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Maximal handgrip strength (HGS) is a convenient and reliable, but incomplete, assessment of muscle function. Although low HGS is a powerful predictor of poor health, several limitations to maximal HGS exist. The predictive value of HGS is restricted because low HGS is associated with a wide range of unspecified health conditions, and other characteristics of muscle function aside from strength capacity are not evaluated. Current HGS protocol guidelines emphasize the ascertainment of maximal force, which is only a single muscle function characteristic. Muscle function is intrinsically multivariable, and assessing other attributes in addition to strength capacity will improve screenings for age-related disabilities and diseases. Digital handgrip dynamometers and accelerometers provide unique opportunities to examine several aspects of muscle function beyond strength capacity, while also maintaining procedural ease. Specifically, digital handgrip dynamometry and accelerometry can assess the rate of force development, submaximal force steadiness, fatigability, and task-specific tremoring. Moreover, HGS protocols can be easily refined to include an examination of strength asymmetry and bilateral strength. Therefore, evaluating muscle function with new HGS technologies and protocols may provide a more comprehensive assessment of muscle function beyond maximal strength, without sacrificing feasibility. This Special Article introduces a novel framework for assessing multiple attributes of muscle function with digital handgrip dynamometry, accelerometry, and refinements to current HGS protocols. Such framework may aid in the discovery of measures that better predict and explain age-related disability, biological aging, and the effects of comorbid diseases that are amenable to interventions. These additional HGS measures may also contribute to our understanding of concepts such as resilience. Using sophisticated HGS technologies that are currently available and modernizing protocols for developing a new muscle function assessment may help transform clinical practice by enhancing screenings that will better identify the onset and progression of the disabling process., (Copyright © 2021 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background/objectives: Examining handgrip strength (HGS) asymmetry and weakness together may extend the predictive capacity of HGS for capturing possible health problems such as cognitive impairment. The purpose of this study was to determine the associations of HGS asymmetry and weakness on lower cognitive functioning in a national sample of aging Americans., Design: Longitudinal panel., Setting: Participant residences., Participants: The analytic sample included 17,163 Americans aged 65.0 years (standard deviation = 10.1 years) who participated in the 2006 to 2016 waves of the Health and Retirement Study (HRS)., Measurements: A handgrip dynamometer was used to measure HGS; weakness was defined as HGS below 26 kg (men) or below 16 kg (women). Persons with HGS above 10% stronger on either hand were considered as having any HGS asymmetry. Those with HGS that was more than 10% stronger on their dominant or nondominant hand were considered as having dominant or nondominant HGS asymmetry, respectively. The Telephone Interview of Cognitive Status determined lower cognitive functioning (≤11 for ages 50-64 years; ≤10 for ages ≥65 years). Covariate-adjusted linear mixed-effects models analyzed the associations of each HGS asymmetry and weakness group on lower cognitive functioning., Results: Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had greater odds for lower cognitive functioning: 1.15 (95% confidence interval [CI] = 1.03-1.27) for any HGS asymmetry alone, 1.64 (95% CI = 1.21-2.23) for weakness alone, and 1.95 (95% CI = 1.51-2.53) for any HGS asymmetry and weakness. Each HGS asymmetry dominance and weakness group also had greater odds for lower cognitive functioning: 1.12 (95% CI = 1.01-1.25) for asymmetric dominant HGS alone, 1.27 (95% CI = 1.05-1.53) for asymmetric nondominant HGS alone, 1.64 (95% CI = 1.21-2.23) for weakness alone, 1.89 (95% CI = 1.39-2.57) for weakness and asymmetric dominant HGS, and 2.10 (95% CI = 1.37-3.20) for weakness and asymmetric nondominant HGS., Conclusion: The presence of both HGS asymmetry and weakness may predict accelerated declines in cognitive functioning., (© 2020 The American Geriatrics Society.)

