Afecto positivo como factor protector de discapacidad en ancianos mexicanos

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participation in this study: T. Allegre, J. Allemand-Sourrieu, M. S. Antolini, J. Bacconnier, J. Berdugo, S. Bregigeon, B. Castan, S. Chadapaud, C. Compagnon, C. Coroiu, C. Dhiver, M. P. Drogoul, O. Faucher, T. Gamby, P. Granet, S. Hakoun, G. Hittinger, H. Husson, P. Kraemer, A. Lafeuillade, A. Madrid, J. L. Mattei, A. Menard, S. Mokhtari, J. Moreau, M. Orticoni, P. Philibert, A. Rieu, F. Simon, M. J. Soavi, M. Thierry, H. Tissot-Dupont, F. Tollinchi, C. Tomei. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Dr. Ravaux is Board member of Boehringer, BMS, and Gilead. Author Contributions: Drs. Darque, Enel, Petit, and Ravaux: Participated in study concept and design, acquisition of subjects and data, analysis and interpretation of data, and preparation of manuscript. Dr. Retornaz: Participated in study concept and design. Dr. Darque: Processed the data and the analysis of drug interactions using the tool described in the manuscript. Sponsor’s Role: The study was not sponsored.

REFERENCES 1. Yeni P. French Guidelines for Medical Care of HIV-Infected People. Recommendations of the Expert Group. Paris: Flammarion Me´decine-Sciences, 2008. 2. Kirk JB, Goetz MB. Human immunodeficiency virus in an aging population, a complication of success. J Am Geriatr Soc 2009;57:2129–2138. 3. Legrain S. Consommation Me´dicamenteuse chez le Sujet Age´. Consommation, Prescription, Iatroge´nie et Observance. [Drug Consumption in the Elderly. Consumption, Prescription, Iatrogenic and Observance]. Saint Denis La Plaine, France: Haute Autorite´ de Sante´, 2005. 4. Gebo KA. HIV and aging: Implications for patient management. Drugs Aging 2006;23:897–913. 5. Evans-Jones JG, Cottle LE, Back DJ et al. Recognition of risk for clinically significant drug interactions among HIV-infected patients receiving antiretroviral therapy. Clin Infectious Dis 2010;50:1419–1421. 6. Tseng A, Raboud J, Walmsley S et al. Polypharmacy in older patients: A study of medication use and potential drug interactions in an aging ambulatory HIV clinic population. First International Workshop on HIV and Aging. October 4–5, 2010. Baltimore, MD. Abstract O_08 7. WHO. Adherence to Long-Term Therapies, Evidence for Action, 96–101. Geneva: World Health Organization, 2003. 8. Carrieri P, Cailleton V, Le Moing V et al. The dynamic of adherence to highly active antiretroviral therapy: Results from the French national APROCO cohort. J Acquir Immune Defic Syndr 2001;28:232–239. 9. Mansur N, Weiss A, Hoffman A et al. Continuity and adherence to longterm drug treatment by geriatric patients after hospital discharge: A prospective cohort study. Drugs Aging 2008;25:861–870.

POSITIVE AFFECT IN ELDERLY MEXICANS AND ITS PROTECTIVE ROLE AGAINST DISABILITY To the Editor: Aging is associated with a higher probability of becoming ill or disabled. Both of these health-related outcomes are also related to greater healthcare needs in elderly populations, representing a true challenge for healthcare systems around the world. The pursuit of effective prevention strategies for disability has been the reason for extensive work, including investigation of the relationship between mood and disability. It is felt that a positive attitude toward life is associated with less prevalent and incident disability and mortality,1–3 but there is little scien-

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tific evidence in this regard with elderly adults living in developing countries, where adverse socioeconomic conditions and cultural traits could modify this association. Thus, a 2-year longitudinal study of 1,826 participants was conducted to determine the effect of positive affect (PA) on incident disability in community-dwelling elderly adults. Participants were adults aged 70 and older without disability in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) at baseline taking part in the Mexican Health and Aging Study (MHAS), conducted in 2001 with a follow-up in 2003.4 PA was established according to a positive response to three questions from a modified version of the CES-D scale (Do you feel happy? Do you enjoy life? and Do you feel full of energy?).5,6 Two measurements of disability, IADL (Lawton scale) and ADL (Katz scale), were investigated as outcomes. For each of these domains, if participants reported that they were unable to perform one or more activities without help, they were considered to have the respective disability. Multivariate logistic regression analyses were performed to test the independent association between PA and incident IADL or ADL disability in participants without prevalent disability in the same domain at baseline. All statistical tests were performed at the .05 level.

RESULTS The mean age of the participants was 75.5 ± 4.9 (range: 70–104), 51.2% were women, and PA prevalence was 31.4% at baseline. Participants meeting PA criteria were younger and more likely to be male and to have a partner. The incidence of disability after 2 years of follow-up was 12.5% for IADL and 6.1% for ADL. Participants with PA had lower incident IADL (20.1% vs 33.1%, P < .001) and ADL (19.6% vs 32.2%, P = .006) disability. The unadjusted regression models showed an inverse association between PA and both types of disability, although when adjusting for age, sex, educational level, cognitive impairment, number of chronic diseases, pain, history of amputation, visual impairment, and negative affect, regression analysis showed that PA decreased the risk of incident IADL disability by a factor of 15% (95% confidence interval = 0.73–0.98, P = .04); nevertheless, the association between PA and incident ADL disability did not remained statistically significant Table 1.

