Muscle strength can be measured through different methods and handgrip strength is one of the most used techniques in epidemiological studies. Given its easy application, high reliability, and low cost, it is considered an important health biomarker. Handgrip strength is associated with adverse health outcomes such as mortality and risk of developing chronic diseases, cardiovascular, respiratory, cancer and dementia. There is a paucity of evidence in Chile about the association of handgrip strength with these health outcomes limiting its visibility and implementation in clinical settings. Therefore, this narrative review summarizes the scientific evidence about the association of grip strength with non-communicable chronic diseases and mortality in middle age and older adults.

O estudo teve como objetivo analisar a associação entre participação social e risco de mortalidade em homens e mulheres idosos no Chile. Utilizamos a Pesquisa Nacional sobre Dependência do Idoso, que está relacionada aos dados vitais, para obter os registros de óbitos. No total, estimamos quatro modelos de regressão de risco proporcional. Mesmo depois de ajustar para variáveis sociodemográficas, econômicas, familiares e de saúde, observamos que idosos envolvidos em atividades sociais têm risco de morte 22% mais baixo em relação aos que não participam socialmente. Como conclusão, a participação social é fator de proteção forte e significativo contra a morte entre idosos chilenos. Portanto, é necessário promover a participação social a partir de uma perspectiva do curso de vida inteiro, uma vez que a mortalidade nas idades mais avançadas pode ser reflexo do acúmulo de desvantagens provocadas pela falta de atividade social ao longo da vida.

We aimed to examine the degree to which social participation is associated with mortality risk in older adults in Chile. We used the Chilean National Survey on Elderly Dependency, which is linked to vital statistics, in order to obtain death records. Four proportional risk regression models were estimated. Even with controlled sociodemographic, economic, family, and health variables, older adults who participate in social activities had a 22% lower risk of death than those who do not participate. We concluded that social participation is a strong and significant protective factor for mortality in Chilean older adults. Social participation should thus be promoted from a life course perspective considering its effect on mortality in older adults who maintained an active social life.

Nuestro objetivo es examinar el grado en el que la participación social está asociada con el riesgo de mortalidad en mujeres y hombres mayores en Chile. Usamos el Estudio Nacional de la Dependencia en Adultos Mayores, que está vinculada a estadísticas vitales para obtener los registros de defunción. En total, estimamos cuatro modelos de riesgo proporcionales. Incluso controlando las variables sociodemográficas, económicas, familiares y de salud, observamos que estos adultos mayores que se implicaban en actividades sociales tenían un 22% de riesgo más bajo de morir, comparados con quienes no participaban socialmente. En conclusión, la participación social es un factor protector fuerte y significativo de mortalidad en edades avanzadas en Chile. Por ello, es necesario promover la participación social desde una perspectiva de curso de vida, puesto que el efecto en la mortalidad en edades avanzadas puede ser un reflejo de la acumulación de ventajas entre quienes a lo largo de su vida mantuvieron una vida social activa.

O estudo teve como objetivo analisar a associação entre participação social e risco de mortalidade em homens e mulheres idosos no Chile. Utilizamos a Pesquisa Nacional sobre Dependência do Idoso, que está relacionada aos dados vitais, para obter os registros de óbitos. No total, estimamos quatro modelos de regressão de risco proporcional. Mesmo depois de ajustar para variáveis sociodemográficas, econômicas, familiares e de saúde, observamos que idosos envolvidos em atividades sociais têm risco de morte 22% mais baixo em relação aos que não participam socialmente. Como conclusão, a participação social é fator de proteção forte e significativo contra a morte entre idosos chilenos. Portanto, é necessário promover a participação social a partir de uma perspectiva do curso de vida inteiro, uma vez que a mortalidade nas idades mais avançadas pode ser reflexo do acúmulo de desvantagens provocadas pela falta de atividade social ao longo da vida.

We aimed to examine the degree to which social participation is associated with mortality risk in older adults in Chile. We used the Chilean National Survey on Elderly Dependency, which is linked to vital statistics, in order to obtain death records. Four proportional risk regression models were estimated. Even with controlled sociodemographic, economic, family, and health variables, older adults who participate in social activities had a 22% lower risk of death than those who do not participate. We concluded that social participation is a strong and significant protective factor for mortality in Chilean older adults. Social participation should thus be promoted from a life course perspective considering its effect on mortality in older adults who maintained an active social life.

