Papers by Mario U Perez-Zepeda
Salud Publica De Mexico, Apr 4, 2019
Objective.-To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican ... more Objective.-To estimate the out-of-pocket expenses (OOPE) during the last year of life in Mexican older adults (OA). Materials and methods.-Estimation of the OOPE corresponding to the last year of life of OA, adjusting by type of management, affiliation and cause of death. Data from the National Health and Aging Study in Mexico (2012) were used. To calculate the total OOPE, the expenses in the last year were used in: medications, medical consultations and hospitalization. The OOPE was adjusted for inflation and is reported in US dollars 2018. Results.-The mean OOPE was $6 255.3±18 500. In the ambulatory care group, the OOPE was $4 134.9±13 631.3. The OOPE in hospitalization was $7 050.6±19 971.0. Conclusions.-The probability of incurre in OOPE is lower when hospitalization is not required. With hospitalization, affiliation to social security and attending to public hospitals plays a protective role. Resumen Estimar el gasto de bolsillo (GB) durante el último año de vida en adultos mayores (AM) mexicanos. Estimación del GB del último año de vida de AM, ajustando por tipo de manejo, afiliación y causa de muerte. Se emplearon datos del Estudio Nacional de Salud y Envejecimiento en México (2012). Los gastos en medicamentos, consultas médicas y hospitalización durante el año previo a la muerte conforman el GB. El GB se ajustó por inflación y se reporta en dólares americanos 2018.
Osteoporosis International, Aug 1, 2012
The Journal of frailty & aging, 2015
BackgroundPhysical performance tests play a major role in the geriatric assessment. In particular... more BackgroundPhysical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described.ObjectivesTo determine risk factors associated with slowness in Mexican older adults.DesignA two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study.Setting, participantsOne representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up).MeasurementsA 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed.ResultsIn the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed.ConclusionsEarly identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.
Journal of the Neurological Sciences, 2022
Geriatrics, gerontology and aging, Dec 1, 2018
Springer eBooks, 2018
Clinical trials are considered to be one of the best methodologies in health research and they ar... more Clinical trials are considered to be one of the best methodologies in health research and they are used primarily to test interventions in medicine. Aging research is no exception for this goal, and clinical trials are used to test different interventions in older adults with a number of variations in this particular research. In addition to drugs, in older adult’s diverse non-pharmacological interventions are experimented for a wide-array of diseases and conditions that are particular for this age group. A careful design and sometimes adaptation of clinical trials methodology are necessary to have accurate results and translate them into actions in everyday clinical care of the older adult. Below, we provide a general and schematic review of the theoretical concept of clinical trials and their variants, followed by examples of interventions and specific outcomes in research on older adults.
PubMed, 2017
Background and objective: Muscular dysfunction and cognitive impairment are both disabling states... more Background and objective: Muscular dysfunction and cognitive impairment are both disabling states, affecting especially the elderly. Thus, are important subjects of research. Our goal is to describe the association between these two entities in the elderly. Methods: This is a secondary analysis from the SABE 2012 Bogota survey, which is a cross-sectional study. We define muscular dysfunction as an abnormal result in gait speed and/or handgrip strength tasks. Cognitive impairment was defined as an abnormal result in Mini Mental State Examination. Other independent variables were measured. Results: A total of 1,564 older adults were included in the analysis. Cognitive impairment showed statistically significant association with both low handgrip strength (OR: 2.25; CI 1.52 - 3.33) and low gait speed (OR: 2.76; CI 1.83 - 4.15) in the adjusted model. Conclusion: In older adults, muscular dysfunction is associated with cognitive impairment. New studies should address the causality and temporality of this relationship.
