Previous research on frailty in older adults has focused on morbidity and mortality. The purpose of this study was to elicit the relationship between being non-frail, pre-frail, or frail and health related quality of life in a representative sample of older Mexican Americans surveyed in 2005–2006.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: A handful of clinics in the U.S. routinely offer patients audio or video recordings of their clinic visits. While interest in the practice of clinic visit recording has increased, to date there is no data on the prevalence of recording in clinical practice in the U.S. Objective: Our objectives were to 1) determine the prevalence of sharing audio-recorded clinic visits for patients’ personal use in the U.S., 2) assess the attitudes of clinicians and the public toward recording, and 3) identify whether or not policies exist to guide recording practices in 49 of the largest health systems in the U.S. Methods: Two parallel cross-sectional surveys were administered in July 2017 to Internet Panels of U.S. based clinicians (SERMO Panel) and the U.S. public (Qualtrics Panel). To ensure a diverse range of perspectives, we set quotas to capture clinicians from eight specialties. Quotas were also applied to the public survey based on U.S. Census data (gender, race, ethnicity and language other than English spoken at home) to approximate views among U.S. adults. Forty-nine of the largest health systems (by clinician number) in the U.S. were contacted by email and telephone to determine the existence, or absence, of policies to guide audio-recordings of clinic visits for patients’ personal use. Multiple logistic regression models were used to determine factors associated with recording. Results: A total of 456 clinicians and 524 public respondents completed surveys. Approximately 28% of clinicians reported that they had recorded a clinic visit for patients’ personal use, while 18% of the public reported doing so, including 3% who recorded visits without the clinician’s permission. Of the 327 clinicians who had not recorded a clinic visit, 50% would be willing to do so in the future, while 66% of the public would be willing to record in the future. Clinician specialty was associated with prior recording: oncology, OR=5.1 (95% CI 1.9 to 14.9; P=0.002) and physical rehabilitation OR=3.9 (95% CI 1.4 to 11.6; P=0.01). Public respondents who were male, OR=2.11 (95% CI 1.26 to 3.61; P=0.005), younger age, OR=0.73 for a 10-year increase in age (95% CI 0.60 to 0.89; P=0.002); or spoke a language other than English at home, OR=1.99 (95% CI 1.09 to 3.59; P=0.02) were more likely to have recorded a clinic visit. None of the large health systems we contacted reported a dedicated policy, however 2 of the 49 health systems did report an existing policy that would cover the recording of clinic visits for patient use. Perceived benefits of recording included improved patient understanding and recall. Privacy and medico-legal concerns were raised. Conclusions: U.S. clinicians and public are taking the lead on recording clinic visits, while health systems seem to be lagging. Policy guidance from health systems and further examination of the impact of recordings, positive or negative, on the delivery of care and patients’ behavioral and health-related outcomes is urgently required.

Purpose: Numerous studies have examined the association of physical, behavioral and social factors with cognitive decline in older adults. Less attention has been placed on factors associated with long-term maintenance of intact cognition even into very old age. A greater understanding of those factors can inform the development of activities for maintaining cognitive strength. Methods: Using a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of non-institutionalized Mexican Americans aged 65 and older from five Southwestern states (N = 2767), latent class mixture models were developed to identify subgroups of cognitive change over time. Results: Three distinct trajectories of cognitive change were identified and characterized as stable, slow decline and rapid decline. Compared to the rapid decline group, a higher proportion of the stable cognition group were women, had high school education, were married and attended church one or more times per week. Regular church attendance had a significant positive impact in the stable group (β = 0.64, p <0.01), the slow decline group (β = 0.84, p <0.001) and the rapid decline group (β = 2.50, p <0.001). Activity limitations had a consistently negative association with cognition in the stable, slow decline and rapid decline groups (β = -0.37, p <0.001; β = -0.85, p <0.001; and β = -1.58, p <0.001 respectively). Conclusion: Substantial heterogeneity exists in rates of cognitive decline among older Mexican Americans. Interventions targeting cognitive maintenance may benefit from increased focus on factors associated with continued social engagement.