Nuestro objetivo es examinar el grado en el que la participación social está asociada con el riesgo de mortalidad en mujeres y hombres mayores en Chile. Usamos el Estudio Nacional de la Dependencia en Adultos Mayores, que está vinculada a estadísticas vitales para obtener los registros de defunción. En total, estimamos cuatro modelos de riesgo proporcionales. Incluso controlando las variables sociodemográficas, económicas, familiares y de salud, observamos que estos adultos mayores que se implicaban en actividades sociales tenían un 22% de riesgo más bajo de morir, comparados con quienes no participaban socialmente. En conclusión, la participación social es un factor protector fuerte y significativo de mortalidad en edades avanzadas en Chile. Por ello, es necesario promover la participación social desde una perspectiva de curso de vida, puesto que el efecto en la mortalidad en edades avanzadas puede ser un reflejo de la acumulación de ventajas entre quienes a lo largo de su vida mantuvieron una vida social activa.

Background: Depression and dependence have a great impact on the quality of life of older people. Aim: To validate the SF-12 (short-form) health related quality of care questionnaire (HRQOL) as an alternative of the SF-36 to estimate health-related quality of life (HRQoL) and its association with depression and dependence in Chilean older people living in the community. Material and Methods: The questionnaire was answered by 4,124 Chilean older people (61% women). HRQoL was evaluated with the SF-36 questionnaire. The SF-12 questionnaire includes 12 items from the SF-36. Results: The internal consistency of the SF-12 questionnaire was high (0.88). The effect size of the differences in the averages of the SF-12 and SF-36 scales was small (0.06-0.41). Good agreement was found between the physical and mental components of the SF-12 and SF-36 (0.94 and 0.89). Logistic regressions determined that people with dependence and depression have a higher risk of poor HRQoL. The figures for the physical component were, mild depression: odds ratio (OR) (95% confidence intervals (CI) = 3.28 (2.74-3.93), severe depression: OR (IC95%CI) = 4.66 (3.55-6.11), mild to moderate dependence: OR (95CI%) = 3.67 (2.97-4.54), severe dependence: OR (95%CI) = 13.06 (7.23-23.61). For the mental component, the figures were: mild depression: OR (95CI%) = 6.11(5.05-7.38), severe depression: OR (95CI%) = 22.01(14.47-33.49), mild to moderate dependence: OR (95CI%) = 1.59 (1.28-1.97), severe dependence: OR (95CI%) = 1.60 (1.04-2.47), adjusting for sociodemographic and health-related variables. Conclusions: The validity of the SF-12 for measuring HRQoL was demonstrated. People with depression and dependence have a worse physical and mental quality of life.

Abstract This study investigates the extent to which aspects of the social integration of the elderly are linked to higher levels of fruit and vegetable consumption. It involved a cross-sectional study based on data from the National Study of Dependency in the Elderly, with a sample of 3278 elderly individuals. The variables of social integration considered were: frequency of meeting with close relatives, other relatives and neighbors and friends in the last 12 months; participation in recreational activities and in community groups, in addition to housing arrangements and marital status. The number of servings of fruit and vegetables consumed per day was the dependent variable. Logistic regression analysis was then conducted. In the adjusted model, more frequent encounters with siblings, in-laws and nephews, participation in community groups or organizations, are factors that increase the possibility of consuming two or more servings of fruit and vegetables a day, versus 1 serving or none; the opposite was observed when living alone. The variables of social integration that can increase the possibility of attaining the recommendation of consumption of fruit and vegetables daily (5 or more) in the adjusted model are frequency of encounters with siblings, in-laws and nephews and living alone.

