Late-life food insecurity and cognition: exploring timing, duration, and mechanisms among older Mexican adults.

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.

Education and cognitive function among older adults in Brazil and Mexico.

Education is protective against cognitive impairment. We used nationally representative data from Mexico and Brazil to assess the association between education and cognitive function. The sample included adults ≥ 50 years from the Brazilian Longitudinal Study of Aging (ELSI) and the Mexican Health and Aging Study (MHAS). Participants were classified as cognitively impaired or not impaired. We used logistic regression models to estimate the association between education and cognitive function. Education level was higher in MHAS than in ELSI. Participants with at least 1 year of education were less likely to have cognitive impairment than those with no formal education in both cohorts. Men in ELSI had higher odds for cognitive impairment compared to men in MHAS. In both cohorts, higher educational level was associated with lower odds of cognitive impairment compared to no formal education. Sex was an effect modifier in MHAS but not in ELSI. HIGHLIGHTS: Cognitive test batteries were harmonized using a regression-based approach.Even very low levels of education were associated with reduced odds of cognitive impairment compared to no formal education.Brazilians were more likely to have cognitive impairment than Mexicans given the same education level.The differences in the association of education with cognition between Brazil and Mexico were only observed among men.

Advanced Activities of Daily Living in Community-Dwelling Older Adults: A Cross-Sectional Study of the Mexican Health and Aging Study (MHAS 2018).

BACKGROUND: The advanced activities of daily living (AADLs) in old age is a key indicator of the mobility domain for the intrinsic capacity of older adults living in the community; for this reason, it is relevant to know the prevalence and risk factors related to performing fewer AADLs in different populations. AIM: To determine the prevalence and factors associated with the ability to perform AADLs in older adults reported in the Mexican Study of Health and Aging (MSHA 2018). METHODS: A secondary cross-sectional analysis of the MSHA 2018 data was carried out, including a convenience sample of 6474 subjects ≥ 60 years of age, for both sexes, without cognitive deficits. Nine questions related to AADLs were selected from the database. Multiple logistic regression analysis was performed to determine factors associated with <3 AADLs, including sociodemographic, lifestyle, and health status factors. RESULTS: The prevalence of the ability to perform <3 AADLs was 63%. Age is the most important risk factor for <3 AADLs, which increases by the decade, followed by sedentary lifestyle (OR = 2.15, 95% CI: 1.91-2.42, p < 0.0001). CONCLUSIONS: Our findings suggest that age, schooling, urban residence, sedentary lifestyle, and comorbidity are the main risk factors for <3 AADLs in older Mexican adults.

Cognition in older adults with healthy aging: analysis of the Mexican Health and Aging Study 2012-2015.

Introduction: Maintaining older adults' health and well-being can be achieved through the optimization of physical and mental health, while preserving independence, social participation, and quality of life. Cognitive change has been described as a normal process of aging and it involves domains such as processing speed, attention, memory, language, visuospatial abilities, and executive functioning, among others. Objective: To describe cognitive changes in older adults with healthy aging. Methods: This is a study that involved data from 14,893 and 14,154 individuals aged >60 years or older from the 2012 and 2015 waves, respectively, who participated in the Mexican Health and Aging Study (MHAS). Participants with healthy aging were identified and described in the MHAS-2012 wave and followed to 2015. Eight cognitive domains evaluated in the Cross-Cultural Cognitive Evaluation (CCCE,) as well as sociodemographic and health characteristics, were described. Criteria for healthy aging involved the following: CCCE ≥ -1.5 standard deviations above the mean on reference norms, independence on basic and instrumental activities of daily living, self-reported "life close to ideal," and preserved functional and social performance. Results: From a total of n = 9,160 older adults from the MHAS-2012 wave, n = 1,080 (11.8%) had healthy aging. In the healthy aging group, the median age was 67 years (IQR: 63-73), 58.1% were female and the median for education was 6 (IQR: 3-8) years. The mean CCCE score was 57 (SD: 16.9) points. In the MHAS-2012 cross-sectional analysis, except for orientation, visuospatial abilities, and verbal fluency, all cognitive domain scores were lower with passing age. When comparing cognitive domain scores in the 225 older adults identified with healthy aging between the 2012 and 2015 MHAS waves, there were almost no observable differences. Conclusion: In the cross-sectional analysis, Mexican adults with healthy aging had lower scores in the verbal learning memory, visual scanning, numeracy, visual memory, and verbal recall domains', as well as lower global cognitive scores in the higher age groups. There were no cognitive changes in the 3 year follow-up, except for a lower gradient of scores in the verbal recall memory domain. Longer prospective studies are needed to characterize greater cognitive changes.

