All ETDs from UAB

Advisory Committee Chair

Michael Crowe

Advisory Committee Members

Olivio J Clay

Brian Downer

Bertha Hidalgo

Richard Kennedy

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences


Puerto Rico has experienced a rapid increase in the older adult population over the last decade. With a growing older adult population, the importance of healthy aging becomes increasingly more important to understand. Understanding the impact that impairments in cognitive and physical functioning have on older adults in Puerto Rico will be important to supporting the rapidly aging population. The current project proposed to (1) examine predictors of transition to frailty, (2) examine whether cognitive function and frailty are associated with healthcare utilization, and (3) examine frailty and cognitive impairment as predictors of mortality and Alzheimer’s disease related cause of death. The aim of this project is to fill a gap in the literature and provide insights into the health characteristics among island dwelling Puerto Ricans. Data come from The Puerto Rican Elderly: Health Conditions (PREHCO) study (n=4,291) of Puerto Rican adults aged 60+ years living in Puerto Rico. The first wave of data collection was in 2002-2003 and the second wave was completed in 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. Incident cognitive impairment was determined by the minimental Cabán (MMC), a brief cognitive screener administered in Spanish. Older age, sex (females), and depressive symptoms were associated with baseline frailty status and transition to higher frailty states over 4-year follow-up. Diabetes was also associated with a higher odds of incident frailty and higher cognitive status was associated with a lower odds of incident frailty among pre-frail participants. This project also found that baseline pre-frailty was associated with an increased rate of doctor visits and baseline frailty was associated with an increased rate of ER visits, hospital stays, and doctor visits cross-sectionally. Lastly, baseline pre-frailty, frailty, and cognitive impairment were associated with shortened survival time. Frailty was not associated with an Alzheimer’s disease related cause of death. The current project highlights the growing public health concern regarding the impact of debilitating conditions on older Puerto Ricans. The findings in this project provide support that frailty and cognitive impairment are important public health concerns for aging Puerto Ricans in that these conditions are associated with poor health outcomes. This study also supports the utility of brief, cost effective measures for screening for cognitive function and physical functioning. Targeted screening and medical interventions for cognitive and physical functioning may be beneficial in reducing poor health outcomes, such as increased mortality. Puerto Ricans have less political representation, poorer economic conditions, and poorer quality healthcare on the island compared to mainland residents. This project contributes to the growing literature on characterizing subgroups of Latinos and underscores the importance of the need for further research to identify potentially modifiable risk factors and predict health outcomes among Latino subgroups.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.