Sadaf Arefi Milani

University of Texas Medical Branch at Galveston | UTMB · Department of Epidemiology

Pain increases with age, disproportionately affects women, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. Few studies have examined longitudinal trajectories of pain, by gender, in Mexico.We used data from five waves (over 2001-2018) of the Mexican Health and Aging Study, a...

Importance The ongoing COVID-19 pandemic and associated mitigation measures have disrupted access to psychiatric medications, particularly for women. Objective To assess the sex differences in trends in the prescribing of benzodiazepines, Z-hypnotics and serotonergic (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine...

Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this per...

Background Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective is to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto R...

Background Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity‐limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. Methods Data...

Background: Better English proficiency and higher frequency of using English among non-native speakers are associated with lower dementia risk. Objective: We investigated if Mexican American older adults who use English and Spanish to a more similar degree demonstrate better cognitive function than those who use one language more than the other....

Background Prior research in clinical and non‐clinical populations demonstrates that speaking more than one language can modify gray matter structure (e.g., DeLuca et al., 2020; Torres et al., 2022). However, existing work has largely classified bilingualism dichotomously, diminishing the ability to establish associations between bilingual factors...

Background Underdiagnosis of pain is common in women and in those with Alzheimer’s disease and related dementias (ADRD). However, sex/gender differences in pain interference, defined as pain that interferes with daily activities, have not been examined along the cognitive spectrum. We assess sex/gender differences in odds of physician‐diagnosed and...

Background Caregivers of people living with dementia are more likely to experience disturbed sleep compared to non‐caregivers. Mexican‐Americans may be especially at risk due to low rates of nursing home use even in advanced dementia, when behavioral symptoms are most apparent. Few studies have evaluated predictors of disturbed sleep in this high‐r...

Pain and depression are common among older Hispanic adults and their combined effects may increase mortality. We examined the joint effects of pain and depressive symptoms on mortality. We used data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (2010-2016), which included Mexican Americans aged 80 and older in...

Air pollution, drought, and extreme heat are associated with elevated depressive symptoms. Older Mexican American adults experience high levels of depressive symptoms compared to other demographic groups, but little is known about the role of environmental factors in depressive symptoms for this population. Mexican American adults are resilient to...

Previous research conducted nearly two decades ago found that almost half of geriatricians published during their fellowships. About 17% of these geriatricians also indicated a need for further training in scholarly activity. However, it is unclear what barriers and facilitators to participating in scholarly activity geriatric fellows currently fac...

Older adults with pain are at risk for developing elevated depressive symptoms. Personality factors, including internal locus of control (LOC) and conscientiousness, have been associated with fewer depressive symptoms in older adults. Our objective was to examine LOC and conscientiousness as potential buffers of depressive symptoms among Mexican ad...

Introduction As the US population continues to age, there is a critical need for geriatricians to be trained and engaged in research to inform high-quality care for older adults. Our objective was to understand the extent, type, barriers, and facilitators of research training and the attitudes toward research training and scholarly activity among A...

Objectives: Mexico's population aging is occurring in the context of social changes such as increased educational attainment and occupational shifts from agriculture to service and industry. The current study compares cognitive function between two birth cohorts of Mexican adults aged 60-76 to determine if population-level changes in education and...

Objectives: In view of the growing number of older incarcerated persons in the US, cognitive impairment represents one of the most challenging and costly health care issues facing the US correctional system. This study examined the prevalence and correlates of this growing public health issue in the nation's largest prison system. Methods: In th...

Background and Objectives Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over six years among Mexican Americans aged 80 years and older. Research Desi...

Objective. To examine the association between insomnia and obesity in Mexican adults aged 50 and older. Materials and methods. We used data from the Mexican Health and Aging Study (2015-2018). Self-reported insomnia was measured using the modified insomnia severity index with scores ranging from zero to six. Obesity was categorized using body mass...

Background: Association between testosterone concentrations and sleep duration is poorly understood. Objective: To evaluate the association between sleep duration and quality with serum T concentrations, and its variation by sex and age. Methods: Data were analyzed for 8748 men and women (≥20 years old) who participated in the cycles of the NH...

Background Health behaviors, such as exercise, smoking, and alcohol consumption, are potentially modifiable risk factors for cognitive impairment and dementia. The effect of these behaviors on cognitive function is important to examine in Mexico, which faces a rapidly aging population. Method Data came from the 2012, 2015, and 2018 waves of the Me...