Purpose: To investigate the effect of early frailty transitions on 15-year mortality risk., Methods: Longitudinal data analysis of the Hispanic Established Populations for the Epidemiological Study of the Elderly involving 1171 community-dwelling Mexican Americans aged ≥67 years and older. Frailty was determined using the modified frailty phenotype, including unintentional weight loss, weakness, self-reported exhaustion, and slow walking speed. Participants were defined at baseline as nonfrail, prefrail, or frail and divided into nine transition groups, during a 3-year observation period., Results: Mean age was 77.0 years (standard deviation [SD] = 5.3) and 59.1% were female. Participants who transitioned from prefrail to frail (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.23-2.28), frail to prefrail (HR = 1.54, 95% CI = 1.05-2.28); or who remained frail (HR = 1.72, 95% CI = 1.21-2.44), had significant higher 15-year mortality risk than those who remained nonfrail. Participants transitioning from frail to nonfrail had a similar 15-year mortality risk as those who remained nonfrail (HR = 0.96, 95% CI = 0.53-1.72). Weight loss and slow walking speed were associated with transitions to frailty., Conclusions: An early transition from frail to nonfrail in older Mexican Americans was associated with a 4% decrease in mortality compared with those who remained nonfrail, although this difference was not statistically significant. Additional longitudinal research is needed to understand positive transitions in frailty., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background/Study Context: Approximately one third of older adults over the age of 65, and over 40% of those over 80 years, fall each year, leading to fractures, morbidity, and mortality. Annual direct medical costs due to falls in the United States are approximately $19.2 billion. The identification of new treatable risk factors for falls has the potential to advance their prevention and rehabilitation., Methods: A cross-sectional study of 127 community-dwelling adults aged 67-99 years was conducted. An electronic gait walkway was used to assess gait coordination, measured as the Phase Coordination Index during normal speed walking. A motion capture system was used to assess rhythmic interlimb antiphase ankle coordination, measured as the standard deviation of ankle relative phase. Having fallen in the previous year was self-reported retrospectively. Odds ratios for falling as a function of coordination quartiles were determined using multivariable logistic regression., Results: Adjusting for age, sex, body mass index, number of chronic conditions, Mini-Mental State Examination score, gait speed, and the variability of step length, time, and width, the odds ratios for falling based upon being in the 4th (the poorest) quartiles of gait or ankle coordination were 5.5 (95% confidence interval [CI]: 1.2-24.7) and 8.2 (95% CI: 2.2-31.3), respectively, and 3.7 (95% CI: 1.0-13.8) for the 3rd quartile of gait coordination, compared with the best (the 1st) coordination quartiles. Similar results were found in regression without adjustment for gait characteristics., Conclusion: The results support the hypothesis that impaired gait and rhythmic interlimb ankle coordination are associated with a history of falls in the past year. Prospective longitudinal research is needed to determine the possible direction of causality between falls and impaired coordination.

Background: The identification of novel rehabilitative impairments that are risk factors for mobility limitations may improve their prevention and treatment among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults., Methods: We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged 67 years and older who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios (ORs) for mobility limitations at 1-year follow-up as a function of coordination variability and asymmetry., Results: After adjusting for age, sex, body mass index, Mini-Mental State Examination score, number of chronic conditions, and baseline Short Physical Performance Battery score, ORs were significant for developing mobility limitations based on a 1 SD difference in the variability of ankle (OR = 1.88; 95% confidence interval [CI]: 1.16-3.05) and shoulder (OR = 1.96; 95% CI: 1.17-3.29) coordination. ORs were significant for asymmetry of shoulder (OR = 2.11; 95% CI: 1.25-3.57), but not ankle (OR = 0.95; 95% CI: 0.59-1.55) coordination. Similar results were found in unadjusted analyses., Conclusions: The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. Future work is needed to further examine the peripheral and central mechanisms underlying this relationship and to test whether enhancing coordination alters mobility limitations., (© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background/Study Context: Mobility limitations affect more than 25% of adults aged 70 years or older. This study tested the hypothesis that impairments in ankle and shoulder coordination are associated with mobility limitations among older adults., Methods: his study consisted of conducted a cross-sectional analysis from a sample of community-dwelling older adults (N = 130) aged ≥67 years. Motion capture equipment was used to collect kinematic data during rhythmic antiphase coordination of the right and left: (a) ankles moving in dorsi-plantarflexion; and (b) glenohumeral ("shoulder") moving in flexion-extension while paced by an auditory metronome. Coordination variability was measured as the standard deviation of the relative phase between right and left body segments. Mobility limitations were defined as a score of ≤9 on the Short Physical Performance Battery (SPPB). Odds ratios for mobility limitations as a function of coordination variability quartiles were determined using multivariable logistic regression., Results: Adjusting for age, gender, body mass index, number of chronic conditions and Mini-Mental State Examination score, the odds ratios for mobility limitation (SPPB score ≤9) were 7.38 (95% confidence interval [CI]: 2.20-24.78) and 15.40 (95% CI: 4.31-55.07) for the 3rd and 4th (the poorest) ankle coordination quartiles, respectively, and 6.73 (95% CI: 2.11-21.51) for the 4th shoulder coordination quartile, compared with the best (the 1st) coordination quartiles., Conclusion: The results supported the hypothesis that impaired interlimb ankle and shoulder coordination are associated with the manifestation of mobility limitations. These findings indicate the need for further study of the role of coordination impairments as potential contributors to poor mobility among older adults.

