malnutrition (RM) by the mini-nutritional assessment (MNA) and the incidence of sarcopenia. This study was designed to assess such an association at 4.2 years of follow-up in community-dwelling subjects over 60 years old.

Methods

The data used were from the FraDySMex cohort study. The exposition variables were RM diagnosed by the long forma of the MNA (MNA-LF) and short form (MNA-SF). The last one included the body mass index and calf circumference at baseline, while sarcopenia was diagnosed by the EWGSOP2 at follow-up and taken as the response variable. Several covariates involved in the association were also considered. A multiple logistic regression analysis was performed to test the association.

Results

At baseline, 27.0 and 37.9% of subjects had RM by the MNA-LF and MNA-SF, respectively. The incidence of sarcopenia was 13.7%. The fat mass variable significantly modified the association, so it was tested in each stratum. Two independent models showed that subjects with RM by the MNA-LF in the normal fat mass stratum were at a higher risk for developing sarcopenia at follow-up than those without RM (OR 9.28; IC 95% 1.57-54.76) after adjusting for age, sex, and waist circumference. No association was found for the excess fat mass stratum subjects. Subjects with RM by the MNA-SF in the excess fat mass stratum were more likely to develop sarcopenia at follow-up than those without RM by the MNA-SF (OR 3.67; IC 95% 1.29-10.43). This association was not found in the subjects in the normal fat mass stratum.

Conclusion

The association was dependent on the variable fat mass. The two forms of the MNA should not be applied indistinctly with older adults. Based on these results, it is clear that the risk of malnutrition precedes the onset of sarcopenia.

Incidence of the Risk of Malnutrition and Excess Fat Mass, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults

BACKGROUND AND AIMS

Only one cohort study exists on the incidence of the risk of malnutrition (RM) in older adults, though numerous cross-sectional reports, identified several risk factors associated with the prevalence and incidence of this condition. However, alterations in body composition and impaired physical performance as exposition variables of RM have not been explored. This study assessed the incidence of RM and determined its association with excess fat mass, low total lean tissue, gait speed, and handgrip strength as exposition variables for RM in community-dwelling older adults.

METHODS

This is a secondary analysis of older adults (≥60 years) derived from the study "Frailty, dynapenia, and sarcopenia in Mexican adults (FraDySMex)", a prospective cohort project conducted from 2014 to 2019 in Mexico City. At baseline, volunteers underwent body composition analysis and physical performance tests. Several covariates were identified through comprehensive geriatric assessment. At baseline and follow-up, RM was assessed using the long form of the mini nutritional assessment (MNA-LF) scale. Associations between the exposition variables and RM were assessed by multiple logistic regression.

RESULTS

The cohort included 241 subjects. The average age was 75.6 ± 7.8 years, and 83.4% were women. The mean follow-up period was 4.1 years, during which 28.6% of subjects developed RM. This condition was less likely to occur in those with an excess fat mass, even after adjusting for several covariates. Regarding total lean tissue, the unadjusted model showed that RM was more likely to occur in men and women with a low TLT by the TLTI classification, compared to the normal group. However, after adjusting for several covariates (models 1 and 2), the association lost significance. Results on the association between gait speed and RM showed that this condition was also more likely to occur in subjects with low gait speed, according to both the unadjusted and adjusted models. Similar results were found for RM in relation to low handgrip strength; however, after adjusting for the associated covariates, models 1 and 2 no longer reached the level of significance.

CONCLUSIONS

RM diagnosed by MNA-LF was significantly less likely to occur among subjects with excess fat mass, and a significant association emerged between low gait speed and RM after 4.1 years of follow-up in these community-dwelling older adults. These results confirm the association between some alterations of body composition and impaired physical performance with the risk of malnutrition and highlight that excess fat mass and low gait speed precede the risk of malnutrition, not vice versa.

Low 25-Hydroxyvitamin D [25(OH)D] Levels as a Predictor of Depressive Symptoms: Evidence from Community-Dwelling Older Adults Population in Mexico City

OBJECTIVE

The purpose of this study was to assess the association between serum 25-hydroxyvitamin D [25(OH)D] levels and depressive symptoms in Mexican older adults 70 years and older.

METHODS

A total of 326 adults aged 70 or older from Coyoacán Cohort Study were included in this study. The depressive symptoms were assessing by Center for Epidemiologic Studies Depression Scale (CES-D) and serum 25-hydroxyvitamin D [25(OH)D] levels were measured by commercially available enzyme-linked immunosorbent assay (ELISA).

RESULTS

Overall, the prevalence of depressive symptoms was 36.5%. The mean age was 79 years, and 53.4% were women. The total serum 25-hydroxyvitamin D [25(OH)D] levels were lower in older adults with depressive symptoms when compared with older adults without depressive symptoms (p = .006). Logistic regression models showed a significant association between low serum 25(OH)D levels and depressive symptoms even after adjusting for potential confounders (OR = 2.453; 95% CI:1.218-4.939; p = .012). In addition, linear regression model to predict the effect of 25-hydroxyvitamin D [25(OH)D] levels on the CES-D score as a continuous variable, was statistically significant [F(1,324) = 8.54, p = .004], and the R-squared value was .026, indicating that this regression model explains 2.6% of the change in the CES-D score.

CONCLUSION

These results suggest that older Mexican adults with lower serum 25-hydroxyvitamin D [25(OH)D] levels are at higher risk of presenting depressive symptoms.

Development and validation of a Sarcopenia Geriatric Scale (SARCO-GS): a new short scale for the screening of sarcopenia

Introduction

Sarcopenia is a highly prevalent disease associated with adverse outcomes such as falls, disability, and death. The current international consensuses agree that muscle strength, muscle mass, and gait speed must be included in the definition. However, these proposed criteria require objective measurements that are not available for most populations. Since the timely identification of sarcopenia is a priority, several subjective screening scales have been developed; however, they have some limitations due to their low sensitivity. The objective of this work was to develop and validate SARCO-GS, a new short scale to screen sarcopenia that is affordable, easy, and accessible for all clinical care settings.

