English Language Use,Health and Mortality in Older Mexican Americans

The purpose of this study is to determine if English language use is associated with smoking, diabetes, hypertension, limitations in Activities of Daily Living (ADL), and 12-year mortality in older Mexican Americans. Using data from a cohort of 3,050 Mexican Americans aged 65 years and older, we examined prevalence of 4 health indicators and survival over 12 years of follow-up by English language use. English language use is associated with increased odds of hypertension in men, independent of nativity and sociodemographic control variables. Among women, English language use is associated with lower odds of ADL limitations and increased odds of smoking. The associations for women were partially explained by occupational status and nativity. After adjusting for health conditions, sociodemographics, and nativity, English language use was associated with increased mortality among men. Interaction terms revealed that for both men and women, higher English language use was associated with mortality for respondents with the highest level of income only. English language use is a predictor of health and mortality in older Mexican Americans separate from country of birth.     

Depressive Symptoms and Mortality in Older Mexican Americans

PURPOSE: We examined the prevalence of comorbid depressive symptomatology and leading chronic medical conditions, and their influence on death rates in older Mexican Americans.METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) were used. Differences in death rates across sociodemographics, self-ratings of health, and health conditions were examined with analysis of variance statistics. Logistic regression models were used to examine main effects and interaction effects of each medical condition separately and in conjunction with depressive symptomatology.RESULTS: Bivariate analyses indicated that death rates were substantially higher when a high level of depressive symptoms was comorbid with diabetes (OR = 3.84, 95% CI = 2.55–5.78), cardiovascular disease (OR = 4.04, 95% CI = 2.36–6.91), hypertension (OR = 2.27, 95% CI = 1.57–3.27), stroke (OR = 3.00, 95% CI = 1.44–6.15), and cancer (OR = 4.46, 95% CI = 2.48–8.01). Multivariate analyses indicated a synergistic effect for comorbid diabetes and depressive symptoms such that the odds of having died among diabetics with high levels of depressive symptoms (OR = 4.03, 95% CI = 2.67–6.11) were three times that of diabetics without high levels of depressive symptoms (OR = 1.36, 95% CI = 0.89–2.06).CONCLUSIONS: High levels of depressive symptoms concomitant with major chronic medical conditions elevate the risk for death among older Mexican Americans. Given the fact that depression is often unrecognized and undertreated in the elderly, awareness of the potential for loss of life as well as the potential for treatment may help to improve this situation not only for older Mexican Americans, but for older adults in general.     

Diet Quality and Health in Older Americans

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged ≥50 years, from the Health and Retirement Study (HRS) 2010–2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2% vs. 19.6%, p < 0.01) and depression (11.8% vs. 14.9%, p < 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, p < 0.05), cystatin C (1.1 vs. 1.2, p < 0.1), total cholesterol (192.1 vs. 196.4, p < 0.1), and high-density lipoprotein (57.2 vs. 53.8, p < 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.     

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.     

Exploring the Food and Health Attitudes of Older Americans

Abstract

What older individuals choose to eat reflects not only on their food preferences but on their life experience and attitudes as well. This paper discusses attitudes that shape food choices of older individuals and the implication of this information for groups that target this population with health and food information.     

Muscle Strength and Functional Limitations: Preserving Function in Older Mexican Americans

Objectives

Understanding the role of muscle strength as a preventive factor for shorter-term declines in function may provide further insights into the disabling process. This study examined if muscle strength was associated with 2-year preservation of instrumental activities of daily living (IADL) function and activities of daily living (ADL) disability status in older Mexican Americans.