DISCUSSION The present study shows an independent relationship between PA and a lower probability of developing early disability (represented by IADL). The association between disability and mood has been described in clinical and epidemiological work suggesting that physical abilities are closely related to emotions beyond the absence of depressive symptoms,7 but the positive spectrum of emotion has somehow been neglected, although some studies have described PA as a protective factor against specific health conditions, including coronary heart disease in older men8 and stroke in elderly adults with diabetes mellitus,9 disability, and mortality.2,3

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Table 1. Regression Analysis of Incident Disability Odds Ratio (95% Confidence Interval) P-Value Presence of Positive Affect

Unadjusted* Adjusted†

Activities of Daily Living

0.83 (0.69–0.98) .04 0.84 (0.69–1.00) .06

Instrumental Activities of Daily Living

0.72 (0.63–0.82) < .001 0.85 (0.73–0.98) .04

*

Adjusted for age. Adjusted for age, sex, educational level, cognitive impairment, number of chronic diseases, pain, history of amputation, visual impairment, and negative affect. †

Several possible mechanisms could explain the protective role of PA against disability. For instance, PA promotes healthy behaviors through self-motivation and better-functioning social networks, which in turn contribute to maintaining good health and avoiding disability. Alternatively, PA could affect health through physiological changes; with people expressing PA being better able to cope with stressful situations and therefore maintaining less-damaging neuroendocrine and immunological patterns.10 The positive spectrum of human emotion should be explored in clinical settings to better understand its protective effect on health-related outcomes. This information would help clinicians in determining whether preservation of PA could play a role in the prevention or management of disability in elderly adults. Julio Alberto Dı´az-Ramos, MD Ana Patricia Navarrete-Reyes, MD ´ vila-Funes, MD, MSc Jose´ Alberto A From the Department of Geriatrics, Instituto Nacional de Ciencias Me´dicas y Nutricio´n Salvador Zubira´n Mexico City, Mexico ´ vila-Funes, MD, MSc Jose´ Alberto A Centre de Recherche Inserm and University Victor Segalen Bordeaux, Bordeaux, France

ACKNOWLEDGMENTS Conflict of Interest: None. Author Contributions: Dı´az-Ramos: Concept and design of the study, analysis and interpretation of data, writing the manuscript under the supervision of Drs. Na´ vila-Funes. The coauthors certify that varrete-Reyes and A they have participated substantially in the conceptualization and design of this work and the analysis of the data and the writing of the manuscript. They have reviewed the final version of the manuscript and have approved it for publication. Sponsor’s Role: None.

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REFERENCES 1. Penninx BW, Guralnik JM, Simonsick EM et al. Emotional vitality among disabled older women: The Women’s Health and Aging Study. J Am Geriatr Soc 1998;46:807–815. 2. Penninx BW, Guralnik JM, Bandeen-Roche K et al. The protective effect of emotional vitality on adverse health outcomes in disabled older women. J Am Geriatr Soc 2000;48:1359–1366. 3. Ostir GV, Markides KS, Black SA et al. Emotional well-being predicts subsequent functional independence and survival. J Am Geriatr Soc 2000;48:473–478. 4. Mexican Health and Aging Study (MHAS) [on-line]. Available at http:// www.ssc.upenn.edu/mhas/ Accessed September 10, 2011. 5. Miller TQ, Markides KS, Black SA. The factor structure of the CES-D in two surveys of elderly Mexican Americans. J Gerontol B Psychol Sci Soc Sci 1997;52B:S259–S269. 6. Aguilar-Navarro SG, Fuentes-Cantu A, Avila-Funes JA et al. Validity and reliability of the screening questionnaire for geriatric depression used in the Mexican Health and Age Study. Salud Publica Mex 2007;49:256–262. 7. Penninx BW, Leveille S, Ferrucci L et al. Exploring the effect of depression on physical disability: Longitudinal evidence from the established populations for epidemiologic studies of the elderly. Am J Public Health 1999;89:1346–1352. 8. Kubzansky LD, Sparrow D, Vokonas P et al. Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the Normative Aging Study Psychosom Med 2001;63:910–916. 9. Araki A, Murotani Y, Kamimiya F et al. Low well-being is an independent predictor for stroke in elderly patients with diabetes mellitus. J Am Geriatr Soc 2004;52:205–210. 10. Penninx BW. A happy person, a healthy person? J Am Geriatr Soc 2000;48:590–592.

USING THE NINTENDO WII AS AN INTERVENTION IN A FALLS PREVENTION GROUP To the Editor: Falls currently cost the UK National Health Service £1.7 billion ($2.6 billion) annually (£4.6 million ($7.1 million) daily),1 and approximately 14,000 deaths occur from falling.2 To counter this, falls prevention training uses a number of common physiotherapy techniques that aim to improve balance, mobility, and educate recovery from the instance of a fall. The Nintendo Wii and balance board (Nintendo, Redmond, WA) is a commercially available computer and software package with which player movements control game play. The literature3 suggests that the Wii can aid rehabilitation, but these trials have not been incorporated into a clinical physiotherapy training program. The aim of the current research was to evaluate the efficacy of including the Wii in an established falls prevention training program. The University of Essex ethics committee approved this study. Sixty-five participants (aged 83.2 ± 5.5, range 66.8–90.2) who met the existing criteria to join the falls prevention training group were identified from a hospitallocated database. Data included primary outcome measures, consisting of pre- and postintervention TimedUp-and-Go (TUG) time and score, functional reach (distance and score), TURN-180 (number of steps and score), and flexibility scores (shoulder internal and external rotation and hamstring). These data are routinely used to categorize individuals as lower or higher functioning. All participated in a 7-week falls prevention training at the hospital in a non-Wii (n = 24) or Wii (n = 41) group. Both