scholarly journals Living Beyond 80: A Longitudinal Study of Cognitive and IADL Disablement Among the Oldest Mexican Americans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 479-479
Author(s):  
Jacqueline Angel ◽  
Sunshine Rote ◽  
Jiwon Kim
Keyword(s):  
Cognitive Decline ◽  
Mexican Americans ◽  
Oldest Old ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Social Consequences ◽  
Mobility Limitations ◽  
Transition Analysis ◽  
Limited Mobility ◽  
Community Activities

Abstract Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in IADL disability and tertiary outcomes of the IADL disablement for the oldest old. We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010-2011, 2012-2013, 2016, N=1,078) to investigate the longitudinal patterns of IADL decline using Latent Transition Analysis. Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

A Longitudinal Study of Cognitive and Instrumental Activities of Daily Living Disablement Among the Oldest Mexican Americans

2021 ◽  
pp. 089826432110375
Author(s):  
Jiwon Kim ◽  
Jacqueline L. Angel ◽  
Sunshine M. Rote
Keyword(s):  
Activities Of Daily Living ◽  
Cognitive Decline ◽  
Mexican Americans ◽  
Daily Living ◽  
Oldest Old ◽  
Epidemiologic Study ◽  
Mobility Limitations ◽  
Limited Mobility ◽  
Community Activities ◽  
Instrumental Activities

Objectives Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in instrumental activities of daily living (IADL) disability and tertiary outcomes of the IADL disablement for the oldest old (after 80 years old). Methods We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010–2011, 2012–2013, and 2016, N = 1,078) to investigate the longitudinal patterns of IADL decline using latent transition analysis. Results Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. Discussion These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

scholarly journals Understanding Transitions in IADL and Their Consequences for Cognitive Impairment Among Older Mexican Americans

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 333-334
Author(s):  
Jiwon Kim ◽  
Jacqueline Angel ◽  
Sunshine Rote
Keyword(s):  
Cognitive Impairment ◽  
Mexican Americans ◽  
Oldest Old ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Cognitive Frailty ◽  
Transition Analysis ◽  
Socioeconomic Resources ◽  
Iadl Disability ◽  
Over Time

Abstract Mexican Americans tend to live longer lives than other ethnic groups, but it remains unclear how this trend influences the trajectory of disability and its consequences for cognitive frailty. Building on previous research, we assess transitions in IADL among the oldest old. We use data from three waves of the Hispanic Established Population of the Epidemiologic Study of the Elderly (H-EPESE) to investigate trajectories of IADL disability as individuals’ age into their 80s and 90s, a period of the life course with much higher rates of morbidity and decreasing socioeconomic resources. The H-EPESE is a benchmark longitudinal cohort study based on an original sample of 3,050 Mexican-Americans aged 65 and older in the Southwestern United States. Our modeling approach estimates transitions in patterns of IADL employing the Latent Transition Analysis (LTA). Results revealed three heterogeneous latent classes: high IADLs, difficulty in transportation and mobility, and low IADLs. Those with high IADLs tended to remain in the same class over time. Individuals having difficulty in transportation and mobility tended to stay in the same class or transfer to high IADLs, whereas those with overall low IADLs transferred to either the same class or to difficulty in transportation and mobility. Additional analysis revealed that cognitive impairment was a significant predictor of instrumental disability over time. Furthermore, females were more likely than males to belong to difficulty in transportation or mobility class than to the low IADL class. Our results highlight the long term consequences of cognitive decline on IADL limitations.

scholarly journals Demography of Living Arrangements Among Oldest-Old Mexican Americans: Evidence From the Hispanic Epidemiologic Study of the Elderly

2017 ◽  
Vol 29 (6) ◽  
pp. 1015-1038 ◽  
Author(s):  
Phillip A. Cantu ◽  
Jacqueline L. Angel
Keyword(s):  
Living Arrangements ◽  
Mexican Americans ◽  
Filial Piety ◽  
Living Arrangement ◽  
Oldest Old ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Future Research ◽  
Elderly Parents ◽  
Household Headship

