Risk Factors for Disability Progression Among Mexican-American Older Adults

PURPOSE: Mexican Americans are the fastest growing segment of the U.S. older adult population and will be considerable consumers of health care resources. Although previous studies reported that gender and age influence disability progression among Mexican–American older adults, it is not clear which health conditions influence disability progression among this rapidly growing population (Díaz–Venegas et al., 2016; Gerst–Emerson et al., 2015). The purpose of this study was to examine the demographic, physical, and mental health factors associated with disability progression among Mexican–American older adults.

METHOD: This study was a longitudinal survey study. We retrieved a representative sample of 731 community–dwelling Mexican–American older adults from the 2006 and 2009 waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly Frailty Study. Participants were aged 65 and older and living in community settings in Arizona, California, Colorado, New Mexico, and Texas.

We created a disability severity scale using the Rasch model and seven basic and 10 instrumental activity of daily living (ADL) items. We measured the disability severity of the sample in 2006 and 2009 using the Rasch–calibrated linear interval scale. We then used a multivariable linear regression model to identify significant risk factors for disability progression over 3 yr. In this regression model, the dependent variable was change in disability severity between 2006 and 2009 and the independent variables were 25 demographic, physical, and mental health conditions.

RESULTS: The majority of the sample was female (n = 477, 65.2%) and single (n = 430, 58.8%). The mean age of the sample was 81.8 (SD = 4.2). The 17 ADL items met unidimensionality (RMSEA = .074, CFI = .983, TLI = .981) and model fit expectations for the Rasch model and demonstrated good internal consistency (Cronbach’s alpha = .92, person reliability = .83). The baseline Rasch–calibrated person measure decreased from 3.20 logits (SD = 2.94) to 2.46 logits (SD = 3.25). Approximately half of the participants (n = 370) demonstrated progression toward disability. Age (β = –.08, p = .003), female sex (β = –.49, p = .021), hypertension (β = –.51, p = .008), and dementia (β = –.95, p = .041) were significantly related to the progression of disability. Conversely, baseline pain (β = .60, p = .002) and depression (β = .05, p = .032) were protective of disability progression.

CONCLUSION: A majority of our cohort of older Hispanic adults demonstrated significant disability progression from 2006 to 2009. Participant characteristics independently associated with disability progression included dementia, hypertension, female sex, and older age. Participants with self–reported pain and depression in 2006 demonstrated improvement in ADLs in 2009, suggesting that pain and depression may lead to temporary declines in functional independence that improve with time.

IMPACT STATEMENT: The identified risk factors for disability progression among Mexican–American older adults can inform clinical decision making for this rapidly growing population. The findings also contribute to future research directions in aging studies targeting healthy aging among community–dwelling older adults.

References

Díaz–Venegas, C., Reistetter, T. A., & Wong, R. (2016). Differences in the progression of disability: A U.S.–Mexico comparison. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 73, 913–922. https://doi.org/10.1093/geronb/gbw082

Gerst–Emerson, K., Wong, R., Michaels–Obregon, A., & Palloni, A. (2015). Cross–national differences in disability among elders: Transitions in disability in Mexico and the United States. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 70, 759–768. https://doi.org/10.1093/geronb/gbu185