Mexican Americans comprise the fastest growing segment of the older adult population in the U.S. They represent a group with distinct health and social characteristics that may influence their use of health care resources and health outcomes. We will study a national sample of Mexican American older adults participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly (EPESE) - a study supported by the NIA for 20 years. With the aging of the U.S. population and increase in persons over the age of 85, the number of frail individuals is projected to increase substantially in the coming decade. Frailty not only affects the older person's function and quality of life, butis a burden for caregiving families and the U.S. healthcare system. Recent research indicates that frailty is a dynamic process and individuals may transition in-and-out of the stages of frailty. Ths research suggests that frailty is preventable and potentially reversible. The goal of the research is to better understand the long-term health outcomes, healthcare utilization, and life expectancy of this population with a focus on the impact of frailty and disability on Mexican American older adults. We will examine three aims.
Aim 1. Explore transitions and trajectories in frailty stages (non-frail, pre-frail, and frail) over 20 years in Mexican American older adults.
Aim 2. Develop life expectancy tables for older Mexican Americans based on stages of frailty. The tables will include frail-free life expectancy, disability life expectancy, frail life expectancy, and disabiliy plus frail life expectancy. Tables will be developed for males and females.
Aim 3. Examine the long-term health outcomes and healthcare utilization of Mexican American older adults. We will analyze how health outcomes (e.g., disability, cognitive function, and health related quality-of-life) are related to frailty status over time. The Hispanic EPESE data will be linked to Medicare files to examine the utilization of health and medical services including, emergency room visits, hospitalizations, post-acute care services (e.g., skilled nursing), and health care costs over time The sample includes 2,438 participants from the Hispanic. A standard measure of physical frailty has been collected eight times over a period of 20 years along with measures of disability and cognitive function. We will link the Hispanic EPESE data with Medicare claims files to obtain information on the use of health resources, presence of chronic diseases, hospitalization, and the use of skilled nursing and other post-acute services. We will use a growth curve model with ordinal measures and generalized linear mixed models to examine longitudinal changes in frailty. The transitions across frailty stages (non-frail, pre-frail and frail) will be compared fo men and women with a focus on persons who have remained non-frail, or have transitioned from a state of frailty back to physical and/or functional independence.

Public Health Relevance

The project will study the long-term health outcomes and use of health care resources in Mexican American older adults, the fastest growing segment of the older population. We will identify the demographic, physical, behavioral, cognitive, social, and environmental factors contributing to health, functional decline, recovery, emergency room visits, hospitalizations and the use of other health and medical resources. Our findings will have important implications for healthcare quality and use of health related resources for members of this population.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project (R01)
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Community Influences on Health Behavior Study Section (CIHB)
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Stinson, Nathaniel
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University of Texas Med Br Galveston
Physical Medicine & Rehab
Sch Allied Health Professions
United States
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Downer, Brian; Al Snih, Soham; Howrey, Bret T et al. (2018) Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans. Aging Ment Health :1-8
Jarvis, Jessica M; Downer, Brian; Baillargeon, Jacques et al. (2018) The modifying effect of positive emotion on the relationship between cognitive impairment and disability among older Mexican Americans: a cohort study. Disabil Rehabil :1-8
Howrey, Bret T; Al Snih, Soham; Markides, Kyriakos S et al. (2018) Frailty and diabetes among Mexican American older adults. Ann Epidemiol 28:421-426.e1
Lewis, Zakkoyya H; Markides, Kyriakos S; Ottenbacher, Kenneth J et al. (2018) The Impact of 10-Year Physical Activity Changes on 7-Year Mortality in Older Mexican Americans. J Phys Act Health 15:30-39
Li, Chih-Ying; Al Snih, Soham; Karmarkar, Amol et al. (2018) Early frailty transition predicts 15-year mortality among nondisabled older Mexican Americans. Ann Epidemiol 28:362-367.e3
Silberschmidt, Seraina; Kumar, Amit; Raji, Mukaila M et al. (2017) Life-Space Mobility and Cognitive Decline Among Mexican Americans Aged 75 Years and Older. J Am Geriatr Soc 65:1514-1520