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Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of Nariño, Colombia

Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of... Hindawi Journal of Aging Research Volume 2019, Article ID 4542897, 9 pages https://doi.org/10.1155/2019/4542897 Research Article Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of Nariño, Colombia 1 2 3 Yenny Vicky Paredes-Arturo, Eunice Yarce-Pinzon , Diego Mauricio Diaz-Velasquez, and Daniel Camilo Aguirre-Acevedo Mariana University Faculty of Humanities and Social Sciences, Psychology Program, Pasto, Colombia Mariana University Health Sciences Faculty, Occupational "erapy Program, Pasto, Colombia "e University of Edinburgh, Global Health Unit, Social Policy Programme, Edinburgh, UK University of Antioquia, School of Medicine, Medell´ın, Colombia Correspondence should be addressed to Eunice Yarce-Pinzon; eyarce@umariana.edu.co Received 30 April 2019; Accepted 29 August 2019; Published 1 October 2019 Academic Editor: Jean-Francois Grosset Copyright © 2019 Yenny Vicky Paredes-Arturo et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Ethnicity in Latin America is a factor of poverty and social exclusion. Like in developed countries, demographic, medical, psychosocial, global cognitive, and functional variables interact in a complex relationship on the elderly population. Such interaction should be considered to determine cognitive and functional performance using screening tests. +e aim of this study was to evaluate the demographic, medical, and psychosocial factors affecting global cognitive performance as well as functional activities. Methods. +e study was conducted in a Colombian elderly indigenous population which included a sample of 518 adults. +is research employed a structural model of latent factors to assess the effects of demographic, medical, and psychosocial factors on cognitive and functional performance. +e model was estimated by least squares and used a maximum-likelihood procedure, and it was determined RMSEA, TLI, and CFI to assess the model’s goodness of fit. +e categorical variables used in the model were as follows: (1) demographics, (2) psychosocial factors, (3) medical condition, (4) global cognition, and (5) functional factors. Results. Demographics, in addition to medical and psychosocial factors, were related to global cognition and functional factors (RMSEA � 0.051, CI 90% 0.045–0.057, CFI � 0.901, and TLI � 0.881). Conclusion. +ese results provide strong evidence about the complex relationships among demographics, medical conditions, and psychosocial factors and their influence on global cognition and functional performance in Colombian indigenous elderly population. On this subject, there are studies that inform about the 1. Introduction direct and indirect effects demographic conditions, general In Latin America, ethnicity is a strong risk factor associated health problems, and psychosocial variables have on the with poverty, inequality, and social exclusion, mainly in execution of cognitive tracking tests as well as functional rural areas and in low-income families. Ethnicity has a evaluations. Such data can be adjusted into a multivariate negative impact on the most vulnerable sectors of the model of complex interactions of 3 factors (the factors have population such as children and the elderly [1]. Ethnicity, as been medical history, global mental state, and gender) re- a condition of social inequality, when it is related to dif- lated to the functional condition and cognitive involvement ferences in language and low education, can impact global of the elderly [3]. +e model shows a complex structure of cognitive tracking evaluations. Such impacts can cause interrelations between factors such as genetics, emotions, heterogeneity in the execution of tests, limiting an in- sociodemographic factors, and health status. +e health dividual’s operational characteristics despite a priori ad- status is usually associated with the comorbidity of chronic justments that could be proposed in [2]. diseases. All these associated factors entail a greater risk for 2 Journal of Aging Research the development of neurodegenerative diseases with nega- factors. +ese factors were evaluated with a multidimen- tive consequences in daily life activities [4]. In this manner, sional questionnaire previously validated [10] and a self- report provided by each participant or a relative responsible the epidemiological profile of the disease in the indigenous community has gradually changed from a scenario char- for caregiving. +e demographic characteristics were acterized by infectious and parasitic disorders to an increase evaluated depending on the particularity of these; age was in the rates of chronic noncommunicable diseases. Never- approached in ranges since it allows a better analysis of it; in theless, this study does not disregard the strong relationship relation to the education variable, it was guided by cate- between cardiovascular risk factors, functional performance, gories that may or may not read and write and by primary, emotional state, cognitive impairment, and dementia in the secondary, technical, undergraduate, and postgraduate population of indigenous older adults [5, 6]. levels; regarding income, it was investigated based on the +ese conditions are shared by indigenous communities current legal minimum wage. +e medical component was in other Latin American countries, where the precarious consulted for the presence or not of medical illness. +e health situation of these contexts constitutes another rele- nutritional assessment was determined using the full ver- sion of the Mini-Nutritional Test [11]. +is evaluation was vant factor for the increase in dependence and mortality [7]. +e increase in risks such as chronic diseases, dependence, carried out by an interdisciplinary team in areas such as and mortality could be related to an acculturation process of nursing, neuropsychology, physical therapy, and occupa- the native population. +e natives have acquired lifestyles tional therapy. +e presence of malnutrition or risk of which in part have increased their life expectancy but, on the malnutrition was defined as follows: malnutrition was other hand, increased the prevalence of chronic diseases, considered when a person scored in the Mini-Nutritional causing dependence on the elderly [7, 8]. +e aim of this Test less than 17 points (<17); malnutrition risk relates to a study was to evaluate the demographic, medical, and psy- score between 17 and 23.5; and good nutritional status chosocial factors affecting global cognitive performance and relates to 24 points or more. +e study applied the Mini- functional activities, through a structural model of latent Mental State Examination (MMSE) test for cognitive factors. +e model was applied to a group of indigenous evaluation. For this study, it was used the cutoff point of ≥24 [12]. senior citizens in the province of Nariño, Colombia. +is study is of great relevance because the most important Additionally, it was used the Rowland Universal De- problems in the adult stage are the loss of cognitive and mentia Assessment (RUDAS) test considering a cutoff point functional abilities, even more regarding ethnic communi- of 21. +e latter was used because it does not contain biases ties belonging to a scenario of old age and multimorbidity linked to instruction level. Its ordinal scoring system is 30 [9]. +erefore, knowing the state of cognitive and functional points [13]. Further, the study applied the subjective performance of these adults allows to understand the levels memory complaints (SMC) consisting of 15 questions to of dependence of indigenous population from others to do determine the functioning of the patient’s memory in daily activities, an important indicator of their health condition. life using a Likert frequency scale. +e maximum score for the Likert scale is 45 and the cutoff point is 19 [14]. Likewise, depressive symptoms were evaluated according to a self- 2. Materials and Methods report that used the Yesavage geriatric depression scale [15]. +e scale considers three categories (normal, moderate +is project was designed as an observational and analytical depression, and severe depression) according to a total score study and is based on a transversal descriptive nature. +e obtained from a sum of 15 items. A score of 0 to 5 denotes reference population was 5759 older indigenous people who normal (no depression), 6 to 10 moderate depression, and 11 belonged to 13 subregions of the former jurisdiction of to 15 severe depression. +e social variables were evaluated Obando in the province of Nariño, in southern Colombia, through the Medical Outcomes Study—Social Support data obtained by the DANE Census and its estimate for 2016. Survey (MOS-SSS) with 20 questions in total, related to the In this way, the sample size included a total of 518 older adults. perception of support of the individual, in addition to ex- To estimate the sample, a prevalence of 50% was considered, a ploring about the accompaniment in the instrumental, af- margin of error between 3 and 5% with a 10% increase in fective, social, and family dimensions. +e response options potential losses. +e sample size was considered appropriate are given through a Likert scale of 1 (never) to 5 (always) for this study, taking into account the rule of 10 participants [16]. per variable in the structural model, for a ratio of 23 par- +e study used the Lawton and Brody scale to assess the ticipants per variable (n � 518/22 variables in the model) [8]. degree of functional independence regarding instrumental +e inclusion criteria were as follows: being an adult 60 years daily life activities [17]. +e scale assesses the ability to of age or older, belonging to an indigenous council, and perform tasks that involve the handling of habitual utensils voluntarily accepting participation in the study by signing the and routine social activities. +e Lawton and Brody scale informed consent. +e exclusion criteria were established uses 8 items for assessment (ability to use the phone, based on the presence of some medical or cognitive impli- shopping, preparing food, taking care of home, laundry, use cations that prevented the application of the protocol. of transportation means, responsibility for medication, and economy administration) and assigns a numerical value 1 (independent) or 0 (dependent) for the assessment process. 