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Objective. Examine differences in health care expenditures between foreign-born and U.S.-born adults in late mid-life, and how these differences change after age 65, when Medicare is near-universal. Data. Medical Expenditures Panel Survey data (2000-2010) on adults ages 5575 years [n = 46,132) to examine annual total and payer-specific expenditures. Study Design. We use (1) propensity score matching to generate quasi-experimental samples with equivalent health needs and health care preferences, (2) generalized linear modeling to estimate group differences in expenditures, and (3) bootstrapping methods to obtain variance estimates for significance testing. Principal Findings. Among adults ages 55-64, the foreign-born spend $3,314 (p < .001) less on health care, even when they have equivalent health needs and health care preferences. This difference is due mainly to lower spending through private insurance. After age 65, differences in total spending disappear but not differences in payer-specific spending. The foreign-born continue to spend significantly less through private insurance and begin to spend significantly more through Medicare and Medicaid. Conclusion. Foreign-bom adults in late mid-life spend significantly less on health care than U.S.-born adults. After age 65, with near-universal Medicare coverage, differences in total spending disappear between the groups, although differences in spending by payer persist. Key Words. Medicare, health expenditures, insurance, immigrant health care, disparities, The United States is undergoing a major change in the demographic composition of older adults, including substantial growth in the proportion who are foreign-born. Recent projections suggest that the share [...]

OBJECTIVE -- Epidemiological studies have demonstrated that older Mexican Americans are at high risk for type 2 diabetes and its complications. Type 2 diabetes leads to a more rapid decline [...]

Research on incidence of mental depression in Sacramento, California's Mexican American aged found that the general prevalence of depression in the population was 25.4%. Men were significantly less likely than women to experience depression, at 16.3% to 32% respectively. Respondents who were least acculturated showed a higher risk of depression than those who were more acculturated.

Many sleep-wake behaviors have been associated with cognition. We examined a panel of sleep-wake/activity characteristics to determine which are most robustly related to having low cognitive performance in midlife. Secondarily, we evaluate the predictive utility of sleep-wake measures to screen for low cognitive performance.

The informal home care received by non-Hispanic whites are compared with those of Latinos and African Americans. It is observed that Latinos receive more hours of informal care than the average Americans and non-Hispanic whites for activity of daily living or instrumental activity of daily living disabilities.

Baseline data from an epidemiological cohort study has been analyzed to estimate p revalence of dementia in older Mexican Americans, determine the distri bution of dementia by etiology , and investigate the contributions of stroke, type 2 diabetes mellitus, and apolipoprotein E (ApoE) genotype. It was found that dementia prevalence is similar to that reported in Canadian and European studies, but lower than in Caribbean-Hispanics living in the US. The fraction of dementia attributable to st roke and type 2 diabetes mellitus is substangial. The allele frquency of ApoE was similar to that in other published studies on Me xican Americans. The E4 allele appears with low frequncy vs older people of European background.

Introduction:A healthy diet may promote healthy cognitive aging; however, little is known about associations between diet quality and cognition in Hispanics/Latinos.Hypothesis:Higher diet quality (2010 Alternative Healthy Eating Index; AHEI-2010) is associated with better global cognition and performance on specific cognitive tests (verbal learning, memory, verbal fluency, and processing speed) in Hispanics/Latinos.Methods:Data from HCHS/SOL Visit 1 (2008-2011; n=8461; ages 45-74 years) were analyzed. The global cognition score was computed as the sum of z-scores for the individual tests. Dietary intake was assessed via two 24-hour recalls. Total AHEI-2010 score was categorized into quintiles (Q); higher Q represents higher diet quality. Cross-sectional associations between AHEI-2010 and each cognitive test were examined using survey-weighted linear regression models adjusted for age, sex, education, and total daily energy intake (Model 1); and Model 1 plus Hispanic/Latino heritage, annual household income, language preference, type 2 diabetes, smoking, and depressive symptoms (Model 2).Results:In minimally-adjusted models (Table 1), global cognition, verbal learning, verbal memory, verbal fluency, and processing speed scores were significantly higher by 1.32, 2.38, 1.40, 2.33, and 1.34 units for Q5 (vs. Q1). In fully-adjusted models, global cognitive function scores were significantly higher by 0.28, 0.52, and 0.48 units for Q2 through Q4 (vs. Q1; p-trend= 0.042). Verbal learning scores were significantly higher by 0.60, 0.62, 0.92, and 0.88 units for Q2 through Q5 (vs. Q1; p-trend= 0.020). Verbal memory scores were significantly higher by 0.33, 0.40, 0.52, and 0.46 units for Q2 through Q5 (vs. Q1; p-trend= 0.007). AHEI-2010 was not associated with verbal fluency and processing speed in Model 2.Conclusions:Among middle-aged and older Hispanics/Latinos, higher diet quality was associated with better global cognition, verbal learning, and memory, but not with verbal fluency, or processing speed.

