RESUMO
OBJECTIVE: Examine the association between frailty and cognitive impairment as predictors of mortality over a 10-year period in a selected sample of older Mexican Americans. DESIGN: Longitudinal analyses using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1995-96/2004-05). SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: Mexican Americans aged 67 and older with complete information on the frailty index and the Mini Mental State Examination (MMSE) (n=1,815). MEASUREMENTS: Cognitive impairment determined by a score in the MMSE < 21. Frailty defined as three or more of the following components: 1) weight-loss, 2) weakness, 3) self-reported exhaustion, 4) slow walking speed, and 5) low physical activity level. Sociodemographic characteristics and chronic medical conditions were used as covariates. Mortality was determined using the National Death Index or by proxy. RESULTS: As MMSE score declines over time, the percent of frail individuals increases in a linear fashion. Frailty and cognitive impairment are independent risk factors for mortality after controlling for all covariates (HR 2.03 95% CI 1.57-2.62; HR 1.26 95% CI 1.05-1.52, respectively). When both cognitive impairment and frailty were added to the model, HR for individuals with cognitive impairment was no longer statistically significant. CONCLUSION: The relation between frailty and cognitive impairment needs careful analysis in this population to establish pathways increasing mortality and decreasing quality of life. Our results suggest frailty is a stronger predictor of mortality for older Mexican Americans than cognitive impairment.
Assuntos
Transtornos Cognitivos/mortalidade , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Americanos Mexicanos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , Mortalidade/etnologia , Mortalidade/tendências , Valor Preditivo dos Testes , Qualidade de Vida , Fatores de RiscoRESUMO
BACKGROUND: Joint pain is a very common complaint among elderly persons and may lead to functional disability. The purpose of this study is to estimate the prevalence of self-reported pain on weight bearing and its impact on the 2-year incidence of limitation in lower-body activities of daily living (ADL) in initially nondisabled Mexican American elderly subjects. METHODS: We studied a probability sample of 2167 noninstitutionalized Mexican American men and women aged 65 or older residing in five Southwestern states. Subjects were asked about pain on weight bearing, ADL, depressive symptomatology, and the presence of chronic diseases. The body mass index was computed using measured height and weight. Finally, a three-task (tandem balance, 8-foot walk, and repeated chair stands), performance-based, lower-body function test was performed. RESULTS: The overall prevalence of pain on weight bearing in the sample was 31.9%, with 37.7% for women versus 24.0% for men (p <.001). The most prevalent sites of pain were knees (14.7%), followed by ankle/feet (12.1%). In a logistic regression analysis, pain was a significant independent predictor of subsequent disability and of the inability to perform tandem balance, 8-foot walk, and repeated chair stands. CONCLUSIONS: Pain on weight bearing is prevalent among older Mexican Americans and is a major independent risk factor for subsequent disability.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Dor/complicações , Distribuição por Idade , Idoso , Artrite/complicações , Distribuição de Qui-Quadrado , Doença Crônica , Depressão/complicações , Complicações do Diabetes , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Estado Civil , Infarto do Miocárdio/complicações , Neoplasias/complicações , Obesidade/complicações , Razão de Chances , Dor/etiologia , Prevalência , Desempenho Psicomotor , Risco , Fatores de Risco , Distribuição por Sexo , Sudoeste dos Estados Unidos/epidemiologia , Acidente Vascular Cerebral/complicações , Suporte de CargaRESUMO
OBJECTIVE: To estimate the impact of self-reported diagnosis of arthritis at baseline on the two year incidence of limitation in activities of daily living and instrumental activities of daily living in initially non-disabled Mexican-American elderly. DESIGN: Longitudinal study. SETTING Southwestern United States (Texas, New Mexico, Colorado, Arizona and California). SUBJECTS: A probability sample of 2,167 non-institutionalized Mexican-American men and women, aged 65 or older. MEASURES: Having ever been told by a doctor that a subject had arthritis, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), depressive symptomatology, presence of chronic diseases (diabetes mellitus, heart attack, stroke, cancer), and body mass index (BMI). RESULTS: Among non-disabled persons at baseline, 11.2% of subjects with arthritis reported at least one ADL limitation after two years, compared to 6.9% of subjects without arthritis. Similarly, among non-disabled persons at baseline, 34.7% of subjects with arthritis reported at least one IADL limitation after two years, compared to 27.0% of subjects without arthritis. In logistic regression analysis, depression, diabetes, and arthritis were found to be predictive of the development of ADL disability, controlling for sociodemographic variables. Depression was the only condition that significantly predicted IADL disability. CONCLUSIONS: Subjects with arthritis were more likely to develop ADL and IADL disability over a two-year period than those without arthritis.
Assuntos
Atividades Cotidianas , Artrite , Americanos Mexicanos , Idoso , Artrite/etnologia , Avaliação da Deficiência , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
OBJECTIVE: This study examines the prevalence of self-reported physician-diagnosed arthritis and arthritis symptoms and their relationship to functional limitations in Mexican American elderly. METHODS: We conducted a cross-sectional study using a probability sample of 2,873 non-institutionalized Mexican American men and women aged 65 or older, residing in the southwestern United States. Measures included self-reported physician-diagnosed arthritis, morning pain or stiffness, pain when standing, global health rating, activities of daily living (ADL), instrumental activities of daily living (IADL), depressive symptoms, presence of chronic diseases (diabetes mellitus, hypertension, heart attack, stroke), and body mass index. The Mantel-Haenszel chi-square statistic was used to test differences by arthritis status, and a logistic regression model was used to predict the odds of having arthritis. RESULTS: The overall prevalence of self-reported physician-diagnosed arthritis in the sample was 40.8 percent, 50.0 percent among women and 28.8 percent among men (P < 0.001). Morning pain or stiffness was reported by 37.7 percent of respondents and pain when standing or walking by 31.9 percent. All comorbid conditions, and both IADL and ADL limitations, were more prevalent in those with arthritis than in those without arthritis. Female sex and several medical conditions were independently associated with self-reported arthritis. CONCLUSIONS: Self-reported physician-diagnosed arthritis is common among older Mexican Americans. Functional limitation and disability are more prevalent among subjects with arthritis than among those without arthritis.