Purpose: To study the effect of undiagnosed diabetes on the relationship between self-reported diabetes and cognitive impairment., Methods: Data were from 1033 participants aged ≥60 from Wave III (2012) of the Mexican Health and Aging Study. Participants were classified as nondiabetic (n = 589), undiagnosed diabetic (n = 201), and self-reported diabetic (n = 243). Multivariate logistic regression models were used to estimate the relationship between self-reported diabetes and severity of cognitive impairment (nonimpaired, moderate impaired, severe impaired)., Results: Self-reported diabetes was associated with significantly higher odds for severe, but not moderate, cognitive impairment (odds ratio [OR] = 2.70, 95% confidence interval [CI] = 1.39-5.32). The association between self-reported diabetes and severe cognitive impairment decreased by 6.3% when undiagnosed diabetics were included in the nondiabetic category and by 30.4% when undiagnosed diabetics were included in the self-reported diabetes category., Discussion: The association between self-reported diabetes and severe cognitive impairment is underestimated when undiagnosed diabetics are not differentiated from self-reported diabetics and nondiabetics., Competing Interests: Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2016.)

Background and Aims: Impaired physical performance in older adults has been shown to vary by ethnic groups. The objective of this study is to examine ethnic differences in physical performance in older Americans., Methods: We conducted a cross-sectional analysis using a sample of 4456 non-institutionalized Americans aged 60 and above (2712 non- Hispanic Whites, 861 non-Hispanic Blacks and 883 Mexican Americans) from a large national representative survey (The Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988- 1994). Measurements included socio-demographic variables; self-reported physician diagnosed medical conditions, body mass index (BMI) and physical performance examination (tandem stand balance, timed chair stand, and timed 8-foot walk)., Results: Of 4456 study participants, 60.9% (n=2712) subjects were non-Hispanic white, 19.3% (n=861) were non-Hispanic black, and 19.8% (n=883) were Mexican American. About 35% (n=1573) of subjects could not hold the tandem balance test for 10 seconds. Older age, diabetes, stroke and arthritis were significantly associated with decreased performance on the balance test. Older age, female gender, being Mexican American or non-Hispanic black, hip fracture and high BMI were significantly associated with decreased performance on 8- foot walking test, while older age, female gender, being non-Hispanic black, low education, stroke, cancer, arthritis and high BMI were significantly associated with decreased performance on the chair stand test., Conclusions: With some ethnic variation, older age, female gender, being non-Hispanic black, being Mexican American, low education, high BMI, diabetes, stroke, cancer and arthritis were associated with decreased physical performance in elderly Americans.