Economic Resources and Health: A Bi-Directional Cycle for Resilience in Old Age.

Objectives: The paper offers an expanded framework for conducting empirical research on resilient aging. Methods: We review the conceptual frameworks for resilient aging and incorporate the role of economic factors as resources that contribute to resilience, in addition to social and psychological factors emphasized in the existing literature. Moreover, the idea of reinforcing cycles of resilience is incorporated in the framework. Existing empirical evidence that supports the conceptual arguments is presented. Results: Examples from Mexico and other low-middle-income countries are included, as well as from high-income countries. Data requirements for applying the conceptual framework in empirical analysis and the state of data availability are examined. We illustrate the measures that are available for this purpose using the Mexican Health and Aging Study. Discussion: We discuss and conclude that the state of the field is rich in data to conduct empirical work on resilience in old age.

Health Shocks and Economic Well-being of the Aging Population: Evidence from Mexico.

We exploit the longitudinal Mexican Health and Aging Study to estimate the effects of health shocks in the short-run on the subsequent economic well-being of the aging population in Mexico. While there is substantial evidence indicating negative economic effects of such changes in industrialized countries, little is known about health impacts on the future economic position of older adults in low- and middle-income countries. This paper takes an important step towards filling this gap in knowledge. Our results are widely relevant, with a large percentage of the world's population residing in developing countries such as Mexico that are experiencing rapid aging. We find evidence of negative impacts of health shocks on subsequent economic well-being of older adults in Mexico, but the effect varies according to several dimensions. First, the impact is clearly on income, not wealth. Second, responses are heterogenous across sources of income, with evidence of an impact mainly on labor income. Third, we find clear differences by gender in the impact of a health shock, with a larger negative impact on men. Fourth, we conclude that the population groups most negatively affected are those with the greatest degree of vulnerability prior to the shock, as measured by education and access to health insurance. Even though Mexico has made important gains with anti-poverty programs such as the Programa 70+ pension and a move towards universal health insurance, additional interventions targeted at the most vulnerable subsets of the aging population might be warranted.

Who Works Less When a Parent Needs Long-Term Care? Gender Disparities in Labor Market Effects in Mexico.

We use longitudinal data from the Mexican Health and Aging Study to analyze the effect of having a parent in need of long-term care on labor supply of men and women aged 50-64 in Mexico. After accounting for both individual and time fixed effects, we find that parents' need of long-term care is associated with both a significant drop in the likelihood of working (by 2.42 percentage points), and a reduction in the number of hours worked (by 7.3%) among women who remain employed. In contrast, we find no effect on the labor supply of men. In a context of rapid population aging, the increase in the need of long-term care risks to hinder the efforts to reduce gender imbalances in the labor market.

Trajectories of frailty and related factors of elderly people in Mexico.

Introduction: Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. Methods: Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it. Results: Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. Conclusion: The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.

