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1.  Factors associated with help-seeking behaviors in Mexican elderly individuals with depressive symptoms: a cross-sectional study 
International journal of geriatric psychiatry  2013;28(12):10.1002/gps.3953.
Depression in the elderly is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help seeking process, which usually starts with the feeling “that something is wrong” and ends with appropriate medical care, is influenced by several factors.
The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms.
A cross-sectional study of 60-year or older of community dwelling elderly belonging to the largest health and social security system in Mexico was done. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition and specialized mental health.
A total of 2,322 individuals were studied; from these, 67.14% (n=1,559) were women, and the mean age was 73.18 years (SD=7.02) 57.9% had symptoms of depression, 337 (25.1%) participants sought help, and 271 (80.4%) received help and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ2=81.66, p<0.0001), significant variables were female gender (OR=0.07 95% CI 0.511–0.958 p=0.026), health care use (OR 3.26 CI 95% 1.64–6.488, p=0.001). Number of years in school, difficulty in activities, SAST score and depression as a disease belief were also significant.
Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of elderly with depressive symptoms.
PMCID: PMC3797168  PMID: 23585359
Mental health services; late life depressive symptoms; help-seeking; late life depression care
2.  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
3.  Oral health status in older adults with social security in Mexico City: Latent class analysis 
Objective: To explore the oral health status through a latent class analysis in elderly social security beneficiaries from Southwest Mexico City. Material and Methods: Cross-sectional study of beneficiaries of the State Employee Social Security and Social Services Institute (ISSSTE, in Spanish) and the Mexican Institute of Social Security (IMSS, in Spanish) aged 60 years or older. Oral health conditions such as edentulism, coronal and root caries (DMFT and DFT ≥ 75 percentile), clinical attachment loss (≥ 4 mm), and healthy teeth (≤ 25 percentile) were determined. A latent class analysis (LCA) was performed to classify the oral health status of dentate patients. Results: In total, 336 patients were included (47.9% from the ISSSTE and 52.1% from the IMSS), with an average age of 74.4 (SD = 7.1) years. The 75th percentile of the DMFT = 23 and of the DFT = 2. Of the patients, 77.9% had periodontal disease. The 25th percentile of healthy teeth = 4. A three class model is adequate, with a high classification quality (Entropy = 0.915). The patients were classified as “Edentulous” (15.2%), “Class 1 = Unfavorable” (13.7%), “Class 2 = Somewhat favorable” (10.4%), and “Class 3 = Favorable” (60.7%). Using “Class 3 = Favorable” as a reference, there was an association (OR = 3.4; 95% CI = 1.8-6.4) between being edentulous and being 75 years of age and over, compared with the 60- to 74-year age group. Conclusion: The oral health in elderly social security beneficiaries is not optimal. The probability of becoming edentulous increases with age. A three-class model appropriately classifies the oral health dimensions in the elderly population.
Key words:Elderly, Latent class analysis (LCA), oral health, social security, Mexico.
PMCID: PMC3935902  PMID: 24596632
4.  Distribution of the IL-1RN, IL-6, IL-10, INF-γ, and TNF-α Gene Polymorphisms in the Mexican Population 
Background: Cytokines are a group of polypeptides with an important role in the inflammatory response. It has been suggested that certain polymorphisms located in several cytokine genes are associated with different diseases. The aim of the present study was to establish the gene frequency of 13 polymorphisms of the IL-1RN, IL-6, IL-10, INF-γ, and TNF-α genes in a Mexican population. These polymorphisms have been reported in several populations, with important variation in frequency according to the studied population. Methods: Thirteen polymorphisms (rs419598, rs315951, rs2234663, rs3811058, rs1800796, rs2069827, rs1800896, rs1800871, rs1800872, rs1800629, rs2069709, rs2069710, and rs361525) were analyzed by 5′ exonuclease TaqMan genotyping assays in a group of 248 healthy unrelated Mexican individuals. Results: The results obtained showed that the studied Mexican population presents significant differences (p<0.05) in the distribution of the IL1RN (rs419598, rs315951, and and rs2234663), IL1F10 (rs3811058), IL6 (rs1800796, rs2069827), IL10 (rs1800896, rs1800871, and rs1800872), and TNF-α (rs1800629) polymorphisms when compared to Caucasian, Asian, and African populations. Conclusions: In summary, the distribution of the IL-1RN, IL-6, IL-10, and TNF-α cytokine gene polymorphisms distinguishes the studied Mexican population from other groups. Since the alleles of these cytokines are associated with the development of several inflammatory diseases, knowledge of the distribution of these alleles in the studied Mexican population could be helpful to understand their true role as a genetic susceptibility marker in this population.
