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Ogaz-González R, Corpeleijn E, García-Chanes RE, Gutierréz-Robledo LM, Escamilla-Santiago RA, López-Cervantes M. Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults. BMC Geriatr 2024; 24:355. [PMID: 38649809 PMCID: PMC11034053 DOI: 10.1186/s12877-024-04948-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. METHODS The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. RESULTS Four different types of patterns were identified: 'Neuro-psychiatric', 'Metabolic', 'Cardiovascular', and 'Mixt' configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07-2.57); 'Mixt' HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09-1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + 'Cardiovascular' HR:1.56 (1.00-2.42); frailty + 'Mixt':1.42 (0.95-2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02-1.49)]. CONCLUSIONS Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.
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Affiliation(s)
- Rafael Ogaz-González
- Department of Public Health, Faculty of Medicine, National Autonomous University of México, Sixth Floor, Building B, 411A Circuito Escolar, Copilco Universidad, Mexico City, Coyoacán, 04360, Mexico
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Ricardo Antonio Escamilla-Santiago
- Department of Public Health, Faculty of Medicine, National Autonomous University of México, Sixth Floor, Building B, 411A Circuito Escolar, Copilco Universidad, Mexico City, Coyoacán, 04360, Mexico
| | - Malaquías López-Cervantes
- Department of Public Health, Faculty of Medicine, National Autonomous University of México, Sixth Floor, Building B, 411A Circuito Escolar, Copilco Universidad, Mexico City, Coyoacán, 04360, Mexico.
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Gutiérrez-Robledo LM, Tella-Vega P, García-Chanes RE, Lozano-Juárez LR, Medina-Campos RH, García-Andrade S, Escamilla-Núñez A, Amuthavalli Thiyagarajan J, Diaz T, Mikton C, García-Peña C. Psychometric properties of ability to contribute measurements as a domain of functional ability of older persons: a COSMIN systematic review. Age Ageing 2023; 52:iv138-iv148. [PMID: 37902526 PMCID: PMC10615053 DOI: 10.1093/ageing/afad099] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/17/2023] [Indexed: 10/31/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Luis Raymundo Lozano-Juárez
- Instituto Nacional de Geriatría, Ciudad de México, México
- Global Health Research Departament, Juntendo University, Tokyo, Japan
| | | | | | - Alberto Escamilla-Núñez
- Analysis and Synthesis of the Evidence Research Unit, National Medical Center XXI Century, Instituto Mexicano del Seguro Social, Mexico City, México
| | | | - Theresa Diaz
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Christopher Mikton
- Department of Social Determinants of Health, Division of Healthier Populations, World Health Organization, Geneva, Switzerland
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García-Hernández H, García-Chanes RE, Pérez-Zepeda MU, García-Peña C. Association between the changes in socialsecurity continuity condition and mortality: MHAS 2001-2018 analysis. Salud Publica Mex 2023; 65:504-512. [PMID: 38060919 PMCID: PMC10751061 DOI: 10.21149/14727] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To analyze the association of changes in social security (SS) continuity and mortality, using the Mexican Health and Aging Study (MHAS) in people aged 60 years and more. MATERIALS AND METHODS Retrospective cohort. We analyzed the SS continuity condition -classified as stable, unstable with SS, unstable without SS, and without SS- and its relation with mortality; a probit regression model was utilized to obtain marginal effects, taking into consideration covariates related to mortality. RESULTS Unstable continuity with and without SS and multimorbidity (two or more diseases) increased the probability of dying by 52.9% (p = 0.000, 95%CI: 0.508,0.551), 50.3% (p = 0.000, 95%CI: 0.474,0.531) and 13.3% (p = 0.000, 95%CI: 0.108,0.159), respectively. Meanwhile, being woman, at least one year of formal education, and marriage reduced it in 8.8% (p = 0.000, 95%CI: -0.106,-0.071), 7% (p = 0.000, 95%CI: -0.091,-0.050) and 7.8% (p = 0.000, 95%CI: -0.096,-0.061), respectively. CONCLUSION Belonging to SS was associated with higher mortality, compared to other social health determinants, like education.