2.1. Valuations. We considered the following variables: soci- odemographic, medical, nutritional, cognitive, and functional +e final score results from the sum of the values in each Journal of Aging Research 3 are presented as standardized coefficients that indicate the answer and goes between 0 (maximum dependence) and 8 (total independence). Concerning the psychometric prop- correlation between the factors and dimensions. +e ana- lyses were carried out in the SPSS IBM software version 23 erties, the scale is reliable with a Pearson coefficient of in- terobserver reliability of 0.85 and good concurrent validity and in MPLUS 7.0 [22]. with other scales of cognitive and daily activities. It assesses the ability of a person to perform ten basic activities of daily 3. Results life in a dependent or independent way. +e Barthel index 3.1. Description of Cognitive and Functional Performance score ranges from 0 (completely dependent) to 100 (com- according to Demographic Characteristics. From the 518 pletely independent). A degree of dependence is established participants in the study, it was found an average in the according to the score obtained, being the most frequent MMSE of 22 points (SD � 5.4) and in the RUDAS scale of cutoff of 60 points (between moderate and mild dependence) 20.3 (SD � 4.7). +e SMC showed an average of 23.6 and 40 points (between moderate and severe dependence) (SD � 9.9). Concerning the functional scales, the average was [18]. 97 (SD � 7) and 6 (SD � 2) for the Barthel and Lawton scales, respectively. After adjusting for age and educational level, 2.2. Ethical Issues. +e study was reviewed and approved by the correlation between RUDAS and MMSE was 0.60 the Bioethics Committee of Mariana University, located in (p< 0.001). Table 1 presents the behaviour of the MMSE, the Pasto, Nariño, Colombia. +e study complies with the RUDAS, and the subjective complaints of memory and recommendations provided by the Resolution 8430 of 1993 functional scales, according to demographic characteristics. of the Colombian Ministry of Health to conduct research. +e correlation with age was − 0.33 (p< 0.001), − 0.36 Additionally, the study fulfils the Helsinki Declaration of the (p< 0.001), − 0.20 (p< 0.001), and − 0.30 (p< 0.001) for the World Medical Association guidelines [19]. Further, the MMSE, the RUDAS, Barthel, and Lawton, respectively. investigation sought approval from each indigenous com- Significant differences were found according to gender munity council. +is process was carried out in the first (MMSE (t � 4.4; gl � 506.0; p< 0.001) and QM (t � − 2.2; semester of 2017. gl � 510; p< 0.028)); level of education (MMSE (F � 91.3; gl1 � 2; gl2 � 515; p< 0.001), RUDAS (F � 29.3; gl1 � 2; gl2 � 515; p< 0.001), Lawton (F � 7.8; gl1 � 2; g2 � 515; 2.3. Statistical Analysis. +e study used frequency to de- p< 0.001), and Barthel (F � 4.3; g1 � 2; g2 � 515; p � 0.014)); scribe variables identified as demographic characteristics, marital status (MMSE (F � 14.6; g1 � 2; g2 � 515; p< 0.001), medical history, social support, and cognitive performance. RUDAS (F � 7.3; gl1 � 2; gl2 � 515; p � 0.001), and Barthel +e study used the percentage value to describe categorical (F � 6.0; gl1 � 2; gl2 � 509; p< 0.003)); and economic de- variables and mean along with standard deviation to de- pendence (MMSE (t � 4.4; gl � 516; p< 0.001), RUDAS scribe continuous variables. According to these character- (t � 2.4; gl � 516; p � 0.015), Lawton (t � 3.7; gl � 423; istics, we explored differences in the cognitive performance p< 0.001), and Barthel (t � 2.7; gl � 383; p � 0.007)). No evaluated by the MMSE and RUDAS using the t-test for significant differences were found regarding the area of independent samples (gender, place of residence, economic residence and home income. dependence, and medical history) and analysis of variance (ANOVA) for level of schooling, marital status, and home income. MMSE had to be transformed using a cubic power 3.2. Description of Cognitive and Functional Performance since it did not fulfil the assumption of homogeneity in according to Medical History. Table 2 presents the cognitive variance. Additionally, the Scheffe test was used when and functional performance according to the presence of comparing groups as a post hoc test. +e Pearson correlation medical history. Hypertension was associated with MMSE coefficients between MMSE and RUDAS were calculated (t � 3.0, df � 499, p � 0.003), RUDAS (t � 2.8, GL � 188, with the MOS-SSS dimension scores. It was proposed a p � 0.005), and Yesavage (t � − 2.0, df � 199, p � 0.047). structural model (Figure 1) assuming latent variables such as Diabetes was associated with MMSE (t � 2.6, df � 496, (1) demographics, (2) psychosocial factor, (3) health con- p � 0.009), RUDAS (t � 2.2, df � 496, p � 0.027), and Bar- dition, (4) cognitive dimension, and (5) functional di- thel (t � 1.6, df � 23.6, p � 0.004). +e presence of osteo- mension. +e model assumed that demographic factors and porosis was associated with the scale of memory complaints psychosocial factors influenced a person’s health condition, (t � − 2.8, df � 481, p � 0.006) and Barthel (t � 2.2, df � 481, in addition to the cognitive and functional dimensions. +e p � 0.029). +e correlation between the MMSE, RUDAS, RMSEA index (root mean square error of approximation), Lawton, and Barthel with Yesavage was − 0.257 (p< 0.001), CFI (confirmatory fit index), and TLI (Tucker–Lewis index) − 0.310 (p< 0.001), − 0.183 (p< 0.001), and − 0.233 were determined to assess the model’s goodness of fit. A (p< 0.001), respectively. good adjustment was assumed if the RMSEA index was less than 0.08 and the CFI and TLI >0.90 [20]. Given that the model included categorical variables, we used a robust es- 3.3.RelationshipbetweenGeneralCognitivePerformancewith timation method through weighted least squares with a Memory Complaints, Depression, Functional Scales, and So- likelihood ratio (WLSMV), using a diagonal weight matrix cial Support. Table 3 presents the Pearson correlation co- with standard errors and chi-square test statistic with an efficients between the MMSE and RUDAS with SMC, adjusted mean and variance [21]. +e results in the model depression, functional scales, and social support. An 4 Journal of Aging Research ε εε ε ε ε εε ε ε HTA DM Obes COPD Ostep Dislip Nutri. Arthritis Catarac Fractur. ∗∗∗ ∗∗∗ ∗∗∗ ∗∗ ∗∗∗ ∗∗∗ ∗∗∗ –0.41 0.49 –0.21 0.26 0.37 0.21 –0.45 –0.37 0.40 0.052 ε Age ∗∗∗ 0.50 ε Gender ∗∗∗ 0.34 Dem. ∗∗∗ ∗∗ ε Married –0.41 0.65 Comorb. Cond. ∗∗∗ –0.54 ε Schooling –0.22 ∗∗∗ –0.50 –0.005 ε ∗∗∗ –0.83 0.12 Funct. –0.14 0.09 0.07 ∗∗∗ ∗∗∗ ε Yesavage 0.548 0.76 ∗∗∗ ∗∗ 0.26 0.42 ε MOS1 ∗∗∗ Barthel Lawton –0.73 Psycho. –0.13 ∗∗∗ –0.76 Cognit. ε MOS2 ε ε ∗∗∗ ε 0.90 ε MOS3 ∗∗∗ ∗∗∗ ∗∗∗ ∗∗∗ 0.80 0.84 0.77 –0.26 ε MOS4 ∗ p < 0.05 MMSE RUDAS SMC ∗∗ p < 0.01 ∗∗∗ εε ε p < 0.001 Figure 1: Structural model of the relationship between demographic conditions, comorbidity, social support, and its relationship with cognitive profile and functionality. Econ. Depend : economic dependency; MOS-SSS1 : informational/emotional dimension; MOS-SSS2 : instrumental dimension; MOS-SSS3 : positive social interaction dimension; MOS-SSS4 : affective support dimension; Demog Cond :de- mographic conditions; Psycho F : psychosocial factor; Comob : comorbidity; Cognit : cognition; Funct : functionality; HT : hypertension; DM : diabetes mellitus; Obes : obesity; COPD : chronic obstructive pulmonary disease; Osteop : osteoporosis; Dyslip: dyslipidemia; Nutr : nutritional status; SMC : subjective memory complaints. inversely proportional correlation was observed in both explains 36.0% of the variability of functionality, 63.0% of scales regarding the scores related to subjective complaints the variability of cognitive profile, and 39.9% of the vari- of memory and depression. Additionally, a positive corre- ability of comorbidity. lation was observed with the functional scales. Only the RUDAS showed significant correlation with MOS-SSS in its 4. Discussion 4 dimensions and for the total scale. Nowadays, the relevance of research in ethnic minorities has received more recognition. +e scientific community has 3.4. Structural Model to Evaluate the Relationship between begun to consider ethnicity as a potential differentiating DemographicConditions,Comorbidity,SocialSupport,andIts factor in the aging process. +is increased interest in this