Background: Walking activity has been associated with reduction in the development of chronic disease, cognitive and physical function impairment, disability, and mortality. The objective of this study was to examine the relationship between walking activity and physical function over 9 years of follow-up among Mexican Americans aged 78 years and older. Methods: Participants (N = 998) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2007–2016). Measures included walking activity duration and frequency, socio-demographics, body mass index, medical conditions, pain, depressive symptoms, limitation in activities of daily living, and the Mini-Mental State Examination. Low physical function was defined as scoring <7 on the Short Physical Performance Battery. At baseline, participants were grouped into nonwalkers (n = 653), walked <150 minutes/week (n = 144), and walked 150 minutes/week or more (n = 201). A Generalized Estimating Equation model was used to estimate the odds ratio and 95% CI of low physical performance as a function of walking activity status. Results: Compared with nonwalkers, participants walking < 150 minutes/week had lower odds (odds ratio = 0.66, 95% CI, 0.51–0.86) of low physical function over time, after controlling for all covariates, as did those walking ≥ 150 minutes/week (odds ratio = 0.54, 95% CI, 0.41–0.71). Conclusions: Mexican American older adults who engage in any walking activity are at reduced risk of low physical function, even those with disability. Interventions at the individual and community level are recommended to reduce physical function impairment, even in those with preexisting medical conditions or disability. [ABSTRACT FROM AUTHOR]

Objective: To examine factors associated with hospitalization among Mexican Americans aged 75 years and older with diabetes (with and without complications) and without diabetes over 12 years of follow up. Methods: Participants (N = 1454) were from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2004/2005-2016) residing in Arizona, California, Colorado, New Mexico, and Texas. Measures included socio-demographics, medical conditions, falls, depressive symptoms, cognitive function, disability, physician visits, and hospitalizations. Participants were categorized as no diabetes (N = 1028), diabetes without complications (N = 180), and diabetes with complications (N = 246). Results: Participants with diabetes and complications had greater odds ratio (1.56, 95% Confidence Interval = 1.23-1.98) over time of being admitted to the hospital in the prior year versus those without diabetes. Participants with diabetes had greater odds of hospitalization if they had heart failure, falls, amputation, and insulin treatment. Conclusions: In Mexican American older adults, diabetes and diabetes-related complications increased the risk of hospitalization. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

We investigated the association between 10 years of change in physical activity (PA) levels and 7-year all-cause mortality. Methods: Mexican American adults aged 67 and older (N = 803) participating in the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/1996-2012/2013) were included. All-cause mortality was our outcome. Participants were divided into 4 groups based on their difference in overall PA between 1995/1996 and 2005/2006 measured by the Physical Activity Scale for the Elderly. Participants were classified as having unchanged low PA (n = 339), decreased activity (n = 233), unchanged high activity (n = 166), and increased activity (n = 65). Change in the frequency of PA domains was also investigated. PA domains included leisure, household, sedentary, and walking activities. Results: After controlling for all covariates, results from the Cox proportional hazards regression found a 43% lower mortality risk in the increased PA group (hazards ratio = 0.57; 95% confidence interval, 0.34-0.97) compared with the unchanged low PA group. In the entire sample, a significantly lower mortality risk was also present among walking (hazards ratio = 0.88) and household (hazards ratio = 0.88) activities. Conclusion: Our results suggest that, independent of other factors, increasing PA is most protective of mortality among older Mexican Americans. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine which socio-demographic, clinical, or functional factors are associated with urgency urinary incontinence (UUI) over 20-years of follow-up in a community-dwelling sample of Mexican American women aged 65 years and older without UUI at baseline. We included 1,358 women participants from the Hispanic Established Population for the Epidemiologic Study of the Elderly study conducted in the southwestern of US (Arizona, California, Colorado, New Mexico, and Texas). Measures included self-reported UUI, socio-demographics, smoking status, body mass index, medical conditions, depressive symptoms, physical and cognitive function, and handgrip strength. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of UUI as a function of socioeconomic, clinical, and functional factors. Self-reported UUI increased from 3.1% to 21.9% from baseline (1993/1994) to follow-up (2012/2013). Current smokers, obesity, arthritis, previous heart attacks, and depressive symptoms were factors associated with greater odds of UUI over time. Identification of these factors can help clinicians determine those at high risk of developing UUI. Preventing and/or treating the risk factors early may delay UUI and increase quality of life in this underserved population. [ABSTRACT FROM AUTHOR]