Introducción: La fragilidad es un indicador del estado de salud en la vejez y un síndrome clínico común en los adultos mayores que conlleva un mayor riesgo de resultados de salud deficientes, que incluyen caídas, incidentes de discapacidad, hospitalización y mortalidad. Este estudio tuvo como objetivo identificar las diferentes trayectorias de la fragilidad y los factores relacionados con ésta entre los adultos mayores mexicanos a lo largo del tiempo. Metodología: Los datos provienen de un panel de cuatro ondas compuesto por adultos mayores mexicanos de 2001 a 2015 del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). La fragilidad es la acumulación de déficits utilizando un índice de fragilidad. Se aplicó un análisis multinivel, utilizando modelos jerárquicos, para conocer los cambios de trayectorias de fragilidad y qué factores se relacionan con ella. Resultados: Ser mujer, ser mayor, ser viuda y tener un menor nivel de educación fueron factores de riesgo para tener un índice de fragilidad alto y una menor satisfacción financiera o realizar actividades en el hogar tienen efectos adversos. Conclusiones: Los hallazgos de este trabajo presentan información acerca de la prevalencia de la fragilidad considerando la proporción de déficits que poseen los individuos y sus primordiales componentes asociados en adultos mayores mexicanos. Se requiere mejorar las condiciones socioeconómicas de salud en fases previas a la vejez para evitar desarrollar fragilidad en el futuro.

Trayectorias de fragilidad y factores relacionados en la población de adultos mayores en México / Trajectories of frailty and related factors of elderly people in Mexico

Resumen Introducción: la fragilidad es un indicador del estado de salud en la vejez y un síndrome clínico común en adultos mayores; conlleva un elevado riesgo de resultados deficientes de salud que incluyen caídas, incidentes de discapacidad, hospitalización y mortalidad. Este estudio tuvo como objetivo identificar las diferentes trayectorias de la fragilidad y los factores relacionados con esta entre adultos mayores mexicanos a lo largo del tiempo. Metodología: los datos provienen de un panel de cuatro rondas compuesto por adultos mayores mexicanos y desarrollado de 2001 a 2015 por el Estudio Nacional de Salud y Envejecimiento en México (ENASEM). La fragilidad es la acumulación de déficits a partir de un índice de fragilidad. Se aplicó un análisis multinivel, utilizando modelos jerárquicos para conocer los cambios de trayectorias de fragilidad y qué factores se relacionan con ella. Resultados: ser mujer mayor, viuda y tener un bajo nivel educativo fueron factores de riesgo para un índice de fragilidad alto y una menor satisfacción financiera o realizar actividades en el hogar tienen efectos adversos. Conclusiones: se halló una prevalencia de la fragilidad según la proporción de déficits que poseen los individuos y sus primordiales componentes asociados. Se requiere mejorar las condiciones socioeconómicas de salud en fases previas a la vejez con miras a evitar la presencia de fragilidad en el futuro.

Abstract Introduction: Frailty is an indicator of health status in old age and a common clinical syndrome in older adults that carries an increased risk of poor health outcomes, including falls, incidents of disability, hospitalization, and mortality. This study aimed to identify the different trajectories of frailty and the factors related to frailty among Mexican older adults over time. Methods: Data are from a four-wave panel composed of older Mexican adults from 2001 to 2015 of the Mexican Health and Aging Study (MHAS). Frailty is the accumulation of deficits using a frailty index. A multilevel analysis, using hierarchical models, was applied to know the changes of frailty trajectories and what factors are related to it. Results: Being female, older, being widowhood, and having a lower level of education were risk factors for having a high frailty index and lower financial satisfaction doing activities at home have adverse effects. Conclusion: The findings of this work present information about the prevalence of frailty considering the proportion of deficits that individuals possess and their main associated components in older Mexican adults. It is necessary to improve socioeconomic health conditions in phases before old age to avoid developing frailty in the future.

Food Insecurity across the Life-Course and Cognitive Function among Older Mexican Adults.

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.

Rural/urban dwelling across the life-course and late-life cognitive ability in Mexico.

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.

Imputation of Non-Response in Height and Weight in the Mexican Health and Aging Study.

The way missing data in population surveys are treated can influence research results. Therefore, the aim of this paper is to explain the reasons and procedure for imputing anthropometric data such as height and weight self-reported by individuals in the first four waves of the Mexican Health & Aging Study (MHAS). We highlight the effect of the imputation versus the exclusion of the cases with missing data, by comparing the distribution of these values and their associated effects on the Body Mass Index using a regression model. We conclude that the incorporation of imputed data offers more solid results compared with elimination the cases with missing data. Hence the importance of applying these statistical procedures, with appropriate treatment of the data, making the methodology and the imputed data available to the users by the same source of information, as offered in the MHAS.

