Biomedical subjects

K S Markides

Publications and source records attributed to K S Markides.

At least 37 records · Page 2Linked to original sources

PubMed2000

Obesity and health conditions in elderly Mexican Americans: the Hispanic EPESE. Established Population for Epidemiologic Studies of the Elderly.

The objective of this analysis was to determine the prevalence of obesity and its association with selected medical conditions in a non-institutionalized elderly Mexican-American population. Data employed are from a representative sample of 3050 elderly Mexican Americans from the five Southwestern states: Texas, California, Colorado, New Mexico, and Arizona. Complete Body Mass Index (BMI) data were available for 2769 individuals. The in-home survey obtained socio-demographic data, anthropometric measurements, including height and weight, blood pressure readings, self-reported health conditions and depressive symptomatology. It was found that 23% of men and 35% of women were obese (BMI > or =30 kg/m2). Using a weighted logistic regression model, a BMI of > or =26 kg/m2 was associated with a significantly higher risk of diabetes; a BMI of > or =30 kg/m2 was significantly associated with arthritis and measured hypertension and a BMI<22 kg/m2 was associated with a higher likelihood of self-reported cancer. In addition, the prevalence of obesity was found to be much higher in this elderly Mexican-American population than in the general population.

Aged↗

PubMed1999

Changes in the smoking behavior of elderly Mexican Americans in the Southwest from 1982-1984 to 1993-1994.

OBJECTIVES: The aim of this work was to examine changes in the smoking behavior of elderly Mexican Americans in the southwestern United States from the early 1980s to the early 1990s. METHODS: Data from the 1993-1994 Hispanic EPESE study (n = 2,809) on persons ages 65 to 74 and 75 to 84 residing in the five southwestern states were compared with data from the 1982-1984 Hispanic HANES study (n = 753, persons ages 55 to 74), which included a Mexican American sample from the same five southwestern states. RESULTS: Rates of current smoking in 1993-1994 for persons ages 65 to 74 were approximately half the rates for persons of the same age a decade earlier. Smoking rates for persons ages 75 to 84 in 1993-1994 were significantly lower than rates for persons ages 65 to 74 a decade earlier. Finally, rates for persons ages 65 to 74 in 1993-1994 were significantly lower than those for persons ages 55 to 64 in 1982-1984. CONCLUSIONS: Although some of the declines in smoking in recent years represent aging effects (including declines due to greater mortality among smokers), the much lower rates for same-age people (65 to 74) over the 10-year period are more significant in that they represent cohort differences. It appears that the broader public health message that is causing the general population to quit smoking is reaching the elderly Mexican American population of the Southwest.

Aged↗

PubMed1999

The influence of noncognitive factors on the Mini-Mental State Examination in older Mexican-Americans: findings from the Hispanic EPESE. Established Population for the Epidemiologic Study of the Elderly.

Mini-Mental State Examination data from the Hispanic Established Population for the Epidemiologic Study of the Elderly baseline survey, a population-based study of community-dwelling Mexican Americans aged 65 and older, were used to examine the relationship between cognitive impairment, sociodemographics, and health-related characteristics. The rate of cognitive impairment found in this group of older Mexican Americans, using the conventional cut point of 23/24 on the MMSE, was 36.7%. Using a more conservative cut point of 17/18 indicated an overall rate of severe cognitive impairment of 6.7%. Rates of impairment varied significantly with age, education, literacy, marital status, language of interview, and immigrant status and were associated with high and moderate levels of depressive symptoms, and history of stroke. Importantly, although education was strongly related to poor cognitive performance, it was not a significant predictor of severe cognitive impairment. Multivariate analyses further indicated that as a screen for cognitive impairment in older Mexican Americans, the MMSE is strongly influenced by these noncognitive factors. Scores may reflect test bias, secondary to cultural differences or the level of education in this population.

Aged↗

PubMed1999

Depressive symptoms and mortality in older Mexican Americans.