Objectives: This study longitudinally examined how older adult cancer survivors perceive disability in activities of daily living over time compared to older adults who have not had cancer. Methods: This was a secondary analysis of the National Health and Aging Trends Study examining participants with a new cancer diagnosis and age-, gender-, and comorbidity-matched comparison participants without a history of cancer. Generalized linear mixed models examined time and group interaction and main effects in disability. Results: There was a significant main effect of time (F 4,771 = 12.81; p <.0001) demonstrating increasing disability levels for both groups. There were significant group differences, with higher disability in the cancer group than the comparison group (β = 0.628, SE = 0.263; t = 2.39, p = 0.017). Discussion: Although perceived disability was greater immediately following cancer diagnosis, older adult cancer survivors and comparison participants appear to have similar perceived disability over time. [ABSTRACT FROM AUTHOR]

Background: Discovering how certain health factors contribute to functional declines may help to promote successful aging. Aims: To determine the independent and joint associations of handgrip strength (HGS) and cognitive function with instrumental activities of daily living (IADL) and activities of daily living (ADL) disability decline in aging Americans. Methods: Data from 18,391 adults aged 50 years and over who participated in at least one wave of the 2006–2014 waves of the Health and Retirement Study were analyzed. A hand-held dynamometer assessed HGS and cognitive functioning was examined with a modified version of the Telephone Interview of Cognitive Status. IADL and ADL abilities were self-reported. Participants were stratified into four distinct groups based on their HGS and cognitive function status. Separate covariate-adjusted multilevel models were conducted for the analyses. Results: Participants who were weak, had a cognitive impairment, and had both weakness and a cognitive impairment had 1.70 (95% confidence interval (CI) 1.57–1.84), 1.97 (CI 1.74–2.23), and 3.13 (CI 2.73–3.59) greater odds for IADL disability decline, respectively, and 2.26 (CI 2.03–2.51), 1.26 (CI 1.05–1.51), and 4.48 (CI 3.72–5.39) greater odds for ADL disability decline, respectively. Discussion: HGS and cognitive functioning were independently and jointly associated with IADL and ADL disability declines. Individuals with both weakness and cognitive impairment demonstrated substantially higher odds for functional decline than those with either risk factor alone. Conclusions: Including measures of both HGS and cognitive functioning in routine geriatric assessments may help to identify those at greatest risk for declining functional capacity. [ABSTRACT FROM AUTHOR]

Background: Falls are a major cause of disability, morbidity, institutionalization, and mortality in older adults.Objectives: The purpose of the study was to examine the risk factors for falls among Mexican older adults aged 60 years and older.Methods: This study included 6247 participants and their spouse or partner aged 60 years and older from the Mexican Health and Aging Study, an ongoing longitudinal study (2001-2012) conducted in Mexico. Measures included socio-demographics, falls, physical activity, comorbid conditions, pain, vertigo, vision and hearing impairments, urinary incontinence, lower extremity functional limitation, activities of daily living (ADLs), cognitive function, and depressive symptoms.Results: Mean age was 69.6 years (standard error = 0.18) and 51.8% were female. Forty percent reported one or more falls at baseline. Older age, being female, obesity, arthritis, fractures, stroke, suffering pain, vertigo, lower extremity functional limitations, physical activity, depressive symptoms, urinary incontinence, and ADL disability were significant factors associated with one or more falls over time.Discussion: Early detection and treatment of the risk factors for falls in this population will help improve the quality of life and reduce medical complications and health care costs. [ABSTRACT FROM AUTHOR]