Resumen Se investiga la medida en que aspectos de la integración social de adultos mayores están vinculados con los niveles de consumo de frutas y verduras. Estudio transversal a partir de datos del Estudio Nacional de la Dependencia en las Personas Mayores, con muestra de 3.278 adultos mayores. Las variables de integración social fueron: frecuencia de encuentro con familiares cercanos, otros familiares y vecinos y amigos en los últimos 12 meses; participación en actividades recreativas y en grupos comunitarios, además de arreglos de vivienda y estado marital. El número de porciones de frutas y verduras consumidas al día fue la variable dependiente. Se realizó análisis de regresión logística ordinal. En el análisis ajustado, mayor frecuencia de encuentros con hermanos, cuñados y sobrinos, participación en grupos comunitarios son factores que aumentan la posibilidad de consumo de dos o más porciones de frutas y verduras al día frente a ninguna o 1 porción; efecto contrario presenta vivir solo. Mayor frecuencia de encuentros con hermanos, cuñados y sobrinos y vivir sólo aumentan la posibilidad de alcanzar la recomendación de consumo de frutas y verduras diaria (5 o más), en el modelo ajustado.

Abstract This study investigates the extent to which aspects of the social integration of the elderly are linked to higher levels of fruit and vegetable consumption. It involved a cross-sectional study based on data from the National Study of Dependency in the Elderly, with a sample of 3278 elderly individuals. The variables of social integration considered were: frequency of meeting with close relatives, other relatives and neighbors and friends in the last 12 months; participation in recreational activities and in community groups, in addition to housing arrangements and marital status. The number of servings of fruit and vegetables consumed per day was the dependent variable. Logistic regression analysis was then conducted. In the adjusted model, more frequent encounters with siblings, in-laws and nephews, participation in community groups or organizations, are factors that increase the possibility of consuming two or more servings of fruit and vegetables a day, versus 1 serving or none; the opposite was observed when living alone. The variables of social integration that can increase the possibility of attaining the recommendation of consumption of fruit and vegetables daily (5 or more) in the adjusted model are frequency of encounters with siblings, in-laws and nephews and living alone.

Resumen Se investiga la medida en que aspectos de la integración social de adultos mayores están vinculados con los niveles de consumo de frutas y verduras. Estudio transversal a partir de datos del Estudio Nacional de la Dependencia en las Personas Mayores, con muestra de 3.278 adultos mayores. Las variables de integración social fueron: frecuencia de encuentro con familiares cercanos, otros familiares y vecinos y amigos en los últimos 12 meses; participación en actividades recreativas y en grupos comunitarios, además de arreglos de vivienda y estado marital. El número de porciones de frutas y verduras consumidas al día fue la variable dependiente. Se realizó análisis de regresión logística ordinal. En el análisis ajustado, mayor frecuencia de encuentros con hermanos, cuñados y sobrinos, participación en grupos comunitarios son factores que aumentan la posibilidad de consumo de dos o más porciones de frutas y verduras al día frente a ninguna o 1 porción; efecto contrario presenta vivir solo. Mayor frecuencia de encuentros con hermanos, cuñados y sobrinos y vivir sólo aumentan la posibilidad de alcanzar la recomendación de consumo de frutas y verduras diaria (5 o más), en el modelo ajustado.

Background: The assessment of frailty among older people could help to reduce its social and health burden. Aim: To determine and characterize the prevalence of frailty in Chilean older adults. Material and Methods: We studied 233 participants, aged > 60 years, participating in the Chilean National Health Survey 2016-2017. Frailty was assessed using modified Fried criteria. Thus, people classified as frail should meet at least 3 out of the 5 criteria (low strength, low physical activity, low body mass index, slow walking pace and tiredness). Results: The prevalence of frailty was 10.9% (7.7% for men and 14.1% for women). The prevalence of pre-frailty was 59.0% whereas 30.1% of participants were classified as robust. At the age of 80 years 58 and 62% of men and women were frail, respectively. These figures increased to 90 and 87% at the age of 90 years. The prevalence of pre-frailty increased from 43 to 92.1% among men and from 76% and 78% among women from the ages of 60 to 90 years, respectively. Conclusions: The prevalence of frailty increased markedly with age. It is important to implement prevention strategies to allow an early identification of high-risk individuals.