El manejo de los datos faltantes en entrevistas por encuestas puede influenciar los resultados de investigación. Por ello, el objetivo de este trabajo es explicar las razones y procedimiento para imputar datos antropométricos como la altura y peso auto reportado por los individuos en las primeras cuatro rondas del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Destacamos el efecto de la imputación versus la eliminación de los casos con datos faltantes, comparando la distribución de dichos valores y sus efectos asociados en el Índice de Masa Corporal mediante un modelo de regresión. Se concluye que la incorporación de datos imputados ofrece resultados más sólidos comparado con la eliminación de los casos con datos faltantes. De ahí la importancia de aplicar estos procedimientos estadísticos con tratamiento adecuado de los datos, y difundir la metodología aplicada para obtener los datos imputados desde la misma fuente de información, tal como se ofrece en el ENASEM.

Midlife Vascular Factors and Prevalence of Mild Cognitive Impairment in Late-Life in Mexico.

OBJECTIVE: To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes and investigate the impact of midlife cardiovascular risk factors on late-life MCI among the aging Mexican population. METHOD: Analyses included a sample of non-demented adults over the age of 55 living in both urban and rural areas of Mexico (N = 1807). MCI diagnosis was assigned based on a comprehensive cognitive assessment assessing the domains of memory, executive functioning, language, and visuospatial ability. The normative sample was selected by means of the robust norms approach. Cognitive impairment was defined by a 1.5-SD cut-off per cognitive domain using normative corrections for age, years of education, and sex. Risk factors included age, education, sex, rurality, depression, insurance status, workforce status, hypertension, diabetes, stroke, and heart disease. RESULTS: The prevalence of amnestic MCI was 5.9%. Other MCI subtypes ranged from 4.2% to 7.7%. MCI with and without memory impairment was associated with older age (OR = 1.01 [1.01, 1.05]; OR = 1.03 [1.01, 1.04], respectively) and residing in rural areas (OR = 1.49 [1.08, 2.06]; OR = 1.35 [1.03, 1.77], respectively). Depression (OR = 1.07 [1.02, 1.12]), diabetes (OR = 1.37 [1.03, 1.82]), and years of education (OR = 0.94 [0.91, 0.97]) were associated with MCI without memory impairment. Midlife CVD increased the odds of MCI in late-life (OR = 1.76 [1.19, 2.59], which was driven by both midlife hypertension and diabetes (OR = 1.70 [1.18, 2.44]; OR = 1.88 [1.19, 2.97], respectively). CONCLUSIONS: Older age, depression, low education, rurality, and midlife hypertension and diabetes were associated with higher risk of late-life MCI among older adults in Mexico. Our findings suggest that the causes of cognitive impairment are multifactorial and vary by MCI subtype.

Imputation Procedures for Cognitive Variables in the Mexican Health and Aging Study: Evaluating the Bias from Excluding Participants with Missing Data.

Non-response of cognitive data in cohort studies is a barrier to cognitive aging research. We describe the procedures for the imputation of non-responses for cognitive data in the Mexican Health and Aging Study (MHAS). Data came from the 2001-2015 MHAS waves. We also describe the association of cognition with education, age, and other variables in 2015 with and without the imputed values. Between 12.3% and 37.9% of participants were missing data for at least one cognition variable. When we conducted the analysis with and without the imputed values, the relationships between education, age, and cognition were similar in direction and significance, but different in magnitude. Non-response of cognitive data is common and non-random in the MHAS. Investigators should use the data sets that include the imputed values, which are publicly available.