Objective:To determine whether older Mexican-Americans who cannot speak and/or understand spoken English have higher rates of mobility limitations or fear of falling than their English-speaking counterparts. Design:We conducted a cross-sectional analysis of 1169 community-dwelling Mexican-Americans aged 72–96 years from the 2000–2001 wave of the Hispanic Established Population for the Epidemiological Study of the Elderly. Mobility limitations were defined as having a Short Physical Performance Battery score ≤9, and fear of falling by participant report of being somewhat, fairly, or very afraid of falling. We determined the rates and odds ratios, for having mobility limitations and fear of falling as a function of English ability in those who were 72–96, <80, and ≥80 years of age. Results:Among participants who were unable to speak and/or understand spoken English 85.7% had mobility limitations and 61.6% were afraid of falling, compared to 77.6% and 57.5%, respectively, of English speakers. Before adjusting for covariates, participants who did not speak and/or understand spoken English were more likely to have mobility limitations (odds ratio: 1.7; 95% CI: 1.3–2.4) but not fear of falling, compared to English speakers. Among those aged ≥80 years, but not those <80 years, who did not speak or understand English were more likely to have mobility limitations (odds ratio: 4.8; 95% CI:2.0–11.5) and fear of falling (odds ratio: 2.0; 95% CI:1.3–3.1). Conclusion:Older Mexican-Americans who do not speak or understand spoken English have a higher rate of mobility limitations and fear of falling than their English-speaking counterparts. [ABSTRACT FROM AUTHOR]

Objectives To determine predictors of fear of falling in older Mexican Americans over time. Design Longitudinal study. Setting Community-dwelling residents throughout California, Colorado, New Mexico, Arizona, and Texas. Participants Community-dwelling Mexican Americans aged 72 and older participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly from 2000-01 to 2010-11 (N = 1,682). Measurements Fear of falling was measured at baseline and at each subsequent wave. Baseline demographic and clinical variables included social support, fall history, depression symptoms, Mini-Mental State Examination ( MMSE) score, activity of daily living ( ADL) and instrumental ADL ( IADL) limitations, and chronic health conditions. Results Nine hundred fifty three (56.7%) subjects reported fear of falling at baseline, 262 of whom reported severe fear of falling. The predictors of reporting any fear of falling over time included female sex, frequent familial interaction, depression, chronic health conditions, IADL limitations, higher MMSE score, and three or more falls in the last 12 months. Predictors of severe fear of falling included older age, female sex, married, depressive symptoms, chronic health conditions, IADL limitations, higher MMSE score, and fall history. Protective factors included frequent friend interaction and higher levels of education. Conclusion Fear of falling is prevalent in older Mexican-American adults. The presence of friends nearby was shown to be protective against, whereas the presence of family nearby was shown to be predictive of fear of falling. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between self-reported physician-diagnosed arthritis and health-related quality of life among older Mexican Americans. Design: Cross-sectional study involving population-based survey. Setting: Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey conducted in Texas, Arizona, New Mexico, Colorado, and California. Participants: 839 non-institutionalized Mexican American older adults (->75 years) participating in Hispanic EPESE. Main Outcome Measures: Self-reported physician-diagnosed arthritis; sociodemographic variables; medical conditions; body mass index; and the physical and mental composite scales from the Medical Outcomes Study Short Form 36 Health Survey (SF-36). Results: 518 (62%) of the subjects reported physician-diagnosed arthritis. Participants with arthritis had significantly lower scores on the physical composite scale (PCS) (mean=35.3, SD=11.3) and the mental composite scale (MCS) (mean=53.5, SD=10.8) of the SF-36 compared to persons without arthritis (PCS mean=42.9, SD=10.9; MCS mean=57.0, SD=8.8). Multiple regression showed that arthritis was associated with decreased PCS and MCS (model estimates of -5.74 [SE=.83]; and -3.16 [SE=.64]), respectively, after controlling for sociodemographic and clinical covariates. Conclusions: Arthritis is a highly prevalent medical condition in Mexican American older adults. Our findings suggest that deficits in both physical health and mental function contribute to reduced quality-of-life in this population. (Ethn Dis. 2011;21 (2):230-236) [ABSTRACT FROM AUTHOR]