Geriatrics & Gerontology International, Jul 1, 2014
We present the case of a 76-year-old man who was admitted to the emergency room of Dario Fernande... more We present the case of a 76-year-old man who was admitted to the emergency room of Dario Fernandez General Hospital, ISSSTE (Mexico City, Mexico) with slurred speech of a few hours of onset. His relevant background included hypertension since he was 68 years-of-age without current treatment, and a posterior cervical laminectomy because of medullar injury when he was 72 years-of-age. During the physical examination, motor aphasia was found. His gait was slow, with short steps and reduced arm swing; his trunk bent forward and there was slight flexion of the neck. Increased muscle tone in the pelvic limbs and muscle stretch reflexes were also found. There were no signs of cerebellar involvement, and the plantar extensor reflex was present. In order to assess parkinsonism, a Unified Parkinson’s Disease Rating Scale (UPDRS) was carried out, resulting in a score of 17 points. No behavioral or psychiatric symptoms were found. Because of these findings, a cranial tomographic scan was carried out (Fig. 1). Symmetrical and bilateral nodular calcifications in the basal ganglia, and the cerebellar dentate nuclei were reported, without evidence of ischemic or hemorrhagic stroke. In order to discard secondary sources of calcinosis; laboratory investigations were carried out: prostatespecific antigen 1.27 ng/mL, parathyroid hormone 71 pg/mL, calcium 8.8 mg/dL, phosphorus 3.30 mg/ dL, magnesium 2.03 mg/dL, alkaline phosphatase 74 IU/L and uric acid 4.3 mg/dL. Consensus among the faculty staff concluded that the final diagnosis was transient ischemic attack and idiopathic basal ganglia calcification (IBGC). The patient was prescribed treatment and appointed for follow-up in 3 months. This entity has a frequency, in the general population, of less than 0.5%, and some authors considered it a rare disease. In 1930, Karl Theodor Fahr described an 81-year-old patient with a long history of dementia, decubitus ulcer and “immobility without paralyses”. Post-mortem examination of the brain showed brain calcifications localized in the semiovale centrum and the striatum. There are a number of names given for this disease including Fahr’s disease bilateral striopallidodentate calcinosis or IBGC (which is codified in the International Classification of Diseases as G23.8), among others; however, the most common name today is IBGC. The main characteristic is bilateral symmetrical calcification of the basal ganglia, thalamus, cerebellum, dentate nucleus and brain hemispheres, in the absence of other metabolic causes of calcinosis – such as hypoparathyroidism. Although still considered idiopathic, there is some evidence of an association with genetic abnormalities; in particular with an autosomic dominant transmission. The clinical characteristics of this condition are circumscribed to movement (mainly parkinsonism), but
Aging Clinical and Experimental Research, Jan 31, 2019
Frailty has been recognized as a common condition in older adults, however there is scarce inform... more Frailty has been recognized as a common condition in older adults, however there is scarce information on the association between frailty and commonly used biomarkers. The aim of this study was to assess the individual and cumulative association of biomarkers with frailty status. This is a cross-sectional analysis of the 2012 wave of the Mexican Health and Aging Study. A sub-sample of 60-year or older adults with anthropometric measurements was analyzed. Frailty was defined with a 31-item frailty index and those considered frail had a score ≥0.21. Biomarkers were further categorized as normal/abnormal and tested both one by one and grouped (according to their usual cut-off values). Adjusted logistic models were performed. From a total of 1,128 older adults their mean age was of 69.45 years and 51.24% were women. 26.7% (n=301) were categorized as frail. Individual biomarkers associated with frailty after adjusting for confounding were: hemoglobin (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.13–2.46, p=0.009), glycated hemoglobin (OR 2.04, 95% CI 1.54–2.7, p<0.001) and vitamin D (OR 1.53, 95% CI 1.13–2.07, p=0.005). Those with ≥4 abnormal biomarkers had an independent association with frailty when compared to those without any abnormal (OR 2.64, 95% CI 1.3–5.25, 0.005). Aside from the individual associations of specific biomarkers, our findings show that an incremental association of abnormal biomarkers increases the probability of frailty; accounting for the multidimensional nature of frailty and the possible interplay between components of the system that potentiate to give rise to a negative condition such as frailty.
Frontiers in Medicine, Sep 29, 2020
Age and Ageing, Feb 1, 2022
Archives of Osteoporosis, Dec 27, 2016
Age and Ageing, Feb 19, 2021
Uploads
Papers by Mario U Perez-Zepeda