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Background: There is no consensus regarding the definition of frailty for clinical uses.Methods: A modified Delphi process was used to attempt to achieve consensus definition. Experts were selected from different fields and organized into five Focus Groups. A questionnaire was developed and sent to experts in the area of frailty. Responses and comments were analyzed using a pre-established strategy. Statements with an agreement more than or equal to 80% were accepted.Results: Overall, 44% of the statements regarding the concept of frailty and 18% of the statements regarding diagnostic criteria were accepted. There was consensus on the value of screening for frailty and about the identification of six domains of frailty for inclusion in a clinical definition, but no agreement was reached concerning a specific set of clinical/laboratory biomarkers useful for diagnosis.Conclusions: There is agreement on the usefulness of defining frailty in clinical settings as well as on its main dimensions. However, additional research is needed before an operative definition of frailty can be established. [ABSTRACT FROM AUTHOR]

Background: We determined the incidence, probable risk factors, causes, and long-term survival of delirium in patients hospitalized in a medical specialty teaching hospital in Mexico City.Method: From June to December 1995, 667 elderly patients 60 years and older were hospitalized and assessed within 48 hours, excluding those with delirium at admission, those sedated, on respiratory support, or unable to speak.Results: Twelve percent of the population developed delirium, identified by means of the daily application of the Confusion Assessment Method; its appearance was attributed in 50% to two or more causes, in 10% to an insufficient control of pain, in 7.5% to a preceding surgical event, and in the rest to other causes. Each case was compared randomly with three nonpaired control patients of the same cohort who did not develop delirium. There was a significant increase in the number of cases of delirium in patients older than 75 years (p < .001), those with low schooling (p = .04), those with greater comorbidity (p < .001), those with a hematocrit lower than 30% (relative risk [RR] 2.1, confidence interval [CI] 1.2-4.1), and those with a glucose level greater than 140 mg/dl (RR 2.1, CI 1.2-3.6). Patients with delirium remained hospitalized longer than controls (p = .02). There was no significant difference in the intrahospital mortality of both groups, although during 5 years' follow-up, survivors demonstrated a significant increase in mortality (p = .03) in the group of individuals with delirium during the hospital stay when compared to controls.Conclusion: In this geriatric population of Mexican patients, delirium incidence was similar to that previously reported in the worldwide literature. Its incidence is associated with longer hospital stay and greater mortality. Age, low level of schooling, greater comorbidity, high glucose levels, poor pain control, and hematocrit lower than 30% were independently associated with a greater incidence of delirium. [ABSTRACT FROM AUTHOR]

During the next 20 years, many less developed countries (LDC) will have age structures approaching those of the present time in more developed countries (MDC). This is occurring more rapidly in the LDC of Asia and Latin America. The future of aging populations in LDC is dependent on the degree of poverty in these countries. Poverty is a major determinant of disability and mortality in older persons. With the march of globalization, diseases in LDC are changing from infectious to noncommunicable diseases, such as diabetes. Nevertheless, infections such as tuberculosis still take a major toll on the elderly. The epidemiological transition in LDC has created a need for health care transitions from systems based on cure to ones that highlight prevention and long-term care. LDC have the opportunity to develop systems that differ from those in MDC by capitalizing on the lack of infrastructure to produce more home-based rather than institution-based long-term care systems. Involvement of the elderly in the planning of their own futures is of paramount importance. Appropriate planning now will decide the future of the elderly in LDC during the next 20 to 40 years. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is a chronic disease that affects older adults' quality of life, with fragility fractures (FF) being its most significant consequence due to their impact on healthcare systems in terms of morbidity, and economic and caregiving burden. FF are defined as fractures resulting from low-energy trauma, defined as falls from a standing height or less, and are usually considered osteoporotic (1). World demographic projections warn of a significant increase in adults aged 65 and older by 2050. These demographic changes mean that OP and FF will soon become an even greater challenge for healthcare systems, where prevention programs should be a priority. In Mexico, FF is also a public health challenge, with an initial reported incidence of nearly 2,000 cases per 100,000 population, and a projected seven-fold increase by 2050. Given this scenario, there is an urgent need for policy- and decision-makers to change their approach and formulate health policies that guarantee that people aged 65 and older are screened for fractures and have access to appropriate care. These policies should be part of a strategy to minimize FF and ensure active and healthy aging according to the WHO's Decade of Healthy Ageing. In this context, a group of Mexican experts representing different health organizations interested in the burden of OP and FF met to discuss possible strategies to reduce their burden for the next decade and summarize them in this Call to Action to promote public policies that prioritize an evidence-based approach to the prevention and treatment of OP and FF., Competing Interests: Conflicts of Interest The authors declare that there are no conflicts of interest regarding the publication of this article. No financial, personal, or professional affiliations have influenced the writing, or conclusions presented in this work. The authors have adhered to ethical guidelines to ensure impartiality and transparency, and all of them contributed and read the final version of the manuscript before being sent to the journal., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: Older adults have heterogeneous aging rates. Here, we explored the impact of biological age (BA) and accelerated aging on frailty in community-dwelling older adults., Methods: We assessed 735 community-dwelling older adults from the Coyocan Cohort. BA was measured using AnthropoAge, accelerated aging with AnthropoAgeAccel, and frailty using both Fried's phenotype and the frailty index. We explored the association of BA and accelerated aging (AnthropoAgeAccel ≥0) with frailty at baseline and characterized the impact of both on body composition and physical function. We also explored accelerated aging as a risk factor for frailty progression after 3-years of follow-up., Results: Older adults with accelerated aging have higher frailty prevalence and indices, lower handgrip strength and gait speed. AnthropoAgeAccel was associated with higher frailty indices (β=0.0053, 95%CI 0.0027-0.0079), and increased odds of frailty at baseline (OR 1.16, 95%CI 1.09-1.25). We observed a sexual dimorphism in body composition and physical function linked to accelerated aging in non-frail participants; however, this dimorphism was absent in pre-frail/frail participants. Accelerated aging at baseline was associated with higher risk of frailty progression over time (OR 1.74, 95%CI 1.11-2.75)., Conclusions: Despite being intertwined, biological accelerated aging is largely independent of frailty in community-dwelling older adults., Competing Interests: CONFLICT OF INTERESTS: The authors declare that they have no conflict of interests.