Relationship with Cognitive Profile and Functionality. subject could be explained by the disparity in terms of health Figure 1 presents the structural model that represents the and illness compared to other contexts [23]. Furthermore, it relationship between demographic conditions, comorbidity, could be explained by the need to better understand the social support, and its relationship with cognitive profile and interaction of health determinants’ characteristics with this functionality. +is model showed an adequate fit with an type of population given their ability to influence morbidity RMSEA index � 0.062 (CI 90% 0.057–0.067, CFI � 0.64, and and mortality [24]. +us, the aim of this study was to TLI � 0.59). +is model explains 34% of the variability of evaluate the demographic, medical, and psychosocial factors functionality, 59.8% of the variability of cognitive profile, that affect global cognitive performance and functional and 44.9% of the variability of comorbidity. According to the activities in a group of indigenous older adults, using a modification indexes, the model improved the adjustment multifactorial structural model of latent factors. +e results considering (Figure 1-Supplement) covariances between of this study show a significant relevance of the afore- demographic condition (latent) with obesity and Yesavage; mentioned factors in cognitive and functional performance comorbility (latent) with Yesavage; cognition (latent) with in the study group, evaluated through the multidimensional Yesavage nutrition level, education, sex, economic de- geriatric model. pendency, and obesity; and functionality (latent) with Regarding the demographic factors, and specifically Yesavage age and nutrition level. +is last model showed an considering the education variable, it was evaluated based on adequate adjustment with an RMSEA index � 0.042 (CI 90% the following categories: the person’s ability to read and 0.036– 0.047, CFI � 0.85, and TLI � 0.82). +is model write or the lack of such skills and the level of instruction in Econ.Dep. Journal of Aging Research 5 Table 1: Cognitive and functional performance according to the demographic characteristics of 518 indigenous senior citizens in the province of Nariño, Colombia. Lawton and RUDAS MMSE SMC Barthel Brody Variables Frequency % Mean SD Mean SD Mean SD Mean SD Mean SD Gender Female 231 44.6 20.2 5 23.2 5 22.6 10 6 2 97 7 Male 287 55.6 20.4 4 21.2 5.4 24.5 9.7 6 2 96 7 Age 70.6 6.8 60–65 130 25.1 22.4 4 24.5 4.3 22.5 9.5 7 1 98 5 66–70 149 28.8 20.7 4 22.3 5 23.1 10 6 2 97 6 71–75 111 21.4 20.3 5 21.8 5.4 25.1 9.8 6 2 96 8 76–80 78 15.1 18.4 5 20.7 5 24.4 10 6 2 96 6 80 or more 50 9.7 16.6 5 18.2 6.1 23.6 11 5 2 93 10 Speaks native language Yes 74 14.3 20.6 5 22.4 5.3 22.8 9.1 6 2 95 9 No 444 85.7 20.2 5 22.1 5.4 23.8 10 6 2 97 7 Schooling S/he cannot read/write 208 40.2 18.5 5 18.8 5.1 23.9 10 6 2 96 9 S/he can read/write 249 48.1 21.6 5 24.5 4.2 23.5 9.5 6 2 97 6 Basic primary education 61 11.7 21.2 4 23.4 4.4 23.4 11 6 2 98 6 Residence Rural 475 91.7 20.2 5 22.1 5.4 23.4 9.9 6 2 97 7 Urban 42 8.3 20.8 5 22.3 5.3 26.2 9.9 6 2 97 5 Income Without income 276 53.3 19.7 5 20.7 5.6 23.3 10 6 2 95 8 Less to a LMMW 237 45.8 20.9 5 23.6 4.6 24.2 9.6 6 1 98 8 Between 1 and 3 LMMW 5 0.9 25.2 4 28.6 1.5 15.8 15 7 1 99 2 Marital status Single 82 15.8 20.2 4 21 5.8 25.6 9.4 6 2 97 5 Married/consensual union 329 63.5 20.8 4 23.1 4.8 23 10 6 2 97 6 Widowed/divorced 107 20.6 18.8 6 19.9 5.7 24 9.9 6 2 95 10 Economic dependency Yes 356 67.6 19.9 4 21.4 5.4 23.8 9.9 6 2 96 7 No 162 32.4 21 4 23.6 4.9 23.4 9.9 7 1 98 6 LMMW: legal minimum monthly wage in Colombia. primary school. In the evaluated subjects, a minimum emotional and economic stability improves [28]. Con- proportion of them reached primary education and illiteracy cerning income, it was determined that most of the subjects prevailed significantly. +is situation is corroborated not evaluated do not receive income. +is reality provides an important account about the difficult economic situation in only in indigenous contexts but also in rural communities, where poor infrastructure conditions, difficult geography, which indigenous elderly adults live. +is problem is ex- dispersed population, and armed conflict have led to edu- acerbated if one considers the precarious health and the deep cational vulnerability [25]. +us, in Colombia, the per- social inequalities they face [29]. +is issue has also been centage of illiterate people is 1.9%, while among indigenous observed in older adult farmers where demographic de- people that percentage amounts to 3.7%, or approximately terminants are precarious [30]. +erefore, the demographic 30,000 individuals [26]. In relation to gender, a higher profile of this population is characterized by situations of prevalence of the male sex is observed. +is is a datum that extreme vulnerability around health conditions, education, differs from the common theoretical references, especially in infrastructure, and basic services (e.g., water and health care). rural and urban contexts. Usually, there is more convergence towards a greater incidence of the female gender, something At the level of cognitive performance, this was de- also referred to as the “feminization phenomenon” of aging termined through the application of the Mini-Mental and [27]. RUDAS scales cognitive. +e latter was used for its psy- In relation to marital status, the data show a significant chometric properties which decrease schooling bias towards percentage of older adults who belong to the married cat- the subjects to whom it is applied given that most test items egory. About this, it could be argued that marriage becomes do not require basic instruction. Similarly, a lower cutoff a protective factor for these people because it determines an point was chosen compared to other population groups, like individual’s main support network. +us, with a partner, an from the rural or urban context. Despite this, the studied individual’s perception of support in matters related to population obtained a significantly lower average score than 6 Journal of Aging Research Table 2: Cognitive and functional performance according to medical records of 518 indigenous senior citizens from the province of Nariño, Colombia. RUDAS MMSE SMC Lawton Barthel Total, n � 518 Illnesses Frequency % Mean SD Mean SD Mean SD Mean SD Mean SD Yes 128 24.7 19.3 5.4 21 5.4 24.3 10 6 2 96 9 HT No 390 75.3 20.6 4.4 22.5 5.3 23.4 9.8 6 2 97 7 Yes 5 3.5 23 3.6 24.6 5 20 9.3 8 1 97 4 ∗∗ CVD No 513 96.5 20.3 3.6 22.1 5.4 23.7 9.9 6 2 97 7 Yes 24 4.6 18.4 5.9 19.5 6.2 27.2 9.1 5 3 93 12 Diabetes No 494 95.4 20.4 4.6 22.2 5.3 23.4 9.9 6 2 97 7 Yes 99 19.1 20.2 5.2 22.3 5.7 24.9 9.6 6 2 96 7 Dyslipidemia No 419 80.9 20.3 4.6 22.0 5.3 23.3 10.0 6 2 97 7 Yes 30 5.8 20.4 4.3 23.5 4.5 23.4 12 7 2 96 6 Obesity No 488 94.2 20.3 4.7 22.0 5.4 23.5 9.8 6 2 97 7 Yes 18 3.5 19.1 5.5 21.4 4.9 26.4 8.5 6 2 94 10 ∗∗∗ COPD No 500 96.5 20.3 4.7 22.1 5.4 23.5 10.0 6 2 97 7 Yes 53 10.2 20 4.9 21.6 5.2 27 9.9 6 2 95 9 Osteoporosis No 465 89.8 20.3 4.7 22.2 5.4 23.2 9.9 6 2 97 7 Yes 247 47.7 20.1 4.5 21.8 5.2 24.7 9.9 6 2 96 7 Arthritis No 271 52.3 20.5 4.9 22.5 5.4 22.7 9.8 6 2 97 7 Yes 120 23.2 20 5.2 20.8 5.5 25.1 10 6 2 96 7 Cataracts No 398 76.8 20.7 4.5 22.5 5.2 23.2 9.8 6 2 97 7 Yes 89 17.2 20.1 4.8 22.6 5.1 24.4 9.1 6 2 96 8 Fractures No 429 82.8 20.3 4.7 22.0 5.4 23.5 10.1 6 2 97 7 Yesavage Normal 181 34.9 22 4.1 23.8 4.8 18.5 10 6 2 98 5 Moderate depression 252 48.6 19.7 4.5 21.4 5.6 25.2 8.8 6 2 97 6 Severe depression 85 16.4 18.4 4.3 20.4 5.4 30 6.8 6 2 93 11 Nutritional status Normal 382 73.7 20.6 4.7 22.5 5 23.2 10 6 2 97 6 Malnutrition risk 136 26.3 19.4 4.7 21 6.1 24.8 9.6 6 2 91 10 ∗ ∗∗ ∗∗∗ HT: hypertension; CVD: cardiovascular disease; COPD : chronic obstructive pulmonary disease. whose gradual increase tends to decrease the ability to solve Table 3: Pearson correlation coefficients between MMSE and RUDAS with the MOS-SSS and its dimensions. problems and process new information [32]. Likewise, gender is a significant factor in terms of MMSE RUDAS cognitive functioning [33]. However, bibliographic refer- ∗∗ ∗∗ Subjective memory complaints (SMC) − 0.178 − 0.250 ences are still divergent on this issue. Traditionally, the ∗∗ ∗∗ Yesavage − 0.244 − 0.297 existence of a differentiated profile is cognitively significant ∗∗ ∗∗ Barthel 0.249 0.232 and can affect at cultural and functional levels [28]. ∗∗ ∗∗ Lawton and Brody 0.385 0.347 Moreover, education is a variable that greatly affects cog- Social support (MOS-SSS) nitive performance. Low schooling could explain the sub- Informational/emotional dimension 0.052 0.107 ∗∗ stantial variation in cognitive test scores among different Instrumental dimension 0.077 0.145 ∗∗ Positive social interaction dimension 0.065 0.159 population groups [24]. In this way, the consensus is gen- ∗∗ Affective support dimension 0.031 0.140 erally established that performance on low-educated in- ∗∗ Total (MOS-SSS) 0.064 0.150 dividuals can result in two standard deviations below the ∗ ∗∗ <0.05, <0.01. normal average on the cognitive follow-up scales [33]. In- deed, such a situation was presented in the evaluated population where a percentage of them had basic primary expected. +is situation is corroborated in a report obtained education and in the worst case belonged to the illiterate in studying an indigenous population of Putumayo, category. Possibly, this