Vision Impairment and Frailty Among Mexican American Older Adults: A Longitudinal Study.

We examined the relationship between vision impairment (VI) and new-onset frailty among non-frail Mexican American older adults (≥70 years) at baseline and determined the differential impact of VI on each frailty criteria. Data were from an 18-year prospective cohort from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1998/1999, N = 1072 to 2016, N = 175). Frailty was defined as ≥3 criteria: unintentional weight loss of >10 pounds, weakness, exhaustion, low physical activity, and slowness. VI was defined as difficulty in recognizing a friend at arm's length's away, across the room, or across the street. We found that participants with VI (near or distant) and distant VI had greater odds of frailty (near or distant VI, OR = 1.89, 95% CI = 1.30-2.73 and distant VI, OR = 1.95, 95% CI = 1.34-2.86, respectively) after controlling for covariates over time. Early screening (optimal management) of VI may prevent or delay onset of frailty among older Mexican Americans.

Pain and incident cognitive impairment in very old Mexican American adults.

BACKGROUND: Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity-limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. METHODS: Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010-2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini-Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6-year period (n = 313). RESULTS: Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09-4.36; treated aOR: 1.99; 95% CI: 1.15-3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. CONCLUSIONS: Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non-pharmacological treatments in these pathways.

Diabetes Complications and Pain Among Mexican Americans Aged 80 and Older.

Background and Objectives: Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over 6 years among Mexican Americans aged 80 years and older. Research Design and Methods: We used data from Waves 7 to 9 (2010-2016) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (n = 853). Participants were categorized as having no diabetes, diabetes without complications, and diabetes with complications. Pain was defined as reporting pain when standing or walking (pain on weight-bearing) and having pain that limited daily activities (pain interference). We used generalized estimating equations to estimate the odds of pain over 6 years as a function of diabetes status controlling for socioeconomic and health characteristics. Results: At baseline, the mean age was 85.7 (standard deviation = 3.9) years, 65.2% female, 68.5% had no diabetes, 14.7% had diabetes without complications, and 16.9% had diabetes with complications. Those with diabetes without complications had lower odds of reporting pain on weight-bearing and pain interference, compared to those with no diabetes. Among those reporting diabetes (n = 269), those with complications had higher odds of pain on weight-bearing and pain interference, compared to those without complications. Those with both micro and macro complications had over 2 times the odds of pain, compared to those having no complications. Discussion and Implications: The lower burden of pain in those with diabetes but no complications may reflect optimal management of diabetes. Routine screening and treatment of pain in patients with diabetes complications can mitigate excess disability and increase the quality of life for patients with diabetes.

Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE).

BACKGROUND: Hospice use is lower among ethnic/racial minorities in the United States, though little is known about trends, associated factors and duration of hospice use by Mexican-Americans. AIM: The purpose of this study is to examine Mexican-American characteristics associated with hospice stay, both ≤ and > 7 days. DESIGN: This retrospective cohort study used data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) and the Centers for Medicare and Medicaid Services. Multivariate logistic regression models were used to estimate the ORs and 95% CIs for hospice stay among Mexican-Americans, both ≤ and > 7 days. SETTING AND PARTICIPANTS: The first cohort (N = 970) includes H-EPESE participants who died between 2004 and 2016 who had Medicare parts A and B. The second cohort (N = 403) includes participants who completed the H-EPESE survey within the last 2 years of life. RESULTS: Although hospice use increased among Mexican-Americans between 2004 and 2016 (OR 1.88, 95% CI 1.19-2.97), 38% of participants died within the first week of hospice care. Mexican-Americans in New Mexico and Arizona were 2-4 times more likely to use hospice than those in Texas and Colorado. Dementia was associated with hospice use (OR 1.47, 95% CI 1.11-1.94). Characteristics, like church attendance and living alone, were not associated with hospice use. CONCLUSIONS: The substantial proportion of Mexican-Americans with 7 days or less of hospice use underscores the need for early palliative/hospice intervention to mitigate variation in use.

Relationship Between Diabetes-Related Complications and Sleep Complaints in Older Mexican Americans.