Methods and materials

The development of the SARCO-GS included four stages: (1) Review and analysis of documentary sources, (2) Contextualization of the theoretical model of sarcopenia, (3) Scale conformation, and (4) Reliability and validity analyses. SARCO-GS was validated in the FraDySMex study, which is a longitudinal cohort of community-dwelling adults.

Results

In the studied population (n=852), the average age was 68.9 years (SD 10.21) and 80.1% of the participants were women. SARCO-GS is a seven-item scale with an innovative structure that included five subjective questions (gait speed, muscular strength, muscle mass) and two measurements of muscular strength and muscle mass (Chair stand test and calf circumference). The results regarding criterion validity showed that the cut-off point ≥ 3 had good sensitivity (77.68%) versus the EWGSOP2 consensus, with an adequate Area Under the Receiver Operating Characteristic (AUC) (0.73), in addition to showing higher values of sensitivity and AUC than SARC-F and SARC-CalF using as reference the same consensus. Furthermore, SARCO-GS presented good predictive validity for functional dependence (HR=2.22, p=0.046) and acceptable correlation with other related measurements (construct validity). Regarding reliability, the scale showed acceptable internal reliability (correlation between items and total score: 0.50 to 0.70). After the validation analysis, the scale was adapted to English.

Conclusions

The SARCO-GS is a novel scale to screen sarcopenia with high sensitivity, good construct, predictive validity, and internal reliability that may be useful for health professionals in different clinical settings and for clinical research.

Low muscle strength and low phase angle predicts greater risk to mortality than severity scales (APACHE, SOFA, and CURB-65) in adults hospitalized for SARS-CoV-2 pneumonia

Introduction

The acute physiology and chronic health evaluation (APACHE), sepsis-related organ failure assessment (SOFA), score for pneumonia severity (CURB-65) scales, a low phase angle (PA) and low muscle strength (MS) have demonstrated their prognostic risk for mortality in hospitalized adults. However, no study has compared the prognostic risk between these scales and changes in body composition in a single study in adults with SARS-CoV-2 pneumonia. The great inflammation and complications that this disease presents promotes immobility and altered nutritional status, therefore a low PA and low MS could have a higher prognostic risk for mortality than the scales. The aim of the present study was to evaluate the prognostic risk for mortality of PA, MS, APACHE, SOFA, and CURB-65 in adults hospitalized with SARS-CoV-2 pneumonia.

Methodology

This was a longitudinal study that included n = 104 SARS-CoV-2-positive adults hospitalized at General Hospital Penjamo, Guanajuato, Mexico, the PA was assessed using bioelectrical impedance and MS was measured with manual dynamometry. The following disease severity scales were applied as well: CURB-65, APACHE, and SOFA. Other variables analyzed were: sex, age, CO-RADS index, fat mass index, body mass index (BMI), and appendicular muscle mass index. A descriptive analysis of the study variables and a comparison between the group that did not survive and survived were performed, as well as a Cox regression to assess the predictive risk to mortality.

Results

Mean age was 62.79 ± 15.02 years (31-96). Comparative results showed a mean PA of 5.43 ± 1.53 in the group that survived vs. 4.81 ± 1.72 in the group that died, p = 0.030. The mean MS was 16.61 ± 10.39 kg vs. 9.33 ± 9.82 in the group that died, p = 0.001. The cut-off points for low PA was determined at 3.66° and ≤ 5.0 kg/force for low grip strength. In the Cox multiple regression, a low PA [heart rate (HR) = 2.571 0.726, 95% CI = 1.217-5.430] and a low MS (HR = 4.519, 95% CI = 1.992-10.252) were associated with mortality.

Conclusion

Phase angle and MS were higher risk predictors of mortality than APACHE, SOFA, and CURB-65 in patients hospitalized for COVID-19. It is important to include the assessment of these indicators in patients positive for SARS-CoV-2 and to be able to implement interventions to improve them.

Identification of Probable sarcopenia based on SARC-F and SARC-CalF in older adults from a low-resource setting

OBJECTIVES

We aimed to investigate the frequency of probable sarcopenia and to compare the performance of SARC-F and SARC-CalF for detecting this condition in outpatient older adults from a low-resource setting.

METHODS

We conducted a retrospective, cross-sectional study in outpatient older adults aged ≥60 years attending a hospital in Peru, between August 2019 and February 2020. Probable sarcopenia was defined as low handgrip strength (<27 kg in men and <16 in women). We used SARC-F and SARC-CalF with their standard cut-off points (≥4 and ≥11, respectively). Low calf circumference was defined as ≤33 cm in women and ≤34 cm in men. We performed sensitivity and specificity analyses.

RESULTS

We included 206 older adults, 102 (49.5%) aged ≥75 years old and 140 (67.9%) females. Probable sarcopenia was present in 36.40% of the participants. SARC-F ≥4 was observed in 29.61% and SARC-CalF ≥11 in 41.26% of the population. SARC-F≥4 showed 41.33% sensitivity and 77.10% specificity, whereas SARC-Calf ≥11 had 50.67% sensitivity and 64.12% specificity.

CONCLUSION

We found that one out of three of the population had probable sarcopenia. SARC-Calf showed superior but still low sensitivity than SARC-F, while both had moderate specificity and thus may be useful for ruling out the disease in clinical practice.

Is there an association between inflammatory markers and lower physical performance in older adults?

Background

Maintenance of physical performance is essential for achievement of healthy aging. A few studies have explored the association between inflammatory markers and physical performance in older adults with inconclusive results. Our aim was to analyze the association of tumor necrosis factor-alpha (TNF-α), Interleukin-10 (IL-10), and C-reactive protein (CRP) with physical performance in a sample of older adults in rural settings of Mexico.

Methods

Our study comprised 307 community-dwelling older men and women who participated in the third wave of the Rural Frailty Study. We assessed the physical performance with the Short Physical Performance Battery (SPPB) and classified older adults as low performance if SPPB scored ≤8. Inflammatory markers were ascertained using serum by immunodetection methods. Logistic regression models were used to estimate the associations between inflammatory markers and physical performance.