PURPOSE: We examined the prevalence of comorbid depressive symptomatology and leading chronic medical conditions, and their influence on death rates in older Mexican Americans. METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) were used. Differences in death rates across sociodemographics, self-ratings of health, and health conditions were examined with analysis of variance statistics. Logistic regression models were used to examine main effects and interaction effects of each medical condition separately and in conjunction with depressive symptomatology. RESULTS: Bivariate analyses indicated that death rates were substantially higher when a high level of depressive symptoms was comorbid with diabetes (OR = 3.84, 95% CI = 2.55-5.78), cardiovascular disease (OR = 4.04, 95% CI = 2.36-6.91), hypertension (OR = 2.27, 95% CI = 1.57-3.27), stroke (OR = 3.00, 95% CI = 1.44-6.15), and cancer (OR = 4.46, 95% CI = 2.48-8.01). Multivariate analyses indicated a synergistic effect for comorbid diabetes and depressive symptoms such that the odds of having died among diabetics with high levels of depressive symptoms (OR = 4.03, 95% CI = 2.67-6.11) were three times that of diabetics without high levels of depressive symptoms (OR = 1.36, 95% CI = 0.89-2.06). CONCLUSIONS: High levels of depressive symptoms concomitant with major chronic medical conditions elevate the risk for death among older Mexican Americans. Given the fact that depression is often unrecognized and undertreated in the elderly, awareness of the potential for loss of life as well as the potential for treatment may help to improve this situation not only for older Mexican Americans, but for older adults in general.

Aged↗

PubMed1999

Disability in older adults. 1: Prevalence, causes, and consequences.

The effects of disability on an aging population's health and welfare are an important issue in gerontological research. The rapid growth of the elderly population and increases in longevity have led to an ongoing debate about whether longer lives can be matched by longer active lives that are free from disability. After a detailed review of current disability literature, the authors discuss the impact of disability in the elderly, defining disability and reviewing three classes of disability--physical, mental, and social. Both subjective and objective disability measures are described, and disability trends and prevalence rates are reviewed and compared cross culturally, by gender, by age, and over time. The path from chronic disease to disability is described and the consequences of living with disability are discussed in terms of family burdens and the increased need for medical care.

Activities of Daily Living↗

PubMed1999

Disability in older adults. 2: Physical activity as prevention.

In this 2nd article in the series on older adults (persons aged > or = 65 years), the role of physical activity in preventing disability associated with aging in the absence of specific illnesses is discussed, and different types of activities and the measures of outcome are described. Evidence for physical activity as a prevention measure is restricted to primary and secondary prevention because the application of physical activity for tertiary prevention of disability is limited. Chronic disease is considered in the context of its influence on disability only when physical activity offers some potential benefit to elderly persons.

Activities of Daily Living↗

PubMed1999

Age at migration and family dependency among older Mexican immigrants: recent evidence from the Mexican American EPESE.

This study employs new data on Mexican-origin individuals aged 65 and older in the Southwestern United States to examine the impact of the age at which an individual immigrated to the United States on his or her sources of income and living arrangements. The data reveal that, in general, those who immigrated after the age of 50 are more dependent on their families than the native born or those who immigrated earlier in life. Although our findings must be interpreted cautiously because of small cell sizes, those who immigrated later in life are found to be less likely than the native born or those who immigrated earlier to have private pensions and Social Security income. They are also more likely to be living with their children and to be receiving money from them. We discuss the implications of recent restrictions on the eligibility of even legal immigrants for Supplemental Security Income on intergenerational relations and on the potential burden placed on the older immigrant's family, many of which may be seriously strained in hard economic times.

Aged↗

PubMed1999

Changes in blood pressure and risk factors for cardiovascular disease among older Mexican-Americans from 1982-1984 to 1993-1994.