INTRODUCTION/OBJECTIVE: The prevalence of Type 2 Diabetes Mellitus is increasing in the older American population, especially Mexican Americans. Sleep disorders are common in older adults with T2DM. This study examined the relationship between T2DM-related complications and sleep complaints in older Mexican Americans over 9 years of follow-up. METHODS: Study included 310 participants aged 77 years or older with self-reported diabetes from the Hispanic Established Population for the Epidemiological Study of the Elderly (2007/08-2016). RESULTS: Of the 310 participants, the mean age was 82.04 years. The cohort had significantly more females (69.03%) than males (30.97%). A substantial number of participants had trouble falling asleep (16.13%), waking up several times (36.45%), trouble staying asleep (15.16%), and feeling tired and worn out after waking up (12.90%). The percent of diabetes complications were 70.2% for circulation problems, 58.2% for eye disorders, 15.9% for kidney disease, and 4.4% for amputation. Participants who experienced sleep complaints for 15 or more days in a month were more likely to experience diabetic complications. DISCUSSION: This study demonstrated a significant relationship between T2DM macro- and micro-vascular complications and increased risk of sleep disorders in older Mexican Americans.

Multimorbidity Is Associated With Pain Over 6 Years Among Community-Dwelling Mexican Americans Aged 80 and Older.

Introduction: Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is associated with decreased quality of life, greater disability, and increased mortality. Yet, the association of multimorbidity with pain, another significant contributor to decreased quality of life, has not been widely studied. This is especially understudied among very old (aged ≥ 80) Mexican Americans, a fast-growing segment of the United States (US) population. Objective: To assess the association of multimorbidity with pain in very old Mexican Americans, over six years of follow-up. Methods: We used data from Waves 7 (2010/2011) to 9 (2015/2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly, a longitudinal study of older Mexican Americans residing in the Southwestern US. Multimorbidity was defined as reporting two or more chronic health conditions. Pain was defined as (1) pain on weight-bearing, (2) pain in back, hips, knees, ankles/feet, legs, entire body, or two or more locations, and (3) pain that limits daily activities. We use generalized estimation equations to estimate the odds ratio of pain as a function of multimorbidity over 6 years. Results: At baseline (n = 841), 77.3% of participants had multimorbidity. Those with multimorbidity had greater odds [2.27, 95% confidence interval (CI): 1.74, 2.95] of reporting pain on weight-bearing over time, compared to those without multimorbidity. Also, those with multimorbidity had 2.12 times the odds of reporting pain that limited their daily activities (95% CI: 1.61, 2.78) compared to those without multimorbidity. Lastly, those with multimorbidity had higher odds of reporting pain in their back, knee, ankles/feet, legs, hips, entire body, or two or more locations, compared to those without multimorbidity. Conclusions: Those with multimorbidity consistently had higher odds of all types of pain, highlighting the need for early management of pain among those with multiple chronic conditions and complex health needs. This is especially important among very old Mexican Americans, who have a high burden of chronic health conditions.

Gender Differences in Neuropsychiatric Symptoms Among Community-Dwelling Mexican Americans Aged 80 and Older.

Background and ObjectivesTo assess gender differences in prevalence of neuropsychiatric symptoms (NPS) among community-dwelling Mexican Americans ≥80 years. Research Design and Methods: Using data from Wave 7 (2010-2011) of the Hispanic Established Population for the Epidemiological Study of the Elderly, we analyzed the NPS of 914 participants as determined by the Neuropsychiatric Inventory (NPI) with assessments conducted by their caregivers. Multivariate logistic regression models were used to test the association of individual NPS with gender, adjusting for relevant characteristics. Results: The average age of our sample was 86.1 years, and 65.3% were women. Over 60% of participants had at least one informant/caregiver reported NPS. After adjustment, women had lower odds than men of agitation/aggression but higher odds of dysphoria/depression and anxiety. Discussion: Recognizing gender differences in NPS phenotype could help guide development of culturally appropriate NPS screening and treatment programs.

Documentation of Dementia as a Cause of Death Among Mexican-American Decedents Diagnosed with Dementia.