ABSTRACT: Quality of life related to oral health assessment oral problems affect an individual´s health, social relations, work and well-being. The objective of the study is to determine the association between the perception of the quality of life related with oral health and self-perception of health. A cross-sectional study of data from the National Survey of Quality of Life and Health (2015-2016) of the Ministry of Health was carried out, for people older than 15 years of age, reported from the 15 regions of Chile. Impact profile in oral health (OHIP-7) used to measure Quality of life related to oral health. The self-perception of health was measured with one question. Logistic regression models were adjusted to identify the association in terms of Odds Ratio using STATA v15.0. Out of 7041 surveys, 50.8 % were women, the average age was 42.3 years (d.s., 0.41), 60.3 % had less than 12 years of education, 36 % reported having a chronic disease. 18.5 % perceive that their oral health problems impact on their quality of life. Factors that are associated with poor perception of the quality of life related to oral health, were a poor self-perception of health OR = 4.84 (95 % CI 3.51, 6.67), age (45-54) years) OR = 1.98 (95 % CI 1.26, 3.12) and frequent use of medications (> 3) OR = 3.67 (95 % CI 2.17, 6,). In conclusion, quality of life related to oral health, is directly related to poor selfperception of health and becomes significantly worse with age, as well as with the frequent use of medications.

RESUMEN: La calidad de vida relacionada con salud oral permite evaluar como los problemas bucodentales pueden ser determinantes el estado de su salud, relaciones sociales, trabajo y bienestar. El objetivo del estudio es determinar la asociación entre la percepción de calidad de vida relacionada a salud oral y la autopercepción de la salud. Estudio transversal de datos de la Encuesta Nacional de Calidad de Vida y Salud (ENCAVI 2015-2016) del Ministerio de Salud, de personas mayores de 15 años de las 15 regiones de Chile. La calidad de vida relacionada con salud oral se midió a través de la versión abreviada del instrumento Oral Health Impact Profile (OHIP-7). La autopercepción de salud se midió con una pregunta única. Se ajustaron modelos de regresión logística para identificar la asociación en términos de Odds Ratio utilizando STATA v15.0. De 7041 encuestas el 50,8 % son mujeres, la media de edad fue de 42,3 años (d.t. 0,41), el 60,3 % tiene menos de 12 años de educación, el 36 % declara tener alguna enfermedad crónica. El 18,5 % percibe que sus problemas de salud oral impactan en su calidad de vida. Los factores que se asociaron significativamente con una mala percepción de calidad de vida relacionada con salud oral fueron mala autopercepción de salud general OR=4,84 (IC95 % 3,51; 6,67), edad (45-54 años) OR=1,98 (IC95 % 1,26;3,12) y uso frecuente de medicamentos (>3) OR=3,67 (IC95 % 2,17;6,). La calidad de vida relacionada con salud oral está asociada con la autopercepción en salud, es decir que una mala autopercepción de salud tiene probablemente más riesgo de tener una peor calidad de vida asociada a salud oral, siendo más fuerte a medida que avanza la edad y con el uso frecuente de medicamentos.

Background: In Chile, comprehensive geriatric assessment does not include the identification of dysphagia, despite being considered a geriatric syndrome. The Eating Assessment Tool 10 (EAT-10) questionnaire is a 10-question instrument that specifically describes the perception of dysphagia and has a Spanish translation. Aim: To validate and test the reliability of the EAT-10 questionnaire in Chilean older people living in the community. Material and Methods: The EAT-10 score was applied to 80 participants aged 75 ± 14 years (51 women). Other observer, blinded to the result of the score, performed the volume-viscosity swallow test as the gold standard to assess dysphagia. Results: The translated version of the EAT-10 had a strong internal consistency (Cronbach alfa =0.89) and interobserver consistency (100%). Using a score of seven as cutoff point, the EAT-10 had a sensitivity of 75%, specificity of 86% to detect dysphagia, when compared with the volume-viscosity swallow test. Conclusions: The EAT-10 questionnaire is valid and reliable and can be used as a clinical instrument in primary care in our country to identify older people with dysphagia.

