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BACKGROUND: Food insecurity (FI) remains a global public health problem. FI is more prevalent in low-and middle-income countries than high-income countries. FI is related with worse cognitive outcomes including cognitive function, cognitive decline, and cognitive impairment. Few studies have sought to identify how patterns of FI relate with cognitive function in old age and the potential mechanisms underlying this association. METHODS: Data from the 2015 and 2018 waves of the Mexican Health and Aging Study (n = 9,654, age 50+) were used in this study. Reports of FI in 2015 and 2018 were combined to create four patterns of FI groups: "persistently food secure", "became food secure", "became food insecure", and "persistently food insecure". Linear regression was used to estimate associations between patterns of FI and cognitive task performance. The mediating roles of depressive symptoms, body mass index, and chronic conditions were tested using Karlson, Holm, and Breen methodology. RESULTS: Approximately half of the sample were persistently food secure, 17% became food secure, 14% became FI, and 15% experienced persistent FI. When adjusting for demographic/socioeconomic confounders, persistent FI related with worse Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency performance compared to the persistently food secure. Becoming FI related with worse Verbal Learning, Visual Scanning, and Verbal Fluency. Mediation analyses provided support for depressive symptoms mediating associations between FI and poorer cognition, where 48% of the association between persistent FI and worse Verbal Recall performance was attributed to higher depressive symptoms. Becoming food secure was not associated with cognitive performance compared to the persistently food secure. CONCLUSIONS: FI may represent an important modifiable risk factor for poorer cognitive outcomes among older adults. Public health efforts should focus on providing stable food access to older adults, especially those living in poverty.

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INTRODUCTION: We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico. METHODS: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education. RESULTS: We included 3170 participants from the HRS-HCAP (Mage = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex-Cog (Mage = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education. DISCUSSION: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies. HIGHLIGHTS: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer's disease and related dementias.

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Previous studies indicate that occupation might affect cognitive functioning in late life. As people in low and middle income countries often have to work until late life, we sought to investigate if there are cognitive benefits to working later into life and whether cognitive function deteriorates after exiting the labor force. We analyzed longitudinal data from the Mexican Health and Aging Study (MHAS), a nationally representative sample of Mexican adults age 50+ (n=7,375), that assessed cognitive functioning by verbal learning, delayed recall, and visual scanning. Analyses were carried out using mixed-effects modeling corrected for the influence of gender, IADLs, diabetes, stroke, hypertension, depression, income, and marital status. Results suggest that working actively, compared to exiting the workforce, was associated with cognitive performance only in context with occupation. Domestic workers had a faster decline in verbal learning (b=-0.02, p=0.020) and delayed recall (b=-0.02, p=0.036) if they continued working actively and people working in administration (b=0.03, p=0.007), sales (b=0.02, p=0.044), and educators (b=0.03, p=0.049) had a slower decline in visual scanning if they continued working in old age. Our findings indicate that continued participation in the labor force in old age does not necessarily come with cognitive benefits. Whether or not working actively in later life protects or even harms cognitive functioning is likely to depend on the type of job.

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BACKGROUND: Food insecurity remains a global public health problem. Experiencing food insecurity is related to poorer cognitive function among older adults. However, few studies have examined how food insecurity, experienced over the life-course, relates to cognitive function among older adults in Mexico. METHODS: Data came from the 2015 Mexican Health and Aging Study (n = 11,507 adults aged 50 and over). Early- and late-life food insecurity were ascertained by self-report. We evaluated how both measures of food insecurity related to the performance of multiple cognitive tasks (Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency), while controlling for key health and sociodemographic confounders using linear regression. RESULTS: In descriptive analyses, respondents who experienced food insecurity in either early or late life performed significantly worse on all cognitive tasks when compared to the food secure. In models adjusted for health and sociodemographic confounders, early-life food insecurity predicted worse Verbal Learning performance and late-life food insecurity was associated with poorer Visual Scanning performance. CONCLUSIONS: Food insecurity was related to poorer cognitive function in a nationally representative sample of older adults in Mexico. However, results suggested that the significance of effects depended on cognitive task and when in the life-course food insecurity was experienced.