Public Health Options for Improving Cardiovascular Health Among Older Americans

Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices.Public health and medical advances continue to beneficially affect the health of Americans. Life expectancy at birth increased from 74 years in 1980 to 78 years in 2006.1 In 2006, people at age 65 could expect to live an average of 17 to 20 additional years, an increase of about 1 year since 2000.1 The percentage of the US population older than 65 years is expected to grow from about 12% in 2007 to about 20% by 2050, with a doubling of the population older than 75 years.1 Furthermore, the older adult population is becoming more ethnically and racially diverse through changing demographics and increased life expectancy for all Americans.Despite significant improvements in treatment and prevention, heart diseases and stroke have been leading causes of death in the United States for almost a century.2 They also are leading causes of disability and poor health-related quality of life,3,4 and cost an estimated $273 billion in direct medical costs per year.5 The majority of those who die from heart disease and stroke are 65 years old or older.6 Furthermore, as life expectancy increases, greater numbers of older adults are living with cardiovascular (CV) conditions,7 which are frequently experienced with comorbid physical and mental conditions as well as social challenges. In their efforts to prevent and control CV conditions among older Americans, public health workers must consider these additional factors.Although the prevalence of CV disease in the US population increases with age, it is not a normal process of aging. For those who survive to older adult years, health status is the result of cumulative exposures and health conditions throughout one’s life. The associations between risk factors and health and illness may be different for older versus younger cohorts because of the effects of survivor biases or comorbid conditions. These elements suggest that a lifespan approach is useful to investigating and improving CV health and reducing disease burden, since prevention can occur at all ages.As increasing numbers of older adults live with CV disease and other chronic conditions, their physical, mental, and social functioning, as well as quality of life, are affected. For older adults in particular, a goal of public health has been to postpone and reduce years of ill health into fewer years before death, a “compression of morbidity.”8,9 Factors affecting successful aging that intersect with promoting and maintaining CV health include disability and comorbidity, independence and functional ability, and cognitive health. Challenges associated with the prevention and treatment of CV conditions in older adults include attitudes about the value of medical expenditures for people with limited life years remaining, decisions about extending life versus maintaining optimum quality of life, competing risks, greater medication use leading to potential drug interactions, changes in the risk-to-benefit ratio of interventions for older vs younger adults, and insufficient evidence of the effectiveness of particular interventions in older populations.We discuss several issues of health and healthy aging for older adults. Although we focus on those aged 65 years and older, we also discuss some issues for those at younger ages, since health in earlier years affects outcomes in later years of life. We focus on heart diseases and stroke as major CV conditions. Although peripheral vascular conditions are included as CV diseases, we do not discuss them. CV health is more difficult to define from a public health perspective. Recent American Heart Association health goals refer to CV health as optimal risk factor levels and the absence of CV conditions.10 Public health approaches for improving CV health and healthy aging will benefit from a multilevel, multisectoral approach at the state and local public health level that includes consideration of these multiple issues.     

Using the Revised Acculturation Rating Scale for Mexican Americans (ARSMA-II) with Older Adults

Projections for the year 2030 show that Latinos are expected to make the largest population increase. Cultural values create expectation levels about what will happen to the elderly. Acculturation is a concept that has been studied extensively, yet the relationship between age and acculturation has not been a focus of study. The present study has proposed an alternate way of scoring the ARSMA-II based on receiver operating characteristics. Specifically, this approach looks at participants' responses to two individual items to determine the level of acculturation of the older adults. It is a quicker method and one that could save healthcare providers a great deal of time as well as help them better understand their clients' level of acculturation; thus, being able to provide the appropriate educational materials.     

Differences In Nutritional And Physical Health Indicators Among Older African Americans,European Americans,And Hispanic Americans

Abstract

Inadequate protein intake contributes to poor nutritional status, reduced muscle mass, strength and function, and increased mortality. Evaluating differences in protein intake and related health indicators among racial/ethnic groups enables the development of targeted interventions. This study’s purpose was to determine differences in protein intake, nutritional status, and muscle strength/function among 273 older African, European, and Hispanic Americans. Protein intake, nutritional status, grip strength, timed-up-and-go (TUG), and chair stand assessments were conducted. Protein intake was significantly greater among Hispanic Americans (0.96?g/kg body weight) followed by European Americans (0.83?g/kg body weight), and African Americans (0.64?g/kg body weight). Intakes by all groups were below recommendations. Low nutritional status, grip strength, chair rise, and TUG scores were observed in African Americans and European American females and were consistent with lower protein intakes. Results show significant differences among the groups and the need for interventions to improve diet and physical health.     

Depressive symptoms among Mexican Americans: the Hispanic Health and Nutrition Examination Survey

This paper presents findings on depressive symptomatology among 3,118 Mexican-American adults who participated in the Hispanic Health and Nutrition Examination Survey (HHANES). In 1982-1984, the National Institute of Mental Health Center for Epidemiologic Studies Depression Scale was administered to Mexican Americans aged 20-74 years as part of the HHANES examination component. Respondents reported in either English or Spanish on both the presence and persistence of depressive symptoms during the week prior to the interview. The caseness rate (high levels of depressive symptoms) was 13.3%. Factors associated with increased risk of high levels of depressive symptoms were female sex, low educational achievement, low income, and US birth combined with Anglo-oriented acculturation. There were no significant differences by language. The relatively low prevalence rate and the increased risk associated with US birth/Anglo-oriented acculturation indicate the need for more multifactor studies and the investigation of possible additional factors that may contribute to the mental health of Mexican Americans.     