Results

In comparison with the normal physical performance group, low physical performance individuals mainly were female (P <  0.01), older (P <  0.01), more illiterate (P = 0.02), more hypertensive (P < 0.01), fewer smokers (P = 0.02), and had higher CRP levels (P < 0.01). The logistic model results showed a significant association between the 3rd tertile of CRP and low physical performance (OR = 2.23; P = 0.03). IL-10 and TNF-α levels did not show a significant association.

Conclusions

The results of this study were mixed, with a significant association of physical performance with higher CRP levels but nonsignificant with IL-10 and TNF-α. Further studies with improved designs are needed by incorporating a broader set of inflammatory markers.

Association between physical activity and physical and functional performance in non-institutionalized Mexican older adults: a cohort study

BACKGROUND

Aging is an independent risk factor for deterioration in functional capacity. Some studies have reported that physical activity (PA) improves functional capacity and physical performance among older adults (OA). Thus the objective of the present study was to assess the longitudinal association between PA and functional and physical performance in non-institutionalized OA.

METHODS

A longitudinal analysis using data from the Frailty, Dynapenia and Sarcopenia in Mexican adults (FRADYSMEX, by its Spanish acronym) cohort study was conducted. PA was assessed through the Community Healthy Activities Model Program for Seniors (CHAMPS) instrument. Functionality was measured with the Barthel index and the Lawton and Brody scale, while physical performance was measured with the Short Physical Performance Battery (SPPB). To evaluate the association between the level of PA and physical and functional performance as a continuous variable, a linear regression of mixed effects was performed. To assess PA and dependence in basic activities of the daily life (BADL), instrumental activities of the daily life (IADL), and low physical performance (PP), generalized estimation equation models [to compute odds ratios (OR) and 95% confidence intervals (95%CI)] were computed.

RESULTS

Older people who performed moderate to vigorous-intensity PA had a lower risk of dependence in IADL (OR = 0.17; 95%CI: 0.10, 0.80) and lower risk of low PP (OR = 0.18; 95%CI: 0.11, 0.58) compared to those in lower categories of PA.

CONCLUSIONS

Older adults living in the community who perform PA of moderate to vigorous intensity have a lower risk of dependence in BADL and IADL and have a lower risk of low PP.

[Answer to Comment on article "Mortality in the elderly: A socio-spatial analysis based on the degree of social deprivation"]

In this letter, the authors respond to the comment received, arguing that the main contribution of their article was to show that the place of habitual residence, as well as the sex and age of the individual, determine the main causes of mortality among Mexican older adults.

The Association of Osteosarcopenia With Functional Disability in Community-Dwelling Mexican Adults 50 and Older

Background: Osteosarcopenia (OS) has recently been described as a predictor of negative outcomes in older adults. However, this alteration in body composition has not been widely studied. In Mexico and Latin America, no information is available on its frequency or associated factors.

Objective: To analyze the association between OS with FD in community-dwelling Mexican adults 50 and older.

Design: Cross-sectional secondary data analysis was performed using primary data from a prospective study Frailty, Dynapenia and Sarcopenia Study in Mexican Adults (FraDySMex).

Setting and Participants: Eight hundred and twenty-five people were included, 77.1% women, aged 70.3 ± 10.8 years old.

Methods: OS was defined as when the person was diagnosed with sarcopenia (SP) plus osteopenia/osteoporosis. The SP diagnosis was evaluated in accordance with the criteria of the European Working Group for the Definition and Diagnosis of Sarcopenia (EWGSOP), and the osteoporosis diagnosis using World Health Organization (WHO) criteria. Muscle mass and bone mass were evaluated using dual-energy X-ray absorptiometry (DXA). FD was evaluated using the basic activities of daily living (BADL) and the instrumental activities of daily living (IADL). Additional sociodemographic and health co-variables were also included, such as sex, age, education, cognitive status, depression, comorbidity, hospitalization, polypharmacy, urinary incontinence, and nutrition variables such as risk of malnutrition and obesity. Associations between OS with FD were evaluated using multiple logistic regression.

Results: The prevalence of OS was 8.9% and that of FD was 8.9%. OS was associated with FD [odds ratio (OR): 1.92; CI 95%: 1.11–3.33].

Conclusions and Implications: Comprehensive OS assessment could help clinicians identify risk factors early, and thus mitigate the impact on FD in older people.

Phase Angle Cut-Off Points and Their Association With Sarcopenia and Frailty in Adults of 50-64 Years Old and Older Adults in Mexico City

Background: In recent studies, the usefulness of the phase angle (PA) to assess geriatric conditions such as sarcopenia and frailty has been evaluated. However, there are no useful cut-off points for clinical research and/or practice. Objective: To analyze PA cut-off points associated with sarcopenia and frailty in adults of 50-64 years old and older adults in Mexico City. Design: Cross-sectional analysis of the FraDySMex cohort study (Frailty, Dynapenia, and Sarcopenia in Mexican Adults). Setting and Participants: 498 people were included, 78.7% women, aged 71.1 ± 9.5 years. Methods: The sarcopenia measurements were made according to the European Working Group on Sarcopenia in Older People (EWGSOP) (2019) (by dynamometer to evaluate hand grip strength and dual energy X-ray absorptiometry (DXA) for appendicular muscle mass), and the frailty through the physical frailty phenotype with cut-off points adjusted to the Mexican population. The PA was evaluated by bioelectrical impedance analysis (BIA), tetrapolar to 50 Hz, other variables such as socio-demographic, comorbidity, cognitive status, and functional dependence were evaluated. Results: The prevalence of frailty was 10.6% and sarcopenia 10.0%. The mean of the PA was 4.6° ± 0.70°. The PA cut-off point for frailty in adults 50 to 64 years was ≤4.3° [sensitivity (S) = 91.95%, specificity (Sp) 66.77%, AUROC (Area Under the Receiver Operating Characteristic) curve = 0.9273 95% CI (0.8720-0.9825)]; the PA cut-off point for sarcopenia was ≤4.3 [S = 91.95%, Sp = 66.77%, AUROC = 0.9306 95% CI (0.8508-1.000)]. The PA cut-off for frailty in adults ≥ 65 years was ≤4.1° [S = 72.37%, Sp 71.43%, AUROC = 0.7925 95%, CI (0.7280-0.8568)] for sarcopenia was ≤4.1° [S = 72.76%, Sp 73.81%, AUROC = 0.7930 95% CI (0.7272-0.8587)]. These cut-off points showed a significant association between PA with frailty (OR 4.84; 95% CI 2.61-8.99) and sarcopenia (OR 8.44; 95% CI 3.85-18.4) after adjusted by age, sex, BMI, comorbidity index and cognitive impairment. Conclusions and Implications: These cut-off points of PA could be useful for the screening of sarcopenia and frailty in Mexican adults of 50 years and older in centers that have BIA.