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BACKGROUND: Urban advantages in older adults' cognitive function have been observed. Less is known about early-life urban dwelling and late-life cognition. We evaluate how rural/urban dwelling throughout life and rural to urban shifts in life relate with cognition in Mexico, a country experiencing aging and urbanization. METHODS: Data came from the 2003 and 2012 Mexican Health and Aging Study (n = 12,238 adults age 50+). Early-life urban dwelling was self-reported. Late-life urban dwelling was based on population size of respondents' community of residence (community 2500+ people) at the time of survey. Cognitive function was measured across several cognitive tasks. We assess differences in baseline cognitive function and nine-year decline across groups using a latent change score model. RESULTS: Cross-sectionally, compared to always rural dwellers, rural-urban transitions were associated with cognitive benefits, though individuals residing in urban areas continuously through life exhibited the highest levels of cognitive function (ß = 0.89, 95% CI: 0.83, 0.96) even after adjusting for SES, health, and health behaviors (ß = 0.28, 95% CI: 0.22, 0.35). Longitudinally, always urban dwellers exhibited slower decline than always rural dwellers when adjusting for baseline cognition (ß = 0.11, 95% CI: 0.03, 0.18), though faster decline when baseline cognition was not adjusted (ß = -0.11, 95% CI: -0.18, -0.04). No differences were observed for cognitive change across comparison groups after adjusting for potential mechanisms. CONCLUSIONS: Early- and late-life urban dwelling may result in cognitive advantages for older Mexican adults. Clinicians should consider where individuals resided throughout life to better understand a patient's likelihood of experiencing poor cognitive outcomes.

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Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

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INTRODUCTION: Exposure to high levels of air pollution is associated with poor health, including worse cognitive function. Whereas many studies of cognition have assessed outdoor air pollution, we evaluate how exposure to air pollution from combustion of polluting household fuels relates with cognitive function using harmonized data from India, Mexico, and China. MATERIALS & METHODS: We analyze adults age 50+ in three nationally representative studies of aging with common data collection methods: the 2017-2019 Longitudinal Aging Study in India (n = 50,532), 2015 Mexican Health and Aging Study (n = 12,883), and 2013 China Health and Retirement Longitudinal Study (n = 12,913). Use of polluting fuels was assessed by self-report of wood, coal, kerosene, crop residue, or dung for cooking. Cognitive function was measured by performance across several cognitive domains and summarized into a total cognition score. We used linear regression, by country, to test how polluting cooking fuel use relates with cognition adjusting for key demographic and socioeconomic factors. RESULTS: Approximately 47%, 12%, and 48% of respondents in India, Mexico, and China, respectively, relied primarily on polluting cooking fuel, which was more common in rural areas. Using polluting cooking fuels was consistently associated with poorer cognitive function in all countries, independent of demographic and socioeconomic characteristics. Adjusted differences in cognitive function between individuals using polluting and clean cooking fuel were equivalent to differences observed between individuals who were 3 years of age apart in Mexico and China and 6 years of age apart in India. Across countries, associations between polluting cooking fuel use and poorer cognition were larger for women. CONCLUSIONS: Results suggest that household air pollution from the use of polluting cooking fuel may play an important role in shaping cognitive outcomes of older adults in countries where reliance on polluting fuels for domestic energy needs still prevails. As these countries continue to age, public health efforts should seek to reduce reliance on these fuels.

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There is growing interest in the contribution of offspring educational attainment to parents' health outcomes. However, less is known about the impacts of offspring socio-economic status (SES) on parents' cognitive decline or about the role of offspring SES disadvantage. We used data from the Mexican Health and Aging Study (n = 10,426) to evaluate the impact of adult child SES disadvantage on parents' verbal memory trajectories over fourteen years (2001-2015). We estimated linear mixed models and used measures of adult child SES (educational, financial, and employment) disadvantage. Our most robust finding was that having an adult child with less than secondary education was associated with faster decline in verbal memory z-scores for older women (ß: -0.009 [95% CI: -0.01, -0.001]) and men (ß: -0.01 [95% CI: -0.02, -0.01]). Although poor adult child financial well-being was associated with a faster decline in parents' verbal memory z-scores, this finding was less consistent across model specifications. Additional analyses also suggested some evidence of heterogeneity by parents' own educational attainment and gender. These findings highlight the potential importance of children's socio-economic status for the cognitive aging of their older parents.