situation can be explained due to Colombia [31], where 87 % of the elderly presented mild schooling processes not consistent with their ethnic char- cognitive impairment. Similarly, this type of data has been acteristics and cultural patterns, among others. reported in more general rural contexts [27]. +e above is Further, in indigenous contexts, there is an increased risk argued based on the demographic characteristics of the of medical comorbidity characterized by the incidence of population, where age represents a fundamental de- cardiovascular diseases and greater exposure to car- terminant in this type of performance in ethnic groups, diometabolic risk factors, such as obesity, diabetes, and Journal of Aging Research 7 evidenced in longitudinal and cross-sectional studies, in hypertension [34]. +is situation would explain the health disparity of ethnic groups. In this sense, diabetes is a which a greater age range is perhaps the most important risk factor in the impairment of functional capacity [40]. Sim- complex and socially mediated disease, explained by a series of factors that include colonization, a situation that has ilarly, there is no continuous relationship between the in- influenced the change in their healthy lifestyles [35]. Di- crease in disability and age but tends to accelerate especially abetes in the indigenous population is related to the prev- in states of greater longevity [41]. Furthermore, structural alence and incidence of hypertension; hence, they have a characteristics such as improvement in psychosocial and bidirectional tendency. In this sense, high blood pressure socioeconomic conditions could generate improvements in represents a health risk and the main cause of disability in cognitive performance among elderly to prevent situations of functional dependence through the maintenance of cognitive functioning. In previous research, hypertension was practically nonexistent among indigenous adults; healthy lifestyles. [5]. Besides, the functionality of older adults is associated not only with the performance of however, the prevalence currently ranges from 29.7% of the before-mentioned population [36]. Several studies have physical activity and social participation, but also with the social support they have, especially from the family, which referred to the epidemiological evidence regarding the re- lationship between diabetes and hypertension with cognitive otherwise may lead to deterioration for adequately coping functioning [37]. +is is explained by the presence of nu- with life, affecting their well-being and increasing functional merous pathophysiological mechanisms that enhance cog- dependence [42]. +us, having strong family and social ties nitive impairment, which is related to impaired insulin allows an emotional exchange that leads to a structural and function and vascular problems, all related to the beta- functional strengthening of this group. amyloid protein. Additionally, hypertension is a risk factor Equally, the functionality in elder adults would be related to the presence of depressive symptomatology, specifically, that generates lesions at the vascular level and can also cause ischemic lesions at the cerebral level [38]. their inability to perform activities of daily life, determined by the complexity and time required to undertake tasks [43]. +e Considering the emotional component, there was a higher frequency of depressive symptomatology in the indigenous related literature on this issue suggests that the dopaminergic hypoactivation process constitutes in the justification for the elderly. +is prevalence is also corroborated in other studies analyzing regular and indigenous elders in a rural context previous argument since a motivational process is necessary with a reported incidence of 80% of the population [30, 31]. Its to carry out activities and sequence motor actions. Mean- diagnosis is important as it represents a criterion of fragility. It while, in a population of indigenous older adults, emotional is also the main cause of emotional suffering and low quality participation can have a greater negative impact on functional of life at old ages [39]. In relation to the population evaluated, capacity than chronic diseases [44]. Further, with respect to a significant percentage of them live in disadvantaged social the cognitive component, the literature refers the fact that deficits in the higher mental processes determine participa- situations. +is precarious condition is related to unfavorable socioeconomic standards in which they have developed their tion and performance in daily life activities, affecting the quality of life in the elderly [45]. In this study, the results lives, contributing to the prevalence of emotional disorders [31]. +e previous argument is relevant if one considers the converge towards the presence of cognitive impairment that relationship between cognitive performance and cerebral compromises functional capacity. However, some authors reserve—the incidence of this latter variable increases the risk express that in ethnic groups without cognitive impairment, of mental deterioration. At the emotional component level, a functional dependence can occur. +e consensus on this issue study refers significant correlation between depressive indicates that in older adults, there is a certain commitment to symptoms and cerebral reserve (rho � 0.583; p< 0.001) perform instrumental activities, although there may be def- among the indigenous community [31]. +erefore, it could be icits in the performance of basic activities in advanced stages concluded that the presence of depressive symptomatology in of dementia [46]. Referring to the strengths of the study, it could be argued the indigenous older adults evaluated could be related by the precariousness of demographic and psychosocial factors in that they are mainly related to the multidimensional eval- uation performed for a specific type of population, that is, which they are immersed. It is also clear that the armed conflict and colonization of these ethnic groups can have an indigenous older adults. In addition, it is the first study of important effect [29]. this nature conducted in Colombia. +erefore, these findings In another context, Early and colleagues argue that could guide the design of strategies, intervention programs, functional capacity is conditioned by multiple factors. In this and structuring of public policies that could improve cog- sense, one of the most referenced variables in this type of nitive and functional performance among the population research is gender. Apparently, women are more vulnerable studied. Parallel to this, the main limitation of the in- vestigation was its transversal nature. Also, some situations to functional dependence attributed to their greater lon- gevity in relation to men [5]. However, the results of the in the elderly are fluctuating, especially those related to the cognitive and emotional state. present investigation indicate otherwise. +e above could be explained due to the agricultural work culture that women have carried out and was an aspect evaluated in the in- 5. Conclusion strument. Depending on age, this variable seems to have a “dose-response association” in which, at an older age, there In a group of older indigenous adults, conditions of extreme is a greater risk of functional dependence. +is argument is demographic vulnerability prevail, mainly in the field of 8 Journal of Aging Research [8] E. J. Wolf, K. M. Harrington, S. L. Clark, and M. W. Miller, educational training. Likewise, depending on the medical “Sample size requirements for structural equation models,” comorbidity, there is evidence of the presence of hyper- Educational and Psychological Measurement, vol. 73, no. 6, tension, diabetes, and depressive symptoms among the pp. 913–934, 2013. adults. +is profile affects and predisposes the indigenous [9] H.-Y. Chen and P. K. Panegyres, “+e role of ethnicity in elderly to clinical conditions such as cognitive impairment alzheimer’s disease: findings from the C-PATH online data and dementia. repository,” Journal of Alzheimer’s Disease, vol. 51, no. 2, pp. 515–523, 2016. Data Availability [10] Y. Paredes, E. Yarce, and H. Moncayo, Factores multi- dimensionales de adultos mayores institucionalizados en la +e university in which we work does not allow us to share ciudad de Pasto, Editorial Unimar, Pasto, Colombia, 2018. the database. [11] Y. Guigoz, B. Vellas, and P. J. Garry, “Assessing the nutritional status of the elderly: the Mini Nutritional Assessment as part Conflicts of Interest of the geriatric evaluation,” Nutrition Reviews, vol. 54, no. 1, pp. S59–S65, 1996. +e authors declare that they have no conflicts of interest. [12] M. F. Folstein, S. E. Folstein, and P. R. McHugh, “Mini-mental state,” Journal of Psychiatric Research, vol. 12, no. 3, Acknowledgments pp. 189–198, 1975. [13] J. T. Rowland, D. Basic, J. E. Storey, and D. A. Conforti, “+e +e authors thank Mariana University for providing support. Rowland universal dementia assessment scale (RUDAS) and the folstein MMSE in a multicultural cohort of elderly per- sons,” International Psychogeriatrics, vol. 18, no. 1, Supplementary Materials pp. 111–120, 2006. [14] L. P. L. Ocampo, L. M. F. Oviedo, and F. V. Ceballos, Structural model was used to evaluate the relationship be- “Capacidad predictiva de una bater´ıa de pruebas neuro- tween demographic conditions, comorbidity, social support, ´ ´ psicologicas en el diagnostico temprano del deterioro cog- and its relationship with cognitive profile and functionality. nitivo leve (DCL) en un grupo de adultos,” Journal +is model showed an adequate adjustment with an RMSEA Encuentros, vol. 13, no. 1, 2015. index � 0.042 (CI 90% 0.036— 0.047, CFI � 0.85, and ´ ´ [15] D. C. Aguirre Acevedo, R. D. Gomez, S. Moreno Masmela TLI � 0.82). +is model explains 36.0% of the variability of et al., “Validez y fiabilidad de la bater´ıa neuropsicologica ´ functionality, 63.0% of the variability of cognitive profile, CERAD-Col,” Revista de Neurolog´ıa, vol. 45, no. 11, and 39.9% of the variability of comorbidity. (Supplementary pp. 655–660, 2007. Materials) [16] N. H. L. Pineda Salazar, H. L. Rogers, J. F. C. 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Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of Nariño, Colombia