Objective: In this article, we examine the demographics of living arrangements and household headship status among Mexican-origin individuals aged 85+ years. Method: Data come from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) caregiver and respondent surveys. Results: Finances of the elderly individual and their caregiver inform living arrangement decisions. Physical and cognitive disability differentiate among living arrangements: The most mentally and physically impaired are most likely to live with others and less likely to be the head of the household. Discussion: Motivations for living with others are clearly more complex than simple filial piety considerations might hold. Extended living arrangements provide concrete financial and instrumental benefits for both elderly parents and their adult child caregiver. Future research should address the question of the capacity of the Mexican American family to provide care for elderly parents in the face of major demographic and social changes.

scholarly journals Likely Dementia and Its Implication for Support Among the Oldest-Old in Mexico and the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 574-574
Author(s):  
Mariana Lopez-Ortega ◽  
Silvia Mejia ◽  
Emma Aguila ◽  
Luis Gutiérrez-Robledo ◽  
William Vega ◽  
...  
Keyword(s):  
United States ◽  
Oldest Old ◽  
Epidemiologic Study ◽  
The Elderly ◽  
The United States ◽  
Low Resource ◽  
Dementia Prevalence ◽  
Memory Care ◽  
Aging Study ◽  
The U.S

Abstract This study examines sources of vulnerabilities to dementia in low resource populations in two specific contexts—Mexico and the United States. Data are drawn from comparable waves of the Mexican Health and Aging Study (MHAS) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) in 2012, which include representative samples of the oldest-old (82 and over), the fastest growing segment of the populations worldwide. Likely dementia prevalence is 30.9% (±0.46SD) for Mexicans in Mexico and 36.3% (±0.48SD) for Mexicans in the U.S. Odds of likely dementia in both populations were increased by age, living in extended households, depressive symptoms, and Seguro Popular and Medicaid receipt. Being female and having comorbid cardiovascular conditions were also associated with likely dementia but only for older Mexicans. There is a need to strengthen the caregiving capacity of memory care services in low resource communities in Mexico and the U.S.

scholarly journals Documentation of Dementia as a Cause of Death Among Mexican-American Decedents With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 59-60
Author(s):  
Brian Downer ◽  
Lin-Na Chou ◽  
Soham Al Snih ◽  
Cheyanne Barba ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Mexican Americans ◽  
Mexican American ◽  
Hospice Care ◽  
Healthcare Resource ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Medical Specialist ◽  
Physician Visits ◽  
Lower Odds

Abstract There is lack of data on the frequency and correlates of dementia being documented as a cause of death in Hispanic populations. We investigated characteristics associated with dementia as a cause of death among Mexican-American decedents diagnosed with dementia. Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims files, and the National Death Index. Of the 744 decedents diagnosed with dementia before death, 26.9% had dementia documented as a cause of death. More health comorbidities (OR=0.38, 95% CI=0.25-0.57), older age at death (OR=1.05, 95% CI=1.01-1.08), and longer dementia duration (OR=1.09, 95% CI=1.03-1.16) were associated with dementia as a cause of death. In the last year of life, any ER admission with (OR=0.56, 95% CI=0.32-0.98) or without (OR=0.31, 95% CI=0.14-0.70) a hospitalization, more physician visits (OR=0.95, 95% CI=0.92-0.98) and seeing a medical specialist (OR=0.41, 95% CI=0.24-0.70) were associated with lower odds for dementia as a cause of death. In the last 30-days of life, any hospitalization with an ICU stay (OR=0.57, 95% CI=0.37-0.88) and ER admission with (OR=0.58, 95% CI=0.40-0.84) or without (OR=0.48, 95% CI=0.25-0.94) a hospitalization were associated with lower odds for dementia as a cause of death. Receiving hospice care in the last 30-days of life was associated with 2.09 (95% CI=1.38-3.16) higher odds for dementia as a cause of death. The possible under-documentation of dementia as a cause of death on death certificates may result in underestimation of healthcare resource need of dementia care for Mexican-Americans.

scholarly journals Mobility but Not Balance Limitations Are Associated With Cognitive Decline among Older Hispanics

2020 ◽  
Vol 6 ◽  
pp. 233372142094795
Author(s):  
Paul A. Wadsworth ◽  
Nai-Wei Chen ◽  
Mukaila Raji ◽  
Kyriakos S. Markides ◽  
Brian Downer
Keyword(s):  
Cognitive Decline ◽  
Gait Speed ◽  
Mexican Americans ◽  
Successful Aging ◽  
Epidemiologic Study ◽  
Summary Score ◽  
High Risk Population ◽  
Lower Body ◽  
Cognitive Changes ◽  
Body Function