Validation of Two Intrinsic Capacity Scales and Its Relationship with Frailty and Other Outcomes in Mexican Community-Dwelling Older Adults

OBJECTIVES

The aim of this study was to compare a short and a long version of an intrinsic capacity index and test their cross-sectional association with relevant health outcomes in older adults.

DESIGN

Cross-sectional analysis of the baseline data of the FraDySMex study.

PARTICIPANTS

543 community-dwelling adults aged 50 years and older living in 2 municipalities in Mexico City, from which 435 had complete data on the variables of interest.

METHODS

The intrinsic capacity indices were obtained using principal components analysis. The performance of the indices was tested respective to frailty, IADL and ADL.

RESULTS

The short and long versions of the IC index performed well for assessing functional status. Using biometrical variables like the phase angle, grip strength and gait speed measured by the GAIT rite improved the index performance vis a vis IADL disability (Lawton), but not to the other evaluated outcomes.

CONCLUSIONS

Both the long and short versions of the intrinsic capacity indices tested were able to classify older adults according to their functional status and were associated with relevant health outcomes.

[Mortality in the elderly: A socio-spatial analysis based on the degree of social deprivation]

BACKGROUND

Mortality in Mexico has decreased substantially in the last years; however, there are segments of the population that experience social deprivation.

OBJECTIVE

To identify and describe at the national level the causes of death by degree of social deprivation (DSD), age and sex.

METHODS

We analyzed variables from the Censo de Vivienda y Población (Census of Population and Housing) and data from statistics of mortality and DSD, all information corresponding to 2010. Demographic and socioeconomic variables were age, sex, marital status, healthcare provider and locality. Variables related to mortality were main cause of death, year, age and the city of residence of the deceased; we analyzed the DSD at a precinct level. We applied techniques of population analysis and we used statistical packages STATA© and SPSS©. We analyzed information from 1,197,496 adults ≥ 60 years old who represented 10,602,181 elderly.

RESULTS

Main causes of death in the very high DSD were heart diseases, neoplasms, malnutrition and anemia, diabetes mellitus (DM) and "lack of an accurate diagnosis related to the type of care received"; in the other DSDs main causes were heart diseases, DM, neoplasms, chronic obstructive pulmonary disease and cerebral vascular disease or liver diseases.

CONCLUSION

We detected several mortality profiles; it is suggested the planning of specific actions.

Association Between Frailty and Elder Abuse in Community-Dwelling Older Adults in Mexico City

OBJECTIVES

To investigate the association between frailty and elder abuse in community-dwelling older adults.

DESIGN

Secondary cross-sectional analysis of a prospective cohort.

SETTING

The Frailty, Dynapenia and Sarcopenia in Mexican Adults study, a cohort of community-dwelling adults from 2 municipalities in Mexico City.

PARTICIPANTS

Community-dwelling adults aged 60 and older (N=487, mean age 73.2 ± 8.0, 80% female).

MEASUREMENTS

Elder abuse was assessed using the Geriatric Mistreatment Scale and frailty using the Frailty Phenotype. Abuse was then classified as total abuse (any subtype), conflict abuse (physical, psychological, sexual abuse), financial abuse, and caregiver neglect. Information was also obtained on sociodemographic characteristics, comorbidities, mental status, nutritional status, disability, and polypharmacy.

RESULTS

Prevalence of total abuse was 35.7%. Frailty was associated with total abuse (odds ratio (OR)=2.52, 95% confidence interval (CI)=1.22-5.21, p=.01) and conflict abuse (OR=2.50, 95% CI=1.18-5.33, p=.02) after adjusting for confounders but not with financial abuse or caregiver neglect. Depression was an effect modifier in the association between frailty and total abuse. Frailty was associated with total abuse in participants with depression (OR=5.23, 95% CI=1.87-14.56, p=.002) but not in those without (OR=0.55, 95% CI=0.10-2.87, p=.47).

CONCLUSION

Frailty is associated with total and conflict abuse in community-dwelling older adults. Further studies are needed to elucidate the effect of frailty on elder abuse and investigate the effectiveness of interventions for primary and secondary prevention.

[Clinical interventions in osteosarcopenic obesity: nutrition, physical and psychological activity]

Osteosarcopenic obesity (OSO) is a condition associated with adverse outcomes in older adults. Since it is a condition which includes three tissues (obesity, sarcopenia and osteopenia/osteoporosis), it requires simultaneous and multidisciplinary clinical interventions to revert it. Until this moment, there have been published review articles only focused on nutrition or physical activity. However, we believe that assembling the existing evidence on potential treatments (nutritional intervention with micro- and macronutrients), physical activity, farmacological treatment for osteopenia/osteoporosis, possible farmacological treatment for sarcopenia, and, finally, psychological interventions focused on the treatment of psychiatric comorbidities (such as anxiety or depression) will help healthcare providers to improve the body composition of older adults.

Osteosarcopenic Obesity: Prevalence and Relation With Frailty and Physical Performance in Middle-Aged and Older Women

OBJECTIVES

The aims of this study were to determine the prevalence of osteosarcopenic obesity (OSO) and to investigate its association with frailty and physical performance in Mexican community-dwelling middle-aged and older women.