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Copyright © 2019 Yenny Vicky Paredes-Arturo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Hindawi Journal of Aging Research Volume 2019, Article ID 4542897, 9 pages https://doi.org/10.1155/2019/4542897 Research Article Factors Associated with Cognitive and Functional Performance in Indigenous Older Adults of Nariño, Colombia 1 2 3 Yenny Vicky Paredes-Arturo, Eunice Yarce-Pinzon , Diego Mauricio Diaz-Velasquez, and Daniel Camilo Aguirre-Acevedo Mariana University Faculty of Humanities and Social Sciences, Psychology Program, Pasto, Colombia Mariana University Health Sciences Faculty, Occupational "erapy Program, Pasto, Colombia "e University of Edinburgh, Global Health Unit, Social Policy Programme, Edinburgh, UK University of Antioquia, School of Medicine, Medell´ın, Colombia Correspondence should be addressed to Eunice Yarce-Pinzon; eyarce@umariana.edu.co Received 30 April 2019; Accepted 29 August 2019; Published 1 October 2019 Academic Editor: Jean-Francois Grosset Copyright © 2019 Yenny Vicky Paredes-Arturo et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Ethnicity in Latin America is a factor of poverty and social exclusion. Like in developed countries, demographic, medical, psychosocial, global cognitive, and functional variables interact in a complex relationship on the elderly population. Such interaction should be considered to determine cognitive and functional performance using screening tests. +e aim of this study was to evaluate the demographic, medical, and psychosocial factors affecting global cognitive performance as well as functional activities. Methods. +e study was conducted in a Colombian elderly indigenous population which included a sample of 518 adults. +is research employed a structural model of latent factors to assess the effects of demographic, medical, and psychosocial factors on cognitive and functional performance. +e model was estimated by least squares and used a maximum-likelihood procedure, and it was determined RMSEA, TLI, and CFI to assess the model’s goodness of fit. +e categorical variables used in the model were as follows: (1) demographics, (2) psychosocial factors, (3) medical condition, (4) global cognition, and (5) functional factors. Results. Demographics, in addition to medical and psychosocial factors, were related to global cognition and functional factors (RMSEA � 0.051, CI 90% 0.045–0.057, CFI � 0.901, and TLI � 0.881). Conclusion. +ese results provide strong evidence about the complex relationships among demographics, medical conditions, and psychosocial factors and their influence on global cognition and functional performance in Colombian indigenous elderly population. On this subject, there are studies that inform about the 1. Introduction direct and indirect effects demographic conditions, general In Latin America, ethnicity is a strong risk factor associated health problems, and psychosocial variables have on the with poverty, inequality, and social exclusion, mainly in execution of cognitive tracking tests as well as functional rural areas and in low-income families. Ethnicity has a evaluations. Such data can be adjusted into a multivariate negative impact on the most vulnerable sectors of the model of complex interactions of 3 factors (the factors have population such as children and the elderly [1]. Ethnicity, as been medical history, global mental state, and gender) re- a condition of social inequality, when it is related to dif- lated to the functional condition and cognitive involvement ferences in language and low education, can impact global of the elderly [3]. +e model shows a complex structure of cognitive tracking evaluations. Such impacts can cause interrelations between factors such as genetics, emotions, heterogeneity in the execution of tests, limiting an in- sociodemographic factors, and health status. +e health dividual’s operational characteristics despite a priori ad- status is usually associated with the comorbidity of chronic justments that could be proposed in [2]. diseases. All these associated factors entail a greater risk for 2 Journal of Aging Research the development of neurodegenerative diseases with nega- factors. +ese factors were evaluated with a multidimen- tive consequences in daily life activities [4]. In this manner, sional questionnaire previously validated [10] and a self- report provided by each participant or a relative responsible the epidemiological profile of the disease in the indigenous community has gradually changed from a scenario char- for caregiving. +e demographic characteristics were acterized by infectious and parasitic disorders to an increase evaluated depending on the particularity of these; age was in the rates of chronic noncommunicable diseases. Never- approached in ranges since it allows a better analysis of it; in theless, this study does not disregard the strong relationship relation to the education variable, it was guided by cate- between cardiovascular risk factors, functional performance, gories that may or may not read and write and by primary, emotional state, cognitive impairment, and dementia in the secondary, technical, undergraduate, and postgraduate population of indigenous older adults [5, 6]. levels; regarding income, it was investigated based on the +ese conditions are shared by indigenous communities current legal minimum wage. +e medical component was in other Latin American countries, where the precarious consulted for the presence or not of medical illness. +e health situation of these contexts constitutes another rele- nutritional assessment was determined using the full ver- sion of the Mini-Nutritional Test [11]. +is evaluation was vant factor for the increase in dependence and mortality [7]. +e increase in risks such as chronic diseases, dependence, carried out by an interdisciplinary team in areas such as and mortality could be related to an acculturation process of nursing, neuropsychology, physical therapy, and occupa- the native population. +e natives have acquired lifestyles tional therapy. +e presence of malnutrition or risk of which in part have increased their life expectancy but, on the malnutrition was defined as follows: malnutrition was other hand, increased the prevalence of chronic diseases, considered when a person scored in the Mini-Nutritional causing dependence on the elderly [7, 8]. +e aim of this Test less than 17 points (<17); malnutrition risk relates to a study was to evaluate the demographic, medical, and psy- score between 17 and 23.5; and good nutritional status chosocial factors affecting global cognitive performance and relates to 24 points or more. +e study applied the Mini- functional activities, through a structural model of latent Mental State Examination (MMSE) test for cognitive factors. +e model was applied to a group of indigenous evaluation. For this study, it was used the cutoff point of ≥24 [12]. senior citizens in the province of Nariño, Colombia. +is study is of great relevance because the most important Additionally, it was used the Rowland Universal De- problems in the adult stage are the loss of cognitive and mentia Assessment (RUDAS) test considering a cutoff point functional abilities, even more regarding ethnic communi- of 21. +e latter was used because it does not contain biases ties belonging to a scenario of old age and multimorbidity linked to instruction level. Its ordinal scoring system is 30 [9]. +erefore, knowing the state of cognitive and functional points [13]. Further, the study applied the subjective performance of these adults allows to understand the levels memory complaints (SMC) consisting of 15 questions to of dependence of indigenous population from others to do determine the functioning of the patient’s memory in daily activities, an important indicator of their health condition. life using a Likert frequency scale. +e maximum score for the Likert scale is 45 and the cutoff point is 19 [14]. Likewise, depressive symptoms were evaluated according to a self- 2. Materials and Methods report that used the Yesavage geriatric depression scale [15]. +e scale considers three categories (normal, moderate +is project was designed as an observational and analytical depression, and severe depression) according to a total score study and is based on a transversal descriptive nature. +e obtained from a sum of 15 items. A score of 0 to 5 denotes reference population was 5759 older indigenous people who normal (no depression), 6 to 10 moderate depression, and 11 