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

OBJECTIVE: To analyze the influence that sex has on the association between insomnia, sleep quality, sleep duration, and frailty in older adults. SUBJECTS & METHODS: Cross sectional study from the Cohort Obesity, Sarcopenia, and Frailty in Older Mexican Adults (COSFOMA). In total, 493 older adults aged 64-94 participated. Insomnia was evaluated with the Athens Insomnia Scale and sleep quality with the Pittsburgh Sleep Quality Index. Duration of sleep was classified as short (<5 h and 5-6 hours), recommended (7-8 hours), and long (≥ 9 h). Frailty was operationalized with the Fried phenotype. Furthermore, sociodemographic variables were collected, along with physical and mental health. Logistic regression models were stratified by sex to analyze the relationship between insomnia, sleep quality, sleep duration, and frailty. RESULTS: Participants included 299 (60.7 %) women and 194 (39.3 %) men. The average age was 70.1 ± 5.6 years. Frail older adults comprised 13.4 % of the sample (n = 66), while 62.5 %(n = 308) were pre-frail and 24.1 % were not frail (n = 119). In the statistical models adjusted for sociodemographic and health covariates, insomnia, low sleep quality, and sleeping less than five hours were shown to increase the odds of being frail in women, but not in men. CONCLUSION: In older adult women, the presence of insomnia, low sleep quality, and sleeping less than five hours could promote frailty. Therefore, treatment of sleep problems among women should be prioritized to avoid the onset of this condition.

Self-perception of oral health in older adults from Mexico City / Autopercepción de la salud oral en adultos mayores de la Ciudad de México

Background: Quality of life related to oral health is assessed through the individual's self-perceived oral health (SPOH). The objective is to determine SPOH in relation to socio-demographic and health characteristics in older adults beneficiaries from the Instituto Mexicano del Seguro Social (IMSS) in Mexico City. Methods: Cross-sectional study. We used data collection with questionnaire and assessment scales related to socio-demographic, health and dependency variables, as well as the visit to the dentist, the use of removable dental prostheses and SPOH. The self-perception means (Geriatric/General Oral Health Assessment Index-GOHAI) were calculated, and we used Student's t, ANOVA and Bonferroni post hoc tests. Results: 60.5% were women; the average age of population was 68.23 ± 7.0. GOHAI total mean was 48.07 (48.05-48.08). Compared to their counterparts, people with the next features showed marked improvement in SPOH: of 60-69 years of age, separated or divorced, ≥ 7 years of study, paid work, living alone, no smoking, drinking alcohol, with a good health perception, low weight, no cognitive impairment, no depression, no anxiety, no comorbidity, consumption < 5 drugs, with limitations in basic activities, without limitations in instrumental activities, who did not visit the dentist and who did not use removable prosthesis. Conclusion: The concept of quality of life essentially incorporates the SPOH as a need in the evaluation of health outcomes.

Introducción: la calidad de vida relacionada con la salud oral se evalúa a partir de la autopercepción de la salud oral (APSO) del individuo. El objetivo es determinar la APSO con respecto a las características sociodemográficas y de salud en adultos mayores derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de la Ciudad de México. Métodos: estudio transversal con datos sociodemográficos, de salud, de dependencia, visita al dentista, uso de prótesis dental removible y APSO. Se calcularon las medias de autopercepción (Geriatric/General Oral Health Assessment Index: GOHAI) y se usaron las pruebas t de Student, ANOVA y post hoc Bonferroni. Resultados: el 60.5% fueron mujeres. La edad promedio de la población fue 68.23 ± 7.0. La media (IC) del GOHAI total fue 48.07 (48.05-48.08). Comparados con sus contrapartes, hubo mejor autopercepción de la salud oral en los individuos del grupo de 60-69 años, separados o divorciados, ≥ 7 años de estudio, con trabajo remunerado, que vivían solos, no fumaban, sí bebían alcohol, tenían buena percepción de salud, bajo peso, sin deterioro cognitivo, ni depresión, ni ansiedad, ni comorbilidades, que consumían < 5 fármacos, con limitaciones en actividades básicas, sin limitaciones en actividades instrumentales, que no visitaban al dentista y no usaban prótesis removible. Conclusión: el concepto de calidad de vida incorpora esencialmente la APSO del paciente como una necesidad en la evaluación de resultados en salud.

Frailty in community-dwelling older adults: association with adverse outcomes.

