Palavras-chave
Dependencia multidimensional
análisis de clases latente
envejecimiento
ENASEM
análisis de clases latente
envejecimiento
ENASEM
Como Citar
Rely, K., García-Peña, C., Salinas-Escudero, G., Gutiérrez-Robledo, L.-. M., Wong, R., & Vargas-Chanes, D. (2020). Subgrupos de dependencia multidimensional en adultos mayores que viven en la comunidad: un análisis de clase latente. Salud UIS, 52(2), 101–109. https://doi.org/10.18273/revsal.v52n2-2020004
Resumo
Objetivo: Utilizar el análisis de clase latente (ACL) para la identificación de patrones de dependencia multidimensional en una muestra de adultos mayores y evaluar factores sociodemográficos predictivos de pertenencia a una clase. Métodos: Se utilizaron datos longitudinales del Estudio Nacional de Salud y Envejecimiento en México (ENASEM). Se analizaron 7,920 adultos mayores, el 55% eran mujeres. El ACL fue utilizado para la identificación de subgrupos significativos. Para el ACL se realizó con el software MPlus. El modelo de clase final se eligió con base a la comparativa de estadísticas de ajuste múltiple y parsimonia teórica, con modelos de complejidad creciente analizados secuencialmente hasta que se identificó el modelo de mejor ajuste. Se incorporaron covariables para explorar la asociación entre estas variables y la pertenencia a clases. Resultados: Se identificaron tres grupos de clases basados en los nueve identificadores. “Adultos mayores activos” estaba compuesto por el 64%. “Relativamente independiente” y “Discapacidad física” comprenden el 26% y el 10% de la muestra, respectivamente. Los perfiles de “Adultos mayores activos” y “Relativamente independiente” eran comparativamente más uniformes. El grupo de “discapacidad física” comprenden a los individuos más propensos a un perfil de dependencia. Conclusiones: Estos hallazgos resaltan la utilidad de adoptar un enfoque centrado en la persona lo que sugiere nuevos horizontes de investigación e intervención a medida de las características particulares de los adultos mayores. Basado en patrones de dependencia multidimensional, este estudio identificó una tipología de dependencia utilizando datos de una encuesta representativa a nivel nacional.
Referências
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4. Angel JL, Vega W, López-Ortega M. Aging in Mexico: Population trends and emerging issues. Gerontologist. 2017; 57(2): 153-162. doi: 10.1093/geront/gnw136.
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7. Wong R, Michaels-Obregon A, Palloni A. Cohort Profile: The Mexican Health and Aging Study (MHAS). Int J Epidemiol. 2015: dyu263.
8. Wong R, Palloni A. Aging in Mexico and Latin America. International handbook of population aging: Springer; 2009. p. 231-252.
9. Murillo-López S, Venegas-Martínez F. Cobertura de los sistemas de pensiones y factores asociados al acceso a una pensión de jubilación en México. Pap Poblac 2011; 17(67): 209-250.
10. Robledo LMG, Campos RHM, Ortega ML. Present State of Elder Care in Mexico. Challenges of Latino Aging in the Americas: Springer; 2015. p. 379-392.
11. García-Peña C, Wagner FA, Sánchez-Garcia S, Juárez-Cedillo T, Espinel-Bermúdez C, García-Gonzalez JJ, et al. Depressive symptoms among older adults in Mexico City. J Gen Intern Med. 2008; 23(12): 1973-1980. doi: 10.1007/s11606-008-0799-2.
12. Gutierrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L, et al. Encuesta nacional de salud y nutrición 2012. Resultados Nacionales Cuernavaca, México: Inst Nacional de Salud Pública. 2012.
13. Gutiérrez-Robledo LMF, García-Peña MdC, Jiménez-Bolón JE. Envejecimiento y dependencia. Realidades y previsión para los próximos años Intersistemas, editor. México:
Intersistemas; 2014.
14. Gerst K, Michaels-Obregon A, Wong R. The impact of physical activity on disability incidence among older adults in Mexico and the United States. J Aging Res. 2011; 2011: 420714. doi: 10.4061/2011/420714.
15. Wong R, Gerst K, Michaels-Obregon A, Palloni A. Burden of Aging in developing countries: disability transitions in Mexico compared to the United States. Manuscript submitted for publication. 2010.
16. Doubova SV, Pérez-Cuevas R, Espinosa-Alarcón P, Flores-Hernández S. Social network types and functional dependency in older adults in Mexico. BMC Public Health. 2010; 10(1): 104.