belonged to 13 subregions of the former jurisdiction of to 15 severe depression. +e social variables were evaluated Obando in the province of Nariño, in southern Colombia, through the Medical Outcomes Study—Social Support data obtained by the DANE Census and its estimate for 2016. Survey (MOS-SSS) with 20 questions in total, related to the In this way, the sample size included a total of 518 older adults. perception of support of the individual, in addition to ex- To estimate the sample, a prevalence of 50% was considered, a ploring about the accompaniment in the instrumental, af- margin of error between 3 and 5% with a 10% increase in fective, social, and family dimensions. +e response options potential losses. +e sample size was considered appropriate are given through a Likert scale of 1 (never) to 5 (always) for this study, taking into account the rule of 10 participants [16]. per variable in the structural model, for a ratio of 23 par- +e study used the Lawton and Brody scale to assess the ticipants per variable (n � 518/22 variables in the model) [8]. degree of functional independence regarding instrumental +e inclusion criteria were as follows: being an adult 60 years daily life activities [17]. +e scale assesses the ability to of age or older, belonging to an indigenous council, and perform tasks that involve the handling of habitual utensils voluntarily accepting participation in the study by signing the and routine social activities. +e Lawton and Brody scale informed consent. +e exclusion criteria were established uses 8 items for assessment (ability to use the phone, based on the presence of some medical or cognitive impli- shopping, preparing food, taking care of home, laundry, use cations that prevented the application of the protocol. of transportation means, responsibility for medication, and economy administration) and assigns a numerical value 1 (independent) or 0 (dependent) for the assessment process. 2.1. Valuations. We considered the following variables: soci- odemographic, medical, nutritional, cognitive, and functional +e final score results from the sum of the values in each Journal of Aging Research 3 are presented as standardized coefficients that indicate the answer and goes between 0 (maximum dependence) and 8 (total independence). Concerning the psychometric prop- correlation between the factors and dimensions. +e ana- lyses were carried out in the SPSS IBM software version 23 erties, the scale is reliable with a Pearson coefficient of in- terobserver reliability of 0.85 and good concurrent validity and in MPLUS 7.0 [22]. with other scales of cognitive and daily activities. It assesses the ability of a person to perform ten basic activities of daily 3. Results life in a dependent or independent way. +e Barthel index 3.1. Description of Cognitive and Functional Performance score ranges from 0 (completely dependent) to 100 (com- according to Demographic Characteristics. From the 518 pletely independent). A degree of dependence is established participants in the study, it was found an average in the according to the score obtained, being the most frequent MMSE of 22 points (SD � 5.4) and in the RUDAS scale of cutoff of 60 points (between moderate and mild dependence) 20.3 (SD � 4.7). +e SMC showed an average of 23.6 and 40 points (between moderate and severe dependence) (SD � 9.9). Concerning the functional scales, the average was [18]. 97 (SD � 7) and 6 (SD � 2) for the Barthel and Lawton scales, respectively. After adjusting for age and educational level, 2.2. Ethical Issues. +e study was reviewed and approved by the correlation between RUDAS and MMSE was 0.60 the Bioethics Committee of Mariana University, located in (p< 0.001). Table 1 presents the behaviour of the MMSE, the Pasto, Nariño, Colombia. +e study complies with the RUDAS, and the subjective complaints of memory and recommendations provided by the Resolution 8430 of 1993 functional scales, according to demographic characteristics. of the Colombian Ministry of Health to conduct research. +e correlation with age was − 0.33 (p< 0.001), − 0.36 Additionally, the study fulfils the Helsinki Declaration of the (p< 0.001), − 0.20 (p< 0.001), and − 0.30 (p< 0.001) for the World Medical Association guidelines [19]. Further, the MMSE, the RUDAS, Barthel, and Lawton, respectively. investigation sought approval from each indigenous com- Significant differences were found according to gender munity council. +is process was carried out in the first (MMSE (t � 4.4; gl � 506.0; p< 0.001) and QM (t � − 2.2; semester of 2017. gl � 510; p< 0.028)); level of education (MMSE (F � 91.3; gl1 � 2; gl2 � 515; p< 0.001), RUDAS (F � 29.3; gl1 � 2; gl2 � 515; p< 0.001), Lawton (F � 7.8; gl1 � 2; g2 � 515; 2.3. Statistical Analysis. +e study used frequency to de- p< 0.001), and Barthel (F � 4.3; g1 � 2; g2 � 515; p � 0.014)); scribe variables identified as demographic characteristics, marital status (MMSE (F � 14.6; g1 � 2; g2 � 515; p< 0.001), medical history, social support, and cognitive performance. RUDAS (F � 7.3; gl1 � 2; gl2 � 515; p � 0.001), and Barthel +e study used the percentage value to describe categorical (F � 6.0; gl1 � 2; gl2 � 509; p< 0.003)); and economic de- variables and mean along with standard deviation to de- pendence (MMSE (t � 4.4; gl � 516; p< 0.001), RUDAS scribe continuous variables. According to these character- (t � 2.4; gl � 516; p � 0.015), Lawton (t � 3.7; gl � 423; istics, we explored differences in the cognitive performance p< 0.001), and Barthel (t � 2.7; gl � 383; p � 0.007)). No evaluated by the MMSE and RUDAS using the t-test for significant differences were found regarding the area of independent samples (gender, place of residence, economic residence and home income. dependence, and medical history) and analysis of variance (ANOVA) for level of schooling, marital status, and home income. MMSE had to be transformed using a cubic power 3.2. Description of Cognitive and Functional Performance since it did not fulfil the assumption of homogeneity in according to Medical History. Table 2 presents the cognitive variance. Additionally, the Scheffe test was used when and functional performance according to the presence of comparing groups as a post hoc test. +e Pearson correlation medical history. Hypertension was associated with MMSE coefficients between MMSE and RUDAS were calculated (t � 3.0, df � 499, p � 0.003), RUDAS (t � 2.8, GL � 188, with the MOS-SSS dimension scores. It was proposed a p � 0.005), and Yesavage (t � − 2.0, df � 199, p � 0.047). structural model (Figure 1) assuming latent variables such as Diabetes was associated with MMSE (t � 2.6, df � 496, (1) demographics, (2) psychosocial factor, (3) health con- p � 0.009), RUDAS (t � 2.2, df � 496, p � 0.027), and Bar- dition, (4) cognitive dimension, and (5) functional di- thel (t � 1.6, df � 23.6, p � 0.004). +e presence of osteo- mension. +e model assumed that demographic factors and porosis was associated with the scale of memory complaints psychosocial factors influenced a person’s health condition, (t � − 2.8, df � 481, p � 0.006) and Barthel (t � 2.2, df � 481, in addition to the cognitive and functional dimensions. +e p � 0.029). +e correlation between the MMSE, RUDAS, RMSEA index (root mean square error of approximation), Lawton, and Barthel with Yesavage was − 0.257 (p< 0.001), CFI (confirmatory fit index), and TLI (Tucker–Lewis index) − 0.310 (p< 0.001), − 0.183 (p< 0.001), and − 0.233 were determined to assess the model’s goodness of fit. A (p< 0.001), respectively. good adjustment was assumed if the RMSEA index was less than 0.08 and the CFI and TLI >0.90 [20]. Given that the model included categorical variables, we used a robust es- 3.3.RelationshipbetweenGeneralCognitivePerformancewith timation method through weighted least squares with a Memory Complaints, Depression, Functional Scales, and So- likelihood ratio (WLSMV), using a diagonal weight matrix cial Support. Table 3 presents the Pearson correlation co- with standard errors and chi-square test statistic with an efficients between the MMSE and RUDAS with SMC, adjusted mean and variance [21]. +e results in the model depression, functional scales, and social support. An 4 Journal of Aging Research ε εε ε ε ε εε ε ε HTA DM Obes COPD Ostep Dislip Nutri. Arthritis Catarac Fractur. ∗∗∗ ∗∗∗ ∗∗∗ ∗∗ ∗∗∗ ∗∗∗ ∗∗∗ –0.41 0.49 –0.21 0.26 0.37 0.21 –0.45 –0.37 0.40 0.052 ε Age ∗∗∗ 0.50 ε Gender ∗∗∗ 0.34 Dem. ∗∗∗ ∗∗ ε Married –0.41 0.65 Comorb. Cond. ∗∗∗ –0.54 ε Schooling –0.22 ∗∗∗ –0.50 –0.005 ε ∗∗∗ –0.83 0.12 Funct. –0.14 0.09 0.07 ∗∗∗ ∗∗∗ ε Yesavage 0.548 0.76 ∗∗∗ ∗∗ 0.26 0.42 ε MOS1 ∗∗∗ Barthel Lawton –0.73 Psycho. –0.13 ∗∗∗ –0.76 Cognit. ε MOS2 ε ε ∗∗∗ ε 0.90 ε MOS3 ∗∗∗ ∗∗∗ ∗∗∗ ∗∗∗ 0.80 0.84 0.77 –0.26 ε MOS4 ∗ p < 0.05 MMSE RUDAS SMC ∗∗ p < 0.01 ∗∗∗ εε ε p < 0.001 Figure 1: Structural model of the relationship between demographic conditions, comorbidity, social support, and its relationship with cognitive profile and functionality. Econ. Depend : economic dependency; MOS-SSS1 : informational/emotional dimension; MOS-SSS2 : instrumental dimension; MOS-SSS3 : positive social interaction dimension; MOS-SSS4 : affective support dimension; Demog Cond :de- mographic conditions; Psycho F : psychosocial factor; Comob : comorbidity; Cognit : cognition; Funct : functionality; HT : hypertension; DM : diabetes mellitus; Obes : obesity; COPD : chronic obstructive pulmonary disease; Osteop : osteoporosis; Dyslip: dyslipidemia; Nutr : nutritional status; SMC : subjective memory complaints. inversely proportional correlation was observed in both explains 36.0% of the variability of functionality, 63.0% of scales regarding the scores related to subjective complaints the variability of cognitive profile, and 39.9% of the vari- of memory and depression. Additionally, a positive corre- ability of comorbidity. lation was observed with the functional scales. Only the RUDAS showed significant correlation with MOS-SSS in its 4. Discussion 4 dimensions and for the total scale. Nowadays, the relevance of research in ethnic minorities has received more recognition. +e scientific community has 3.4. Structural Model to Evaluate the Relationship between begun to consider ethnicity as a potential differentiating DemographicConditions,Comorbidity,SocialSupport,andIts factor in the aging process. +is increased interest in this Relationship with Cognitive Profile and Functionality. subject could be explained by the disparity in terms of health Figure 1 presents the structural model that represents the and illness compared to other contexts [23]. Furthermore, it relationship between demographic conditions, comorbidity, could be explained by the need to better understand the social support, and its relationship with cognitive profile and interaction of health determinants’ characteristics with this functionality. +is model showed an adequate fit with an type of population given their ability to influence morbidity RMSEA index � 0.062 (CI 90% 0.057–0.067, CFI � 0.64, and and mortality [24]. +us, the aim of this study was to TLI � 0.59). +is model explains 34% of the variability of evaluate the demographic, medical, and psychosocial factors functionality, 59.8% of the variability of cognitive profile, that affect global cognitive performance and functional and 44.9% of the variability of comorbidity. According to the activities in a group of indigenous older adults, using a modification indexes, the model improved the adjustment multifactorial structural model of latent factors. +e results considering (Figure 1-Supplement) covariances between of this study show a significant relevance of the afore- demographic condition (latent) with obesity and Yesavage; mentioned factors in cognitive and functional performance comorbility (latent) with Yesavage; cognition (latent) with in the study group, evaluated through the multidimensional Yesavage nutrition level, education, sex, economic de- geriatric model. pendency, and obesity; and functionality (latent) with Regarding the demographic factors, and specifically Yesavage age and nutrition level. +is last model showed an considering the education variable, it was evaluated based on adequate adjustment with an RMSEA index � 0.042 (CI 90% the following categories: the person’s ability to read and 0.036– 0.047, CFI � 0.85, and TLI � 0.82). +is model write or the lack of such skills and the level of instruction in Econ.Dep. Journal of Aging Research 5 Table 1: Cognitive and functional performance according to the demographic characteristics of 518 indigenous senior citizens in the province of Nariño, Colombia. Lawton and RUDAS MMSE SMC Barthel Brody Variables Frequency % Mean SD Mean SD Mean SD Mean SD Mean SD Gender Female 231 44.6 20.2 5 23.2 5 22.6 10 6 2 97 7 Male 287 55.6 20.4 4 21.2 5.4 24.5 9.7 6 2 96 7 Age 70.6 6.8 60–65 130 25.1 22.4 4 24.5 4.3 22.5 9.5 7 1 98 5 66–70 149 28.8 20.7 4 22.3 5 23.1 10 6 2 97 6 71–75 111 21.4 20.3 5 21.8 5.4 25.1 9.8 6 2 96 8 76–80 78 15.1 18.4 5 20.7 5 24.4 10 6 2 96 6 80 or more 50 9.7 16.6 5 18.2 6.1 23.6 11 5 2 93 10 Speaks native language Yes 74 14.3 20.6 5 22.4 5.3 22.8 9.1 6 2 95 9 No 444 85.7 20.2 5 22.1 5.4 23.8 10 6 2 97 7 Schooling S/he cannot read/write 208 40.2 18.5 5 18.8 5.1 23.9 10 6 2 96 9 S/he can read/write 249 48.1 21.6 5 24.5 4.2 23.5 9.5 6 2 97 6 Basic primary education 61 11.7 21.2 4 23.4 4.4 23.4 11 6 2 98 6 Residence Rural 475 91.7 20.2 5 22.1 5.4 23.4 9.9 6 2 97 7 Urban 42 8.3 20.8 5 22.3 5.3 26.2 9.9 6 2 97 5 Income Without income 276 53.3 19.7 5 20.7 5.6 23.3 10 6 2 95 8 Less to a LMMW 237 45.8 20.9 5 23.6 4.6 24.2 9.6 6 1 98 8 Between 1 and 3 LMMW 5 0.9 25.2 4 28.6 1.5 15.8 15 7 1 99 2 Marital status Single 82 15.8 20.2 4 21 5.8 25.6 9.4 6 2 97 5 Married/consensual union 329 63.5 20.8 4 23.1 4.8 23 10 6 2 97 6 Widowed/divorced 107 20.6 18.8 6 19.9 5.7 24 9.9 6 2 95 10 Economic dependency Yes 356 67.6 19.9 4 21.4 5.4 23.8 9.9 6 2 96 7 No 162 32.4 21 4 23.6 4.9 23.4 9.9 7 1 98 6 LMMW: legal minimum monthly wage in Colombia. primary school. In the evaluated subjects, a minimum emotional and economic stability improves [28]. Con- proportion of them reached primary education and illiteracy cerning income, it was determined that most of the subjects prevailed significantly. +is situation is corroborated not evaluated do not receive income. +is reality provides an important account about the difficult economic situation in only in indigenous contexts but also in rural communities, where poor infrastructure conditions, difficult geography, which indigenous elderly adults live. +is problem is ex- dispersed population, and armed conflict have led to edu- acerbated if one considers the precarious health and the deep cational vulnerability [25]. +us, in Colombia, the per- social inequalities they face [29]. +is issue has also been centage of illiterate people is 1.9%, while among indigenous observed in older adult farmers where demographic de- people that percentage amounts to 3.7%, or approximately terminants are precarious [30]. +erefore, the demographic 30,000 individuals [26]. In relation to gender, a higher profile of this population is characterized by situations of prevalence of the male sex is observed. +is is a datum that extreme vulnerability around health conditions, education, differs from the common theoretical references, especially in infrastructure, and basic services (e.g., water and health care). rural and urban contexts. Usually, there is more convergence towards a greater incidence of the female gender, something At the level of cognitive performance, this was de- also referred to as the “feminization phenomenon” of aging termined through the application of the Mini-Mental and [27]. RUDAS scales cognitive. +e latter was used for its psy- In relation to marital status, the data show a significant chometric properties which decrease schooling bias towards percentage of older adults who belong to the married cat- the subjects to whom it is applied given that most test items egory. About this, it could be argued that marriage becomes do not require basic instruction. Similarly, a lower cutoff a protective factor for these people because it determines an point was chosen compared to other population groups, like individual’s main support network. +us, with a partner, an from the rural or urban context. Despite this, the studied individual’s perception of support in matters related to population obtained a significantly lower average score than 6 Journal of Aging Research Table 2: Cognitive and functional performance according to medical records of 518 indigenous senior citizens from the province of Nariño, Colombia. RUDAS MMSE SMC Lawton Barthel Total, n � 518 Illnesses Frequency % Mean SD Mean SD Mean SD Mean SD Mean SD Yes 128 24.7 19.3 5.4 21 5.4 24.3 10 6 2 96 9 HT No 390 75.3 20.6 4.4 22.5 5.3 23.4 9.8 6 2 97 7 Yes 5 3.5 23 3.6 24.6 5 20 9.3 8 1 97 4 ∗∗ CVD No 513 96.5 20.3 3.6 22.1 5.4 23.7 9.9 6 2 97 7 Yes 24 4.6 18.4 5.9 19.5 6.2 27.2 9.1 5 3 93 12 Diabetes No 494 95.4 20.4 4.6 22.2 5.3 23.4 9.9 6 2 97 7 Yes 99 19.1 20.2 5.2 22.3 5.7 24.9 9.6 6 2 96 7 Dyslipidemia No 419 80.9 20.3 4.6 22.0 5.3 23.3 10.0 6 2 97 7 Yes 30 5.8 20.4 4.3 23.5 4.5 23.4 12 7 2 96 6 Obesity No 488 94.2 20.3 4.7 22.0 5.4 23.5 9.8 6 2 97 7 Yes 18 3.5 19.1 5.5 21.4 4.9 26.4 8.5 6 2 94 10 ∗∗∗ COPD No 500 96.5 20.3 4.7 22.1 5.4 23.5 10.0 6 2 97 7 Yes 53 10.2 20 4.9 21.6 5.2 27 9.9 6 2 95 9 Osteoporosis No 465 89.8 20.3 4.7 22.2 5.4 23.2 9.9 6 2 97 7 Yes 247 47.7 20.1 4.5 21.8 5.2 24.7 9.9 6 2 96 7 Arthritis No 271 52.3 20.5 4.9 22.5 5.4 22.7 9.8 6 2 97 7 Yes 120 23.2 20 5.2 20.8 5.5 25.1 10 6 2 96 7 Cataracts No 398 76.8 20.7 4.5 22.5 5.2 23.2 9.8 6 2 97 7 Yes 89 17.2 20.1 4.8 22.6 5.1 24.4 9.1 6 2 96 8 Fractures No 429 82.8 20.3 4.7 22.0 5.4 23.5 10.1 6 2 97 7 Yesavage Normal 181 34.9 22 4.1 23.8 4.8 18.5 10 6 2 98 5 Moderate depression 252 48.6 19.7 4.5 21.4 5.6 25.2 8.8 6 2 97 6 Severe depression 85 16.4 18.4 4.3 20.4 5.4 30 6.8 6 2 93 11 Nutritional status Normal 382 73.7 20.6 4.7 22.5 5 23.2 10 6 2 97 6 Malnutrition risk 136 26.3 19.4 4.7 21 6.1 24.8 9.6 6 2 91 10 ∗ ∗∗ ∗∗∗ HT: hypertension; CVD: cardiovascular disease; COPD : chronic obstructive pulmonary disease. whose gradual increase tends to decrease the ability to solve Table 3: Pearson correlation coefficients between MMSE and RUDAS with the MOS-SSS and its dimensions. problems and process new information [32]. Likewise, gender is a significant factor in terms of MMSE RUDAS cognitive functioning [33]. However, bibliographic refer- ∗∗ ∗∗ Subjective memory complaints (SMC) − 0.178 − 0.250 ences are still divergent on this issue. Traditionally, the ∗∗ ∗∗ Yesavage − 0.244 − 0.297 existence of a differentiated profile is cognitively significant ∗∗ ∗∗ Barthel 0.249 0.232 and can affect at cultural and functional levels [28]. ∗∗ ∗∗ Lawton and Brody 0.385 0.347 Moreover, education is a variable that