BACKGROUND: The study of frailty is important to identify the additional needs of medical long-term care and prevent adverse outcomes in community dwelling older adults. This study aimed to determine the prevalence of frailty and its association with adverse outcomes in community dwelling older adults. METHODS: A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 older adults (≥60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD). RESULTS: Frailty was identified in 20.6% (n=258), pre-frailty in 57.6% (n=721), and not frail in 21.8% (n=273). The association between frailty and limitations in ADL was odds ratio (OR) =2.3 (95% confidence interval [CI] 1.7-3.2) and adjusted OR =1.7 (95% CI 1.2-2.4); falls OR =1.6 (95% CI 1.2-2.1) and adjusted OR =1.4 (95% CI 1.0-1.9); admission to emergency services OR =1.9 (95% CI 1.1-3.1) and adjusted OR =1.9 (95% CI 1.1-3.4); low quality of life OR =3.4 (95% CI 2.6-4.6) and adjusted OR =2.1 (95% CI 1.5-2.9). CONCLUSION: Approximately 2 out of 10 older adults demonstrate frailty. This is associated with limitations in ADL, falls, and admission to emergency rooms during the previous year as well as low quality of life.

[Quality of life related to oral health in older people. Evaluation instruments]. / Calidad de vida relacionada con la salud oral en adultos mayores. Instrumentos de evaluación.

Given that life expectancy has increased considerably due to medical and technological advances, in recent years researchers have decided to meet the specific needs of the elderly in order to provide them better health care, in view of the fact that the aging process generates physical, biological and social changes. On the basis of this knowledge it becomes evident the impact of general health and oral health quality of life, which usually has a negative impact. Consequently, the aim of this work is to provide researchers and clinicians a review of the instruments that have been used for evaluation of the quality of life related to oral health. These instruments are the Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performances (OIDP) and the General Oral Health Assessment Index (GOHAI). Supplementary to the explanation of these instruments, our aim is to describe their structure, assessment, validation and application in studies performed on elderly Mexicans. In addition to this, we review some of the reports that compare the usefulness of those instruments.

Dado que ha habido un aumento en la expectativa de vida gracias a los avances médicos y tecnológicos, desde hace ya algunos años los investigadores se han propuesto conocer las necesidades de los adultos mayores con el fin de ofrecerles una mejor atención en salud, puesto que el proceso de envejecimiento genera cambios físicos, biológicos y sociales. A partir de este conocimiento se hace evidente la repercusión del estado de salud general y oral en la calidad de vida, lo cual tiene un impacto que, por lo general, es negativo. Por lo tanto, el objetivo de este trabajo es brindar tanto a investigadores como a clínicos una revisión de los instrumentos que han sido más utilizados para la evaluación de la calidad de vida relacionada con la salud oral (el Oral Health Impact Profile [OHIP], el Oral Impacts on Daily Performances [OIDP] y el General Oral Health Assessment Index [GOHAI]), su estructura, evaluación, validación y aplicación en investigaciones llevadas a cabo en adultos mayores mexicanos. Asimismo, se revisan muchos de los reportes en los que se compara la utilidad de los instrumentos mencionados.

Comportamiento del Geriatric/General Oral Health Assessment Index (GOHAI) y Oral Impacts on Daily Performances (OIDP) en una población de adultos mayores de la Ciudad de México / Behavior of the Geriatric/General Oral Health Assessment Index (GOHAI) and Oral Impacts on Daily Performances (OIDP) in a senior adult population in Mexico City

Objetivo: Determinar el comportamiento del Geriatric/General Oral Health Assessment Index y Oral Impacts on Daily Performances como medidas de efecto de la salud bucodental relacionada con la calidad de vida en adultos mayores en una misma población. Métodos: Muestra representativa de adultos mayores derechohabientes del Instituto Mexicano del Seguro Social del suroeste de la Ciudad de México. Se realizaron entrevistas domiciliarias para conocer las características de la muestra y aplicación de los instrumentos Geriatric/General Oral Health Assessment Index y Oral Impacts on Daily Performances. Evaluación clínica para determinar la experiencia de caries coronal y caries radicular. Resultados: Un total de 531 sujetos de 60 años y más participaron, 68.4% mujeres. La media (desviación estándar) de edad fue de 71.4 (7.0) años. El Geriatric/General Oral Health Assessment Index presentó una media de 46.8 (6.2), y 4.1 (12.4) para el Oral Impacts on Daily Performances. La escolaridad mayor de seis años, no presentar limitaciones, con deterioro cognitivo y sin depresión, presentaron una media mayor del puntaje del Geriatric/General Oral Health Assessment Index en comparación con los que no presentaban (p < 0.05). La escolaridad mayor de seis años, con una actividad laboral remunerada y sin depresión, presentaron una media menor del puntaje del Oral Impacts on Daily Performances en comparación a los que no presentaban (p < 0.05). Existe una correlación entre el Geriatric/General Oral Health Assessment Index y componentes obturados, dientes funcionales (p < 0.05). Los componentes perdidos, obturados e índice caries coronal, así como coronas sanas y dientes funcionales presentaron una correlación con el Oral Impacts on Daily Performances (p < 0.05). Conclusión: El Geriatric/General Oral Health Assessment Index tuvo mayor discriminación en las características de la población y el Oral Impacts on Daily Performances presentó mayor correlación con el estado de la dentición.