Obesity is a major health problem worldwide. Obesity prevalence in Chilean older adults (OA) is increasing, associated with several negative health outcomes. Therefore, determining critical periods of adiposity increase is relevant in OA. The aim of the study was to assess body composition changes in OA during summer holidays. This observational study involved two test visits, without a control group. Twelve OA (9 females) with an average age of 71.92±6.97 years participated in an initial evaluation (E1) and final evaluation (E2) at the beginning and at the end of the summer in 2015. Weight, height, and body mass index (BMI) were assessed; fat-free mass (FFM), fat mass (FM), and muscular mass (MM) data were collected through foot-to-foot bioimpedance analysis. No significant variations were reported in weight and BMI between E1 and E2. This prevalence was maintained between E1 and E2. The FM significantly increased between E1 (27.63±10.91) and E2 (28.64±11.39) (p= 0.007), while the FFM significantly decreased between E1 (45.38±5.89) and E2 (44.33±5.36) (P= 0.006), also the MM between E1 (43.08±5.62) and E2 (42.07±5.10). Both, weight and BMI are insufficient measures for detecting changes during this critical summer holiday period. However, the body composition measures identified significant changes in the OA during the study.

La obesidad es el principal problema de salud en todo el mundo. La prevalencia de obesidad en adultos mayores (AM) chilenos es cada vez mayor, lo que se ha asociado con varios efectos negativos para la salud. Por lo tanto, la determinación de períodos críticos de aumento de la adiposidad es relevante en AM. El objetivo fue evaluar los cambios de la composición corporal en adultos mayores AM durante las vacaciones de verano. Doce AM participaron en una evaluación inicial (E1) y final (E2) del verano 2015. Se evaluó: peso, talla, índice de masa corporal (IMC), masa libre de grasa (MLG), masa grasa (MG) y masa muscular (MM). No hubo diferencias significativas en peso e IMC. La MG aumentó entre E1 (27,63±10,91) y E2 (28,64±11,39) (p= 0,007), la MLG disminuyó significativamente entre E1 (45,38±5,89) y E2 (44,33±5,36), como también la MM entre E1 (43,08±5,62) y E2 (42,07±5,10). Tanto el peso como el IMC son medidas insuficientes para detectar cambios durante este período crítico de vacaciones de verano. Sin embargo, las medidas de la composición corporal identificaron cambios significativos en AM durante el estudio.

Objectives: To estimate and validate cut-off points of skeletal muscle mass index (SMI) in Chilean population, for using in an algorithm for a diagnosis of sarcopenia developed by European Working Group on Sarcopenia in Older People (EWGSOP). Methods: Secondary analysis of Cross-sectional data in 440 Chilean older subjects to estimate cut-off points of SMI determined by DEXA and predicted by an anthropometric equation. Afterward a cross-sectional validation in a sample of 164 older people was performed. Anthropometric measures, self-reported health status, physical performance tests and DEXA were carried out. Decreased muscle strength was defined as handgrip strength <15 kg in women and <27 kg in male. Cut-off points of SMI were defined as values under 20th percentile for DEXA measures and estimated through ROC curves for the anthropometric model. Biological validity of the algorithm was tested by contrasting the diagnosis with physical performance tests and functionality. Results: Cut-off points of SMI obtained by DEXA were 7.19 kg/m² in men and 5.77 kg/m² in women and 7.45 kg/ m² and 5.88 kg/m², respectively for the predicted by the model. Sensibility and specificity of estimations vs DEXA measures were 80% and 92% in men and 77% and 89% in women. Conclusions: We obtained cut-off points of SMI for DEXA and for a prediction equation for older adults Chilean, with good sensibility and specificity for the measurement by DEXA. It will allow to apply the EWGSOP algorithm to the early diagnosis of sarcopenia and to develop programs for prevention, delay or reversion this syndrome.