BACKGROUND: Hispanic older adults are a high-risk population for Alzheimer's disease and related dementias (ADRD) but are less likely than non-Hispanic White older adults to have ADRD documented as a cause of death on a death certificate. OBJECTIVE: To investigate characteristics associated with ADRD as a cause of death among Mexican-American decedents diagnosed with ADRD. METHODS: Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, Medicare claims, and National Death Index. RESULTS: The final sample included 853 decedents diagnosed with ADRD of which 242 had ADRD documented as a cause of death. More health comorbidities (OR = 0.40, 95% CI = 0.28-0.58), older age at death (OR = 1.18, 95% CI = 1.03-1.36), and longer ADRD duration (OR = 1.08, 95% CI = 1.03-1.14) were associated with ADRD as a cause of death. In the last year of life, any ER admission without a hospitalization (OR = 0.45, 95% CI = 0.22-0.92), more physician visits (OR = 0.96, 95% CI = 0.93-0.98), and seeing a medical specialist (OR = 0.46, 95% CI = 0.29-0.75) were associated with lower odds for ADRD as a cause of death. In the last 30 days of life, any hospitalization with an ICU stay (OR = 0.55, 95% CI = 0.36-0.82) and ER admission with a hospitalization (OR = 0.67, 95% CI = 0.48-0.94) were associated with lower odds for ADRD as a cause of death. Receiving hospice care in the last 30 days of life was associated with 1.98 (95% CI = 1.37-2.87) higher odds for ADRD as a cause of death. CONCLUSION: Under-documentation of ADRD as a cause of death may reflect an underestimation of resource needs for Mexican-Americans with ADRD.

Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia.

BACKGROUND: Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer's disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD. METHODS: Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis. RESULTS: The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43-1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27-1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80-0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82-0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant. CONCLUSIONS: Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.

Characteristics Associated with Feeding Tube Placement: Retrospective Cohort Study of Texas Nursing Home Residents with Advanced Dementia.

OBJECTIVES: To investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: NH residents in Texas with dementia diagnosis and severe cognitive impairment (N = 20,582). METHODS: This study used 2011-2016 Texas Medicare data to identify NH residents with a stay of at least 120 days who had a diagnosis of dementia on Long Term Care Minimum Data Set (MDS) evaluation and severe cognitive impairment on clinical score. Multivariable repeated measures analyses were conducted to identify associations between FT placement and resident-level, provider-type, NH, and regional factors. RESULTS: The prevalence of FT placement in advanced dementia in Texas between 2011 and 2016 ranged from 12.5% to 16.1% with a nonlinear trend. At the resident level, the prevalence of FT decreased with age [age > 85 years, prevalence ratio (PR) 0.60, 95% confidence interval (CI) 0.52-0.69] and increased among residents who are black (2.74, 95% CI 2.48-3.03) or Hispanic (PR 1.91, 95% CI 1.71-2.13). Residents cared for by a nurse practitioner or physician assistant were less likely to have an FT (PR 0.90, 95% CI 0.85-0.96). No facility characteristics were associated with prevalence of FT placement in advanced dementia. There were regional differences in FT placement with the highest use areas on the Texas-Mexico border and in South and East Texas (Harlingen border area, PR 4.26, 95% CI 3.69-4.86; San Antonio border area, PR 3.93, 95% CI 3.04-4.93; Houston, PR 2.17, 95% CI 1.87-2.50), and in metro areas (PR 1.36, 95% CI 1.22-1.50). CONCLUSIONS AND IMPLICATIONS: Regional, race, and ethnic variations in prevalence of FT use among NH residents suggest opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.

Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer's disease and related dementias.