17. Angel RJ, Angel JL, Lee G-Y, Markides KS. Age at migration and family dependency among older Mexican immigrants: Recent evidence from the Mexican American EPESE. The Gerontologist. 1999; 39(1): 59-65.
18. Angel RJ, Angel JL, Hill TD. Subjective control and health among Mexican-origin elders in Mexico and the United States: Structural considerations in comparative research. J Gerontol B Psychol Sci Soc Sci. 2009; 64B(3): 390-401. doi: 10.1093/geronb/gbn029.
19. Bandeen-Roche K, Xue Q-L, Ferrucci L, Walston J, Guralnik JM, Chaves P, et al. Phenotype of frailty: characterization in the women›s health and aging studies. The J Gerontol A: Biol Sci Med Sci. 2006; 61(3): 262-266. doi: 10.1093/gerona/61.3.262.
20. Bandeen-Roche K, Miglioretti DL, Zeger SL, Rathouz PJ. Latent variable regression for multiple discrete outcomes. J Am Statistical Association. 1997; 92(440): 1375-1386. doi: https://doi.org/10.1080/01621459.1997.10473658.
21. Moran M, Walsh C, Lynch A, Coen RF, Coakley D, Lawlor BA. Syndromes of behavioural and psychological symptoms in mild Alzheimer’s disease. Int J Geriatr Psychiatry. 2004;19(4): 359-364. doi: 10.1002/gps.1091.
22. Robledo LMG. La salud del anciano en México y la nueva epidemiología del envejecimiento. 2004.
23. Gutiérrez-Robledo LMF, García-Peña MdC, Jiménez-Bolón JE. Envejecimiento y dependencia. Realidades y previsión para los próximos años. México: Intersistemas; 2014.
24. Barrantes-Monge M, García-Mayo EJ, Gutiérrez-Robledo LM, Miguel-Jaimes A. Dependencia funcional y enfermedades crónicas en ancianos mexicanos. Salud Pública Méx. 2007; 49(s4): S59-S66.
25. Aguilar-Navarro SG, Amieva H, Gutiérrez-Robledo LM, Avila-Funes JA. Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican health and aging study. Salud Pública Mex. 2015; 57(Supp 1): s62-s9.
26. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963; 185(12): 914-919. doi: 10.1001/jama.1963.03060120024016.
27. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Nursing Research. 1970; 19(3): 278.
28. Harwood RH, Sayer AA, Hirschfeld M. Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios. Bull World Health Organ.
2004; 82(4): 251-258.
29. Isherwood LM, King DS, Luszcz MA. A longitudinal analysis of social engagement in latelife widowhood. Int J Aging Hum Dev. 2012; 74(3): 211-229. doi: https://doi.org/10.2190/AG.74.3.c.
30. Donnelly EA, Hinterlong JE. Changes in social participation and volunteer activity among recently widowed older adults. Gerontologist. 2009; 50(2):
158-169. doi: 10.1093/geront/gnp103.
31. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Applied psychological measurement. 1977; 1(3): 385-401.
32. Lafortune L, Béland F, Bergman H, Ankri J. Health state profiles and service utilization in community living elderly. Med Care. 2009; 47(3): 286-294. doi: 10.1097/MLR.0b013e3181894293.
33. Muthén BO. Beyond SEM: General latent variable modeling. Behaviormetrika. 2002; 29(1): 81-117.
34. Dorantes-Mendoza G, Avila-Funes JA, Mejia-Arango S, Gutierrez-Robledo LM. Factors associated with functional dependence in older adults: a secondary analysis of the National Study on Health and Aging, Mexico, 2001. Rev Panam Salud Publica 2007; 22(1): 1-11. doi: 10.1590/s1020-49892007000600001.
35. Magidson J, Vermunt J. Latent class models for clustering: A comparison with K-means. Canadian J Marketing Res. 2002; 20(1): 36-43.
36. Reboussin BA, Liang KY, Reboussin DM. Estimating equations for a latent transit ion model with multiple discrete indicators. Biometrics 1999; 55(3): 839-845. doi: 10.1111/j.0006-341x.1999.00839.x.
37. Muthén B, Muthén LK. Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcohol
Clin Exp Res. 2000; 24(6): 882-891.