Health practices among Mexican Americans: Further evidence from the human population laboratory studies

Data are presented from sample surveys conducted in 1974 (N = 3,119) and 1975 (N = 657) in Alameda County, California, comparing discretionary health practices of Mexican Americans, Blacks, and Anglos. Practices include hours of sleep, regularity of meals, physical activity, obesity, smoking and drinking. Analyses reported focus on a summary measure of health practices and measures of smoking and exercise. Comparisons of crude percentages indicate that while there are differences among the groups, they are not dramatic. In general, Mexican Americans report fewer overall health practices, less exercise, and less smoking than Anglos. Controlling for the effects of age, sex, income, education, perceived health, health status, and use of health examinations reduces differences in overall health practices by decreasing Anglo rates and increasing rates for Chicanos and Blacks. However, even after adjustment for demographic and socioeconomic differences, rates remain lower for the two minority groups. Controlling for the effects of the eight covariates also reduces ethnic differences in exercise, but Chicanos still rank the lowest in terms of reported physical activity. By contrast, adjustment for demographic and socioeconomic differences does not reduce ethnic differentials in smoking behavior. Before and after adjustment Chicanos smoke least and Blacks smoke most. In general, controlling for socioeconomic status and health has the most effect, while some additional explanation is provided by age and sex. Overall, however, ethnicity and the covariates account for less than 10% of the variance in smoking and overall health practices, and less than 20% of the variance in exercise.     

Gender Differences in Participation and Responsiveness to a Health Intervention for Older Americans

ABSTRACT

Women increasingly outnumber men in the US population (Arber & Ginn, 1993), but most research has been conducted with men (Stacey & Olesen, 1988). The purpose of this study was to determine whether older men and women differ in their participation rates and in their responsiveness to a health intervention. Three hundred sixty-three health maintenance organization members with osteoarthritis, 60 years of age or older, were randomly assigned to a control group or to receive social support, education, or a combination of education and social support. Of the 363 randomly assigned members, 245 completed all of the follow-up assessments. Men and women volunteered in proportion to their representation in the osteoarthritis population. Although the genders differed in several ways, the interventions were equally effective for men and women, and the study results applied to both genders.     

The prevalence of intrauterine growth retardation in Mexican Americans.

This study evaluated the prevalence of intrauterine growth retardation in Mexican Americans compared with non-Hispanic Whites in the state of Arizona. Data came from all live birth certificates in 1986 and 1987. Rates of intrauterine growth retardation in Mexican-American and non-Hispanic White infants in Arizona were lower than those in White infants in California. Differences in patterns of the 10th percentile growth distribution curves were observed between infants born in Arizona and those born in California. Compared with non-Hispanic Whites, Mexican Americans had lower adjusted odds ratios for intrauterine growth retardation according to several maternal risk characteristics.     

Health Literacy,Depression Literacy,and Depression among Older Korean Americans

The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.     

Ozone Exposure,Outdoor Physical Activity,and Incident Type 2 Diabetes in the SALSA Cohort of Older Mexican Americans

Background: Type 2 diabetes is a leading contributor to the global burden of morbidity and mortality. Ozone (O3) exposure has previously been linked to diabetes.Objective: We studied the impact of O3 exposure on incident diabetes risk in elderly Mexican Americans and investigated whether outdoor physical activity modifies the association.Methods: We selected 1,090 Mexican American participants from the Sacramento Area Latino Study on Aging conducted from 1998 to 2007. Ambient O3 exposure levels were modeled with a land-use regression built with saturation monitoring data collected at 49 sites across the Sacramento metropolitan area. Using Cox proportional hazard models, we estimated the risk of developing incident diabetes based on average O3 exposure modeled for 5-y prior to incident diabetes diagnosis or last follow-up. Further, we estimated outdoor leisure-time physical activity at baseline and investigated whether higher vs. lower levels modified the association between O3 exposure and diabetes.Results: In total, 186 incident diabetes cases were identified during 10-y follow-up. Higher levels of physical activity were negatively associated with incident diabetes [hazard ratio (HR)=0.64 (95% CI: 0.43, 0.95)]. The estimated HRs for incident diabetes was 1.13 (95% CI: 1.00, 1.28) per 10-ppb increment of 5-y average O3 exposure; also, this association was stronger among those physically active outdoors [HR=1.52 (95% CI: 1.21, 1.90)], and close to null for those reporting lower levels of outdoor activity [HR=1.04 (95% CI: 0.90, 1.20), pinteraction=0.01].Conclusions: Our findings suggest that ambient O3 exposure contributes to the development of type 2 diabetes, particularly among those with higher levels of leisure-time outdoor physical activity. Policies and strategies are needed to reduce O3 exposure to guarantee that the health benefits of physical activity are not diminished by higher levels of O3 pollution in susceptible populations such as older Hispanics. https://doi.org/10.1289/EHP8620