BACKGROUND: Older adults with Alzheimer's disease and related dementias (ADRD) are high-risk to experience hospitalizations and emergency room (ER) admissions. Mexican-Americans have a high prevalence of ADRD, but there is limited information on the healthcare use of older Mexican-Americans with ADRD. We used data from a cohort of older Mexican-Americans that has been linked with Medicare files to investigate differences in hospitalizations, ER admissions, and physician visits according to ADRD diagnosis. We also identify sociodemographic, health, and functional characteristics that may contribute to differences in healthcare utilization between Mexican-American Medicare beneficiaries with and without an ADRD diagnosis. METHODS AND FINDINGS: Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare Master Beneficiary Summary Files, Medicare Provider Analysis and Review files, Outpatient Standard Analytic files, and Carrier files. The final analytic sample included 1048 participants. Participants were followed for two years (eight quarters) after their survey interview. Generalized estimating equations were used to estimate the probability for one or more hospitalizations, ER admissions, and physician visits at each quarter. ADRD was associated with higher odds for hospitalizations (OR = 1.65, 95%CI = 1.29-2.11) and ER admissions (OR = 1.57, 95%CI = 1.23-1.94) but not physician visits (OR = 1.23, 95%CI = 0.91-1.67). The odds for hospitalizations (OR = 1.24, 95%CI = 0.97-1.60) and ER admissions (OR = 1.27, 95%CI = 1.01-1.59) were reduced after controlling for limitations in activities of daily living and comorbidities. CONCLUSIONS: Mexican-American Medicare beneficiaries with ADRD had significantly higher odds for one or more hospitalizations and ER admissions but similar physician visits compared to beneficiaries without ADRD. Functional limitations and comorbidities contributed to the higher hospitalizations and ER admissions for older Mexican-Americans with ADRD.

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer's Disease and Related Dementias.

BACKGROUND: Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer's disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis. METHODS: We used Medicare claims data linked with survey information from 1,090 participants (mean age of death 85.1 years) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Multivariable logistic regression models were used to estimate the odds for hospitalization, intensive care unit use, and ventilator use in the last 30 days of life for decedents with ADRD than those without ADRD. Generalized linear models were used to estimate the risk ratio (RR) for length of stay in hospital. RESULTS: Within the last 30 days of life, 64.5% decedents had an acute hospitalization (59.1% ADRD, 68.3% no ADRD), 33.9% had an intensive care unit stay (31.3% ADRD, 35.8% no ADRD), and 17.2% used a ventilator (14.9% ADRD, 18.8% no ADRD). ADRD was associated with significantly lower hospitalizations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.50-0.89) and shorter length of stay in hospital (RR = 0.77, 95% CI = 0.65-0.90). CONCLUSION: Hospitalization, intensive care unit stay, and ventilator use are common at the end of life for older Mexican Americans. The lower hospitalization and shorter length of stay in hospital of decedents with ADRD indicate a modest reduction in acute care use. Future research should investigate the impact of end-of-life planning on acute-care use and quality of life in terminally ill Mexican American older adults.

Pain as a predictor of frailty over time among older Mexican Americans.

The objective of this study was to examine pain as a predictor of frailty over 18 years of follow-up among older Mexican Americans who were nonfrail at baseline. Data were from a prospective cohort study of 1545 community-dwelling Mexican Americans aged ≥67 years from the Hispanic Established Populations for the Epidemiological Study of the Elderly (1995/1996-2012/2013). Frailty was defined as meeting 2 or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, and slowness. The independent predictor was self-reported pain. Covariates included age, sex, marital status, education, comorbid conditions, body mass index, Mini-Mental State Examination, depressive symptoms, and limitation in activities of daily livings. General equation estimation was performed to estimate the odds ratio of frailty as a function of pain. A total of 538 participants (34.8%) reported pain at baseline. The prevalence of frailty among those with pain ranged from 24.4% in wave 3 to 41% in wave 8. The odds ratio of becoming frail over time as a function of pain was 1.71; 95% confidence interval: 1.41 to 2.09 after controlling for all covariates. Older age, hip fracture, high depressive symptoms, and activities of daily living disability were also associated with higher odds of becoming frail over time. Female participants and those with higher levels of education and high Mini-Mental State Examination scores were less at risk. In conclusion, pain was a significantly predictor of frailty. Early assessment and better management of pain may prevent early onset of frailty in older Mexican Americans.

Chronic Respiratory Disease and Cognitive Impairment in Older Mexican Adults.