Objective: To validate AnthropoAge, a new metric of biological age (BA), for prediction of all-cause mortality and age-related outcomes and characterize population-specific aging patterns using multinational longitudinal cohorts., Methods: We analyzed harmonized multinational data from the Gateway to Global Aging, including studies from the US, England, Mexico, Costa Rica, and China. We used body mass index and waist-to-height ratio to estimate AnthropoAge and AnthropoAgeAccel in participants aged 50-90 years old as proxies of BA and age acceleration, respectively. We compared the predictive capacity for all-cause mortality of AnthropoAge and chronological age (CA) using Cox models, described aging trends in all countries and explored the utility of longitudinal assessments of AnthropoAgeAccel to predict new-onset functional decline and age-related diseases using generalized estimating equations (GEE)., Findings: Using data from 55,628 participants, we found AnthropoAge (c-statistic 0.772) outperformed CA (0.76) for prediction of mortality independently of comorbidities, sex, race/ethnicity, education, and lifestyle; this result was replicated in most countries individually except for Mexico. Individuals with accelerated aging had a ~39% higher risk of death, and AnthropoAge also identified trends of faster biological aging per year. In longitudinal analyses, higher AnthropoAgeAccel values were independently predictive of self-reported health deterioration and new-onset deficits in basic/instrumental activities of daily living (ADL/IADL), diabetes, hypertension, cancer, chronic lung disease, myocardial infarction, and stroke., Conclusions: AnthropoAge is a robust and reproducible BA metric associated with age-related outcomes. Its implementation could facilitate modeling trends of biological aging acceleration in different populations, although recalibration may enhance its utility in underrepresented populations such as individuals from Latin America., Competing Interests: CONFLICT OF INTEREST/FINANCIAL DISCLOSURE: Nothing to disclose. CONFLICT OF INTERESTS: The authors declare that they have no conflict of interests.

In this article, we summarise the findings of the situational analysis of dementia care generated as part of the STRiDE: Strengthening responses to dementia care in developing countries project, including a desk review, a SWOT analysis and views from relevant stakeholders. In addition, the article incorporates the experience of 4 years of work within the STRiDE project of FEDMA, Mexico's Federation of Alzheimer's and other dementias and its allied Associations in presenting specific recommendations to optimise dementia care in the country. All the information gathered brings together a detailed understanding of the current dementia care systems of diagnosis, treatment, and support in general and what is lacking, allowing for the generation of general recommendations to enhance the isolated efforts currently available and amplify their impact, as well as strategies to generate new services currently unavailable, but urgently needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article., (© 2024. The Author(s).)

Background: Older person's ability to contribute covers contributions divided into five subdomains: assisting friends and neighbours, mentoring peers and younger people, caring for family, engaging in the workforce and voluntary activity., Objective: To evaluate the psychometric properties of ability to contribute measurements as a domain of functional ability of older persons using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic reviews., Methods: A systematic search was performed in PubMed, Embase and PsycINFO databases, for observational studies published within the last 10 years. The measurement properties of these ability measures were evaluated against the COSMIN taxonomy. Risk-of-bias assessment was performed using the COSMIN Risk of Bias checklist., Results: Of the 32,665 studies identified, we selected 19, of which the main purpose was to develop or validate an instrument or have related items that measure at least one of the subdomains. None of the instruments contained items that were fully related to the five subdomains, 60% (n = 12) were related to voluntary activities and 15% (n = 3) to mentoring peers and younger people. As for psychometric properties, two studies assessed content validity. Factor analysis was used to evaluate structural validity in 10 studies. Internal consistency was evaluated in 63% of the instruments and Cronbach's alpha ranges from 0.63 to 0.92. No study reported predictive validity. A very limited overview of their scope and limitations for their application was observed., Conclusions: We found no single instrument measuring all subdomains of ability to contribute. We found several instruments containing items that could indirectly measure some of the subdomains of the ability to contribute., (© World Health Organization, 2023. All rights reserved. The World Health Organization has granted the Publisher permission for the reproduction of this article.)

The Mexican Health and Aging Study (MHAS) is a longitudinal study using a national sample of approximately 15,000 community-dwelling adults aged 50 years old and older in Mexico. Spanning over 20 years (2001-2021), six waves of data collection establish the MHAS as the leading data platform for the study of aging in Latin America.

Background: Frailty has been recognized as a growing issue in older adults, with recent evidence showing that this condition heralds several health-related problems, including cognitive decline. The objective of this work is to determine if frailty is associated with cognitive decline among older adults from different countries., Methods: We analyzed the baseline the Study on Global Ageing and Adult Health (SAGE), that includes six countries (Ghana, South Africa, Mexico, China, Russia, and India). A cross-section analysis was used to assess how Frailty was related with the Clinical Frailty Scale decision tree, while cognitive decline was evaluated using standardized scores of tests used in SAGE., Results: A total of 30,674 participants aged 50 years or older were included. There was an association between frailty levels and cognitive performance. For example, women had an inverse relationship between frailty levels and cognitive scores, even when comparing robust category with frailty level 2 (RRR = 0.85; p  = 0.41), although the relative risks decrease significantly at level 3 (RRR = 0.66; p  = 0.03). When controlling for age, the relative risks between frailty levels 4 to 7 significantly decreased as cognitive performance increased (RRR = 0.46, RRR = 0.52, RRR = 0.44, RRR = 0.32; p  < 0.001)., Conclusion: Our results show an association between frailty levels measured in a novel way, and cognitive decline across different cultural settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 García-Chanes, Avila-Funes, Borda, Pérez-Zepeda and Gutiérrez-Robledo.)

Objectives: Vaccination has been effective in ameliorating the impact of COVID-19. Here, we report vaccine effectiveness (VE) of the nationally available COVID-19 vaccines in Mexico., Methods: Retrospective analysis of a COVID-19 surveillance system to assess the VE of the BNT162b2, messenger RNA (mRNA)-12732, Gam-COVID-Vac, Ad5-nCoV, Ad26.COV2.S, ChAdOx1, and CoronaVac vaccines against SARS-CoV-2 infection, COVID-19 hospitalization, and death in Mexico. The VE was estimated using time-varying Cox proportional hazard models in vaccinated and unvaccinated adults, adjusted for age, sex, and comorbidities. VE was also estimated for adults with diabetes, aged ≥60 years, and comparing the predominance of SARS-CoV-2 variants B.1.1.519 and B.1.617.2., Results: We assessed 793,487 vaccinated and 4,792,338 unvaccinated adults between December 24, 2020 and September 27, 2021. The VE against SARS-CoV-2 infection was the highest for fully vaccinated individuals with mRNA-12732 (91.5%, 95% confidence interval [CI] 90.3-92.4) and Ad26.COV2.S (82.2%, 95% CI 81.4-82.9); for COVID-19 hospitalization, BNT162b2 (84.3%, 95% CI 83.6-84.9) and Gam-COVID-Vac (81.4% 95% CI 79.5-83.1), and for mortality, BNT162b2 (89.8%, 95% CI 89.2-90.2) and mRNA-12732 (93.5%, 95% CI 86.0-97.0). The VE decreased for all vaccines in adults aged ≥60 years, people with diabetes, and periods of Delta variant predominance., Conclusion: All the vaccines implemented in Mexico were effective against SARS-CoV-2 infection, COVID-19 hospitalization, and death. Mass vaccination with multiple vaccines is useful to maximize vaccination coverage., Competing Interests: Declaration of competing interest SECL, GCS, CAZJ, GGR, RCA, and HLG works at the Mexican Ministry of Health and oversee the monitoring SARS-CoV-2 epidemiological surveillance and designing COVID-19 vaccination policies in Mexico. Data analysis and interpretation were primarily conducted by members of the team independent of these duties., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aging is believed to occur across multiple domains, one of which is body composition; however, attempts to integrate it into biological age (BA) have been limited. Here, we consider the sex-dependent role of anthropometry for the prediction of 10-year all-cause mortality using data from 18,794 NHANES participants to generate and validate a new BA metric. Our data-driven approach pointed to sex-specific contributors for BA estimation: WHtR, arm and thigh circumferences for men; weight, WHtR, thigh circumference, subscapular and triceps skinfolds for women. We used these measurements to generate AnthropoAge, which predicted all-cause mortality (AUROC 0.876, 95%CI 0.864-0.887) and cause-specific mortality independently of ethnicity, sex, and comorbidities; AnthropoAge was a better predictor than PhenoAge for cerebrovascular, Alzheimer, and COPD mortality. A metric of age acceleration was also derived and used to assess sexual dimorphisms linked to accelerated aging, where women had an increase in overall body mass plus an important subcutaneous to visceral fat redistribution, and men displayed a marked decrease in fat and muscle mass. Finally, we showed that consideration of multiple BA metrics may identify unique aging trajectories with increased mortality (HR for multidomain acceleration 2.43, 95%CI 2.25-2.62) and comorbidity profiles. A simplified version of AnthropoAge (S-AnthropoAge) was generated using only BMI and WHtR, all results were preserved using this metric. In conclusion, AnthropoAge is a useful proxy of BA that captures cause-specific mortality and sex dimorphisms in body composition, and it could be used for future multidomain assessments of aging to better characterize the heterogeneity of this phenomenon., (© 2022 The Authors. Aging Cell published by Anatomical Society and John Wiley & Sons Ltd.)