Aging is associated with changes in lower-body functioning. The extent to which lower-body function is associated with cognitive changes over time is unclear, especially among older Hispanics, a high-risk population for declines in physical and cognitive functioning. We sought to determine if the association between lower-body functioning and cognitive decline over 9-years differentially varied with respect to balance, gait speed, lower-body strength (chair stands), or a summary score of the three measures. This retrospective cohort study used clinical performance data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE). Cognitive function was measured using the Mini-Mental Status Exam. Linear mixed modeling was used to investigate the association between lower-body function and cognitive decline, controlling for patients’ demographic and health characteristics. We found that gait speed and timed chair stands but not balance were associated with accelerated cognitive decline in Mexican-Americans age 75 years and older. These parameters of lower-body function can be feasibly measured in any clinic. As limitations in lower-body functioning may be an early marker of cognitive decline, this suggests an opportunity for the development of interventions to slow cognitive and physical disablement and promote successful aging among persons older than 75 years.

scholarly journals ROLE OF SOCIAL DETERMINANTS IN ENROLLMENT AND DISENROLLMENT IN MEDICARE INSURANCE PLANS IN OLDER MEXICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S563-S563
Author(s):  
Amit Kumar ◽  
Maricruz Rivera-Hernandez ◽  
Lin-Na Chou ◽  
Amol Karmarkar ◽  
Yong-Fang Kuo ◽  
...  
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Mexican Americans ◽  
Epidemiologic Study ◽  
The Elderly ◽  
Fee For Service ◽  
Clinical Factor ◽  
Medical Risk ◽  
Medicare Data ◽  
Dual Eligible

Abstract Objective: The objective of this study is to examine the association between social-medical risk factor with disenrollment from Medicare Fee-for-Service (FFS) and enrollment in a Medicare Advantage (MA) plan in Older Mexican Americans. Methods: The sample included older adults participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly linked with Medicare data. We used logistic regression to estimate odds ratios (OR) for the association of each sociodemographic and clinical factor with insurance plan switching. Results: FFS enrollees were more likely to speak Spanish, less educated, lower income, disability, and be dual eligible compared to MA enrollees. At 2-year follow up, older adults with social support had higher odds of switching from FFS to MA after controlling for all covariates (OR; 1.73, 95% CI: 1.11-2.69). Conclusion: Having social support from family and the community was strongly associated with disenrollment from FFS and transition to an MA plan.

scholarly journals A 20-YEAR COHORT STUDY OF LIVING ARRANGEMENTS AND COGNITIVE DECLINE IN THE MEXICAN AMERICAN POPULATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S712-S712
Author(s):  
Phillip A Cantu
Keyword(s):  
Social Support ◽  
Cognitive Decline ◽  
Living Arrangements ◽  
Mexican Americans ◽  
Independent Living ◽  
Mexican American ◽  
Living Arrangement ◽  
Growth Mixture Modeling ◽  
The Elderly ◽  
Community Based Interventions

Abstract Backgrounds/Objectives: The prevalence of dementia in the elderly Latino population is expected to significantly increase from around 200,000 cases in 2000 to as many as 1.3 million cases in 2050. This demographic trend has important consequences for options in care and living arrangements. Very little is known about how of cognitive impairment trajectories co-vary with support available to Mexican Americans. We examine the relationship between living arrangements and the social support of individuals with dementia. Methods: Using data from nine waves from the 23 years of the Hispanic EPESE (n=3,952), we examine trajectories of cognitive functioning and family and social support. We first describe the change in Mini Mental Status Examination (MMSE) scores for survivors from Wave 1 (1993/1994) to Wave 9 (2015/2016), n=255. Growth Mixture Modeling (GMM) is then used to assess how changes in MMSE scores are distributed among living arrangements for individuals living independently compared to household extension (living with others) using the full sample. Results: Analyses reveal different trajectories in MMSE score. 12% (n=27) of the sample had no decrease, while the remaining (88%) were split between moderate decline (60% n=136, 1-10 point decline in MMSE) and severe decline (28% n=62 >10 point decline In MMSE). Changes in living arrangement over the same period show that 89% of individuals who move from independent living into extended household experienced cognitive decline. Conclusions: This study provides new information on how cognitive trajectories are associated with living arrangements. We discuss implications for improving community-based interventions for Latino family caregivers.

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