Background.Although it has been demonstrated that physical performance measures predict incident disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of disability risk according to age, sex, and level of performance.

OBJECTIVE -To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. RESULTS -The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro-and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. RESEARCH DESIGN AND METHODSCONCLUSIONS -Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.

Although some research has recently begun to question whether indeed all Hispanic groups enjoy a mortality advantage, the majority of the evidence continues to support a mortality advantage at a minimum among Mexican Americans and especially in old age, at least among men, which may provide partial, albeit indirect, support for a selective return migration or "salmon bias" effect. There is a need to further explore the existence of a selective return migration effect with expanded data bases that include more subjects from the various Hispanic origins. To date, the majority of the evidence continues to support the Hispanic paradox at least among people of Mexican origin and calls for additional attention to this interesting and highly important phenomenon.

Our results support the concept that positive affect, or emotional well-being, is different from the absence of depression or negative affect. Positive affect seems to protect individuals against physical declines in old age.

Sociocultural advantages conferred on Mexican Americans by living in high-density Mexican American neighborhoods outweigh the disadvantages conferred by the high poverty of those neighborhoods.

Older Mexican Americans with reduced handgrip strength at baseline demonstrated a statistically significant decline in cognitive function over a 7-year period. By contrast, participants in the highest handgrip strength quartile maintained a higher level of cognitive function.

Handgrip strength is a strong predictor of mortality in older Mexican Americans, after controlling for relevant risk factors.

Objectives-We examined frailty, particularly how diabetes and obesity impact disability and morbidity in Mexican American older adults.Methods-We studied the trajectory of frailty over 10 years in 2,049 Mexican Americans participating in the Hispanic Established Populations Epidemiologic Studies of the Elderly. A frailty index based on weight loss, exhaustion, grip strength, walking speed, and physical activity was computed and data were collected on sociodemographic and health status, comorbidities and performance-based functional measures.Results-The sample was 58% female with a mean age of 74.43 (sd = 6.04) at baseline. Analyses at 10 year follow-up revealed 75% of the surviving sample (N = 777) were classified as pre-frail or frail compared to 55% at baseline. 84% of persons identified as frail at baseline died by the end of follow-up. Baseline age, diabetes, arthritis, smoking status, body mass index, cognition, negative affect, and number of comorbid conditions were predictors of frailty at follow-up (R 2 = 0.29, p <. 05).Conclusions-Research is needed to reduce the number of Mexican American older adults who become frail and transition to disability and loss of independence. MeSH keywordsFrail elderly; Mexican Americans; health status; activities of daily living CONTRIBUTORSKenneth Ottenbacher was responsible for conceptualization of the longitudinal frailty component of the study and development of hypotheses. He contributed to writing and reviewing all sections of the paper and interpretation of data. James Graham assisted in data analysis, interpretation and contributed to writing discussion. Soham Al Snih conducted data analyses and prepared drafts of the results section. Mukaila Raji contributed to identification of covariates, interpretation of analyses, and prepared the methods section. Rafael Samper-Ternent contributed to management and analysis of the 2006 data and coding of variables. He also participated in writing results section. Glenn Ostir contributed to interpretation of data from all behavioral and psychological measures and helped prepare the methods section. He reviewed all aspects of the paper. Kyriakos Markides was responsible for overall design of the larger EPESE study and identification of variables and analyses of 1995/96 data. He also contributed to introduction, discussion and interpretation of longitudinal trends. HUMAN PARTICIPANT PROTECTION