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Studies of air pollution and cognition often rely on measures from outdoor environments. Many individuals in low- and middle-income countries are exposed to indoor air pollution from combustion of solid cooking fuels. Little is known about how solid cooking fuel use affects cognitive decline over time. This study uses data from the 2012, 2015, and 2018 Mexican Health and Aging Study (n = 14 245, age 50+) to assess how use of wood or coal for cooking fuel affects cognition of older adults relative to use of gas. It uses latent change score modeling to determine how using solid cooking fuel affected performance in Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency. Solid cooking fuel was used by 17% of the full sample but was more common in rural areas. Solid fuel users also had lower socioeconomic status. Compared to those using gas, solid fuel users had lower baseline scores and faster decline in Verbal Learning (ß = -0.18, p < 0.05), Visual Scanning (ß = -1.00, p < 0.001), and Verbal Fluency (ß = -0.33, p < 0.001). Indoor air pollution from solid cooking fuels may represent a modifiable risk factor for cognitive decline. Policy should focus on facilitating access to clean cooking fuels.

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Population-level disparities in later-life cognitive health point to the importance of family resources. Although the bulk of prior work establishes the directional flow of resources from parents to offspring, the "linked lives" perspective raises the question of how offspring resources could affect parental health as well. This paper examines whether adult children's education influences older parents' (aged 50+) cognitive health in Mexico, where schooling reforms have contributed to significant gains in the educational achievements of recent birth cohorts. Harnessing a change in compulsory school laws and applying an instrumental variables approach, we found that each year of offspring schooling was associated with higher overall cognition among parents, but was less predictive across different cognitive functioning domains. More offspring schooling improved parents' cognitive abilities in verbal learning, verbal fluency, and orientation, but not in visual scanning, visuo-spatial ability, or visual memory. The beneficial effects of offspring schooling on those cognitive domains are more salient for mothers compared to fathers, suggesting potential gendered effects in the influence of offspring schooling. The results remained robust to controls for parent-child contact and geographic proximity, suggesting other avenues through which offspring education could affect parental health and a pathway for future research. Our findings contribute to growing research which stresses the causal influence of familial educational attainment on population health.

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OBJECTIVES: Mexico is aging rapidly, which makes identification of life-course factors influencing cognition a public health priority. We evaluate how the number of children one has relates to cognition in Mexico, a rapidly aging country that experienced fertility declines across recent cohorts of older people. METHOD: We analyze older adults (age 50+, n = 11,380) from the 2015 Mexican Health and Aging Study. Respondents were categorized by number of children ever born (0-1, 2-3, 4-5, 6+). Using ordinary least squares regression, we estimate independent associations between fertility history and cognition accounting for demographic, socioeconomic, health, and psychosocial factors. RESULTS: We observed an inverse U-shaped relationship between number of children (peaking at 2-3 children) and cognitive function, regardless of gender. In regression analyses adjusted for confounding variables, having 0-1 (vs 2-3 children) was associated with poorer cognitive function only for females. Regardless of gender, having 6+ (vs 2-3 children) was associated with poorer cognitive function. These associations remained significant even after accounting for socioeconomic, health, employment, and psychosocial factors. DISCUSSION: Our results suggest fertility history may play a role in late-life cognitive health and provide evidence that both low and high fertility may relate to poorer cognitive function. We discuss differences by gender.

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OBJECTIVES: A growing body of research has identified factors related to loneliness among older adults. Fewer have investigated predictors of loneliness within married couples. This analysis investigates how spousal support and strain relate with loneliness within older couples (age 50+), and whether these associations are modified by functional limitation. The study focuses on Mexico, a country experiencing rapid aging occurring alongside historically limited institutional support for older adults, and where traditional gender roles extend to marriage. METHODS: The analytic sample consisted of 3,584 husband-wife dyads from the 2012 and 2015 Mexican Health and Aging Study. Loneliness was measured using the Three-Item Loneliness Scale. Associations between spousal support, strain, and loneliness were estimated within husband-wife dyads using the Actor-Partner Interdependence Model. RESULTS: Experiencing more spousal support was associated with less loneliness, whereas experiencing spousal strain was associated with more loneliness 3 years later among married adults. The associations between spousal support/strain and loneliness were stronger among husbands with limitations in activities of daily living (ADL) when compared to their counterparts without ADL limitations. DISCUSSION: Among married adults, spousal support and strain may be important factors to understand loneliness within marriage. Effects should be interpreted within the context of functional limitation.

