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1.  Late-life Depressive Symptoms: Prediction Models of Change 
Journal of affective disorders  2013;150(3):886-894.
Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms.
Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item Geriatric Depression Scale, and a score of 11 was used as cutoff point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms.
7,882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR .971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR .581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations.
New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms.
The study has not included clinical evaluations and nutritional assessments
PMCID: PMC3759587  PMID: 23731940
late-life depression; depression trajectories; depressive symptoms; geriatric syndromes; geriatric depression scale
2.  Nurse home visits with or without alert buttons versus usual care in the frail elderly: a randomized controlled trial 
To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults.
Unblinded, randomized, controlled trial.
Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.
Patients were aged over 60 years with a frailty index score higher than 0.14.
After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.
The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.
The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group.
An intervention based on NV+AB seems to have a positive effect on frailty scores.
PMCID: PMC3558028  PMID: 23378751
gerontechnology; frailty; elderly
3.  Pandemic (H1N1) 2009 Virus and Down Syndrome Patients 
Emerging Infectious Diseases  2010;16(8):1312-1314.
We compared prevalence of hospitalization, endotracheal intubation, and death among case-patients with and without Down syndrome during pandemic (H1N1) 2009 in Mexico. Likelihoods of hospitalization, intubation, and death were 16-fold, 8-fold, and 335-fold greater, respectively, for patients with Down syndrome. Vaccination and early antiviral drug treatment are recommended during such epidemics.
PMCID: PMC3298326  PMID: 20678334
Running title: Pandemic (H1N1) 2009 and Down Syndrome; influenza; Down syndrome; viruses; pandemic (H1N1) 2009; dispatch
4.  Depressive Symptoms Among Older Adults in Mexico City 
Journal of General Internal Medicine  2008;23(12):1973-1980.
Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.
To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.
Cross-sectional, multistage community survey.
A total of 7,449 persons aged 60 years and older.
Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.
The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = −20.2, 95% CI = −21.3, −19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).
According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.
PMCID: PMC2596501  PMID: 18818976
aged; depression; comorbidity; primary healthcare
5.  A frailty index to predict the mortality risk in a population of senior mexican adults 
BMC Geriatrics  2009;9:47.
Frailty in the elderly can be regarded as nonspecific vulnerability to adverse health outcomes, caused by multiple factors. The aim was to analyze the relationships between the frailty index, age and mortality in a two year follow up study of Mexican elderly.
A frailty index was developed using 34 variables. To obtain the index, the mean of the total score for each individual was obtained. Survival analyses techniques were used to examine the risk ratios for the different levels of the frailty index. Kaplan-Meier estimates were obtained, adjusted for age and gender. Cox proportional hazards models were also built to obtain hazard ratio estimates.
A total of 4082 participants was analyzed. Participants had an average age of 73 years and 52.5% were women. On average, participants were followed-up for 710 days (standard deviation = 111 days) and 279 of them died. Mortality increased with the frailty index level, especially in those with levels between .21 to .65, reaching approximately 17% and 21%, respectively. Cox proportional hazards models showed that participants with frailty index levels associated to increased mortality (.21 and higher) represent 24.0% of those aged 65-69 years and 47.6% of those 85 and older.
The frailty index shows the properties found in the other studies, it allows stratifying older Mexican into several groups different by the degree of the risk of mortality, and therefore the frailty index can be used in assessing health of elderly.
PMCID: PMC2776593  PMID: 19887005

Results 1-5 (5)