OBJECTIVE: To determine the 10-year changes in blood pressure and cardiovascular risk factors among older Mexican-Americans. DESIGN: Comparative analyses of the Hispanic Health and Nutrition Examination Survey (HHANES) and the Hispanic EPESE (Established Populations for Epidemiologic Studies of the Elderly). Both of these were population-based studies using a multistage stratified probability sampling design of noninstitutionalized persons. SETTING: Five US states in the southwest: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 216 Mexican-Americans aged 65 to 74 from the 1982-1984 HHANES and 3050 Mexican-Americans aged 65+ from the 1993-1994 Hispanic EPESE. MEASUREMENTS: Mean systolic and diastolic blood pressure; cigarette smoking; high levels of alcohol use; body mass index and obesity; self-reported heart attack, stroke, and diabetes; hypertension. RESULTS: Among 65- to 74-year-old Mexican-Americans, there was a decrease over time in the percent of those who smoked cigarettes from 27.60% to 13.96% and a decrease in mean systolic blood pressure level. The percent of subjects categorized as obese or severely obese increased significantly, as did the prevalence of diagnosed diabetes, increasing from 20.06% in 1982-1984 to 29.82% in 1993-1994. Mean diastolic blood pressure increased from 77.15 mm Hg in 1982-1984 to 81.21 mm Hg in 1993-1994. CONCLUSIONS: Our findings suggest major changes in cardiovascular risk factors between 1982-1984 and 1993-1994 among older Mexican-Americans.

Aged↗

PubMed1999

The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly.

OBJECTIVES: The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans. METHODS: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older. RESULTS: The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults. CONCLUSIONS: Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men.

Aged↗

PubMed1998

The association between chronic diseases and depressive symptomatology in older Mexican Americans.

BACKGROUND: Among the elderly population, the risk for psychological distress increases with the number of chronic diseases and accompanying functional disability. The prevalence of chronic medical conditions and functional disability varies substantially across ethnocultural groups, however. Using data from the Hispanic EPESE, we previously reported that among older Mexican Americans, the total number of chronic medical conditions and the presence of functional impairment are strong predictors of depressive symptoms. METHODS: Using multiple regression, we examined the association between specific chronic diseases, individual functional disabilities, and depressive symptoms in this group of ethnic elders. RESULTS: Multiple regression models indicated that diabetes (OR = 1.25, 95% CI = 1.03-1.56), arthritis (OR = 1.42, 95% CI = 1.17-1.72), urinary incontinence (OR = 1.94, 95% CI = 1.46-2.59), bowel incontinence (OR = 2.28, 95% CI = 1.15-4.55), kidney disease (OR = 3.11, 95% CI = 1.13-8.58), and ulcers (OR = 2.56, 95% CI = 1.23-5.29) were predictive of high levels of depressive symptoms. Hip fracture, although recognized as having a substantial impact on functional status, was not found to be associated with depressive symptoms. History of stroke was not significantly associated with depressive symptoms in bivariate or multivariate analyses, but history of stroke with residual speech problems was predictive (OR = 2.16, 95% CI = 1.01-4.79). Among specific activities of daily living, only impaired ability to walk across a room (OR = 1.65, 95% CI = 1.04-2.73) or to bathe oneself (OR = 1.87, 95% CI = 1.12-3.12) proved to be predictive in multivariate analyses. CONCLUSIONS: This constellation of chronic medical conditions and functional disabilities is very different from those reported to be associated with depressive symptoms in older non-Hispanic White and African Americans, and appears to comprise those conditions most associated with substantial physical impairment, pain, and discomfort.

Aged↗

PubMed1998

Lower body functioning as a predictor of subsequent disability among older Mexican Americans.

BACKGROUND: Disability measures among elderly non-Hispanic White populations have traditionally been associated with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). More recently, performance-based measures have increasingly been used to predict the onset of disability in initially nondisabled elderly populations. METHODS: We used data from two waves (1993-94 and 1995-96) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (EPESE) to assess the degree with which lower mobility performance measures predict future disability in a representative sample of older Mexican Americans from the Southwestern United States. RESULTS: Performances on an 8-foot walk, repeated chair stands, and standing balance among nondisabled subjects at baseline were significantly associated with the onset of ADL and lower body disability 2 years later, controlling for age, gender, and the presence of medical conditions. The results were significant for each performance measure and for a measure combining all three. CONCLUSION: This study offers further evidence that performance-based measures of lower body function are able to predict future disability in older Mexican Americans, as has been found with other elderly populations. These measures were able to detect changes over a relatively short period of time (2 years). In addition, the study found that the short (8-foot) walk was the most sensitive measure in predicting future disability.