After the first wave of the COVID-19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the inhabitants, the authors of this paper initiated a literature review of educational trajectories, health, and ageing well. The findings strongly demonstrate that alongside genetics, the affective and educational family environment, as well as the general environment, greatly interact starting from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease [DOHAD] in the first 1,000 days of life as well as in the characterization of gender. Other factors such as socio-economic level, parental education, schooling in urban or rural areas, also play a major role in the differential acquisition of health literacy. This determines adherence (or lack thereof) to healthy lifestyles, risky behaviours, substance abuse, but also compliance with hygiene rules, and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes), which promote cardiovascular and kidney damage, and neurodegenerative diseases, explaining that the less well educated have shorter survival and spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of this inter-academic group propose specific educational actions at three levels: (1) teachers and health professionals, (2) parents, (3) the public, emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities., (© 2023 S. Karger AG, Basel.)

Background: In 2020, Mexico experienced one of the highest rates of excess mortality globally. However, the extent of non-COVID deaths on excess mortality, its regional distribution and the association between socio-demographic inequalities have not been characterized., Methods: We conducted a retrospective municipal and individual-level study using 1 069 174 death certificates to analyse COVID-19 and non-COVID-19 deaths classified by ICD-10 codes. Excess mortality was estimated as the increase in cause-specific mortality in 2020 compared with the average of 2015-2019, disaggregated by primary cause of death, death setting (in-hospital and out-of-hospital) and geographical location. Correlates of individual and municipal non-COVID-19 mortality were assessed using mixed effects logistic regression and negative binomial regression models, respectively., Results: We identified a 51% higher mortality rate (276.11 deaths per 100 000 inhabitants) compared with the 2015-2019 average period, largely attributable to COVID-19. Non-COVID-19 causes comprised one-fifth of excess deaths, with acute myocardial infarction and type 2 diabetes as the two leading non-COVID-19 causes of excess mortality. COVID-19 deaths occurred primarily in-hospital, whereas excess non-COVID-19 deaths occurred in out-of-hospital settings. Municipal-level predictors of non-COVID-19 excess mortality included levels of social security coverage, higher rates of COVID-19 hospitalization and social marginalization. At the individual level, lower educational attainment, blue-collar employment and lack of medical care assistance prior to death were associated with non-COVID-19 deaths., Conclusion: Non-COVID-19 causes of death, largely chronic cardiometabolic conditions, comprised up to one-fifth of excess deaths in Mexico during 2020. Non-COVID-19 excess deaths occurred disproportionately out-of-hospital and were associated with both individual- and municipal-level socio-demographic inequalities., (© The Author(s) 2022; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Barker's hypothesis affirms that undernourishment in early-life induces metabolic reprogramming that compromises organism functions later in life, leading to age-related diseases. We are exposed to environmental and social conditions that impact our life trajectories, leading to ageing phenotypes as we grow. Epigenetic mechanisms constitute the link between both external stimuli and genetic programming. Studies have focused on describing the effect of early adverse events such as trauma, famines, or childhood labor on epigenetic markers in adulthood and the elderly. However, we lack information on epigenetic programming in individuals born in rural communities from underdeveloped countries, exposed to negative influences during fetal and postnatal development, particularly chronic malnutrition. Hence, in this exploratory analysis, we characterize the epigenome of individuals and some parents from Tlaltizapan (a rural community in Mexico originally studied almost 50 years ago) and collect anthropometric data on growth and development, as well on the living conditions of the families. Our results help build a biological hypothesis indicating that most of the epigenetic age measures of the subjects are significantly different among them. Interestingly, the most affected methylated regions correspond to pathways involved in neuronal system development, reproductive behaviour, learning and memory regulation., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2022. Published by Elsevier Inc.)

Background: Research suggests a significant association between increasing age and memory impairments. Nevertheless, for some individuals, memory performance stays within or above the normative values of younger subjects. This is known as successful memory aging and is associated with specific neurophysiological features and psychological and lifestyle-related variables. To date, little is known about the association between successful memory aging and intrinsic capacity (IC) defined as "the composite of all the physical and mental (including psychosocial) capacities that an individual can draw on at any point in time" and resilience. Hence, the aim of this study was to determine if longitudinal associations between IC and successful memory aging and resilience exist and to find differences in cognitive performance between Mexican older adults with successful memory aging, older adults with average memory, and older adults with memory impairment., Methods: Longitudinal data from 590 individuals from the third wave (2012) and the Mex-Cog subsample (2016) of the Mexican Health and Aging Study was analysed. Subjects were classified into 3 groups: (1) older adults with successful memory aging (SUMA), (2) older adults with average memory (AVMA), and (3) older adults with memory impairment (IMA). Cognitive domains of orientation, language, attention, constructional praxis, and executive function were evaluated. IC and resilience were measured using items from the MHAS battery. Analysis of variance and multinomial logistic regressions were used to find differences in IC and resilience across the memory aging groups., Results: ANOVAs showed significant differences across the three cognitive performance groups in all cognitive domains. Multinomial logistic regression analyses revealed that respondents with higher scores in the psychological and cognitive domains of IC at baseline were more likely to have successful memory aging in the subsequent wave of the study. More resilient subjects in 2012 were not more likely to become a SUMA in 2016. However, this could be a result of the way resilience was measured., Conclusion: Our main findings suggest that intrinsic capacity could be used as a predictor of successful memory aging specifically in the psychological and the cognitive domains. More longitudinal studies are needed to further examine these associations., Competing Interests: The authors declare that no conflicts of interest exist., (Copyright © 2022 Rosa Estela García-Chanes et al.)