38. McLachlan G, Peel D. Finite mixture models: John Wiley & Sons; 2004.
39. Vermunt JK, Magidson J. Latent class cluster analysis. Applied latent class analysis. Edited by: Hagenaars JA, McCutcheon AL. 2002. Cambridge, UK: Cambridge University Press.
40. Lo Y, Mendell NR, Rubin DB. Testing the number of components in a normal mixture. Biometrika. 2001; 88(3): 767-778. doi: https://doi.org/10.1093/biomet/88.3.767.
41. Schwarz G. Estimating the dimension of a model. Ann Statist. 1978; 6(2): 461-464.
42. Sclove SL. Application of model-selection criteria to some problems in multivariate analysis. Psychometrika. 1987; 52(3): 333-343.
2. Coale AJ, Hoover EM. Population growth and economic development: Princeton University Press; 2015.
3. Mirkin B, Weinberger MB. The demography of population ageing. publicado en Population Bulletin of the United Nations. 2001; 42(43): 37-53.
4. Angel JL, Vega W, López-Ortega M. Aging in Mexico: Population trends and emerging issues. Gerontologist. 2017; 57(2): 153-162. doi: 10.1093/geront/gnw136.
5. Frenk J, Bobadilla JL, Stern C, Frejka T, Lozano R. Elements for a theory of the health transition. Health Transit Rev. 1991; 1(1): 21-38.
6. Frenk J, Sepúlveda J, Gómez-Dantés O, Knaul F. Evidence-based health policy: three generations of reform in Mexico. Lancet. 2003; 362(9396): 1667-1671. doi: 10.1016/S0140-6736(03)14803-9.
7. Wong R, Michaels-Obregon A, Palloni A. Cohort Profile: The Mexican Health and Aging Study (MHAS). Int J Epidemiol. 2015: dyu263.
8. Wong R, Palloni A. Aging in Mexico and Latin America. International handbook of population aging: Springer; 2009. p. 231-252.
9. Murillo-López S, Venegas-Martínez F. Cobertura de los sistemas de pensiones y factores asociados al acceso a una pensión de jubilación en México. Pap Poblac 2011; 17(67): 209-250.
10. Robledo LMG, Campos RHM, Ortega ML. Present State of Elder Care in Mexico. Challenges of Latino Aging in the Americas: Springer; 2015. p. 379-392.
11. García-Peña C, Wagner FA, Sánchez-Garcia S, Juárez-Cedillo T, Espinel-Bermúdez C, García-Gonzalez JJ, et al. Depressive symptoms among older adults in Mexico City. J Gen Intern Med. 2008; 23(12): 1973-1980. doi: 10.1007/s11606-008-0799-2.
12. Gutierrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L, et al. Encuesta nacional de salud y nutrición 2012. Resultados Nacionales Cuernavaca, México: Inst Nacional de Salud Pública. 2012.
13. Gutiérrez-Robledo LMF, García-Peña MdC, Jiménez-Bolón JE. Envejecimiento y dependencia. Realidades y previsión para los próximos años Intersistemas, editor. México:
Intersistemas; 2014.
14. Gerst K, Michaels-Obregon A, Wong R. The impact of physical activity on disability incidence among older adults in Mexico and the United States. J Aging Res. 2011; 2011: 420714. doi: 10.4061/2011/420714.
15. Wong R, Gerst K, Michaels-Obregon A, Palloni A. Burden of Aging in developing countries: disability transitions in Mexico compared to the United States. Manuscript submitted for publication. 2010.
16. Doubova SV, Pérez-Cuevas R, Espinosa-Alarcón P, Flores-Hernández S. Social network types and functional dependency in older adults in Mexico. BMC Public Health. 2010; 10(1): 104.
17. Angel RJ, Angel JL, Lee G-Y, Markides KS. Age at migration and family dependency among older Mexican immigrants: Recent evidence from the Mexican American EPESE. The Gerontologist. 1999; 39(1): 59-65.
18. Angel RJ, Angel JL, Hill TD. Subjective control and health among Mexican-origin elders in Mexico and the United States: Structural considerations in comparative research. J Gerontol B Psychol Sci Soc Sci. 2009; 64B(3): 390-401. doi: 10.1093/geronb/gbn029.
19. Bandeen-Roche K, Xue Q-L, Ferrucci L, Walston J, Guralnik JM, Chaves P, et al. Phenotype of frailty: characterization in the women›s health and aging studies. The J Gerontol A: Biol Sci Med Sci. 2006; 61(3): 262-266. doi: 10.1093/gerona/61.3.262.