DESIGN

Cross-sectional analysis of a prospective cohort.

SETTING

The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City.

PARTICIPANTS

Participants were 434 women aged 50 years or older, living in the designated area in Mexico City.

MEASUREMENTS

Body composition was measured with dual-energy X-ray absorptiometry and OSO was defined by the coexistence of sarcopenia, osteopenia, or osteoporosis and obesity. Information regarding demographic characteristics; comorbidities; mental status; nutritional status; and history of falls, fractures, and hospitalization was obtained from questionnaires. Objective measurements of muscle strength and function were grip strength using a hand dynamometer, 6-meter gait speed using a GAIT Rite instrumented walkway, and lower extremity functioning measured by the Short Physical Performance Battery (SPPB). Frailty was assessed using the Frailty Phenotype (Fried criteria), the Gerontopole Frailty Screening Tool (GFST), and the FRAIL scale, to build 3 logistic regression models.

RESULTS

The prevalence of OSO was 19% (n = 81). Frailty (according to the Frailty Phenotype and the GFST) and poor physical performance measured by the SPPB were independently associated with OSO, controlled by age. In the logistic regression model assessing frailty with the Frailty Phenotype, the odds ratio (95% confidence interval) for frailty was 4.86 (2.47-9.55), and for poor physical performance it was 2.11 (1.15-3.89). In the model assessing frailty with the GFST, it was 2.12 (1.10-4.11), and for poor physical performance it was 2.15 (1.18-3.92). Finally, in the model with the FRAIL scale, it was 1.69 (0.85-3.36) for frailty and 2.29 (1.27-4.15) for poor physical performance.

CONCLUSION

OSO is a frequent condition in middle-aged and older women, and it is independently associated with frailty and poor physical performance.

[Herpes zoster and post-herpetic neuralgia in the elderly: Particularities in prevention, diagnosis, and treatment]

Herpes zoster (HZ) results from the reactivation of the varicella zoster virus latent in the sensory ganglia when cell-mediated immunity is altered. It is a frequent condition in older adults, leading to undesirable adverse outcomes. Aging is its main risk factor and the elderly may have different clinical presentations: zoster sine herpete, and a higher incidence of post-herpetic neuralgia (15%) and ophthalmic herpes (7%). Both HZ and post-herpetic neuralgia may impact the quality of life, functional status, mental health, and social interaction in older adults. Clinical trials have demonstrated that the vaccine decreases the incidence of HZ and post-herpetic neuralgia by up to 51% and 67%, respectively. When treating older adults with multi-morbidity, practitioners should consider starting low-dose drugs so they can look for potential drug-drug and drug-disease interactions. The aim of this article was to review the particularities of the risk factors, clinical presentation, complications, and treatment of HZ and post-herpetic neuralgia.

Psychometric properties of the Satisfaction with Life Scale (SWLS): secondary analysis of the Mexican Health and Aging Study

BACKGROUND

The Satisfaction with Life Scale (SWLS) has been widely used and has proven to be a valid and reliable instrument for assessing satisfaction with life in diverse population groups, however, research on satisfaction with life and validation of different measuring instruments in Mexican adults is still lacking. The objective was to evaluate the psychometric properties of the Satisfaction with Life Scale (SWLS) in a representative sample of Mexican adults.

METHODS

This is a methodological study to evaluate a satisfaction with life scale in a sample of 13,220 Mexican adults 50 years of age or older from the 2012 Mexican Health and Aging Study. The scale's reliability (internal consistency) was analysed using Cronbach's alpha and inter-item correlations. An exploratory factor analysis was also performed. Known-groups validity was evaluated comparing good-health and bad-health participants. Comorbidity, perceived financial situation, self-reported general health, depression symptoms, and social support were included to evaluate the validity between these measures and the total score of the scale using Spearman's correlations.

RESULTS

The analysis of the scale's reliability showed good internal consistency (α = 0.74). The exploratory factor analysis confirmed the existence of a unique factor structure that explained 54% of the variance. SWLS was related to depression, perceived health, financial situation, and social support, and these relations were all statistically significant (P < .01). There was significant difference in life satisfaction between the good- and bad-health groups.

CONCLUSIONS

Results show good internal consistency and construct validity of the SWLS. These results are comparable with results from previous studies. Meeting the study's objective to validate the scale, the results show that the Spanish version of the SWLS is a reliable and valid measure of satisfaction with life in the Mexican context.

Cross-Cultural Adaptation and Validation of the Spanish-Language Version of the SARC-F to Assess Sarcopenia in Mexican Community-Dwelling Older Adults

OBJECTIVES

To cross-culturally adapt and validate the Spanish-language version of the SARC-F in Mexican community-dwelling older adults.

DESIGN

Cross-sectional analysis of a prospective cohort.

SETTING

The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City.

PARTICIPANTS

Participants were 487 men and women older than 60 years, living in the designated area in Mexico City.

MEASUREMENTS

Information from questionnaires regarding demographic characteristics, comorbidities, mental status, nutritional status, dependence in activities of daily living, frailty, and quality of life. Objective measurements of muscle mass, strength and function were as follows: skeletal muscle mass index (SMI) was taken using dual-energy x-ray, grip strength using a hand dynamometer, 6-meter gait speed using a GAIT Rite instrumented walkway, peak torque and power for knee extension using a isokinetic dynamometer, lower extremity functioning measured by the Short Physical Performance Battery (SPPB), and balance using evaluation on a foam surface, with closed eyes, in the Modified Clinical Test of Sensory Integration. The SARC-F scale translated to Spanish and the consensus panels' criteria from European, international, and Asian sarcopenia working groups were applied to evaluate sarcopenia.

