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Hernández-Ruiz V, García-Lara JMA, Zamudio-Rodríguez A, García-Juárez I, Avila-Funes JA. Liver transplantation in Mexican older adults: A comparative single-center study. Rev Gastroenterol Mex (Engl Ed) 2019; 84:455-460. [PMID: 31570173 DOI: 10.1016/j.rgmx.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/05/2018] [Accepted: 09/30/2018] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Liver disease is currently one of the leading causes of death in older adults and the only option deemed curative is liver transplantation. However, it is uncertain whether the successful results obtained in older adults that receive a liver transplant in developed countries can be replicated in developing countries. AIM To determine if there are differences in the survival time between older (≥60years) and younger adults that underwent liver transplantation at a university-affiliated tertiary care center in Mexico City. MATERIALS AND METHODS A 2-year longitudinal study was conducted. It included 244 participants that were divided into 2groups according to age at the time of transplantation: older adults (≥60years) and younger adults (18-59years). Survival time was defined as the number of days that elapsed between transplantation and death. Survival was expressed as Kaplan-Meier curves. RESULTS Median age in the older adults (n=52) was 63.0 (IQR=60-69) and 23 participants were females (44.2%). In the younger adults (n=196) median age was 47.0 (IQR=16-59) and 104 were females (52%). The leading indication for transplant was hepatitisC virus. After the follow-up, fifteen participants died (12 younger adults and 3 older adults). No significant differences were observed between older and younger participants in postoperative complications, the number of re-admissions, or mean post-transplantation survival time. CONCLUSIONS There were no statistically significant differences in relation to survival times between older and younger adults that received a liver transplant. Older patients in developing countries should not be excluded from the selection process due only to age.
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Affiliation(s)
- V Hernández-Ruiz
- Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, Burdeos, Francia
| | - J M A García-Lara
- Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - A Zamudio-Rodríguez
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, Burdeos, Francia
| | - I García-Juárez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J A Avila-Funes
- Servicio de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR, Burdeos, Francia.
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Gomez-Moreno C, Verduzco-Aguirre H, Contreras-Garduño S, Perez-de-Acha A, Alcalde-Castro J, Chavarri-Guerra Y, García-Lara JMA, Navarrete-Reyes AP, Avila-Funes JA, Soto-Perez-de-Celis E. Perceptions of aging and ageism among Mexican physicians-in-training. Clin Transl Oncol 2019; 21:1730-1735. [PMID: 30977047 DOI: 10.1007/s12094-019-02107-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/29/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Attributing negative stereotypes to older adults (ageism) may lead to undertreatment, but little is known about the prevalence of ageism among physicians treating patients with cancer in Ibero-America. We studied stereotypes of aging among Mexican physicians-in-training. MATERIALS AND METHODS Physicians-in-training attending an oncology meeting answered the "Negative Attributes and Positive Potential in Old Age" survey. Ten questions assessed positive characteristics of aging (PPOA; score 1-4, higher scores represent a positive perception), and four assessed negative characteristics (NAOA; score 1-4, higher score representing a negative perception). Descriptive statistics were used to analyze the questionnaires. Participants completed the "Image-of-Aging" question by writing five words describing older adults and young individuals. Each word was rated from - 5 (negative) to + 5 (positive), and presented as word clouds. RESULTS One hundred physicians-in-training (median age 28.5) were included. For the PPOA scale, the mean score was 2.9 (SD 0.4), while for the NAOA scale it was 2.1 (SD 0.4). Perceptions of aging were better among women and trainees enrolled in geriatrics and/or oncology-related programs. In the "Image-of-Aging" questions, median rating of words describing older adults was - 2, compared to + 3 for young individuals (p < 0.001). Among words used to describe older adults, the most frequent was "frail/frailty" (n = 45), while "health" (n = 46) was the most frequent for younger individuals. CONCLUSIONS Mexican physicians-in-training showed mostly negative perceptions of aging, exemplified by the use of negative terms to describe older adults. Creating educational initiatives aimed at decreasing ageism among oncology trainees is necessary across Ibero-America.
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Affiliation(s)
- C Gomez-Moreno
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - H Verduzco-Aguirre
- Department of Oncology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - S Contreras-Garduño
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - A Perez-de-Acha
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - J Alcalde-Castro
- Department of Oncology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Y Chavarri-Guerra
- Department of Oncology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - J M A García-Lara
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - A P Navarrete-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - J A Avila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - E Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Séptimo Piso UPA, Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
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Abstract
Muscle Frailty has been previously associated with increased vulnerability for adverse health-related outcomes that could lead to social consequences such as mistreatment. The aim of this cross-sectional study is to determine the association between frailty and mistreatment in 852 community-dwelling persons aged 70 or older. Mistreatment was defined as one positive answer in the Geriatric Mistreatment Scale and frailty was used as a continuum where the greater number of positive criteria according to Fried et al. indicates a higher frailty score. Multivariate logistic regression models were run to establish this association. The mean age of participants was 77.7 years (SD=6.1). Prevalence of frailty phenotype and mistreatment were 13.9% and 20% respectively. Unadjusted analysis showed frailty score was associated with mistreatment (OR = 1.16; 95% CI 1.02 to 1.3, p=0.022). However, after adjustment, the association was no longer present. The results showed that in the presence of other geriatric syndromes such as disability or depression, frailty did not show association with mistreatment in this population.