BACKGROUND: Cognitive impairment has emerged as an important concern in clinical practice in aging population. Several comorbid factors contribute to etiopathogenesis; one disease of interest is chronic respiratory disease. AIM: The aim of this study is to investigate the association of chronic respiratory disease with risk of cognitive impairment in older Mexicans. MATERIALS AND METHODS: Data were obtained from 2782 Mexicans, aged ≥60 years, enrolled in waves I (2001) and III (2012) of the Mexican Health and Aging Study, a prospective cohort of nationally representative sample of older Mexicans. Participants' self-reported responses were used to categorize them into having respiratory disease or not. Study outcome included participants categorized into "cognitively impaired" or "cognitively normal" groups. Multivariable logistic regression models were used to investigate the relationship. RESULTS: Overall, 16% of cohort participants reported cognitively impaired at Wave III. Compared with older Mexicans without chronic respiratory disease diagnosis, those diagnosed were not significantly associated with risk of cognitive impairment [adjusted odds ratio (OR): 0.94, 95% confidence interval (CI): 0.58-1.58]. CONCLUSION: Chronic respiratory disease is not significantly associated with risk of cognitive impairment in older Mexican adults.

Cohort Differences in Cognitive Impairment and Cognitive Decline Among Mexican-Americans Aged 75 Years or Older.

Research suggests that the prevalence and incidence of cognitive impairment among older adults is decreasing. This analysis used data from 9 waves (1993-2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess cognitive status and cognitive decline for 2 cohorts of Mexican-Americans aged ≥75 years in 1993-1994 versus 2004-2005. Logistic regression, joint longitudinal survival models, and illness-death models for interval-censored data were used to examine cohort differences in the odds of prevalent cognitive impairment, trajectories of cognitive decline, and the risk of 10-year incident cognitive impairment, respectively. Results indicated that compared with the 1993-1994 cohort, the 2004-2005 cohort had higher odds for prevalent cognitive impairment (odds ratio = 2.51, 95% confidence interval (CI): 1.92, 3.29), particularly among participants with <4 years of education (odds ratio = 2.99, 95% CI: 2.14, 4.18). Conversely, the 2004-2005 cohort exhibited significantly slower rates of cognitive decline (߈ = 0.50, 95% CI: 0.39, 0.62) and had a significantly lower risk of incident cognitive impairment (hazard ratio = 0.75, 95% CI: 0.62, 0.91) compared with the 1993-1994 cohort. This analysis provides mixed results for cohort trends in the cognitive health of older Mexican-Americans. Continued research is needed to identify risk factors that contribute to these population-level trends.

Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans.

Objectives: Impaired cognition and pre-frailty are associated with poor health outcomes. However, research has not examined the combined impact of cognitive impairment and pre-frailty on future frailty and mortality among older Mexican Americans. Methods: Data for this analysis came from the 2006-2007 and 2010-2011 waves of the Hispanic EPESE. The final sample included 639 Mexican Americans aged ≥77 years who were non-frail or pre-frail in 2006-2007. Frailty measure included weight loss, exhaustion, weakness, and slow walking speed. Participants were classified as non-frail (0 criteria) and pre-frail (1 criterion) at baseline. Cognitive impairment was defined as <21 points on the MMSE. At baseline, participants were grouped as: cognitively intact non-frail, cognitively intact pre-frail, cognitively impaired non-frail, and cognitively impaired pre-frail. Logistic and hazard regression models were used to evaluate the odds of being frail in 2010-2011 and risk for 10-year mortality. Results: Cognitively impaired pre-frail participants were more likely to become frail (OR = 4.82, 95% CI = 2.02-11.42) and deceased (HR = 1.99, 95% CI = 1.42-2.78). Cognitively impaired non-frail participants had significantly higher risk for mortality (HR = 1.55, 95% CI = 1.12-2.19) but not frailty (OR = 1.29, 95% CI = 0.50-3.11). Being cognitively intact and pre-frail at baseline was not significantly associated with being frail at follow-up (OR = 1.62, 95% CI = 0.83-3.19) or mortality (HR = 1.29, 95% CI = 0.97-1.71). Conclusions: Comorbid cognitive impairment and pre-frailty is associated with future frailty and mortality in older Mexican Americans. Screening for cognitive impairment may be effective for identifying pre-frail Mexican Americans who are at the highest risk of frailty and mortality.

Life Expectancies With Depression by Age of Migration and Gender Among Older Mexican Americans.