In this article, we report on the recommendations of a binational conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or the generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment, and care management require additional knowledge and skills of general and specialized staff in the health care workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for binational dementia care policy and practice., (© The Author(s) 2021. 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: The impact of the coronavirus disease 2019 (COVID-19) pandemic in Mexico City has been sharp, as several social inequalities at all levels coexist. Here we conducted an in-depth evaluation of the impact of individual and municipal-level social inequalities on the COVID-19 pandemic in Mexico City., Methods: We analyzed suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases, from the Mexico City Epidemiological Surveillance System from 24 February 2020 to 31 March 2021. COVID-19 outcomes included rates of hospitalization, severe COVID-19, invasive mechanical ventilation, and mortality. We evaluated socioeconomic occupation as an individual risk, and social lag, which captures municipal-level social vulnerability, and urban population density as proxies of structural risk factors. Impact of reductions in vehicular mobility on COVID-19 rates and the influence of risk factors were also assessed. Finally, we assessed discrepancies in COVID-19 and non-COVID-19 excess mortality using death certificates from the general civil registry., Results: We detected vulnerable groups who belonged to economically unfavored sectors and experienced increased risk of COVID-19 outcomes. Cases living in marginalized municipalities with high population density experienced greater risk for COVID-19 outcomes. Additionally, policies to reduce vehicular mobility had differential impacts modified by social lag and urban population density. Finally, we report an under-registry of COVID-19 deaths along with an excess mortality closely related to marginalized and densely populated communities in an ambulatory setting. This could be attributable to a negative impact of modified hospital admission criteria during the pandemic., Conclusions: Socioeconomic occupation and municipality-wide factors played a significant role in shaping the course of the COVID-19 pandemic in Mexico City., (© The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objectives: To evaluate the feasibility outcomes of implementing a multicomponent staff training intervention (PROCUIDA-Demencia) to promote psychosocial interventions and reduce antipsychotic prescription in Mexican care homes and study its effect on staff's care experience and residents' quality of life., Design: A mixed-methods 2-arm cluster randomized controlled pilot study of a 2-day staff training program with baseline, 12 weeks, and 24 weeks of the PROCUIDA-Demencia intervention vs treatment as usual (TAU)., Setting and Participants: Eight care homes in Mexico City were selected, from which 55 residents and 126 staff were recruited., Intervention: In situ staff training consisting of evidence-based manualized psychosocial interventions of person-centered activities, reminiscence therapy, doll therapy, psychomotor dance therapy, and antipsychotic prescription review. Fidelity to protocol was supervised once a week., Methods: Cluster-level feasibility measures included views of staff, residents, and relatives on acceptability, satisfaction, adherence, and fidelity to the intervention. Staff outcome measures were Maslach Burnout Inventory (MBI), Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff. Residents' outcome measures included Quality of Life-Alzheimer's Disease scale (QoL-AD), and Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). Staff distress was measured using the NPI-NH occupational disturbance scale. Feasibility was elicited through a focus group, and hierarchical linear mixed effects models were used to assess the adjusted effects of the respective measures., Results: Observed medical practice showed the prescription of at least 1 antipsychotic in 41% of participants in the intervention group. Overall, 39% of residents reported discontinuation, and 15% reduction of antipsychotics, following the 12-week medical review in parallel with psychosocial interventions. Clinical outcomes contributed positively to the reduction in baseline staff burden according to the MBI after the intervention [mean difference -8.9, 95% confidence interval (CI) -17.7, -0.1, P = .049] and to the reduction in severity and frequency of behavior as per NPI-NH in residents (mean difference -9.4, 95% CI -17.5, -1.3, P = .025)., Conclusions and Implications: PROCUIDA-Demencia is a feasible intervention for Mexican care homes. Results contribute to the Mexican Dementia Plan optimizing dementia care by supporting the need for staff training to implement psychosocial interventions prior to prescribing antipsychotic medication., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Midlife physical capability (PC) is associated with developmental factors in the populations of economically developed countries. As far as we know, there is no information for rural populations of low- and middle-income countries. The aim of the study was to investigate the influence of pre- and postnatal factors on midlife objective measures of PC in a 1966-67 birth cohort from a Mexican rural community. The hypothesis was that adverse developmental conditions are associated with low midlife PC., Methods: In 1966-67, a birth cohort of all children from a poor Mexican rural community was assembled. Data on family socioeconomic status (SES), parental health and nutritional status, birth weight, postnatal growth and feeding patterns were registered. In 2018, out of the 336 cohort members, 118 were living in the community, and eighty-two of them underwent a comprehensive clinical evaluation. The evaluation included grip strength, gait velocity and chair-stand PC tests. In multivariable linear models, PC tests were the dependent variables, and prenatal, birth and postnatal factors were the independent variables. Adjustment for confounding was made with adult anthropometric, body composition, clinical and ageing status variables., Results: Independent of adult health status and other ageing indicators, lower PC was associated with family organization and SES, parental nutritional status, birth weight, infant postnatal growth velocity, and weaning time. These results indicate that adverse family and environmental conditions that are prevalent in poor rural communities are associated with low midlife PC., (© 2022. The Author(s).)

Objective: To identify and quantify potentially inappropriate prescribing (prescripción potencialmente inapropiada, PPI) and other drug prescribing problems in public health care services in a population-based study at the three existing levels of complexity in Mexico., Methods: Descriptive analysis of the Study on Satisfaction of Users of the Social Protection System in Health 2014-2016, prescription and drug supply section, to obtain the prevalence of PPI in older adults (≥ 65 years), based on Beers, STOPP, Prescrire and BSP listings using AM (older adults) prescription indicators, one for each listing., Results: Most older adults (67%) were prescribed at least one medication, with a mean of 2.7 medications per prescription. The PPI prevalence was 74% according to the BSP criteria, 67% according to the STOPP listing, 59% with the Beer criteria, and 20% with Prescrire. The most frequent PPI prescriptions were NSAIDs, vasodilators and sulfonylureas., Conclusions: The use of PPIs in AM is high in Mexico. The higher prevalence found in this study may reflect the use of a source with population representativeness. The partial use and adaptations of the criteria make difficult comparing the studies; however, the STOPP criteria are the ones with the highest prevalence, as they cover a greater number of drugs and their use is more common in the first level of care.