Objetivos: Estimar y validar puntos de corte de índice de masa muscular esquelética (IMMAE) en adultos mayores chilenos, para el diagnóstico de sarcopenia. Métodos: Estimación de puntos de corte para IMMAE determinados por DEXA y por ecuación antropométrica en un análisis secundario de datos transversales de 440 Adultos Mayores (AM) chilenos, y posterior validación transversal en una muestra de 164 AM. Se realizaron pruebas de rendimiento físico, auto-reporte de salud, antropometría y DEXA. Se definió la fuerza muscular disminuida por dinamometría de mano <15 kg mujeres y <27 kg hombres. Los puntos de corte del IMMAE se definieron los inferiores al p20 según medición DEXA y con curvas ROC para aquellos estimados por ecuación. La validez biológica del algoritmo se efectuó contrastando el diagnóstico con pruebas de rendimiento físico y funcionalidad. Resultados: Los puntos de corte de IMMAE obtenidos por DEXA fueron 7,19 kg/m² en hombres y 5,77 kg/m² en mujeres y 7,45 kg/m² y 5,88 kg/m² respectivamente para las estimaciones del modelo. La sensibilidad y especificidad de las estimaciones respecto a DEXA fueron 80% y 92% en hombres y 77% y 89% en mujeres. Conclusiones: Se obtuvieron puntos de corte para el IMMAE en adultos mayores chilenos, calculados por DEXA y estimados a través de una ecuación de predicción, con buena sensibilidad y especificidad respecto de la medición por DEXA. Ello permitirá aplicar el algoritmo diagnóstico del EWGSOP en la atención primaria para diagnosticar precozmente esta condición y desarrollar programas destinados a su prevención, retardo y reversión.

O Chile está num avançado estágio de transição epidemiológica, com a população de 60 anos ou mais representando 15% da população total e o número de idosos tem mais que dobrado entre 1990 e 2014. O rápido avanço econômico tem promovido significantes mudanças na organização social para as quais o país não está habituado. Os problemas de saúde mental em idosos são particularmente desafiadores para as estruturas sociais e de saúde atuais do país. A prevalência de demência entre aqueles com idade superior a 60 anos excede 8% e é mais elevada na população rural. Há mais treinamento em demência na população médica e comunidade científica locais, aumentando o conhecimento dentro da comunidade civil, porém, com insuficiente resposta do estado às necessidades diagnósticas e terapêuticas de pacientes e cuidadores. O objetivo deste estudo foi providenciar uma atualização da informação sobre demência no contexto de envelhecimento cerebral do Chile.

Chile is in an advanced demographic transition stage with the population over 60 years of age representing 15% of the total population and whose number of elderly has more than doubled between 1990 and 2014. Rapid economic advancement has promoted significant changes in social organization to which the country is not accustomed. The mental health problems of the elderly are particularly challenging to the country's present social and health structures. The prevalence of dementia in people over 60 years exceeds 8% and is even higher in the rural population. There is more training on dementia in the local medical and scientific community, increased awareness within the civilian community but insufficient responsiveness from the state to the broad diagnostic and therapeutic requirements of patients and caregivers. The objective of the present study was to provide an update of the information on dementia in the context of the ageing process in Chile.

Introduction: The aim of the study was to estimate if B12 deficiency is associated with the use of metformin in the elderly diabetics. Methods: Case-control study in diabetic OP. Cases (n = 137) were defined as elderly with B12 < 221 pmol/L and controls (n = 279) elderly with B12 > 221 pmol/L. Four categories of metformin use were defined: non-users, ≤ 850 mg/day, > 850 and < 2,550 mg/day and ≥ 2,550 mg/day. Metformin ≥ 2,550 mg/day was high doses considered. The crude OR for B12 deficiency and consumption of Metformin were calculated. Logistic regression models were developed to explore the association between B12 deficiency and metformin dose. The research protocol was approved by the Ethics Committee of INTA. Results: The age of cases and controls was (70.2 years vs 68.6 years (p < 0.05). The 62% were women in cases vs 74.9% in controls (p < 0.05). The 73% of cases and 76% of controls used metformin (p < 0.05) the average consumption of metformin was de 1,954.3 mg/day (SD: 1,063.2) in cases and 1,696.6 mg/day (SD: 1,074.4) in controls (p < 0.05). The use of 2,550 mg/day was observed in 29.2% of cases and 19.3% for controls (p < 0.05). It was observed that OP who consumed high doses of metformin had 1.9 times the risk of B12 deficiency (OR: 1.9; 95%CI: 1,083,30). Conclusion: These results show a strong association between high doses of metformin and low levels of vitamin B12 in diabetic elderly.