Activities of Daily Living↗

PubMed1998

Correlates of depressive symptomatology among older community-dwelling Mexican Americans: the Hispanic EPESE.

OBJECTIVES: The prevalence of depressive symptoms and associated risk factors is described, using data from the Hispanic EPESE, the first large, representative study of older Mexican Americans. METHODS: Multivariate logistic regression was used to examine the association between depressive symptoms and sociodemographics, chronic health conditions, disability, and cultural factors. RESULTS: Using the Center for Epidemiologic Studies of Depression scale, 25.6% of the 2,823 subjects reported high symptom levels. Rates among women (31.9%) and particularly men (17.3%) were higher than has been typically reported for older Mexican Americans and older adults in general. Consistent with previous studies of older adults, gender, lack of insurance, financial strain, chronic health conditions, and disability were found to be associated with depressive symptoms. Several cultural factors were also associated with increased risk, including immigrant status, levels of acculturation and assimilation, health locus of control, and recency of immigration. An interaction between gender and immigrant status was found such that, in relation to subjects born in the United States, female immigrants were at significantly higher risk for depressive symptoms, whereas male immigrants were at lower risk.

Acculturation↗

PubMed1998

Undertreatment of hypertension in older Mexican Americans.

OBJECTIVE: To identify the prevalence of hypertension and factors associated with nontreatment and poor control of hypertension in Mexican Americans aged 65 years and older. DESIGN: A population-based survey of older Mexican Americans conducted in 1993-1994. SETTING: Subjects residing in five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: An area probability sample of 3050 noninstitutionalized Mexican American men and women aged 65 and older took part in a 90-minute in-home interview, which included review of all medications taken and two sitting blood pressure measurements. OUTCOME MEASURES: Measured were previous diagnoses of hypertension, current medication for hypertension, and current blood pressure RESULTS: Sixty-one percent of older Mexican-Americans were hypertensive, and 51% of those with hypertension were taking antihypertensive medications. Only 25% of hypertensive subjects (18% of males and 30% of females) were in good blood pressure control (i.e., systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg). In multivariate analyses, factors associated with increased likelihood of treatment included female gender (OR = 1.9), history of heart disease (OR = 2.4), possessing a regular source of health care (OR = 2.7), and having seen a physician two or more times in the previous year (OR = 3.8). These were also independent predictors of good blood pressure control. CONCLUSION: Nontreatment of hypertension is still a major public health concern in older Mexican Americans. We estimate that adequate blood pressure control in this population would prevent approximately 30,000 adverse cardiovascular events over 10 years, affecting approximately 6% of the entire Mexican American older population.

Aged↗

PubMed1998

Lower-extremity functioning in older Mexican Americans and its association with medical problems.

OBJECTIVE: To describe lower-extremity functioning in community-dwelling older Mexican Americans and to examine its relationship with medical problems. DESIGN: Cross-sectional analyses of survey and performance-based data obtained in a population-based study employing area probability sampling. SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older. MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower-extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure. RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower-extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance. CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower-extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance-based tests of lower-extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.

Activities of Daily Living↗

PubMed1998

Correlates of prescription and over-the-counter medication usage among older Mexican Americans: the Hispanic EPESE study. Established Population for the Epidemiologic Study of the Elderly.