Objective: To describe the levels of intrinsic capacity and those factors related to its decline in Mexican older adults, using the Mexican Health and Aging Study., Methods: This is a cross-sectional secondary analysis of the 2015 data of the Mexican Health and Aging Study, including adults aged 50 years and above. Selected questions were included to represent each domain of intrinsic capacity screening: cognition, depression, hearing, vision, anorexia, weight loss, and mobility. Sociodemographic characteristics, psychosocial factors, and health conditions were included to assess their association with intrinsic capacity. Further categories were established to assess not only individual characteristics but also different groupings. Along with descriptive statistics, multinomial regression models were performed., Results: From a total of 12 459 adults aged 50 years and above, 54.7% were women and the average age was 71.2 years; 87.8% of the individuals had at least one intrinsic capacity domain affected, and mobility had the highest frequency (47.6%). All domains showed a trend of increasing with age and were higher among women. Self-rated health, chronic diseases, number of visits to a physician in the last year, and ≥2 affected activities of daily living were consistently associated with more intrinsic capacity domains affected., Conclusions: Decreased levels of intrinsic capacity in Mexican older people are associated with less schooling, self-rated health, chronic diseases, visits to a physician, and activities of daily living.

Since 1948, the World Health Organization has been publishing the International Statistical Classification of Diseases and Related Health Problems (ICD), a coded system of causes of disease and death with an in-depth revision every 10-15 years. In its latest revision, the ICD-11 uses nomenclature characterizing old age as "initial and final geriatric periods," implying the medicalization of this stage of life, which has created confusion and sparked controversy. This article discusses the new nomenclature proposed, given the current knowledge about old age and the aging process and its most accepted definition. The ICD not only classifies diseases but periods of life and "health-related problems," and old age per se is not a health-related problem for many people at this stage of life. It is therefore essential to change or provide a more nuanced definition of the term "old age" in the ICD-11, so it is not perceived as a symptom, sign, or anomalous clinical outcome, and to introduce nomenclature that more accurately reflects pathological aging. Two terms that are enjoying growing experimental and bibliographic support are "fragility" and "loss of intrinsic capacity," which offer greater precision when defining the condition of a person who is not experiencing healthy aging.

Background: To determine the association between oral health condition and development of frailty over a 12-month period in community-dwelling older adults., Methods: Population-based, case-cohort study derived from the Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults (COSFOMA) study, including data from years 2015 and 2016. Using latent class analysis, we determined the oral health condition of older adults with teeth (t 0 ), i.e., functional teeth, presence of coronal caries, root caries, periodontal disease, dental calculus, dental biofilm, root remains, xerostomia, and need for dental prosthesis. Edentulous was considered as a separate class. Criteria of the Frailty Phenotype (t 1 ) by Fried et al. were used: weight loss, self-report of exhaustion, walking speed, decreased muscle strength, and low physical activity. The presence of three or more criteria indicated a frail condition. The strength of the association (odds ratio, OR) between oral health condition and development of frailty was estimated through bivariate analysis. Multiple logistic regression was used to adjust for the other variables of study: sociodemographic data (sex, age, marital status, level of education, paid work activity, and living alone), comorbidities, cognitive impairment, depressive symptoms, nutritional status, and use of oral health services., Results: 663 non-frail older adults were evaluated, with a mean age of 68.1 years (SD ± 6.1), of whom 55.7% were women. In t 0 , a three-class model with an acceptable value was obtained (entropy = 0.796). The study participants were classified as: edentulous persons (6.9%); Class 1 = Acceptable oral health (57.9%); Class 2 = Somewhat acceptable oral health (13.9%); and Class 3 = Poor oral health (21.3%). In t 1 , 18.0% (n = 97) of participants developed frailty. Using Acceptable oral health (Class 1) as a reference, we observed that older adults with edentulism (OR 4.1, OR adjusted 2.3) and Poor oral health (OR 2.4, OR adjusted 2.2) were at an increased risk of developing frailty compared to those with Acceptable oral health., Conclusion: Older adults with edentulism and poor oral health had an increased risk of developing frailty over a 12-month period., (© 2021. The Author(s).)

Background: Chronological age (CA) is a predictor of adverse coronavirus disease 2019 (COVID-19) outcomes; however, CA alone does not capture individual responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components., Method: In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (intensive care unit admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components., Results: We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel >0 had higher risk of death and critical illness compared to those with lower values (log-rank p < .001). Using unsupervised clustering, we identified 4 adaptive responses to SARS-CoV-2 infection: (i) inflammaging associated with CA, (ii) metabolic dysfunction associated with cardiometabolic comorbidities, (iii) unfavorable hematological response, and (iv) response associated with favorable outcomes., Conclusions: Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA., (© The Author(s) 2021. 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.)

Objective: To calculate the cost assumed by society for having underaged individuals who do not study and provide care to dependent older adults., Materials and Methods: The Mexican Health and Ageing Study (MHAS) 2015 was used to calculate the number of underage caregivers who do not attend school. The Household Income and Expenditure Survey (ENIGH) 2018 was used to estimate wage differences between populations of working age with complete elementary and complete high school education. Those differences were then converted to present value, added, and multiplied by the number of underage caregivers., Results: The total annual cost of having underage caregivers who drop out of school adds to 1 112 179 210 pesos., Conclusions: The topic concerning underage caregivers has not received enough attention from specialized literature, and there is still a large research gap in this area., Competing Interests: The authors declare that they have no conflict of interests, (Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.)

Background: Falls are a significant public health problem among older people worldwide. The aim was to perform a new systematic review and meta-analysis to assess whether cataract surgery is effective in reducing the rate of falls in older persons., Methods: The systematic review was performed following the recommendations by the Cochrane Collaboration. Original papers were included with RCT or quasi-experimental design, which described the effect on uni- or bilateral cataract surgery on the rate of falls among people aged 60 or older. Titles and abstracts were reviewed, full-text versions were retrieved, and two independent examiners reviewed them to assess inclusion criteria. All relevant variables were synthesised in an evidence table. Random-effects meta-analyses were performed pooling the trials, and results were expressed as relative risk (RR) and 95% confidence intervals., Results: The initial search reported 99 potential abstracts, and 41 full-text versions were examined. In the end, eight studies were included. Five included patients 65 years of age and older, two patients 55 years and older, and one included patients 50 years or older. Phacoemulsification and intraocular lens implant were performed in all studies. Two were RCT, and six were quasi-experimental. Falls was the main outcome. The six quasi-experimental studies reported that a reduction in the frequency of falls was observed (RR 0.68, 95% CI 0.48-0.96), although heterogeneity was significant ( I 2  = 74%). Only one RCT reported risk reduction of 34% (RR 0.66, 95% CI 0.45-0.96)., Conclusions: This meta-analysis provides evidence that the first cataract surgery reduces the frequency of falls in older people with bilateral cataracts, but a second surgery does not have significant impact., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Luis Miguel Gutiérrez-Robledo et al.)

