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

Objective-Examine the association between frailty status and change in cognitive function over time in older Mexican Americans. Design-Data used are from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE)Setting-Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California.Participants-1,370 non-institutionalized Mexican American men and women aged 65 and older with a Mini Mental State Examination (MMSE) ≥ 21 at baseline (1995−1996). Measurements-Frailty Financial disclosure: NoneSponsor's role: Had no role in the design, methods, subject recruitment, data collections, analysis and preparation of paper. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript slow walking speed (lowest 20% 16ft walk-time in seconds), and 5) low physical activity level (lowest 20% Physical Activity Scale for the Elderly (PASE) score). Socio-demographic factors, MMSE, medical conditions (stroke, heart-attack, diabetes, arthritis, cancer and hypertension), depressive symptoms and visual-impairment were obtained.Results-Of the 1370 subjects, 684 (49.9%) were not-frail, 626 (45.7%) were pre-frail (1 − 2 components) and 60 (4.4%) were frail (≥3 components) in 1995/96. Using general linear mixed models, we found that frail subjects had greater cognitive decline over 10-years compared with nonfrail subjects (Estimate = −0.67, SE = 0.13; p< .0001). This association remained statistically significant after controlling for potential confounding factors. Conclusion-Frail status in older MexicanAmericans with MMSE ≥ 21 at baseline is an independent predictor of MMSE score decline over a 10-year period. Future research is needed to establish pathophysiological components that can clarify the relationship between frailty and cognitive decline.

Objective To examine the association between frailty status and incidence of disability among non-disabled older Mexican Americans. Design A 10-year prospective cohort study. Subjects A total of 1645 non-institutionalized Mexican Americans aged 67 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), who reported no limitation in activities of daily living at baseline. Methods Frailty was defined as meeting 3 or more of the following components: (i) unintentional weight loss of > 2.26 kg; (ii) weakness (lowest 20% in hand grip strength); (iii) self-reported exhaustion; (iv) slow walking speed; and (v) low physical activity level. Socio-demographic factors, Mini Mental State Examination, medical conditions, body mass index, and self-reported activities of daily living were obtained. Results Of the 1645 non-disabled subjects at baseline, 820 (50%) were not frail, 749 (45.7%) were pre-frail, and 71 (4.3%) were frail. The hazard ratio of activities of daily living disability at 10-year follow-up for pre-frail subjects was 1.32 (95% confidence interval 1.10–1.58) and 2.42 (95% confidence interval 70–3.46) for frail subjects compared with not frail subjects. This association remained statistically significant after controlling for potential confounding factors at baseline. Conclusion Pre-frail and frail status in older Mexican Americans was associated with an increased risk of activities of daily living disability over a 10-year period among non-disabled subjects.

Frailty has been hypothesized to reflect age-related physiological vulnerability to stressors, and the analyses presented indicate partial support for this hypothesis in an older sample of Mexican Americans. Future research needs to incorporate measures of stressors and social support in examining those who become frail, especially in minority populations.

To study the effect of education on the performance in the Mini-Mental State Examination (MMSE) domains, we included 2,861 Mexican Americans aged 65 and older from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) followed from 1993-1994 until 2004-2005. The MMSE was examined as total score (0-30) or divided in two global domains: 1) no-memory (score 0-24): Orientation, attention, and language; and 2) memory (score 0-6): working and delayed memory. Mean age and total MMSE were 72.7 and 24.6 at wave 1, and 81.7 and 20.5 at wave 5. Spanish speaking subjects had lower years of education (4.1 vs. 7.4, p<. 0001), they had significantly higher adjusted (by age, education, and gender) mean scores for memory, no-memory and the total MMSE compared with English speaking subjects across the five waves of follow-up. In multivariate longitudinal analyses over 11 years of follow-up, subjects with more years of education performed better than those less educated, especially in no-memory and the total MMSE. Spanish speaking subjects with 4-6 years of education had higher memory scores than those speaking English (estimate 0.40, standard error [SE] = 0.14, p<.001), [7][8][9][10][11] SE= 0.13, p<.01) or 12+ (estimate 0.44, SE= 0.13, p<.001). This suggests that cultural factors and factors related to preferred language use may determine variations in MMSE performance. Since the memory domain of the MMSE is less affected by education, it may be used along with other cognitive tests in older populations with low education.