RESULTS

The Spanish language version of the SARC-F scale showed reliability (Cronbach alfa = 0.641. All items in the scale correlated to the scale's total score, rho = 0.43 to 0.76), temporal consistency evaluated by test-retest (CCI = 0.80), criterion validity when compared to the consensus panels' criteria (high specificity and negative predictive values). The scale was also correlated to other measures related to sarcopenia (such as age, quality of life, self-rated health status, cognition, dependence in activities of daily living, nutritional status, depression, gait speed, grip strength, peak torque and power for knee extension, SPPB, balance, SMI, and frailty).

CONCLUSION

The SARC-F scale was successfully adapted to Spanish language and validated in community-dwelling Mexican older adults.

[Jaundice secondary to bile duct obstruction by polycystic liver disease]

Polycystic liver disease is an autosomal dominant disorder commonly associated with autosomal dominant polycystic kidney disease. It is a rare disease that usually occurs asymptomatically in 85% of cases and diagnosis is incidentally. We present the case of 57 years old woman with progressive pruritus and jaundice secondary to stenosis of the common hepatic duct and common bile by liver cyst, rare presentation which only has been documented in case reports: Deepak, et al., Wittig, et al. and Howard, et al.1-3.

Cross-Cultural Adaptation and Validation of the FRAIL Scale to Assess Frailty in Mexican Adults

OBJECTIVES

The objectives of this study were to cross-culturally adapt and validate the FRAIL scale in Mexican community-dwelling adults.

DESIGN

Cross-sectional analysis of a prospective cohort.

SETTING

The FraDysMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City.

PARTICIPANTS

Participants were 606 men and women living in the designated area in Mexico City.

MEASUREMENTS

Interviewers obtained data regarding demographics, comorbidities, mental status, nutritional status, dependency in activities of daily living, quality of life, mobility, balance, and strength. The FRAIL scale translated to Spanish and the Fried criteria were applied to screen frailty.

RESULTS

The Mexican Spanish version of the FRAIL scale showed internal consistency (4 of 5 items in the scale correlated to the scale's total score, rho = 0.41-0.74), external consistency (interrater correlation CCI = 0.82), known-group validity based on age (9.6% of frailty in persons ≥50 years × 3.2% in persons <50 years, P = .001), convergent validity with the Fried criteria (CCI = 0.63), and the scale was also correlated with other measures related to frailty (such as age, quality of life, self-rated health status, cognition, dependency, nutritional status, depression, and physical performance).

CONCLUSION

The FRAIL scale was successfully adapted to Mexican Spanish and validated in community-dwelling Mexican adults.

Severe potential drug-drug interactions in older adults with dementia and associated factors

OBJECTIVE

To identify the main severe potential drug-drug interactions in older adults with dementia and to examine the factors associated with these interactions.

METHOD

This was a cross-sectional study. The enrolled patients were selected from six geriatrics clinics of tertiary care hospitals across Mexico City. The patients had received a clinical diagnosis of dementia based on the current standards and were further divided into the following two groups: those with severe drug-drug interactions (contraindicated/severe) (n=64) and those with non-severe drug-drug interactions (moderate/minor/absent) (n=117). Additional socio-demographic, clinical and caregiver data were included. Potential drug-drug interactions were identified using Micromedex Drug Reax 2.0® database.

RESULTS

A total of 181 patients were enrolled, including 57 men (31.5%) and 124 women (68.5%) with a mean age of 80.11±8.28 years. One hundred and seven (59.1%) patients in our population had potential drug-drug interactions, of which 64 (59.81%) were severe/contraindicated. The main severe potential drug-drug interactions were caused by the combinations citalopram/anti-platelet (11.6%), clopidogrel/omeprazole (6.1%), and clopidogrel/aspirin (5.5%). Depression, the use of a higher number of medications, dementia severity and caregiver burden were the most significant factors associated with severe potential drug-drug interactions.

CONCLUSIONS

Older people with dementia experience many severe potential drug-drug interactions. Anti-depressants, antiplatelets, anti-psychotics and omeprazole were the drugs most commonly involved in these interactions. Despite their frequent use, anti-dementia drugs were not involved in severe potential drug-drug interactions. The number and type of medications taken, dementia severity and depression in patients in addition to caregiver burden should be considered to avoid possible drug interactions in this population.

Evaluation of inflammation-related genes polymorphisms in Mexican with Alzheimer's disease: a pilot study

Amyloid peptide is able to promote the activation of microglia and astrocytes in Alzheimer’s disease (AD), and this stimulates the production of pro-inflammatory cytokines. Inflammation contributes to the process of neurodegeneration and therefore is a key factor in the development of AD. Some of the most important proteins involved in AD inflammation are: clusterin (CLU), complement receptor 1 (CR1), C reactive protein (CRP), tumor necrosis factor α (TNF-α), the interleukins 1α (IL-1α), 6 (IL-6), 10 (IL-10) and cyclooxygenase 2 (COX-2). In particular, COX-2 is encoded by the prostaglandin-endoperoxide synthase 2 gene (PTGS2). Since variations in the genes that encode these proteins may modify gene expression or function, it is important to investigate whether these variations may change the developing AD. The aim of this study was to determine whether the presence of polymorphisms in the genes encoding the aforementioned proteins is associated in Mexican patients with AD. Fourteen polymorphisms were genotyped in 96 subjects with AD and 100 controls; the differences in allele, genotype and haplotype frequencies were analyzed. Additionally, an ancestry analysis was conducted to exclude differences in genetic ancestry among groups as a confounding factor in the study. Significant differences in frequencies between AD and controls were found for the single-nucleotide polymorphism (SNP) rs20417 within the PTGS2 gene. Ancestry analysis revealed no significant differences in the ancestry of the compared groups, and the association was significant even after adjustment for ancestry and correction for multiple testing, which strengthens the validity of the results. We conclude that this polymorphism plays an important role in the development of the AD pathology and further studies are required, including their proteins.

Social Representation of Dementia and Its Influence on the Search for Early Care by Family Member Caregivers

INTRODUCTION

Social representations (SRs) contain 3 dimensions: information, attitude, and field. These affect the recognition of the first symptoms of dementia by the patient's caregiver. This study focused on the period from the first signs of cognitive difficulties to the diagnosis of dementia.