OBJECTIVES: To determine the prevalence rates of prescription and over-the-counter (OTC) medication usage among community-dwelling older Mexican Americans. DESIGN: Cross-sectional survey of a regional probability sample of older Mexican Americans. SETTING: The 1992-1997 Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE), a probability sample of noninstitutionalized Mexican Americans, age 65 and over, living in the five Southwestern states of Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: 2899 persons, age 65 and over, considered Mexican American, using appropriate weighting procedures to produce regional estimates. OUTCOME MEASURES: Use of prescription and OTC medication within the last 2 weeks before the survey confirmed by in-home review of medication containers. RESULTS: Medication users consumed a mean of 2.9 prescription and 1.3 OTC medications. Over half (58.9%, n = 1,798) of the participants used at least one prescribed medication, and 31.3% (n = 847) used at least one OTC medication within the 2 weeks before their participation in the study. Factors associated with both prescription and OTC medication usage were self-perceived health and number of co-morbid conditions. Factors associated only with prescription medication usage included female gender, alcohol usage, ADL dependency, and presence of additional insurance. Structural assimilation was associated only with OTC medication usage. CONCLUSIONS: These data show lower prevalence rates of prescription medication usage among Mexican American older men and lower rates of OTC medication usage in older Mexican Americans of both genders than previously reported in other ethnic groups. This may reflect differences in time and geographic location of the Hispanic EPESE relative to other EPESE studies, ethnic differences in access to care as reflected by insurance in addition to Medicare, ethnic differences in survival, especially among males, or ethnic differences in medication preferences.

Activities of Daily Living↗

PubMed1998

Alcohol use among Cuban-Americans, Mexican-Americans, and Puerto Ricans.

Studies of alcohol consumption among Hispanics in the United States show different patterns based on gender, country of origin, and economic status. The literature shows a lower frequency but higher volume of consumption among Mexican-American and Puerto Rican males than among non-Hispanic white males. Cuban-American males have a pattern of relatively moderate consumption that resembles that of non-Hispanic whites. Women from Mexican-American, Cuban-American, and Puerto Rican populations have low alcohol consumption rates, which appear to increase with the level of acculturation. Existing data are old, however, and new studies are needed to update information on alcohol consumption patterns of the largest Hispanic subgroups in the United States as well as the drinking habits of the growing numbers of Hispanics from places other than Mexico, Puerto Rico, and Cuba.

Alcohol Drinking↗

PubMed1998

Impact of selected medical conditions on self-reported lower-extremity function in Mexican-American elderly.

OBJECTIVE: To examine the independent impact of common medical conditions on lower-extremity function in Mexican-American elderly. DESIGN: Cross-sectional study using a probability sample of non-institutionalized Mexican Americans aged 65 or older. SETTING: The five Southwestern states, Texas, New Mexico, Arizona, Colorado and California. PARTICIPANTS: All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. MAIN OUTCOME MEASURES: Respondents were asked whether they could perform four activities related to lower-extremity function without help: walking across a small room, getting from a bed to a chair, walking up and down stairs, and walking half a mile. A summary measure of lower body disability created from these four items was regressed on seven common medical conditions plus five control variables using multiple logistic regression. RESULTS: Adjusted Odds Ratios (OR) suggested that impaired lower-extremity function was associated with previous diagnosis of hip fracture (OR = 4.28), stroke (OR = 3.47), lower extremity arthritis (OR = 2.60), heart attack (OR = 2.29), diabetes (OR = 2.03) and obesity (OR = 1.50). Impaired lower-extremity function was significantly associated with older age (75+ years old), gender (female) and marital status (unmarried). In addition, there was a linear increase in the risk of function loss by number of medical conditions. CONCLUSIONS: It appears that Mexican-American elderly diagnosed with medical conditions, especially stroke and hip fracture, have a high risk for lower-extremity dysfunction. These findings have implications for efforts to prevent or reduce lower-extremity dysfunction, as well as for the provision of community-based long-term care services for Mexican-American elderly.

Activities of Daily Living↗

PubMed1997

The factor structure of the CES-D in two surveys of elderly Mexican Americans.

The factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) has not been well defined among elderly Mexican Americans. Although most prior research suggests the CES-D has four factors, prior research also suggests that the factor structure of the CES-D may vary with culture. In addition, previous theory and research on other depression inventories suggest only two factors: a general depression factor and a psychological well-being factor. The current study determines the number of factors for the CES-D in the Hispanic Established Populations for Epidemiologic Studies (H-EPESE) survey (N = 2,536) and in a previous study of elderly Mexican Americans living in San Antonio, Texas (N = 330). The factor analytic results argue strongly for the two-factor model, and this model is the only structure that yielded consistent results across subgroups (e.g., male vs female or Spanish vs English language of interview). We conclude that the CES-D has only two factors among elderly Mexican Americans.

Aged↗