greatly affects cog- Social support (MOS-SSS) nitive performance. Low schooling could explain the sub- Informational/emotional dimension 0.052 0.107 ∗∗ stantial variation in cognitive test scores among different Instrumental dimension 0.077 0.145 ∗∗ Positive social interaction dimension 0.065 0.159 population groups [24]. In this way, the consensus is gen- ∗∗ Affective support dimension 0.031 0.140 erally established that performance on low-educated in- ∗∗ Total (MOS-SSS) 0.064 0.150 dividuals can result in two standard deviations below the ∗ ∗∗ <0.05, <0.01. normal average on the cognitive follow-up scales [33]. In- deed, such a situation was presented in the evaluated population where a percentage of them had basic primary expected. +is situation is corroborated in a report obtained education and in the worst case belonged to the illiterate in studying an indigenous population of Putumayo, category. Possibly, this situation can be explained due to Colombia [31], where 87 % of the elderly presented mild schooling processes not consistent with their ethnic char- cognitive impairment. Similarly, this type of data has been acteristics and cultural patterns, among others. reported in more general rural contexts [27]. +e above is Further, in indigenous contexts, there is an increased risk argued based on the demographic characteristics of the of medical comorbidity characterized by the incidence of population, where age represents a fundamental de- cardiovascular diseases and greater exposure to car- terminant in this type of performance in ethnic groups, diometabolic risk factors, such as obesity, diabetes, and Journal of Aging Research 7 evidenced in longitudinal and cross-sectional studies, in hypertension [34]. +is situation would explain the health disparity of ethnic groups. In this sense, diabetes is a which a greater age range is perhaps the most important risk factor in the impairment of functional capacity [40]. Sim- complex and socially mediated disease, explained by a series of factors that include colonization, a situation that has ilarly, there is no continuous relationship between the in- influenced the change in their healthy lifestyles [35]. Di- crease in disability and age but tends to accelerate especially abetes in the indigenous population is related to the prev- in states of greater longevity [41]. Furthermore, structural alence and incidence of hypertension; hence, they have a characteristics such as improvement in psychosocial and bidirectional tendency. In this sense, high blood pressure socioeconomic conditions could generate improvements in represents a health risk and the main cause of disability in cognitive performance among elderly to prevent situations of functional dependence through the maintenance of cognitive functioning. In previous research, hypertension was practically nonexistent among indigenous adults; healthy lifestyles. [5]. Besides, the functionality of older adults is associated not only with the performance of however, the prevalence currently ranges from 29.7% of the before-mentioned population [36]. Several studies have physical activity and social participation, but also with the social support they have, especially from the family, which referred to the epidemiological evidence regarding the re- lationship between diabetes and hypertension with cognitive otherwise may lead to deterioration for adequately coping functioning [37]. +is is explained by the presence of nu- with life, affecting their well-being and increasing functional merous pathophysiological mechanisms that enhance cog- dependence [42]. +us, having strong family and social ties nitive impairment, which is related to impaired insulin allows an emotional exchange that leads to a structural and function and vascular problems, all related to the beta- functional strengthening of this group. amyloid protein. Additionally, hypertension is a risk factor Equally, the functionality in elder adults would be related to the presence of depressive symptomatology, specifically, that generates lesions at the vascular level and can also cause ischemic lesions at the cerebral level [38]. their inability to perform activities of daily life, determined by the complexity and time required to undertake tasks [43]. +e Considering the emotional component, there was a higher frequency of depressive symptomatology in the indigenous related literature on this issue suggests that the dopaminergic hypoactivation process constitutes in the justification for the elderly. +is prevalence is also corroborated in other studies analyzing regular and indigenous elders in a rural context previous argument since a motivational process is necessary with a reported incidence of 80% of the population [30, 31]. Its to carry out activities and sequence motor actions. Mean- diagnosis is important as it represents a criterion of fragility. It while, in a population of indigenous older adults, emotional is also the main cause of emotional suffering and low quality participation can have a greater negative impact on functional of life at old ages [39]. In relation to the population evaluated, capacity than chronic diseases [44]. Further, with respect to a significant percentage of them live in disadvantaged social the cognitive component, the literature refers the fact that deficits in the higher mental processes determine participa- situations. +is precarious condition is related to unfavorable socioeconomic standards in which they have developed their tion and performance in daily life activities, affecting the quality of life in the elderly [45]. In this study, the results lives, contributing to the prevalence of emotional disorders [31]. +e previous argument is relevant if one considers the converge towards the presence of cognitive impairment that relationship between cognitive performance and cerebral compromises functional capacity. However, some authors reserve—the incidence of this latter variable increases the risk express that in ethnic groups without cognitive impairment, of mental deterioration. At the emotional component level, a functional dependence can occur. +e consensus on this issue study refers significant correlation between depressive indicates that in older adults, there is a certain commitment to symptoms and cerebral reserve (rho � 0.583; p< 0.001) perform instrumental activities, although there may be def- among the indigenous community [31]. +erefore, it could be icits in the performance of basic activities in advanced stages concluded that the presence of depressive symptomatology in of dementia [46]. Referring to the strengths of the study, it could be argued the indigenous older adults evaluated could be related by the precariousness of demographic and psychosocial factors in that they are mainly related to the multidimensional eval- uation performed for a specific type of population, that is, which they are immersed. It is also clear that the armed conflict and colonization of these ethnic groups can have an indigenous older adults. In addition, it is the first study of important effect [29]. this nature conducted in Colombia. +erefore, these findings In another context, Early and colleagues argue that could guide the design of strategies, intervention programs, functional capacity is conditioned by multiple factors. In this and structuring of public policies that could improve cog- sense, one of the most referenced variables in this type of nitive and functional performance among the population research is gender. Apparently, women are more vulnerable studied. Parallel to this, the main limitation of the in- vestigation was its transversal nature. Also, some situations to functional dependence attributed to their greater lon- gevity in relation to men [5]. However, the results of the in the elderly are fluctuating, especially those related to the cognitive and emotional state. present investigation indicate otherwise. +e above could be explained due to the agricultural work culture that women have carried out and was an aspect evaluated in the in- 5. Conclusion strument. Depending on age, this variable seems to have a “dose-response association” in which, at an older age, there In a group of older indigenous adults, conditions of extreme is a greater risk of functional dependence. +is argument is demographic vulnerability prevail, mainly in the field of 8 Journal of Aging Research [8] E. J. Wolf, K. M. Harrington, S. L. Clark, and M. W. Miller, educational training. Likewise, depending on the medical “Sample size requirements for structural equation models,” comorbidity, there is evidence of the presence of hyper- Educational and Psychological Measurement, vol. 73, no. 6, tension, diabetes, and depressive symptoms among the pp. 913–934, 2013. adults. +is profile affects and predisposes the indigenous [9] H.-Y. Chen and P. K. Panegyres, “+e role of ethnicity in elderly to clinical conditions such as cognitive impairment alzheimer’s disease: findings from the C-PATH online data and dementia. repository,” Journal of Alzheimer’s Disease, vol. 51, no. 2, pp. 515–523, 2016. Data Availability [10] Y. Paredes, E. Yarce, and H. Moncayo, Factores multi- dimensionales de adultos mayores institucionalizados en la +e university in which we work does not allow us to share ciudad de Pasto, Editorial Unimar, Pasto, Colombia, 2018. the database. [11] Y. Guigoz, B. Vellas, and P. J. 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