Objective:The AHA Life’s Simple 7 (LS7) defines cardiovascular health with smoking, physical activity, diet quality, body mass index (BMI), blood pressure, total cholesterol, and blood glucose. We examined changes in LS7 score and its components in older adults over seven years of follow-up.Methods:We analyzed 2,234 adults aged 65+ in the Cardiovascular Health Study who had all LS7 components measured at baseline (1989) and seven years later (1996). We scored each component as ideal (2), intermediate (1), or poor (0). LS7 score was the sum of components, ranging from 0 (worst) to 14 (best), then categorized as ideal (10-14), intermediate (5-9), or poor (0-4).Results:Mean LS7 score at baseline was 8.71, declining by 0.24 points (95% CI: 0.17, 0.31) to 8.47 seven years later. At baseline, LS7 score was ideal in 35% of participants, intermediate in 63%, and poor in 1.7%. Seven years later, the distribution shifted down, with 31% scoring ideal, 67% scoring intermediate, and 2.0% scoring poor. Of those scoring ideal at baseline, 57% (95% CI: 53%, 60%) maintained ideal scores seven years later (Figure, Panel A). Of those scoring intermediate at baseline (Panel B), 18% (95% CI: 16%, 20%) improved to ideal. Of those scoring poor at baseline (Panel C), 76% (95% CI: 63%, 90%) improved to intermediate, but none improved to ideal. For components, maintenance of baseline ideal status was 95% for smoking, 86% for glucose, 80% for BMI, 77% for cholesterol, and 55% for physical activity, but only 35% for blood pressure and 7% for diet (Panel A). Decline of baseline intermediate status to poor was 33% for blood pressure and 24% for diet (Panel B). Improvement of baseline poor status to intermediate or ideal was >50% for cholesterol and physical activity and >40% for smoking and diet (Panel C).Conclusions:While cardiovascular health declined on average in an aging population, some older adults improved their cardiovascular health as they aged. Declines in diet quality and blood pressure control contributed to overall declines in cardiovascular health.

Objective:The AHA Life’s Simple 7 (LS7) defines cardiovascular health with smoking, physical activity, diet quality, body mass index (BMI), blood pressure, total cholesterol, and blood glucose. We examined associations of LS7 score and its components with cognitive decline in older adults.Methods:The Cardiovascular Heart Study is a longitudinal cohort of 5,888 adults aged 65 and above. We analyzed 4,165 who had LS7 score measured at baseline (1989), complete covariate data, and at least one Modified Mini-Mental State Examination (3MS) score during follow-up (through 1998). We scored each LS7 component as ideal (2), intermediate (1), or poor (0), summed all components to a total LS7 score ranging from 0 (worst) to 14 (best), and categorized total LS7 score as ideal (10-14), intermediate (5-9), or poor (0-4). 3MS is a measure of global cognition ranging from 0 (worst) to 100 (best) and was obtained annually during a mean follow-up of 6.8 years. Using linear mixed models, we estimated associations of LS7 score and its components with annual rate of cognitive decline, adjusted for demographic, behavioral, and clinical factors.Results:In adjusted models, mean annual decline in 3MS score was 0.83 points (95% CI: 0.61, 1.04) for those with poor LS7 scores at baseline, 0.63 points (95% CI: 0.59, 0.67) with intermediate scores, and 0.42 points (95% CI: 0.37, 0.47) with ideal scores (p < 0.0001 for difference in mean annual decline across LS7 categories). Better physical activity, diet quality, blood pressure control, and blood glucose control were all associated with slower cognitive decline (Table). BMI, however, was opposite, with obesity (poor) associated with slower decline, and normal weight (ideal) associated with faster decline (p <0.0001).Conclusions:Better cardiovascular health measured by LS7 in old age is associated with slower average cognitive decline. The role of BMI as a component of LS7 in older adults may warrant reconsideration, as lower BMI in late-life may represent frailty and increased risk for cognitive decline.