Objective: To determine the behavior of the Geriatric/General Oral Health Assessment Index as well as the Oral Impacts on Daily Performances as effective measures in oral-dental health related to quality of life in senior citizens in a given population. Methods: A representative sample of senior citizens entitled to medical services at the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) located in the southwest region of Mexico City. Home interviews were conducted in order to ascertain the sample's characteristics as well as the application of the Geriatric/General Oral Health Assessment Index and Oral Impacts on Daily Performances instruments. Clinical evaluation in order to determine experience of crown caries (CPO-D) and root caries CO-R). Results: A total of 531 subjects aged 60 years and over participated in the study, of which 68.4% were female. Age average (AA) was 71.4 years (7.0). Geriatric/General Oral Health Assessment Index exhibited a mean of 46.8 (6.2) and Oral Impacts on Daily Performances showed 4.1 (12.4). Subjects included in the sample had attended school for over 6 years, did not present limitations of cognitive deterioration, and were depression-free, exhibited a higher mean in Oral Impacts on Daily Performances score than those which did not present those characteristics (p < 0.05). Six or more years of schooling with paid work and depression-free subjects presented lesser Oral Impacts on Daily Performances scores when compared to those who did not. (p < 0.05) A correlation was found between the Geriatric/General Oral Health Assessment Index and filled components, functional teeth (p > 0.05). Filled and lost components and CPO-D index as well as healthy crowns and functional teeth exhibited a correlation with Oral Impacts on Daily Performances (p < 0.05). Conclusion: Geriatric/General Oral Health Assessment Index exhibited higher discrimination in the population's characteristics whereas Oral Impacts on Daily Performances showed higher correlation with the state of the dentition.

Oral health status in older adults with social security in Mexico City: Latent class analysis.

OBJECTIVE: To explore the oral health status through a latent class analysis in elderly social security beneficiaries from Southwest Mexico City. MATERIAL AND METHODS: Cross-sectional study of beneficiaries of the State Employee Social Security and Social Services Institute (ISSSTE, in Spanish) and the Mexican Institute of Social Security (IMSS, in Spanish) aged 60 years or older. Oral health conditions such as edentulism, coronal and root caries (DMFT and DFT ≥ 75 percentile), clinical attachment loss (≥ 4 mm), and healthy teeth (≤ 25 percentile) were determined. A latent class analysis (LCA) was performed to classify the oral health status of dentate patients. RESULTS: In total, 336 patients were included (47.9% from the ISSSTE and 52.1% from the IMSS), with an average age of 74.4 (SD = 7.1) years. The 75th percentile of the DMFT = 23 and of the DFT = 2. Of the patients, 77.9% had periodontal disease. The 25th percentile of healthy teeth = 4. A three class model is adequate, with a high classification quality (Entropy = 0.915). The patients were classified as "Edentulous" (15.2%), "Class 1 = Unfavorable" (13.7%), "Class 2 = Somewhat favorable" (10.4%), and "Class 3 = Favorable" (60.7%). Using "Class 3 = Favorable" as a reference, there was an association (OR = 3.4; 95% CI = 1.8-6.4) between being edentulous and being 75 years of age and over, compared with the 60- to 74-year age group. CONCLUSION: The oral health in elderly social security beneficiaries is not optimal. The probability of becoming edentulous increases with age. A three-class model appropriately classifies the oral health dimensions in the elderly population. Key words:Elderly, Latent class analysis (LCA), oral health, social security, Mexico.

[Health status and wellness among older adult beneficiaries of the ISSSTE and IMSS in Southwest Mexico City]. / Estado de salud y bienestar en adultos mayores derechohabientes usuarios del ISSSTE e IMSS del suroeste de la Ciudad de México.

OBJECTIVE: To explore the conditions of health and wellness in older adults beneficiaries to ISSSTE and IMSS of the Southwest Mexico City. MATERIAL AND METHODS: Cross-sectional study samples of users to health services in primary care ISSSTE (n = 161) and IMSS (n = 176) in Southwest Mexico City. Were determined chronic health conditions, cognitive function, depressive symptoms, use of health services, nutritional status, functioning and disability and quality of life related to health. RESULTS: It is observed that there is a difference between samples ISSSTE vs. IMSS in comorbidity conditions (ISSSTE 53.4% vs. IMSS 57.9%), nutritional status (malnutrition risk ISSSTE 25.8% us. IMSS 36.4%; overweight ISSSTE 23.3% vs. IMSS 11.6%) (p < 0.05). There were no differences between samples IMSS us. ISSSTE in cognitive function, depression, use of health services, abdominal obesity, functioning and disability, and quality of life related to health. CONCLUSIONS: The conditions of health and wellness in older adults beneficiaries to ISSSTE and IMSS users are similar, with meaning in comorbidity conditions, nutritional status.