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BACKGROUND/OBJECTIVES: Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. DESIGN: Prospective cohort study. SETTING: The Mexican Health and Aging Study is a national population-based study of older adults in Mexico. PARTICIPANTS: A total of 10,693 Mexican adults aged 50 and older enrolled in 2001 with no history of prior stroke. MEASUREMENTS: Depressive symptoms were assessed with a modified 9-item Centers for Epidemiologic Studies Depression Scale (elevated depressive symptom cutoff ≥5) in 2001 and 2003. We evaluated associations between baseline and short-term (2-year) changes in elevated depressive symptoms (categorized as stable low, recently remitted, recent-onset, or stable high symptoms) with incident self-reported or next-of-kin reported doctor-diagnosed stroke through 2015 using Cox proportional hazards models and sensitivity analyses applying inverse probability weights. RESULTS: Over an average follow-up of 11.4 years (standard deviation = 4.2), 10,693 respondents reported 546 incident strokes. Individuals with elevated baseline depressive symptoms experienced a moderately higher hazard of incident stroke (hazard ratio [HR] = 1.13; 95% confidence interval [CI] = .95-1.36) compared with those without elevated baseline depressive symptoms. In analyses of short-term changes in elevated depressive symptoms (n = 8,808; 414 incident stokes), participants with recent-onset (HR = 1.38; 95% CI = 1.06-1.81) or stable high (HR = 1.42; 95% CI = 1.10-1.84) elevated depressive symptoms had a greater hazard of incident stroke compared to those with stable low/no depressive symptoms, whereas recently remitted (HR = 1.01; 95% CI = .74-1.37) symptoms was not associated with stroke hazard. CONCLUSION: Strategies to reduce depressive symptoms merit evaluation as approaches to prevent stroke in middle-income countries. Findings are similar to those in high-income countries but should be replicated in other LMICs.

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OBJECTIVES: Education and cognition are closely associated, yet the role of spousal education is not well understood. We estimate the independent effects of own and spousal education on cognitive ability in late-life in Mexico, a developing country experiencing rapid aging. METHOD: We analyzed 4,017 married dyads (age 50+) from the 2012 Mexican Health and Aging Study. Cognitive ability for married adults was a factor score from a single factor model. Using seemingly unrelated regression, we test whether spousal education influences older adults' cognitive ability, whether associations are explained by couple-level socioeconomic position, health and health behaviors, and social support, and whether associations differed by gender. RESULTS: Education and cognitive ability were correlated within couples. Higher spousal education was associated with better cognitive ability. Associations between spousal education and cognitive ability were independent of own education, did not differ by gender, and remained significant even after adjustment for couple-level socioeconomic position, health and health behaviors, and perceived social support. DISCUSSION: In addition to own education, spousal education was associated with better cognitive ability, even at relatively low levels of education. We discuss the possibility that spousal education may improve cognition via transmission of knowledge and mutually reinforcing cognitively stimulating environments.

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Objective: To evaluate associations between depression and individual cognitive domains and how changes in depressive symptoms relate to cognition three years later in the context of Mexico, a developing country experiencing rapid aging.Method: Data comes from the 2012 and 2015 waves of the Mexican Health and Aging Study (n = 12,898, age 50+). Depression is ascertained using a modified Center for Epidemiologic Studies - Depression Scale. Cognition is assessed using verbal learning, verbal memory, visual scanning, verbal fluency, visuospatial ability, visual memory, and orientation tasks. Depressive symptoms and cognitive functioning were both measured in 2012 and 2015. Scores across cognitive domains are modeled using ordinary least squares regression, adjusting for demographic, health, and economic covariates.Results: When depression and cognition were measured concurrently in 2015, depression exhibited associations with all cognitive domains. When considering a respondent's history of depression, individuals who had elevated depressive symptoms in 2012 and recovered by 2015 continued to exhibit poorer cognitive function in 2015 in verbal learning, verbal memory, visual scanning, and verbal fluency tasks compared to individuals who were neither depressed in 2012 nor 2015.Conclusions: Depression was associated with cognition across cognitive domains among older Mexican adults. Despite improvements in depressive symptomatology, formerly depressed respondents continued to perform worse than their counterparts without a history of depression on several cognitive tasks. In addition to current mental health status, researchers should consider an individual's history of depression when assessing the cognitive functioning of older adults.