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Affiliation(s)
- S D Piña-Escudero
- José Alberto ÁVILA-FUNES M.D., PhD. Instituto Nacional de Nutrición Salvador Zubirán. Vasco de Quiroga 15. Colonia Belisario Domínguez Sección XVI. Delegación Tlalpan. C.P. 14080, Mexico City, Mexico; e-mail:, Phone number: + 52 (55) 5487 0900, 5703
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García-Lara JMA, Navarrete-Reyes AP, Medina-Méndez R, Aguilar-Navarro SG, Avila-Funes JA. Successful Aging, a New Challenge for Developing Countries: The Coyoacán Cohort. J Nutr Health Aging 2017; 21:215-219. [PMID: 28112779 DOI: 10.1007/s12603-016-0728-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the socio-demographic and health factors associated with a biomedical phenotype of successful aging (SA) among Mexican community-dwelling elderly. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of 935 older adults aged 70 or older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS SA was operationalized in accordance with the phenotype proposed by Rowe and Kahn. Univariate and multivariate logistic regression analyses were carried out in order to identify the correlates of SA. RESULTS The phenotype of SA was present in 10% of participants. Age (P < 0.001), illiteracy (P = 0.021), polypharmacy (P < 0.001), and physical pain (P < 0.001) were factors independently and inversely associated with the presence of the SA phenotype. The only variable positively associated with SA was good self-perceived health-status (P < 0.001). CONCLUSION Although age is not modifiable, several other factors associated with SA are. If we are to promote SA, efforts should be made towards improving those modifiable factors negatively associated with its presence, such as pain or polypharmacy. Also, enhancing factors positively associated to it might play a role in improving wellbeing.
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Affiliation(s)
- J M A García-Lara
- José Alberto Ávila-Funes. Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. Colonia Belisario Domínguez Sección XVI. CP 14080; Tlalpan, Phone: + 52 (55) 54 87 09 00, 5703. E-mail:
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Aguilar-Navarro S, Gutiérrez-Robledo LM, García-Lara JMA, Payette H, Amieva H, Avila-Funes JA. The Phenotype of Frailty Predicts Disability and Mortality among Mexican Community-Dwelling Elderly. J Frailty Aging 2016; 1:111-7. [PMID: 27093198 DOI: 10.14283/jfa.2012.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty represents a major public health priority in Western countries. Specific social and cultural factors may influence the prevalence and predictive value for negative health-related events of this syndrome. OBJECTIVE To determine the prevalence and predictive value of the phenotype of frailty among community-dwelling Mexican American older persons. DESIGN, SETTING AND PARTICIPANTS Two-year longitudinal study of 5,644 men and women aged 60 years and older participating in the Mexican Health and Aging Study. MEASUREMENTS The Frailty index used in the present study was a modified version of the operational definition proposed in the Cardiovascular Health Study (CHS). Frailty was defined by the presence of at least three of the four following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. The main outcomes were incident disability and mortality. Chi-square, ANOVA and multiple logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. RESULTS The mean age of the study sample was 68.7 (SD 6.9) years. Thirty-seven percent of participants (n=2,102) met the definition of frailty. Frail subjects were significantly older, and more likely to be women than non-frail participants. They also presented lower education, more chronic diseases, lower income, and poorer self-reported health status. After adjusting for potential confounders, frailty was found to be a predictor of incident mobility disability (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.37-2.66), activities of daily living (ADL) disability (OR 9.33; 95%CI 3.37-25.82), and instrumental ADL (IADL) disability (OR 1.81, 95%CI 1.23-2.68). The risk of mortality among frail participants was almost three-fold higher than in non-frail ones. CONCLUSION The prevalence of frailty is higher in this elderly population than what previously reported in other cohorts. The phenotype of frailty was confirmed to be a predictor for adverse health-related outcomes (including mobility, ADL, and IADL disability). Further studies in Latin American countries are needed to identify frailty and develop adapted interventions for the prevention of adverse outcomes in older persons.