Background. Because cognitive impairment and frailty share common risk factors (eg, high proinflammatory cytokines), we examined whether poor cognition predicts subsequent risk of frailty in initially nonfrail Mexican Americans aged 67 years and older. Methods. Frailty was defined as meeting one or more of the following components: (a) unintentional weight loss of >10 pounds, (b) weakness, (c) self-reported exhaustion, and (d) slow walking speed. Sociodemographic factors, Mini-Mental State Examination, medical conditions (stroke, heart attack, diabetes, arthritis, cancer, and hypertension), and depressive symptoms were obtained. Main outcome measure was risk of becoming frail over 10 years. Results. Out of 942 participants who were nonfrail at baseline (1995–1996), 57.8% were women and the mean age was 73.7 years (SD = 5.3). In general estimation equation models testing the relationship between Mini-Mental State Examination (<21 vs. ≥21) and the risk of becoming frail over a 10-year period, there was a significant association (odds ratio = 1.09, 95% confidence interval = 1.00–1.19; p = .0310)] between the cognition-by-time interaction and odds of becoming prefrail or frail over time. This association was independent of age, sex, marital status, education, time, and medical conditions, indicating that nonfrail participants with poor cognition had a 9% odds per year of becoming frail over time compared with those with good cognition. Conclusion. Low Mini-Mental State Examination score was independently associated with increased risk of frailty over a 10-year period in older Mexican Americans. Low Mini-Mental State Examination score may be an early marker for future risk of frailty. [ABSTRACT FROM PUBLISHER]

Background: Diabetes is common in elderly persons and is highly prevalent in Mexican Americans. Little is known about factors associated with the incidence of diabetes complications.Objective: To examine the social, demographic and health factors associated with a 7-year incidence of diabetes complications among older Mexican Americans with diabetes.Methods: A 7-year prospective cohort of 536 non-institutionalized Mexican Americans aged > or =65 years with diabetes residing in the Southwest of USA. Measures included socio-demographic factors, duration of diabetes, diabetes treatment, medical conditions and body mass index. Diabetes complications were assessed by self-reports of any kidney, eye and circulation problems or amputation due to diabetes over a 7-year period.Results: Subjects with disease duration of > or =10 years were found to have an increased incidence of kidney, eye and circulation problems or amputation over a 7-year period. Hazard ratio (HR) for circulation problems was significantly higher in foreign-born subjects with >15 years in the USA. Foreign-born subjects with <15 years in the USA and those with a frequent number of physician visits were at increased risk of kidney complications. Subjects with baseline eye complications had a higher HR for incidence of amputations in the next 7 years. Subjects with baseline circulation complications had a higher incidence of amputations, eye and kidney complications in the next 7 years.Conclusions: Our data suggest that risks of diabetes complications are influenced by different factors. Prolonged diabetes duration, being foreign-born, living in the USA for a longer period, and frequent physician visits were factors associated with diabetes complications. Designing intervention strategies to reduce diabetes complication risks requires an understanding of the differences in demographic and health predictors of such risks. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between handgrip strength and mortality in older Mexican American men and women. DESIGN: A 5-year prospective cohort study. SETTING: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 2,488 noninstitutionalized Mexican-American men and women aged 65 and older. MEASUREMENTS: Maximal handgrip strength, timed walk, and body mass index were assessed at baseline during 1993/94. Self-reports of functional disability, various medical conditions, and status at follow-up were obtained. RESULTS: Of the baseline sample with complete data, 507 persons were confirmed deceased 5 years later. Average handgrip strength ± standard deviation was significantly higher in men (28.4 kg ± 9.5) than in women (18.2 kg ± 6.5). Of men who had a handgrip strength less than 22.01 kg and women who had a handgrip strength less than 14 kg, 38.2% and 41.5%, respectively, were dead 5 years later. In men in the lowest handgrip strength quartile, the hazard ratio of death was 2.10 (95% confidence interval (CI) = 1.31–3.38) compared with those in the highest handgrip strength quartile, after controlling for sociodemographic variables, functional disability, timed walk, medical conditions, body mass index, and smoking status at baseline. In women in the lowest handgrip strength quartile, the hazard ratio of death was 1.76 (95% CI = 1.05–2.93) compared with those in the highest handgrip strength quartile. Poorer performance in the timed walk and the presence of diabetes mellitus, hypertension, and cancer were also significant predictors of mortality 5 years later. CONCLUSION: Handgrip strength is a strong predictor of mortality in older Mexican Americans, after controlling for relevant risk factors. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to examine the association between cognitive impairment and low physical function over a 20-year follow-up period among older Mexican Americans.Methods: The final sample included 1545 community-dwelling Mexican Americans age ≥ 65 years from the Hispanic Established Population for the Epidemiological Study of the Elderly, who scored moderate-high on Short Physical Performance Battery (SPPB) and were non-disabled at baseline (1993/94). Cognitive impairment was defined at each observation wave as less than equal to 21 points on the Mini Mental State Examination. General Estimating Equation was used to estimate the odds ratio of having low physical function (SPPB <7 points) over time as a function of cognitive impairment, adjusting for socio-demographics, self-reported medical conditions, body mass index, and depressive symptoms. All variables were time-varying, except sex and education.Results: Participants with cognitive impairment had increased odds ratio of low physical function over time compared to those without cognitive impairment (Odds Ratio = 1.89; 95% Confidence Interval = 1.59-2.26, P <.0001), after controlling for all covariates.Conclusion: Despite having moderate to high physical function and being non-disabled at baseline, participants with cognitive impairment were more likely to decline in physical function over 20-years of follow-up. [ABSTRACT FROM AUTHOR]