BACKGROUND AND OBJECTIVES: Prior studies examining depression among older Mexican Americans suggest both women and immigrants are at higher risk of depressive symptomatology than males and U.S.-born Mexican Americans. We use data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine whether life expectancy with depression and without depression varies by nativity, age of migration, and gender. RESEARCH DESIGN AND METHODS: Sullivan-based life tables were used to estimate depression life expectancies among Mexican Americans aged 65 years and older residing in the Southwestern United States. Depression is based on the 20-item Center for Epidemiological Studies Depression scale (CES-D). The CES-D is a continuous scale (0-60) with higher values indicating worse mental health. We dichotomize depression as a score of 16 or greater. RESULTS: Immigrant women, particularly those who migrated in late-life (after age 50) are at a significant disadvantage in the number of years after age 65 lived with depression and the ratio of years spent without depression relative to U.S.-born women. Among men, only late-life immigrants were disadvantaged in the number of years spent with depression. Early- and mid-life immigrant males did not differ from U.S.-born males. DISCUSSION AND IMPLICATIONS: Our results highlight the heterogeneity among older Mexican Americans in life expectancies with depression. These findings illustrate the importance of considering age of migration as a high-risk factor for depression among Mexican-origin immigrants. Including this risk factor as a part of depression screening is a key step for timely interventions in preventing disability and comorbidities associated with untreated depression.

Age of Migration Life Expectancy with Functional Limitations and Morbidity in Mexican Americans.

The U.S. Mexican American population enjoys longer life expectancies relative to other racial/ethnic groups but is disproportionately affected by chronic conditions and functional limitations. Studying the impact of heterogeneity in age, time and other characteristics of migration among older Mexican Americans can inform our understanding of health disparities and healthcare needs in later-life. This research used 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to assess the proportion of life spent with functional limitations and one or more morbidity (according to age of migration and sex) in the U.S. Mexican-American population. The results indicate that early-life and late-life migrant women spend more years with Performance-Oriented Mobility Assessment limitations than U.S.-born women. Conversely, midlife migrant women were not statistically different from U.S.-born women in years spent disabled. In men, midlife migrants had longer life expectancies and had more disability-free years than U.S.-born men. For morbidity, late-life migrant women spent a significantly smaller proportion of their elderly years with morbidity than U.S.-born women, but late-life migrant men spent more years with morbidity than U.S.-born men. These findings illustrate that older Mexican Americans in the United States are heterogeneous in nativity and health outcomes. More years spent disabled or unhealthy may result in greater burden on family members and greater dependence on public resources. These findings have implications for the development of social and health policies to appropriately target the medical conditions and disabilities of older Mexican Americans entering late life.

Life-Space Mobility and Cognitive Decline Among Mexican Americans Aged 75 Years and Older.

OBJECTIVES: To examine the association between life-space mobility and cognitive decline over a five-year period among older Mexican Americans. DESIGN: Longitudinal study. SETTING: Hispanic Established Population for the Epidemiologic Study of the Elderly survey conducted in the southwestern of United States (Texas, Colorado, Arizona, New Mexico, and California). PARTICIPANTS: Four hundred thirty-two Mexican Americans aged 75 and older with normal or high cognitive function at baseline. MEASUREMENTS: Socio-demographic factors, living arrangement, type of household, social support, financial strain, self-reported medical conditions, Mini-Mental State Examination (MMSE), depressive symptoms, activities of daily living (ADLs), and Short Physical Performance Battery. Life-space assessment (LSA) during the past 4 weeks was assessed during in-home interview. Scores ranged from 0 (daily restriction to the bedroom) to 120 (daily trips outside of their own town without assistance) and categorized as 0 to 20, 21 to 40, 41 to 60, 61 to 80, and 81 to 120. Because of the small sample size in the category of 81 to 120, the two highest categories were combined into a single group. RESULTS: The mean LSA score and MMSE score of participants at baseline was 44.6 (Standard Deviation [SD], 20.7) and 25.7 (SD, 3.2), respectively. Mixed Model analyses showed that participants in the highest life-space category (≥61) experienced slower rates of cognitive decline over time compared to participants in the lowest category (0 to 20) (ß = 1.03, Standard Error [SE] = 0.29, P = 0.0004), after adjusting for all covariates. CONCLUSION: Greater life-space mobility at baseline was predictor of slower rates of cognitive decline over 5 years in older Mexican Americans.