METHODS

Eight caregivers of elderly patients with dementia were interviewed to construct their SRs regarding dementia and how this influences seeking medical treatment during the first stages of the disease. Social representations were analyzed through a structural focus, based on the content analysis.

RESULTS

Decision making is related to knowledge about dementia, attitude (emotions and sensitivity), and the concept of the caregiver about the relative with dementia. The results confirm the importance of the symbolic dimension of personal experience in managing care and seeking medical treatment.

CONCLUSION

The presence of dementia in the family creates interpersonal dilemmas that caregivers experience. The solutions are framed in the sociocultural context.

[Validation of a cutoff point for the short version of the Depression Scale of the Center for Epidemiologic Studies in older Mexican adults]

OBJECTIVE

To identify a valid cutoff point associated with Center for Epidemiologic Studies, Depression Scale (CES-D) of seven items, which allows the classification of older adults according to presence/absence of clinically significant depressive symptoms.

MATERIALS AND METHODS

Screening study with 229 older adults residing in two states of Mexico (Morelos and Tlaxcala), which were part of the sample from the National Survey of Health and Nutrition, 2012. We estimated the sensitivity and specificity associated with the selected cutoff points using the diagnostic criteria of ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition).

RESULTS

The cutoff point estimated was CES-D=5. According to the ICD-10 sensitivity and specificity were 83.3 and 90.2%, and ROC was 87%. Using DSM-IV, the values were 85, 83.2, and 84%, respectively.

CONCLUSIONS

The short version of the CES-D can be used as a screening test to identify probable cases of older adults with clinically significant depressive symptoms.

Frailty among community-dwelling elderly Mexican people: prevalence and association with sociodemographic characteristics, health state and the use of health services

AIM

To estimate the prevalence of frailty phenotypes and their association with the sociodemographic characteristics, health state and the use of health services in the last 6 months among community-dwelling elderly in Mexico City.

METHODS

The present study included 1933 elderly individuals from Mexico City. We estimated the prevalence of the frailty phenotype based on Fried and Walston. Household interviews were carried out to collect information on sociodemographics (sex, age, education, marital status, live alone, paid job), health state (activities of daily living, cognitive function, depression, comorbidity, nutritional status) and the use of health services in the last 6 months.

RESULTS

The estimated prevalence of frailty was 15.7%, pre-frailty at 33.3% and non-frailty at 51.0%. The statistically relevant associations in the pre-frail elderly were female (OR 0.83), older age (OR 2.48), single (OR 1.03), living alone (OR 1.23), no paid work (OR 0.82), limitations in the basic activities of daily living (OR 2.11) and instrumental activities of daily living (OR 2.10), cognitive impairment (OR 1.49), depression symptoms (OR 3.82), underweight/malnourished (OR 1.89), overweight/obesity (OR 0.80), moderate comorbidity (OR 2.05), and use of health services (OR 1.04) using the non-frail phenotype as the comparison category. Frailly is associated with female (OR 1.05), older age (OR 10.32), less educated (OR 2.51), single OR 1.39), living alone (OR 0.86), no paid work (OR 1.16), limitations in the basic activities of daily living (OR 7.66) and instrumental activities of daily living (OR 8.42), cognitive impairment (OR 3.02), depression symptoms (OR 11.23), underweight/malnourished (OR 1.49), overweight/obesity (OR 0.49), moderate comorbidity (OR 3.55), and use of health services (OR 1.99) using the non-frail phenotype as the comparison category.

CONCLUSIONS

The results suggest that older age, disability, comorbidity, cognitive impairment and depression could have an influence role in frailty.

Development and psychometric properties of the Geriatric Mistreatment Scale

AIM

Elder mistreatment is a phenomenon that has increased proportionally to the increase in the number of older adults in different populations of the world. So far, in Mexico there is no instrument measuring and assessing this phenomenon. The objective of the present study was to develop and to know some psychometric properties of the Geriatric Mistreatment Scale (GMS).

METHODS

A documentary and qualitative investigation was undertaken to contextualize the mistreatment phenomenon in Mexico. Each item was included in the preliminary version if it obtained 80% or greater agreement by experts (content validity). The preliminary scale (49-item) was applied to 626 older adults using a probabilistic sample representative of the older adults living in Mexico City. Then a statistical process was carried out to reduce the number of items, prove their internal consistency and associations with other measurements. The 22-item final version of the GMS that assesses physical, psychological, neglect, economic mistreatment and sexual abuse is reported herein.

RESULTS

The mean age of participants was 71.94 ± 8 years. The internal consistency (Cronbach's alpha = 0.83) was appropriate. Subject memory complaint, depression, functional dependence and other measurements were associated with overall mistreatment. Regarding prevalence, 10.28% reported having experienced at least one type of mistreatment.

CONCLUSION

The 22-item GMS had an acceptable internal consistency; the relationship with other measurements was significant according to the hypotheses. Therefore, the GMS is recommended for the screening of the five different types of elder mistreatment.

Overweight and obesity as markers for the evaluation of disease risk in older adults

OBJECTIVES

To explore disease risk through the measurement of BMI scores and waist circumferences in older Mexican adults with favorable health statuses and to determine how this risk is associated with sociodemographic characteristics.

METHODS

Using data from the National Health and Nutrition Survey of 2006, we created a cross-sectional design and selected 878 participants (60 years or older) who had favorable health statuses. The demographic data, health status, body mass index (BMI), waist circumference (WC), and an estimation of disease risk (arterial hypertension, diabetes type 2, and metabolic syndrome) were obtained through the survey.

RESULTS

The prevalence of overweight, obesity, and abdominal obesity were 42.1%, 29.7%, and 80.9%, respectively. Disease risks, which were classified as least, increased, high, or very high, were 14.7%, 17.5%, 38.7%, and 29.1%, respectively. We observed that younger age has a higher risk for disease and that this decreases as age increases until it becomes minimal. After controlling for some risk factors such as tobacco, alcohol, and physical activity, we observed that being female, younger, and married are all factors significantly associated with a high and very high risk for disease. On the other hand, being indigenous, having a low education level, living in a rural setting are all protective factors with a minimum disease risk.