Introducción: El objetivo del estudio es estimar si el déficit de B12 se asocia con el uso de la metformina en adultos mayores (AM) diabéticos. Métodos: Estudio de casos y controles en AM diabéticos. Los casos (n = 137) se definieron como AM con B12 < 221 pmol/L y los controles(n = 279) como AM con B12 > 221 pmol/L. Se definieron 4 categorías de uso de metformina: no usuarios, ≤ 850 mg/día; > 850 y < 2.550 mg/día; ≥ 2.550 mg/día. Se consideró altas dosis de metformina (≥ 2.550 mg/día). Se calcularon los OR crudos para déficit de B12 y consumo de Metformina. Se elaboraron modelos de regresión logística para explorar la asociación entre déficit B12 y dosis de metformina. El protocolo de investigación fue aprobado por el Comité de Ética del INTA. Resultados: La edad de casos y controles fue (70,2 años vs 68,6 años (p < 0,05); 62% fueron mujeres en los casos vs 74,9% en los controles (p < 0,05). El 73% de los casos y el 76% de los controles usaban metformina (p < 0,05). El promedio de uso de metformina fue de 1.954,3 mg/día (DS: 1.063,2) en los casos y 1696.6 mg/día (DS: 1.074,4) en los controles(p < 0,05). La dosis de 2.550 mg/día se observó en el 29,2% de los casos y en 19,3 de los controles (p < 0,05). Se observó que los adultos mayores que consumían altas dosis de metformina presentaban 1,9 veces más riesgo de déficit de B12 (OR:1,9; 95%IC: 1,08-3,30). Conclusión: Estos resultados muestran una fuerte asociación entre altas dosis de metformina y niveles bajos de vitamina B12.

Objective: To explore the association between global self-rated health and mortality in older people. Methods: A systematic review was performed. The inclusion criteria were longitudinal studies that assessed self-rated health with a single general question and samples of community-dwelling persons aged 60 years or more. Electronic databases were searched and references were reviewed. Results: We selected 18 studies published between 1993 and 2011. Six out of seven studies that analyzed men and women found a higher risk of dying among persons who rated their health as poor; the most frequent covariables were age, gender, chronic diseases, and functional status. Half of the studies that analyzed only men or women found a significant association. The effect of self-reported health on mortality was observed among people younger than 75 years. Results were not dependent on the length of follow-up. Conclusions: The results confirm previous findings suggesting that a negative self-rating of general health predicts mortality. The mechanisms through which this indicator may predict mortality among older people could differ in men and women and need to be elucidated. The role of depression should be investigated, considering that the effect of self-rated health on mortality was not present when depression was included.

Objetivo: Explorar la asociación entre autopercepción de salud general negativa y mortalidad en adultos mayores. Método: Revisión sistemática cuyos criterios de inclusión fueron estudios longitudinales, evaluación de la autopercepción de salud mediante una pregunta sobre salud general, muestras de personas de 60 años o más de edad que vivieran en la comunidad. Búsqueda en bases de datos electrónicas y revisión de referencias. Resultados: Se seleccionaron 18 estudios publicados entre 1993 y 2011. Seis de los siete que analizaban muestras de ambos sexos encontraban mayor riesgo de morir en las personas que calificaban su salud como mala; las covariables más frecuentes eran la edad, el sexo, las enfermedades crónicas y el estado funcional. La mitad de los estudios que analizaban sólo hombres o mujeres encontró que la asociación era significativa. El efecto de la autopercepción de la salud sobre la mortalidad se observaba en las personas menores de 75 años. El tiempo de seguimiento no influía en los resultados. Conclusiones: Los resultados apoyan los hallazgos previos respecto a que la autopercepción de la salud general negativa predice la mortalidad. Es necesario dilucidar los mecanismos por los que este indicador puede predecir la mortalidad en los adultos mayores, que pueden ser diferentes para hombres y mujeres. Se sugiere investigar el papel de la depresión, considerando que el efecto de la autopercepción de la salud sobre la mortalidad no estaba presente en los estudios que la incluían.