La no-respuesta en datos de cognición en estudios poblacionales dificulta la realización de investigaciones del envejecimiento cognitivo. Describimos procedimientos para imputarla en la Encuesta Nacional sobre Salud y Envejecimiento en México (ENASEM) del Instituto Nacional de Estadística y Geografía usando datos de las rondas 2001 a 2015. También, describimos la asociación de cognición con años de educación, edad y otras variables en el 2015, incluyendo y excluyendo los valores imputados. Entre 12.3 y 37.9% de los participantes tenían datos faltantes en una o más variables cognitivas. Tras comparar los análisis con y sin los valores imputados, las relaciones entre educación, edad y cognición fueron similares en dirección y significancia, pero diferentes en magnitud. Puesto que la no-respuesta en variables de cognición es común y no-aleatoria en la ENASEM, sugerimos que los investigadores usen las bases de datos con los valores imputados, las cuales se encuentran a disposición de los usuarios.

Social Engagement and Cognitive Function of Older Adults in Mexico and the United States: How Universal Is the Interdependence in Couples?

OBJECTIVES: Increased social engagement in older adults has been linked to positive cognitive outcomes; however, it is unclear if the social engagement of husbands and wives influences their own cognition as well as each other's cognition. Moreover, it is unknown if any such patterns persist in different country contexts. METHODS: Data from the 2001 Mexican Health and Aging Study (MHAS) and the 2000 Health and Retirement Study (HRS) were combined, and comparable samples of married couples without cognitive impairment at baseline were drawn. Follow-up cognition data was obtained from the 2012 MHAS and the 2012 HRS. Structural equation models (SEM) were used to test the actor-partner interdependence model with moderating effect of country on the association of social engagement with cognition. RESULTS: Significant actor effects were observed for wives in both countries. Actor effects for husbands were observed in the United States only. In Mexico, a significant partner effect was observed where wives' social engagement benefited their own cognition as well as their husbands', but not vice versa. Partner effects were not observed in the United States. No moderation effects of country were observed. DISCUSSION: Our results suggest asymmetric patterns of actor-partner interdependence in Mexico, which may be reflective of the more traditional social role of women, and codependence within the couple. On the other hand, our results for the United States, where each spouse had significant actor effects but no partner effects, may suggest more independence within the couple.

Malnutrition Risk among Older Mexican Adults in the Mexican Health and Aging Study.

Few studies assess the malnutrition risk of older Mexican adults because most studies do not assess nutritional status. This study proposes a modified version of the Mini Nutritional Assessment (MNA) to assess the risk of malnutrition among older Mexicans adults in the Mexican Health and Aging Study (MHAS). Data comes from the 2012, 2015, and 2018 waves of the MHAS, a nationally representative study of Mexicans aged 50 and older. The sample included 13,338 participants and a subsample of 1911 with biomarker values. ROC analysis was used to calculate the cut point for malnutrition risk. This cut point was compared to the definition of malnutrition from the ESPEN criteria, BMI, low hemoglobin, or low cholesterol. Logistic regression was used to assess predictors of malnutrition risk. A score of 10 was the optimal cut point for malnutrition risk in the modified MNA. This cut point had high concordance to identify malnutrition risk compared to the ESPEN criteria (97.7%) and had moderate concordance compared to BMI only (78.6%), and the biomarkers of low hemoglobin (56.1%) and low cholesterol (54.1%). Women, those older than 70, those with Seguro Popular health insurance, and those with fair/poor health were more likely to be malnourished. The modified MNA is an important tool to assess malnutrition risk in future studies using MHAS data.

Factors associated with pain at the end-of-life among older adults in Mexico.

OBJECTIVES: The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN: We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions during the last year of life of those who died. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS: The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in one or two waves (occasional and persistent), and the pain intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS: Pain was reported by 71.5% of older adults who died between 2001 and 2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (P < 0.05) and 0.55 for those with more than 7 years (P < 0.001). Poor self-reported health, arthritis, taking more medications, depression, and functional limitations in the wave prior to death were associated with higher odds of persistent pain at the end-of-life (P < 0.05). Conversely, older age, more years of education, and diabetes were associated with lower odds of persistent pain (P < 0.001). CONCLUSIONS: The prevalence of pain among older Mexican adults is high at the end-of-life. Sociodemographic factors, some chronic diseases, number of medications, psychosocial factors, and functional status impact the odds of reporting pain in this group at the end-of-life. Providing education to families on psychosocial interventions to improve the quality of care at the end-of-life is a pressing need in Mexico. These findings provide information to help policymakers and healthcare providers in Mexico improve the quality of care at the end-of-life.