Objectives A natural decline of muscle strength occurs during the aging process; however, preserving muscle strength may lower the rate of many preventable diseases such as diabetes, especially in higher risk populations. The purpose of this study was to examine the sex-specific association between muscle weakness and incident diabetes in older Mexican Americans. Design Observational, longitudinal study. Setting Urban and rural households in the Southwestern United States. Participants A subsample of 1903 Mexican Americans aged at least 65 years without diabetes at baseline were followed for 19 years. Measurements Muscle weakness was assessed with a hand-held dynamometer and was normalized to body weight (normalized grip strength). Male and female participants were categorized as weak if their normalized grip strength was ≤0.46 and ≤0.30, respectively. Sex-stratified Cox proportional hazard regression models were used to determine the association between muscle weakness and incident diabetes (self-reported) when using age as an entry variable and after adjusting for education, employment status, instrumental activities of daily living disability, interview language, marital status, and obesity. A sensitivity analysis was performed to account for influential outliers for the outcome variable (incident diabetes) and the model was re-run. Results The hazard ratio for incident diabetes was 1.05 (95% confidence interval: 1.02–1.09; P < .001) in weak vs not-weak male participants and 1.38 (95% confidence interval: 1.35–1.41; P < .001) in weak vs not-weak female participants, after adjusting for relevant covariates. Conclusions Muscle weakness was associated with an increased rate of diabetes in older male and female Mexican Americans. Health professionals should encourage activities that preserve muscle strength, thereby preventing the incidence of diabetes in older Mexican Americans. [ABSTRACT FROM AUTHOR]

Background The risk of cardiovascular problems due to diabetes mellitus is highest among older Mexicans, and yet what remains to be determined is the association between muscle weakness and diabetes in this population. Therefore, the purpose of this study was to determine the association between muscle strength and diabetes among Mexican adults greater than 50 years of age. Design Cross-sectional. Setting National sample of households in both urban and rural areas. Participants A subsample of 1841 individuals aged 50 years and older was included from the 2012 Mexican Health and Aging Study. Measurements Strength was assessed using a hand-held dynamometer, and the single largest reading from either hand was normalized to body mass (normalized grip strength [NGS]). Conditional inference tree analyses were used to identify sex-specific NGS weakness thresholds. Linear regression was used to examine the association between NGS and HbA1c, and logistic regression was used to assess the association between weakness and risk of diabetes (HbA1c ≥ 6.5% [≥48 mmol/mol]), after controlling for age, sex, and waist circumference. Results NGS was inversely associated with HbA1c (β = −1.56; P < .001). Optimal sex-specific NGS weakness thresholds to detect diabetes were ≤0.46 and ≤0.30 for men and women, respectively. Weakness was associated with significantly increased odds of diabetes (odds ratio, 1.69; 95% confidence interval, 1.37-2.10), even after adjusting for age, sex, and waist circumference. Conclusions NGS was robustly associated with diabetes and other cardiometabolic risk factors in older Mexicans. This simple screen may serve as a valuable tool to identify adults that are at risk for negative health consequences or early mortality and who might benefit from lifestyle interventions to reduce risk. [ABSTRACT FROM AUTHOR]