Background: COVID-19 has had a disproportionate impact on older adults. Mexico's population is younger, yet COVID-19's impact on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging., Methods: We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for COVID-19 mortality risk prediction., Results: We analyzed 20 804 confirmed SARS-CoV-2 cases in adults aged 60 and older. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization, and intensive care unit (ICU) admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and combination of structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age alone. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas., Conclusions: Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach., (© The Author(s) 2020. 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.)

The frailty syndrome is a common clinical marker of vulnerability in older adults conducive to an overall decline in inflammatory stress responsiveness; yet little is known about the genetic risk factors for frailty in elderly. Our aim was to investigate the association between the rs2476601 polymorphism in PTPN22 gene and susceptibility to frailty in Mexican older adults. Data included 630 subjects 70 and older from The Coyoacán cohort, classified as frail, pre-frail, and non-frail following Fried's criteria. Sociodemographic and clinical characteristics were compared between groups at baseline and after a multivariate analysis. The rs2476601 polymorphism was genotyped by TaqMan genotyping assay using real-time PCR and genotype frequencies were determined for each frailty phenotype in all participants and subsets by age range. Genetic association was examined using stratified and interaction analyses adjusting for age, sex and variables selected in the multivariate analysis. Disability for day-life activities, depression and cognitive impairment were associated with the risk of pre-frailty and frailty at baseline and after adjustment. Carrying the T allele increased significantly the risk of frailty in patients 76 and older (OR 5.64, 95% CI 4.112-7.165) and decreased the risk of pre-frailty under no clinical signs of depression (OR 0.53; 95% CI 0.17-1.71). The PTPN22 polymorphism, rs2476601, could be a genetic risk factor for frailty as subject to quality of life. This is the first study analyzing such relationship in Mexican older adults. Confirming these findings requires additional association studies on wider age ranges in populations of older adults with frailty syndrome.

Since the emergence of the COVID-19 pandemic, the most affected population group has been that of older people living in long-term care facilities (LTCFs), which has accumulated between 30 and 60 % of total number of deaths in the world. In Mexico, outbreaks have been reported in LTCFs of at least eight states. Various factors make this population group and LTCFs susceptible to COVID-1 outbreaks, mainly due to coexistence in common spaces, shared bedrooms and permanent physical contact with the personnel who work there, coupled with a lack of protocols and standards of care of mandatory observance, as well as personnel training limitations. There is evidence of the need to formally develop a National Care System that provides support to those in need of care and their families, and that includes LTCFs. In view of the challenges due to the lack of information and competencies in infection prevention and control at LTCFs, a group of experts, in collaboration with different public institutions, joined efforts with the purpose to update the guidelines in order to allow LTCFs face the pandemic and to contribute to the generation of said National Care System., (Copyright: © 2020 Permanyer.)

Objectives: The aim of this study was to compare a short and a long version of an intrinsic capacity index and test their cross-sectional association with relevant health outcomes in older adults., Design: Cross-sectional analysis of the baseline data of the FraDySMex study., Participants: 543 community-dwelling adults aged 50 years and older living in 2 municipalities in Mexico City, from which 435 had complete data on the variables of interest., Methods: The intrinsic capacity indices were obtained using principal components analysis. The performance of the indices was tested respective to frailty, IADL and ADL., Results: The short and long versions of the IC index performed well for assessing functional status. Using biometrical variables like the phase angle, grip strength and gait speed measured by the GAIT rite improved the index performance vis a vis IADL disability (Lawton), but not to the other evaluated outcomes., Conclusions: Both the long and short versions of the intrinsic capacity indices tested were able to classify older adults according to their functional status and were associated with relevant health outcomes., Competing Interests: Authors declare no conflict of interest.

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent., Competing Interests: Dr. Anker reports grants and personal fees from Vifor Int, personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Servier, grants and personal fees from Abbott Vascular, personal fees from Cardiac Dimensions, personal fees from Actimed, personal fees from Astra Zeneca, personal fees from Amgen, personal fees from Bioventrix, personal fees from Janssen, personal fees from Respicardia, personal fees from V-Wave, personal fees from Brahms, personal fees from Cordio, personal fees from Occlutech, outside the submitted work. Dr. Ruiz reports grants from Longeveron Inc, outside the submitted work. Dr. Marzetti reports personal fees from Abbott, personal fees from Nestlè, personal fees from Nutricia, personal fees from ThermoFisher, outside the submitted work. All the other authors have nothing to disclose.

Introduction: Substantial gaps in research remain across oldest-old ethnic populations while the burden of dementia increases exponentially with age among Mexican and Mexican American older adults., Methods: Prevalence and correlates of dementia among individuals ≥82 years of age were examined using two population-based cohort studies: The Mexican Health and Aging Study (MHAS, n = 1078, 2012) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, n = 735, 2012-2013). The analytic MHAS and HEPESE samples had an average age of 86.4 and 88.0 years, 1.2 and 1.8 women to men, and 2.7 and 5.1 average years of education, respectively., Results: We identified 316 (29.2%) and 267 (36.3%) cases of likely dementia in the MHAS and HEPESE cohorts, respectively. For Mexicans but not Mexican Americans, age-adjusted prevalence rates of likely dementia were higher in women than men. For both populations prevalence rates increased with age and decreased with education for Mexican Americans but not for Mexicans. In both populations, odds of likely dementia increased with age. Health insurance for the low-income was significantly associated with higher odds of likely dementia for Mexican American men and women and Mexican women but not men. Living in extended households increased the odds of likely dementia in women, but not in men for both studies. Multiple cardiovascular conditions increased the odds of likely dementia for Mexicans but not for Mexican Americans., Discussion: Our study provides evidence of the high burden of dementia among oldest-old Mexicans and Mexican Americans and its association with health and social vulnerabilities., Competing Interests: The authors have no conflicts of interest to report., (© 2020 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.)

Objectives: To identify trajectories of depression and daily disability in the context of serious falls and widowhood and to predict those trajectories before the events occurred. Methods: Longitudinal data were used from the Mexican Health and Aging Study. Trajectories were estimated using latent class growth analysis. Internal and socio-ecological resources were analyzed as predictors of the trajectories. Results: Unfavorable (worsening of symptoms and chronic high symptoms) and favorable (improvement of symptoms and stable low symptoms (resistance)) trajectories were identified. Favorable trajectories were more likely for daily disability. Persons who showed resistance in depression also tended to show resistance in daily disability. Net worth, cognition, and subjective well-being were early predictors for most trajectories. Discussion: Besides resistance, individuals rather show different co-occurring trajectories in the studied outcomes. While some factors could be identified that lead to favorable trajectories in both stressful contexts, the study also shows the necessity for context-specific research and praxis.

Background: Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions., Aim: To identify and define the characteristics of intermediate care models., Methods: A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted., Results: Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models., Discussion: There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination., Conclusions: This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.