Adultos mayores en riesgo de Covid-19 y sus vulnerabilidades socioeconómicas y familiares: un análisis con el ENASEM: Older adults at risk of Covid-19 and their socioeconomic and family vulnerabilities: an analysis with MHAS.

The objective of this manuscript is to analyze the socioeconomic and family characteristics of 50 years and older population who are at high risk of testing positive for Covid-19, being hospitalized or intubated in Mexico. We used two sources of information, the database of the Ministry of Health on Covid-19 and the Mexican Health and Aging Study in Mexico, in the first, regression models are estimated to calculate the risk and they are applied in the second to analyze socioeconomic and family vulnerabilities. Results show that gender and age are strong predictors of high risk. Those with less schooling, those who work without having a place, those who perceive their economic situation as fair or bad, as well as those who live in single-person households, receive financial and non-financial help from their children are presented as a highly vulnerable group to Covid-19 and its repercussions. It is necessary to develop strategies and support aimed to minimize the impacts of events such as the pandemic, ensure access to quality and timely health services, an economic income in accordance with the needs, and maintaining the standards of well-being of older adults.

The Mexican Cognitive Aging Ancillary Study (Mex-Cog): Study Design and Methods.

OBJECTIVE: Describe the protocol sample and instruments of the Cognitive Aging Ancillary Study in Mexico (Mex-Cog). The study performs an in-depth cognitive assessment in a subsample of older adults of the ongoing Mexican Health and Aging Study (MHAS). The Mex-Cog is part of the Harmonized Cognitive Assessment Protocol (HCAP) design to facilitate cross-national comparisons of the prevalence and trends of dementia in aging populations around the world, funded by the National Institute on Aging (NIA). METHODS: The study protocol consists of a cognitive assessment instrument for the target subject and an informant questionnaire. All cognitive measures were selected and adapted by a team of experts from different ongoing studies following criteria to warrant reliable and comparable cognitive instruments. The informant questionnaire is from the 10/66 Dementia Study in Mexico. RESULTS: A total of 2,265 subjects aged 55-104 years participated, representing a 70% response rate. Validity analyses showed the adequacy of the content validity, proper quality-control procedures that sustained data integrity, high reliability, and internal structure. CONCLUSIONS: The Mex-Cog study provides in-depth cognitive data that enhances the study of cognitive aging in two ways. First, linking to MHAS longitudinal data on cognition, health, genetics, biomarkers, economic resources, health care, family arrangements, and psychosocial factors expands the scope of information on cognitive impairment and dementia among Mexican adults. Second, harmonization with other similar studies around the globe promotes cross-national studies on cognition with comparable data. Mex-Cog data is publicly available at no cost to researchers.

Recovery from physical limitations among older Mexican adults.

OBJECTIVES: This paper examines the key determinants of the likelihood of recovery from a physical disability among older adults. METHODS: Data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003, 2012 and 2015. At baseline, we divided our sample of older adults aged 60+ by dimensions of physical limitations (ADLs, IADLs, mobility) and classified respondents as having physical limitations in zero, one, two or three dimensions. Each respondent was then categorized as "same", "worse", "improved" or "died" depending on the number of physical dimensions with a limitation in a 2-year span (2001-2003) and again, separately, in a 3-year span (2012-2015). We then used a multinomial logistic regression to analyze the relative risk of transitioning from one category to another. FINDINGS: Around 21 % of our sample exhibited some recovery in 2003 and around 20 % recovered in 2015. Age, gender, poor self-rated health, depression and some chronic conditions were significant for shifting the relative risk from staying the same to getting worse, dying or even improving. CONCLUSIONS: Disability from a physical limitation is a reversible and dynamic process. Our results reflect the importance of considering the dimensions of physical ability while analyzing recovery, and illustrate that the presence of a chronic condition or depressive symptoms does not necessarily imply permanent disability.