PMCID: PMC3468120  PMID: 22971140
5.  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
6.  Health care utilization in the elderly Mexican population: Expenditures and determinants 
BMC Public Health  2011;11:192.
Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual).
To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly.
A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age.
Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization.
The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this group requires immediate attention.
PMCID: PMC3073904  PMID: 21443805
Health expenditures; elderly in Mexico; health needs
7.  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
8.  Direct costs associated with the appropriateness of hospital stay in elderly population 
Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated.
Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City.
The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9–5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6 – 2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2 – US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7 – US$6,198.3), (p < 0.001).
Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.
PMCID: PMC2744673  PMID: 19698130
9.  Oral health service utilization by elderly beneficiaries of the Mexican Institute of Social Security in México city 
The aging population poses a challenge to Mexican health services. The aim of this study is to describe recent oral health services utilization and its association with socio-demographic characteristics and co-morbidity in Mexican Social Security beneficiaries 60 years and older.
A sample of 700 individuals aged 60+ years was randomly chosen from the databases of the Mexican Institute of Social Security (IMSS). These participants resided in the southwest of Mexico City and made up the final sample of a cohort study for identifying risk factors for root caries in elderly patients. Sociodemographic variables, presence of cognitive decline, depression, morbidity, medication consumption, and utilization of as well as reasons for seeking oral health services within the past 12 months were collected through a questionnaire. Clinical oral assessments were carried out to determine coronal and root caries experience.
The sample consisted of 698 individuals aged 71.6 years on average, of whom 68.3% were women. 374 participants (53.6%) had made use of oral health services within the past 12 months. 81% of those who used oral health services sought private medical care, 12.8% sought social security services, and 6.2% public health services. 99.7% had experienced coronal caries and 44.0% root caries. Female sex (OR = 2.0), 6 years' schooling or less (OR = 1.4), and caries experience in more than 22 teeth (OR = 0.6) are factors associated with the utilization of these services.
About half the elderly beneficiaries of social security have made use of oral health services within the past 12 months, and many of them have to use private services. Being a woman, having little schooling, and low caries experience are factors associated with the use of these services.
PMCID: PMC2245816  PMID: 18154658
10.  Anthropometric measures and nutritional status in a healthy elderly population 
BMC Public Health  2007;7:2.
Anthropometric evaluation is an essential feature of geriatric nutritional evaluation for determining malnutrition, being overweight, obesity, muscular mass loss, fat mass gain and adipose tissue redistribution. Anthropometric indicators are used to evaluate the prognosis of chronic and acute diseases, and to guide medical intervention in the elderly. We evaluated anthropometric measurements and nutritional status as they relate to age and gender in healthy elderly people.
The study analyzed data from the national survey "Health needs and health service use by older-than-60-year-old beneficiaries of the Mexican Institute of Social Security (IMSS)". The present study included only individuals who reported no chronic disease in the last 20 years and had no hospital admission in the two months prior to the survey. Anthropometric measurements included weight, height, body mass index (BMI), body circumference (arm, waist, hip and calf), waist to hip ratio (WHR), elbow amplitude and knee-heel length.
Application of the inclusion criteria resulted in a study population elderly of 1,968, representing 12.2% of the original number in the national survey in urban areas beneficiaries of the IMSS. The study population comprised 870 women and 1,098 men, with a mean age of 68.6 years. The average weights were 62.7 kg for women and 70.3 kg for men (p < 0.05), and the mean heights were 1.52 m for women and 1.63 m for men (p < 0.05). Age related changes in anthropometric values were identified. BMI values indicated that 62.3% of the population was overweight, and 73.6% of women and 16.5% of men had high fat tissue distribution.
Our findings suggest that applying the BMI thresholds that identify being overweight in the general adult population may lead to an overestimation in the number of overweight elderly Similar problems appear to exist when assessing waist circumference and WHR values. Prospective studies are required to determine the associations between health and BMI, waist circumference and WHR in the elderly.
PMCID: PMC1769489  PMID: 17201919

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