20. Bandeen-Roche K, Miglioretti DL, Zeger SL, Rathouz PJ. Latent variable regression for multiple discrete outcomes. J Am Statistical Association. 1997; 92(440): 1375-1386. doi: https://doi.org/10.1080/01621459.1997.10473658.
21. Moran M, Walsh C, Lynch A, Coen RF, Coakley D, Lawlor BA. Syndromes of behavioural and psychological symptoms in mild Alzheimer’s disease. Int J Geriatr Psychiatry. 2004;19(4): 359-364. doi: 10.1002/gps.1091.
22. Robledo LMG. La salud del anciano en México y la nueva epidemiología del envejecimiento. 2004.
23. Gutiérrez-Robledo LMF, García-Peña MdC, Jiménez-Bolón JE. Envejecimiento y dependencia. Realidades y previsión para los próximos años. México: Intersistemas; 2014.
24. Barrantes-Monge M, García-Mayo EJ, Gutiérrez-Robledo LM, Miguel-Jaimes A. Dependencia funcional y enfermedades crónicas en ancianos mexicanos. Salud Pública Méx. 2007; 49(s4): S59-S66.
25. Aguilar-Navarro SG, Amieva H, Gutiérrez-Robledo LM, Avila-Funes JA. Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican health and aging study. Salud Pública Mex. 2015; 57(Supp 1): s62-s9.
26. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963; 185(12): 914-919. doi: 10.1001/jama.1963.03060120024016.
27. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Nursing Research. 1970; 19(3): 278.
28. Harwood RH, Sayer AA, Hirschfeld M. Current and future worldwide prevalence of dependency, its relationship to total population, and dependency ratios. Bull World Health Organ.
2004; 82(4): 251-258.
29. Isherwood LM, King DS, Luszcz MA. A longitudinal analysis of social engagement in latelife widowhood. Int J Aging Hum Dev. 2012; 74(3): 211-229. doi: https://doi.org/10.2190/AG.74.3.c.
30. Donnelly EA, Hinterlong JE. Changes in social participation and volunteer activity among recently widowed older adults. Gerontologist. 2009; 50(2):
158-169. doi: 10.1093/geront/gnp103.
31. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Applied psychological measurement. 1977; 1(3): 385-401.
32. Lafortune L, Béland F, Bergman H, Ankri J. Health state profiles and service utilization in community living elderly. Med Care. 2009; 47(3): 286-294. doi: 10.1097/MLR.0b013e3181894293.
33. Muthén BO. Beyond SEM: General latent variable modeling. Behaviormetrika. 2002; 29(1): 81-117.
34. Dorantes-Mendoza G, Avila-Funes JA, Mejia-Arango S, Gutierrez-Robledo LM. Factors associated with functional dependence in older adults: a secondary analysis of the National Study on Health and Aging, Mexico, 2001. Rev Panam Salud Publica 2007; 22(1): 1-11. doi: 10.1590/s1020-49892007000600001.
35. Magidson J, Vermunt J. Latent class models for clustering: A comparison with K-means. Canadian J Marketing Res. 2002; 20(1): 36-43.
36. Reboussin BA, Liang KY, Reboussin DM. Estimating equations for a latent transit ion model with multiple discrete indicators. Biometrics 1999; 55(3): 839-845. doi: 10.1111/j.0006-341x.1999.00839.x.
37. Muthén B, Muthén LK. Integrating person-centered and variable-centered analyses: Growth mixture modeling with latent trajectory classes. Alcohol
Clin Exp Res. 2000; 24(6): 882-891.
38. McLachlan G, Peel D. Finite mixture models: John Wiley & Sons; 2004.
39. Vermunt JK, Magidson J. Latent class cluster analysis. Applied latent class analysis. Edited by: Hagenaars JA, McCutcheon AL. 2002. Cambridge, UK: Cambridge University Press.
40. Lo Y, Mendell NR, Rubin DB. Testing the number of components in a normal mixture. Biometrika. 2001; 88(3): 767-778. doi: https://doi.org/10.1093/biomet/88.3.767.
41. Schwarz G. Estimating the dimension of a model. Ann Statist. 1978; 6(2): 461-464.
42. Sclove SL. Application of model-selection criteria to some problems in multivariate analysis. Psychometrika. 1987; 52(3): 333-343.
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