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Affiliation(s)
- S Aguilar-Navarro
- José Alberto Ávila-Funes. Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14000; Tlalpan, Distrito Federal, México. Phone: +52 (55) 54 87 09 00, 5703. E-mail: , Alternate Corresponding Author: Sara Aguilar-Navarro. E-mail:
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González-Pichardo AM, Navarrete-Reyes AP, Adame-Encarnación H, Aguilar-Navarro S, García-Lara JMA, Amieva H, Avila-Funes JA. Association between Self-Reported Health Status and Frailty in Community-Dwelling Elderly. J Frailty Aging 2016; 3:104-8. [PMID: 27049902 DOI: 10.14283/jfa.2014.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The phenotype of frailty proposed by Fried et al. has been related with increased vulnerability for the development of adverse health-related outcomes. However, this phenotype is not often used in daily clinical practice. On the other hand, poor self-reported health status (SRHS) has been associated with similar adverse health-related outcomes. OBJECTIVES To determine the association between poor SRHS and frailty. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of 927 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS SRHS was established by the question "How do you rate your health status in general?" Frailty was defined according to the phenotype proposed by Fried et al. The association between SRHS and frailty was determined through the construction of multinomial logistic regression models. Final analyses were adjusted by socio-demographic and health covariates, including depressive symptoms. Also, agreement between SRHS and the phenotype of frailty was explored. RESULTS Prevalence of frailty was 14.1%, and 4.4% of participants rated their health status as "poor". The unadjusted regression analyses demonstrated that fair and poor SRHS were significantly associated with prefrail and frail status. After adjustment for multiple covariates, the association remained statistically significant. However, in the final adjustment for depressive symptoms, only the association between poor SRHS and frail status continued to be statistically significant. Fair agreement between poor SRHS and frail status was also found. CONCLUSION Poor SRHS shares common correlates as well as health-related adverse outcomes with frailty syndrome, and remains associated with it even when possible confounders are taken into account. Therefore, poor SRHS could be further explored as an option for frailty syndrome screening.
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Affiliation(s)
- A M González-Pichardo
- José Alberto Ávila-Funes. Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14000; Tlalpan, México, Distrito Federal. Phone: + 52 (55) 54 87 09 00, 5703. E-mail:
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Navarrete-Reyes AP, García-Muñoz I, García-Lara JMA, Torres-Carrillo NM, Amieva H, Avila-Funes JA. 25-OH-Vitamin D Is Not Associated with Cognitive Performance among Mexican Community-Dwelling Older Persons. J Frailty Aging 2016; 4:74-9. [PMID: 27032048 DOI: 10.14283/jfa.2015.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Low cognitive performance has been associated with a wide array of adverse health-related outcomes in elderly populations. Recently, the effect of vitamin D on cognition has been studied; however, its benefits are still controversial. Moreover, most studies have been carried out on North-American and European populations where vitamin D deficiency could represent a greater public-health issue when compared to Latin American ones. OBJECTIVE To investigate the association between 25-OH-vitamin D and cognitive performance in Mexican community-dwelling elderly. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study sample of 331 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS Serum 25-OH-vitamin D, cognitive performance as per the Mini-Mental State Examination (MMSE) and the IST (Isaacs Set Test), as well as several elements from the comprehensive geriatric assessment. RESULTS Mean age of participants was 79.3 years (SD 5.9), 54.1% were women. The mean serum 25-OH-vitamin D level was 59.0 (SD 23.3) nmol/L while mean MMSE score was 22.3 (SD 3.4) and mean IST score was 37.1 (SD 9.1). Although 25-OH-vitamin D levels were lower across all the definitions of low cognitive perfomance, the difference between groups was not statistically significant in any of them. CONCLUSION No association between 25-OH-vitamin D level and cognitive performance was found in this population of Mexican community-dwelling elderly. Further investigation is required in order to clarify its existence and if so, to delineate its characteristics.
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Affiliation(s)
- A P Navarrete-Reyes
- José Alberto Ávila-Funes. Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14000; Tlalpan, Distrito Federal, México. Phone: +52(55)54 87 09 00, 5703. E-mail:
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Moreno-Aguilar M, García-Lara JMA, Aguilar-Navarro S, Navarrete-Reyes AP, Amieva H, Ávila-Funes JA. The Phenotype of Frailty and Health-Related Quality of Life. J Frailty Aging 2013; 2:2-7. [PMID: 27070451 DOI: 10.14283/jfa.2013.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty is a multidimensional problem in the elderly, but there is little information about its implications on health-related quality of life (HRQoL). OBJECTIVES To determine the association between frailty and HRQoL as well as the association between each component of the phenotype of frailty and the physical (PCS) and mental (MCS) components summaries of QoL. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of 496 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. QoL and both of its components were assessed through the SF-36. The association of each component of frailty with the PCS and the MCS of QoL was determined through the construction of multivariate lineal regression models. Final analyses were adjusted by socio-demographic characteristics and by the remaining four components of frailty as covariates. RESULTS Mean age of participants was 78.0 (SD ± 6.2), 49.4% were women, and 12.7% were frail. Multivariate lineal regression analysis showed that frail and prefrail participants had lower scores for the PCS (P < .001) and the MCS (P < .001) of QoL in comparison with non-frail subjects. Weight loss (P < .001) and exhaustion (P < .001) had an independent inverse association with the MCS of QoL while gait speed (P < .001) and grip strength (P < .001) were also inversely associated with the PCS score. CONCLUSION Frailty is independently associated with lower scores in the MCS and the PCS of QoL. The finding that different components of frailty were associated with both dimensions of QoL reflects the need for individualized treatment of frail elderly.
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Affiliation(s)
- M Moreno-Aguilar
- José Alberto Ávila-Funes. Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14000; Tlalpan, Distrito Federal, México. Phone: +52 (55) 54 87 09 00, 5703. E-mail: . Alternate Corresponding Author: Mauricio Moreno-Aguilar. E-mail:
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