Background: Due to a high prevalence of chronic non-degenerative diseases, it is suspected that COVID 19 poses a high risk of fatal complications for the Mexican population. The present study aims to estimate the risk factors for hospitalization and death in the Mexican population infected by SARS-CoV-2., Methods and Findings: We used the publicly available data released by the Epidemiological Surveillance System for Viral Respiratory Diseases of the Mexican Ministry of Health (Secretaría de Salud, SSA). All records of positive SARS-CoV-2 cases were included. Two multiple logistic regression models were fitted to estimate the association between hospitalization and mortality, with other covariables. Data on 10,544 individuals (57.68% men), with mean age 46.47±15.62, were analyzed. Men were about 1.54 times more likely to be hospitalized than women (p<0.001, 95% C.I. 1.37-1.74); individuals aged 50-74 and ≥74 were more likely to be hospitalized than people aged 25-49 (OR 2.05, p<0.001, 95% C.I. 1.81-2.32, and OR 3.84, p<0.001, 95% C.I. 2.90-5.15, respectively). People with hypertension, obesity, and diabetes were more likely to be hospitalized than people without these comorbidities (p<0.01). Men had more risk of death in comparison to women (OR = 1.53, p<0.001, 95% C.I. 1.30-1.81) and individuals aged 50-74 and ≥75 were more likely to die than people aged 25-49 (OR 1.96, p<0.001, 95% C.I. 1.63-2.34, and OR 3.74, p<0.001, 95% C.I. 2.80-4.98, respectively). Hypertension, obesity, and diabetes presented in combination conveyed a higher risk of dying in comparison to not having these diseases (OR = 2.10; p<0.001, 95% C.I. 1.50-2.93). Hospitalization, intubation and pneumonia entail a higher risk of dying (OR 5.02, p<0.001, 95% C.I. 3.88-6.50; OR 4.27, p<0.001, 95% C.I. 3.26-5.59, and OR = 2.57; p<0.001, 95% C.I. 2.11-3.13, respectively). Our study's main limitation is the lack of information on mild (asymptomatic) or moderate cases of COVID-19., Conclusions: The present study points out that in Mexico, where an important proportion of the population has two or more chronic conditions simultaneously, a high mortality rate is a serious risk for those infected by SARS-CoV-2., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To assess the burden of disease and disability in older persons in Mexico from the Global Burden of Disease (GBD) 2016 study data. Methods: Analysis of the Mexican data from the GBD 2016 study is presented by state, sex, and stratified into four age groups: 60 to 69, 70 to 79, 80 to 89, and 90+ years. Results: The majority of disability-adjusted life-years (DALYs) attributable to disorders in persons 60+ in Mexico were due to premature mortality (68%). Diabetes mellitus, ischemic heart disease, and chronic kidney disease were the main causes of DALYs. With progressing age, sense organ diseases, dementias, and falls climbed to the top causes of years lived with disability (YLDs) in both sexes. Discussion: Most of the burden of disease in older Mexicans is due to premature mortality, underlining the need to strengthen the health system to respond better to health care needs of older persons with non-communicable diseases. This analysis provides information for the development of national health policies.

Objectives: Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership., Material and Methods: Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership., Results: Three classes groups based on the nine indicators were identified: "Active older adults" was comprised of 64% of the sample participants, "Relatively independent" and "Physically impaired" were comprised of 26% and 10% of the sample. The "Active older adults" profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the "Active older adults" and "Relatively independent" were comparatively more uniform. Finally, respondents belonging to the "Physically impaired" profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile., Conclusions: These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey., Competing Interests: Conflict of interests The authors declare that they have no Financial and Non-financial competing interests.

Objectives: Intrinsic capacity is a composite of five domains that summarizes the physical and mental capacities of an individual. Intrinsic capacity is increasing in relevance for adapting health systems to population ageing. Therefore, our objective was to analyse how intrinsic capacity has been assessed in older adults and if these measurements have been validated, as an initial step towards the construction of a standard intrinsic capacity index., Design: Narrative review with electronic searches performed in PubMed and Cochrane databases, including the studies which used the term "intrinsic capacity" in the context of human ageing and health. The full text was then accessed to select studies with at least one operationalised domain of intrinsic capacity. We also looked for information on the validity and reliability of the reported measures of intrinsic capacity., Results: We included ten articles reporting a quantitative measurement of intrinsic capacity. There were two intrinsic capacity scores which combined retrospective data on the intrinsic capacity domains sub-scores, with low concordance among tests chosen to measure each domain. Two studies reported on reliability and validity of the IC scores. The main gaps in the construction and validation process were a) analysis undertaken with each domain separately rather than for the construct of intrinsic capacity, b) lack of a clear conceptual and operational definition of the vitality domain, c) summary score that depends upon the distribution of the study sample., Conclusion: Further validation of the intrinsic capacity concept is needed, together with more robust approaches to measure it. A standard index of IC has not been validated for translation into clinical or research purposes., Competing Interests: The authors declare no competing interests.

Background: Frailty remains a challenge in the aging research area with a number of gaps in knowledge still to be filled. Frailty seems to behave as a network, and in silico evidence is available on this matter. Having in vivo evidence that frailty behaves as a complex network was the main purpose of our study., Methods: Data from the Mexican Health and Aging Study (main data 2012, mortality 2015) was used. Frailty was operationalized with a 35-deficit frailty index (FI). Analyzed nodes were the deficits plus death. The edges, linking those nodes were obtained through structural learning, and an undirected graph associated with a discrete probabilistic graphical model (Markov network) was derived. Two algorithms, hill-climbing (hc) and Peter and Clark (PC), were used to derive the graph structure. Analyses were performed for the whole population and tertiles of the total FI score., Results: From the total sample of 10,983 adults aged 50 or older, 43.8% were women, and the mean age was 64.6 years (SD = 9.3). The number of connections increased according to the tertile level of the FI score. As the FI score raised, groups of interconnected deficits increased and how the nodes are connected changed., Conclusions: Frailty phenomenon can be modeled using a Bayesian network. Using the full sample, the most central nodes were self-report of health (most connected node) and difficulty walking a block, and all deficits related to mobility were very interconnected. When frailty levels are considered, the most connected nodes differ, but are related with vitality, mainly at lower frailty levels. We derived that not all deficits are equally related since clusters of very related deficits and non-connected deficits were obtained, which might be considered in the construction of the FI score. Further research should aim to identify the nature of all observed interactions, which might allow the development of specific interventions to mitigate the consequences of frailty in older adults., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Mexico's National Institute of Geriatrics (INGER) is the national research center of reference for matters related to human aging. INGER scientists perform basic, clinical, and demographic research which may imply different scientific cultures working together in the same specialized institution. In this paper, by a combination of text mining, coauthorship network analysis, and agent-based modeling, we analyzed and modeled the team assembly practices and the structure of the knowledge produced by scientists from INGER. Our results showed a weak connection between basic and clinical research and the emergence of a highly connected academic leadership. Importantly, basic and clinical-demographic researchers exhibited different team assembly strategies: basic researchers tended to form larger teams mainly with external collaborators, while clinical and demographic researchers formed smaller teams that very often incorporated internal (INGER) collaborators. We showed how these two different ways to form research teams impacted the organization of knowledge produced at INGER. Following these observations, we modeled, via agent-based modeling, the coexistence of different scientific cultures (basic and clinical research) exhibiting different team assembly strategies in the same institution. Three virtual experiments were run in our agent-based model. The three experiments kept similar values to the collaborating dynamics of INGER in terms of average team size and probabilities of choosing incumbents and external collaborators. The only difference among these experiments was the value of homophily defined as the trend to collaborate with research studies from the same field (14% corresponding to the 46% and 79%). The main result of these experiments is that by modulating just one variable (homophily), we could successfully reproduce the current situation of INGER (homophily of 79%) and simulate alternative scenarios in which interdisciplinary (46%) and transdisciplinary (14%) research could be done.