CONCLUSIONS

The prevalence rates of overweight, obesity, and abdominal obesity are high among older Mexican adults. We observed that as age increases, disease risk decreases, which also occurs with some lifestyle factors such as living in a rural setting, being indigenous, having a low education level, and being married.

The relationship between potential drug-drug interactions and mortality rate of elderly hospitalized patients

BACKGROUND

The increase in drug-drug interactions (potential DDIs) is a consequence that older adults experience by high availability of prescription medications for an increasing variety of diseases. This increase in potential DDIs could be associated with mortality rate during hospitalization.

OBJECTIVE

To determine whether the association between the presence of Potential DDIs and mortality rate in hospitalized elderly and to describe the frequency of potential DDIs and characterize drugs.

MATERIAL AND METHODS

A retrospective research was performed by reviewing the medical records of patients 60 years and older who were admitted to a second-level care hospital. The Potential DDIs were identified through the Micromedex program. Comorbidity was classified according to the Charlson Index (CCI). Other variables such as gender, age, number and type of drug, type of interaction, and duration of hospital stay were evaluated.

RESULTS

505 patients were included, among whom the 62.77% presented at least one type of DDI. We found that 15.25% of moderate interactions were due to the combined use of angiotensin converting enzyme inhibitors and loop diuretics. Among serious interactions, 14.92% occurred due to the combined use of fluroquinolones and hypoglycemic agents. The duration of stay and a high comorbidity score, the presence of three or more interactions and exposure time to the interaction, were independently associated with mortality rate.

CONCLUSIONS

This work shows that the occurrence of potential DDIs in the hospital environment for the elderly population is frequent and may be implicated in the cause of death for these patients.

Health care utilization in the elderly Mexican population: expenditures and determinants

BACKGROUND

Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual).

OBJECTIVE

To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly.

METHODS

A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age.

RESULTS

Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization.

CONCLUSIONS

The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this group requires immediate attention.

[Assessment of comorbidity in elderly]

The objective was to offer to the clinical researchers who work on elderly and health field a review of the main instruments use for assessment the presence of comorbidity in elderly. A systematic quest at Medline using keywords was made. A group of experts on geriatric and internal medicine physicians was integrated for the evaluation of paper found. The group analyzed the structure, clinical utility, clinimetrics properties, focus on elderly patients. This communication included the four main tools: Charlson's comorbidity index, Geriatric index of comorbidity, Kaplan-Feinstein's index and Cumulative Illness Rating Scale-Geriatric (CIRS-G). Each of them showed adequate clinometric properties, although, the assessment of CIRS-G requires a health professional more skilled on clinical examination, all of these indexes have been shown to have a good predictive value about functional impairment and mortality. However, the choice of the index by researchers depends on the context of the study.

[Validation of the Quality of Life in Alzheimer's Disease (QOL-AD) scale in Mexican patients with Alzheimer, vascular and mixed-type dementia]

AIM

To adapt the Quality of Life in Alzheimer's Disease (QOL-AD) scale to Spanish, as well as to evaluate its reliability and validity in Mexico.

SUBJECTS AND METHODS

The study involved a sample of 114 patients diagnosed with Alzheimer, vascular and mixed-type dementia, according to the criteria of the National Institute for Neurological and Communicative Disorders/Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA), the National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) and the Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), respectively. Their primary caregivers (n = 114) and a control group (n = 30) of persons aged 60 or over without dementia and their closest relatives were also evaluated.

RESULTS

The total group with dementia obtained a mean age and a standard deviation of 80.15 +/- 7.13. The Folstein minimental test was 18.55 +/- 4.99. We obtained a Cronbach's alpha of 0.88 for the patient version of the QOL-AD (QOL-ADp) and 0.82 for the caregiver version of the QOL-AD (QOL-ADc). The test-retest yielded an intraclass correlation coefficient of 0.9 (p < 0.001; 95% confidence interval, CI 95% = 0.58-0.91) for the QOL-ADp and 0.81 (p < 0.001; CI 95% = 0.78-0.95) for the QOL-ADc. Moreover, the QOL-ADp showed a significant correlation with the geriatric depression scale (r = -0.73; p < 0.001) and with the neuropsychiatric inventory (r = -0.44; p < 0.001). With the QOL-ADc, these correlations were r = -0.5 (p < 0.001) and r = -0.3 (p < 0.001), respectively. Both versions of the QOL-AD were able to distinguish between the group of subjects with dementia and the control group.

CONCLUSIONS

The QOL-AD yielded satisfactory results in terms of internal and external reliability, validity between measurements and between known groups. Thus, we can recommend its use to evaluate the quality of life of patients with dementia.

[Quality of medication prescribing for elderly patients with non-malignant pain syndrome attending family medicine clinics]

OBJECTIVE

To assess the quality of medication prescribing in ambulatory elderly patients attending to family medicine clinics due to non-malignant pain syndrome.

PATIENTS AND METHODS

By doing a secondary data analysis we evaluated the quality of medication prescribing in 495 subjects aged 60 or more years, which were seen due to non-malignant pain syndrome in family medicine clinics belonging to Instituto Mexicano del Seguro Social. The analyzed information included general patient characteristics, medical histories, and medication (complete data). The quality of medication prescribing was assessed by using the Beers criteria and the MAI. All data were analyzed by using descriptive statistics.

RESULTS

The total number of medicines prescribed was 3017, with an average number of prescribed drugs of 6 (+/- 2.5). About 35% of patients had prescriptions with at least one inappropriate medication according to the Beers criteria. The mean MAI score was 3.5 (+/- 4.3) for drug and 20.9 (+/- 10.7) per patient. According to MAI criteria, the most frequent errors were: failure to provide practical directions, prescription of drug combinations with potential drug-drug interactions, and inappropriate indications.

CONCLUSION

Inappropriate prescription is a common problem in elderly patients with nonmalignant pain syndrome attending to primary care facilities.