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OBJECTIVES: Although research suggests that religious involvement tends to favor longevity, most of this work has been conducted in the United States. This article explores the association between religious participation and all-cause mortality risk in Mexico. METHODS: We used data from the 2003-2015 Mexican Health and Aging Study (n = 14,743) and Cox proportional hazard regression models to assess the association between religious participation and all-cause mortality risk. RESULTS: Our key finding is that older Mexicans who participate once or more per week in religious activities tend to exhibit a 19% reduction in the risk of all-cause mortality than those who never participate. This estimate persisted with adjustments for health selection (chronic disease burden, activities of daily living, instrumental activities of daily living, cognitive functioning, and depressive symptoms), several potential mediators (social support, smoking, and drinking), and a range of sociodemographic characteristics. Although we observed considerable health selection due to physical health and cognitive functioning, we found no evidence of mediation. DISCUSSION: Our results confirm that religious participation is associated with lower all-cause mortality risk among older adults in Mexico. Our analyses contribute to previous research by replicating and extending the external validity of studies conducted in the United States, Israel, Denmark, Finland, and Taiwan.

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An extensive body of research documents marital status differences in health among older adults. However, few studies have investigated the heterogeneity in depressive symptomatology among older married adults living in developing countries. Our study investigates the interplay of gender and marital power dynamics for mental health among older Mexican adults. Our sample includes older married couples in the 2015 Wave of the Mexican Health and Aging Study (n=3,621 dyads). We use seemingly unrelated regression to model the association between self-reported distributions of decision-making power within marriages and depressive symptoms for husbands and wives. For approximately 41 per cent of couples, the husband and wife both reported an equal distribution of power in the marriage. Compared to those who reported an equal power distribution, husbands and wives who reported an imbalance of power (having more power or less power than their spouse) reported more depressive symptoms. Levels of depressive symptoms were higher in marriages characterised by an unequal balance of power. The relationship between equality in power and depressive symptoms is not explained by health care needs or living arrangements. Marital quality is an important factor for understanding depressive symptoms among older Mexican adults.

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Aimed at covering the large fraction of workers in the informal sector without access to a social security program, the Mexican public health insurance program Seguro Popular began in 2002 and now reaches more than 50 million individuals. We estimate impacts of Seguro Popular for the population aged 50 and older on a set of indicators related to health care including utilization, diagnostic/preventive tests, and treatment conditional on being ill. Using the longitudinal Mexican Health and Aging Study over the period 2001-2012, we conduct before and after difference-in-difference matching impact estimators. Our results suggest large and important effects of the Program on utilization and diagnostic tests. We find overall smaller effects on the probability of being in treatment for individuals with chronic diseases, but these effects are concentrated in rural areas with relatively more health services versus rural areas with lower levels of health services. These results suggest that, to the extent that health services become more available in rural areas lacking services, effects of health insurance may increase.

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BACKGROUND: A growing body of research suggests exposure to high levels of outdoor air pollution may negatively affect cognitive functioning in older adults, but less is known about the link between indoor sources of air pollution and cognitive functioning. We examine the association between exposure to indoor air pollution and cognitive function among older adults in Mexico, a developing country where combustion of biomass for domestic energy remains common. METHOD: Data come from the 2012 Wave of the Mexican Health and Aging Study. The analytic sample consists of 13 023 Mexican adults over age 50. Indoor air pollution is assessed by the reported use of wood or coal as the household's primary cooking fuel. Cognitive function is measured with assessments of verbal learning, verbal recall, attention, orientation and verbal fluency. Ordinary least squares regression is used to examine cross-sectional differences in cognitive function according to indoor air pollution exposure while accounting for demographic, household, health and economic characteristics. RESULTS: Approximately 16% of the sample reported using wood or coal as their primary cooking fuel, but this was far more common among those residing in the most rural areas (53%). Exposure to indoor air pollution was associated with poorer cognitive performance across all assessments, with the exception of verbal recall, even in fully adjusted models. CONCLUSIONS: Indoor air pollution may be an important factor for the cognitive health of older Mexican adults. Public health efforts should continue to develop interventions to reduce exposure to indoor air pollution in rural Mexico.

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Prior research indicates age of migration is associated with cognitive health outcomes among older Mexican Americans; however, factors that explain this relationship are unclear. This study used eight waves from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the role of education in the risk for cognitive impairment (CI) by nativity, age of migration, and gender. Foreign-born women had a higher risk for CI than U.S.-born women, regardless of age of migration. After adjusting for education, this risk remained significant only for late-life migrant women (risk ratio [RR] = 1.28). Foreign-born men who migrated at >50 had significantly higher risk for CI compared to U.S.-born men (RR = 1.33) but not significant after adjusting for education. Findings from a decomposition analysis showed education significantly mediated the association between age of migration and CI. This study highlights the importance of education in explaining the association between age of migration and CI.

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