Background: Mortality in Mexico has decreased substantially in the last years; however, there are segments of the population that experience social deprivation., Objective: To identify and describe at the national level the causes of death by degree of social deprivation (DSD), age and sex., Methods: We analyzed variables from the Censo de Vivienda y Población (Census of Population and Housing) and data from statistics of mortality and DSD, all information corresponding to 2010. Demographic and socioeconomic variables were age, sex, marital status, healthcare provider and locality. Variables related to mortality were main cause of death, year, age and the city of residence of the deceased; we analyzed the DSD at a precinct level. We applied techniques of population analysis and we used statistical packages STATA© and SPSS©. We analyzed information from 1,197,496 adults ≥ 60 years old who represented 10,602,181 elderly., Results: Main causes of death in the very high DSD were heart diseases, neoplasms, malnutrition and anemia, diabetes mellitus (DM) and "lack of an accurate diagnosis related to the type of care received"; in the other DSDs main causes were heart diseases, DM, neoplasms, chronic obstructive pulmonary disease and cerebral vascular disease or liver diseases., Conclusion: We detected several mortality profiles; it is suggested the planning of specific actions.

Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults., Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty., Competing Interests: E. Dent, J.E. Morley, A.J. Cruz-Jentoft, L. Rodríguez-Mañas, L.P. Fried, J. Woo, I. Aprahamian, A. Sanford, J. Lundy, J. Beilby, F.C. Martin, L. Ferrucci, R.A. Merchant, H. Arai, E.O. Hoogendijk, C.W. Won, A. Abbatecola, T. Cederholm, T. Strandberg, L.M. Gutiérrez Robledo, L. Flicker, M. Aubertin-Leheudre, H.A. Bischoff-Ferrari, J.M. Guralnik, J. Muscedere, M. Pahor, A.M. Negm, D.L. Waters declare there are no conflicts. L. Woodhouse reports personal fees from American Physical Therapy Association (APTA), personal fees from Focus on Therapeutic Outcomes (FOTO) Inc., personal fees from Canadian Physiotherapy Association (CPA), personal fees from Eli Lilly, personal fees from Scholar Rock, outside the submitted work. J.M. Bauer reports personal fees from Fresenius, personal fees from Nestlé, personal fees from Novartis, personal fees from Pfizer, personal fees from Bayer, grants and personal fees from Nutricia DANONE, outside the submitted work. J Ruiz: employees Longeveron. S. Bhasin reports grants from AbbVie, grants from Alivegen, grants from MIB, other from FPT, other from AbbVie, outside the submitted work. J.Y. Reginster reports grants and personal fees from IBSA-GENEVRIER, grants and personal fees from MYLAN, grants and personal fees from RADIUS HEALTH, personal fees from PIERRE FABRE, grants from CNIEL, personal fees from DAIRY RESEARCH COUNCIL (DRC), outside the submitted work. B. Vellas reports grants from Nestle, Nutricia, Novartis outside the submitted work.

Objectives: Intrinsic capacity (IC) is one of the latest views of positive aging. In its current status lacks a biological substrate amenable to be intervened. The aim of this study was to determine the association of allostatic load (AL) with IC., Design: We present a cross-sectional analysis of the Costa Rican Longevity and Healthy Aging Study., Setting: This report is from a representative sample of Costa Rican older adults; one of the countries that integrate the Central America region., Participants: 2,827, 60-year or older community-dwelling individuals., Methods: An IC index was gathered and validated, including different domains: cognitive, psychological, sensory, vitality and locomotion. AL was integrated with: blood pressure, abdominal obesity, body mass index, HDL-cholesterol, glycosylated hemoglobin, DHEAS, cortisol, epinephrine and norepinephrine. AL was grouped in three categories according to the number of abnormal biomarkers (0-1, 2-3 and ≥4). Chronic diseases, socioeconomic level, sex and age were the adjusting variables. Ordinal logistic regression models were estimated in order to test the strength of the association., Results: From a total sample of 1,888 individuals, 51% (n=962) were women, 36.4% were in the 60-69 age category. The mean score of the IC index was of 6.6 (±2.2). Odds ratio (OR) of the adjusted models were significant for the group of those with 2-3 abnormal biomarkers of AL (OR 0.67, p=0.007) and also for those with ≥4 (OR 0.56, p=0.002), when compared to the reference group of AL (0-1 abnormal biomarkers)., Conclusions and Implications: AL showed an incremental association with IC, even when adjusted for factors such as socioeconomic status and chronic diseases. Targeting therapeutically AL could potentially improve IC in older adults and therefore decreasing the progression to disability or to overt dependency., Competing Interests: Authors declare no conflict of interest

Non-contributory pension programs in the developing world seek to provide older adults with an income that may improve their health and wellbeing in old age by enabling access to health care and better nutrition. There is no previous evidence of the effects of non-contributory pensions on frailty, a comprehensive measure of health and well-being of the oldest old. We aimed to estimate the effects of non-contributory pension programs on frailty of older adults in the state of Yucatan, Mexico. We use rich panel data, including objective markers and self-reported assessments of health and well-being, for 944 adults at least 70 years of age in two communities of Yucatan, Mexico. The first wave was collected in 2008; the second wave was collected in 2010, 18 months after implementation of a monthly state pension in one community and 12 months after a federal pension paid every two months in the other. We found the state pension led to a statistically significant decrease in the severity of frailty for women, but the federal pension was associated with an increase. We found no statistically significant change in the frailty index for men in either community. Among explanations for these findings are monthly payments being more likely to be spent on health care, medicines, and more regular food expenditures, enabling women who previously lacked independent means of support to increase their longer-term health. The federal program paid every two months led to irregular patterns of food expenditure and increased ownership of durable goods but had no effects on health care utilization, subsequently leading to deterioration in longer-term health for women., Competing Interests: The authors have declared that no competing interests exist.