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Mexico City, Mexico

Bozek A.,Medical University of Silesia, Katowice | Rogala B.,Medical University of Silesia, Katowice | Bednarski P.,National Institute of Geriatrics
Journal of Asthma | Year: 2016

Co-morbidities are a significant problem in the elderly population but are rarely presented and analyzed for interdependencies among the various coexisting chronic diseases. Objective: The aim of this study was to present a profile of comorbidities in elderly patients with and without asthma and COPD. Methods: Respondents were recruited at 20 sites in Poland. Stratified random sampling from patient databases resulted in 15,973 patients older than 60 years of age. A retrospective analysis of medical history and ICD-10 codes was performed. In addition, patients underwent a spirometry test with a bronchial reversibility test and were administered questionnaires on the prevalence of chronic diseases by doctors. Results: The study population consisted of 1023 asthmatic patients, 1084 patients with COPD and 1076 control subjects without any signs of bronchoconstriction and with correct spirometry. Patients with asthma exhibited a similar distribution of cardiovascular and metabolic co-morbidities as the control group. However, asthmatic patients had a higher prevalence of arterial hypertension and depression with an odds ratio (OR) = 1.48 (95% CI: 1.38–1.62) and OR = 1.52 (95% CI: 1.44–1.68), respectively. Coronary disease (OR = 2.12; 95% CI: 1.97–2.33), cor pulmonale (OR = 3.1; 95% CI: 2.87–3.22) and heart failure (OR = 2.71; 95% CI: 2.64–3.11) were predominantly observed in patients with COPD. Patients with severe asthma exhibited a greater predisposition to cardiovascular and neuropsychiatric diseases. Conclusion: Asthma coexisted frequently with arterial hypertension and depression in elderly patients. Patients with COPD have a more exaggerated profile of coexisting diseases, specifically cardiovascular problems. © 2016 Taylor & Francis

Lourenco R.A.,State University of Rio de Janeiro | Perez-zepeda M.,Instituto Nacional Of Geriatria | Gutierrez-robledo L.,National Institute of Geriatrics | Garcia-garcia F.J.,Servicio de Geriatria | Rodriguez manas L.,Hospital Universitario Of Getafe
Age and Ageing | Year: 2015

Background: there is a lack of consensus on the diagnosis of sarcopenia. A screening and diagnostic algorithm was proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).Objective: to assess the performance of the EWGSOP algorithm in determining the proportion of subjects suspected of having sarcopenia and selected to undergo subsequent muscle mass (MM) measurement.Design: a cross-sectional study.Setting: the cohorts, Frailty in Brazilian Older People Study-Rio de Janeiro (FIBRA-RJ), Brazil; Coyoacan Cohort (CC), Mexico City, Mexico; and Toledo Study for Healthy Aging (TSHA), Toledo, Spain.Subjects: three thousand two hundred and sixty community-dwelling individuals, 65 years and older.Methods: initially, the EWGSOP algorithm was applied using its originally proposed cut-off values for gait speed and handgrip strength; in the second step, values tailored for the specific cohorts were used.Results: using the originally suggested EWGSOP cut-off points, 83.4% of the total cohort (94.4% in TSHA, 75.5% in FIBRA-RJ, 67.8% in CC) would have been considered as suspected of sarcopenia. Adapted cut-off values lowered the proportion of abnormal results to 34.2% (quintile-based approach) and 23.71% (z-score approach).Conclusions: the algorithm proposed by the EWGSOP is of limited clinical utility in screening older adults for sarcopenia due to the high proportion of subjects selected to further undergo MM assessment. Tailoring cut-off values to specific characteristics of the population being studied reduces the number of people selected for MM assessment, probably improving the performance of the algorithm. Further research including the objective measure of MM is needed to determine the accuracy of these specific cut-off points. © The Author 2014.

Perez-Zepeda M.U.,National Institute of Geriatrics | Gutierrez-Robledo L.M.,Head Office of the National Institute of Geriatrics
European Geriatric Medicine | Year: 2016

Introduction: Calf circumference is a surrogate measurement of muscle mass. However, there is scarce evidence on its validity in predicting adverse outcomes such as mobility disability. The aim of this report is to determine if calf circumference could predict incident mobility disability in Mexican 60-year or older adults. Methods: This is a secondary analysis of the Mexican Health and Aging Study and in particular of its two first waves. Sixty-year or older adults without mobility disability in the first assessment were included and followed-up for two years. Calf circumference quartile groups were compared to test the difference of incident mobility disability. Logistic regression models were fitted to test the independent association when including confounding variables. Results: A total of 745 older adults were assessed, from which 24.4% of the older adults developed mobility disability at follow-up. A calf circumference > 38 cm was associated with a higher risk of developing mobility disability, even after adjustment in the multivariate model, with an odds ratio 0.55 (95% confidence interval 0.31-0.99, P = 0.049). Conclusions: High calf circumference in Mexican older adults is independently associated with incident mobility disability. This could reflect the impact of adverse health conditions such as obesity (with high fat tissue) or edema. Further research should aim at testing these results in different populations. © 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Hayward M.D.,University of Texas at Austin | Hummer R.A.,University of Texas at Austin | Chiu C.-T.,National University of Singapore | Gonzalez-Gonzalez C.,National Institute of Geriatrics | Wong R.,University of Texas Medical Branch
Population Research and Policy Review | Year: 2014

Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics' low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born. © 2013 Springer Science+Business Media Dordrecht.

Mino-Leon D.,National Institute of Geriatrics | Reyes-Morales H.,National Health Research Institute | Flores-Hernandez S.,National Health Research Institute
Journal of Evaluation in Clinical Practice | Year: 2014

Rationale, aims and objectives To evaluate the effectiveness of incorporating the pharmacist into the ambulatory health care team to increase the proportion of patients with type 2 diabetes mellitus (T2DM) and/or hypertension who adhere to their drug regimen and to improve disease control. Methods A non-randomized clinical trial was carried out in patients with T2DM and/or hypertension from two primary care clinics. Patients from one of the clinics comprised the intervention group (IG) who received 'counselling' from the pharmacist. The control group (CG) was comprised of patients who attended another clinic and received the usual care. Adherence was measured by counting pills; hypertension control was evaluated by blood pressure and diabetes control by blood glucose. Statistical analysis was carried out by intention to treat using generalized linear models. Results There were 440 patients included. There was no difference in the proportion of IG and CG patients who adhered to treatment according to baseline measurements. An increase in the proportion of adherence at baseline and final determination was observed in both groups (IG 71-80%, P = 0.006 and CG 72-87%, P = 0.000). Generalized linear models showed a 55% or higher probability of IG patients achieving control of hypertension in comparison with the CG. Patients from the IG with T2DM have 13% more possibility of achieving glycaemic control than those of the CG. Conclusion Counselling offered by the pharmacist proved to be effective for improving drug adherence of diabetic and hypertensive patients in ambulatory health care. © 2014 John Wiley & Sons, Ltd.

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