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Affiliation(s)
| | | | - Mario Ulises Pérez-Zepeda
- Dirección de Investigación, Instituto Nacional de Geriatría. Mexico City, Mexico. Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte. Estado de México, Mexico..
| | - Carmen García-Peña
- Dirección General, Instituto Nacional de Geriatría. Mexico City, Mexico..
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García-Chanes RE, Avila-Funes JA, Borda MG, Pérez-Zepeda MU, Gutiérrez-Robledo LM. Higher frailty levels are associated with lower cognitive test scores in a multi-country study: evidence from the study on global ageing and adult health. Front Med (Lausanne) 2023; 10:1166365. [PMID: 37324127 PMCID: PMC10267459 DOI: 10.3389/fmed.2023.1166365] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
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.
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Affiliation(s)
| | - José Alberto Avila-Funes
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Bordeaux Population Health Research Center, INSERM-University of Bordeaux, UMR 1219, Bordeaux, France
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Mario Ulises Pérez-Zepeda
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Huixquilucan de Degollado, Mexico
| | - Luis Miguel Gutiérrez-Robledo
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Gutierrez-Robledo LM, García-Chanes RE. Editorial: Intrinsic Capacity Trajectories: The Underlying Social and Economic Determinants. J Nutr Health Aging 2023; 27:172-173. [PMID: 36973921 DOI: 10.1007/s12603-023-1896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- L M Gutierrez-Robledo
- Luis Miguel Gutierrez-Robledo, Researcher in medical Sciences Instituto Nacional de Geriatría, Mexico,
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Gutiérrez-Robledo LM, García-Chanes RE, Pérez-Zepeda MU. Screening intrinsic capacity and its epidemiological characterization: a secondary analysis of the Mexican Health and Aging Study. Rev Panam Salud Publica 2021; 45:e121. [PMID: 34531905 PMCID: PMC8437155 DOI: 10.26633/rpsp.2021.121] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
| | - Rosa Estela García-Chanes
- Instituto Nacional de Geriatría Mexico City Mexico Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría Mexico City Mexico Instituto Nacional de Geriatría, Mexico City, Mexico
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Gonzalez-Bautista E, Andrieu S, Gutiérrez-Robledo LM, García-Chanes RE, de Souto Barreto P. In the quest of a Standard Index of Intrinsic Capacity. A Critical Literature Review. J Nutr Health Aging 2021; 24:959-965. [PMID: 33155621 DOI: 10.1007/s12603-020-1394-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- E Gonzalez-Bautista
- Emmanuel Gonzalez-Bautista, Université Fédérale Toulouse Midi-Pyrénées, France,
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Gutiérrez-Robledo LM, García-Chanes RE, González-Bautista E, Rosas-Carrasco O. Validation of Two Intrinsic Capacity Scales and Its Relationship with Frailty and Other Outcomes in Mexican Community-Dwelling Older Adults. J Nutr Health Aging 2021; 25:33-40. [PMID: 33367460 DOI: 10.1007/s12603-020-1555-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- L M Gutiérrez-Robledo
- Luis Miguel Gutiérrez-Robledo, MD, PhD, Instituto Nacional de Geriatría, Blvd. Adolfo Ruiz Cortines (Periférico Sur) 2767, Col. San Jerónimo Lídice, Del. La Magdalena Contreras, ciudad de México, C.P.10200, México, E-mail address:
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Gutiérrez-Robledo LM, García-Chanes RE, Pérez-Zepeda MU. Allostatic Load as a Biological Substrate to Intrinsic Capacity: A Secondary Analysis of CRELES. J Nutr Health Aging 2019; 23:788-795. [PMID: 31641727 DOI: 10.1007/s12603-019-1251-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- L M Gutiérrez-Robledo
- Luis Miguel Gutiérrez-Robledo, MD, PhD, Instituto Nacional de Geriatría, Blvd. Adolfo Ruiz Cortines (Periférico Sur) 2767, Col. San Jerónimo Lídice, Del. La Magdalena Contreras, ciudad de México, C.P. 10200, México, E-mail address:
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