Objectives: Mexico has a rapidly aging population at risk for cognitive impairment. Social and leisure activities may protect against cognitive decline in older adults. The benefits of these behaviors may vary by patterns of cognitive impairment. The objectives of this study were to identify latent states of cognitive functioning, model the incide...

Objectives Early-life disadvantage (ELD) relates with lower late-life cognition. However, personality factors including having an internal locus of control (LOC) or a conscientious personality relate with resilience and effective stress coping. We explore whether personality factors convey resilience against negative effects of ELD on cognition, by...

Working in physically demanding jobs may be associated with pain in middle and old age. This has not been widely studied in Mexico, which has a rapidly aging population. We evaluated the association between primary occupation and pain over 17 years of follow-up among Mexicans aged 50 and older using data from the Mexican Health and Aging Study (200...

Objectives: The association of pain and depression has not been evaluated in low- and middle-income countries, which have a disproportionate burden of pain compared to high-income countries. Methods: Using data from the Mexican Health and Aging Study (baseline, 2012; follow-up, 2015), we examined the bidirectional relationship between pain and d...

Background: The independent and joint association of metformin and testosterone replacement therapy (TTh) with the incidence of prostate, colorectal, and male breast cancers remain poorly understood, including the investigation of the risk of these cancers combined (HRCs, hormone-associated cancers) among men of different racial and ethnic backgro...

Introduction Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is associated with decreased quality of life, greater disability, and increased mortality. Yet, the association of multimorbidity with pain, another significant contributor to decreased quality of life, has not been widely studied. Thi...

Many risk factors for cognitive decline are associated with mortality and are common among older adults who cannot complete a survey interview. Our objective was to compare analyses of risk factors for cognitive decline among older adults in Puerto Rico with and without accounting for sample attrition. Data came from the Puerto Rican Elderly: Healt...

Disparities throughout the life course, including social position, result in gendered pathways to health, which ultimately result in gender disparities in late life. Using data from the Mexican Health and Aging Study, we explore the concept of gendered social position over the life course (educational achievement, marital history, employment histor...

Given the hypothesized bidirectional association between functional and cognitive decline, further characterization of the temporal association between the two is needed, especially in Latinx samples as they are the most rapidly growing demographic in the United States and at greater risk for Alzheimer’s disease. This study assessed bidirectional a...

Background Pain is associated with cognitive decline, but research has not considered low‐ and middle‐income countries (LMICs) such as Mexico and gender differences. This is an important gap, as individuals living in Mexico have a large burden of chronic pain due to exposure to risk factors over the life course. Methods Using data from the Mexican...

Background Early‐life disadvantage, including low socioeconomic position (SEP), few resources, and limited education, has downstream effects on cognitive ability. However, personality‐related factors such as having an internal locus of control or a more conscientious personality have been related with greater resilience and ability to cope with adv...

Background Diabetes is a risk factor for dementia and mortality, while obesity later in life is associated with a reduced risk. Their co-occurrence, diabesity, is common, but its association with dementia and mortality is unclear. Methods Using data from the Mexican Health and Aging Study, we used multinomial logistic regression to examine the ass...

Background and Objectives To assess gender differences in prevalence of neuropsychiatric symptoms (NPS) among community-dwelling Mexican Americans ≥80 years. Research Design and Methods: Using data from Wave 7 (2010–2011) of the Hispanic Established Population for the Epidemiological Study of the Elderly, we analyzed the NPS of 914 participants as...

As the population ages, the prevalence of dementia will increase. More research is needed; however, low rates of research participation, especially by older adults, hinder progress. Data came from HealthStreet, a University of Florida community engagement program in which community health workers assess community members for their health conditions...

Pain increases with age, disproportionately affects females, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. However, few studies have looked at longitudinal trajectories of pain, by sex, using population data. We used data from the 2001, 2003, 2012, and 2015 waves of the Mex...

Background Mounting evidence suggests that pain is associated with cognitive decline; however, most of these studies are limited to high‐income countries. As the number of older adults living in low and middle‐income countries (LMICs) increases, by 2030 the majority of individuals living with dementia will reside in these countries. This makes Mexi...

IntroductionOlder adults, including racial and ethnic minorities, are underrepresented in research. As the US population ages, the number of older racial and ethnic minority individuals will increase. Including these individuals in research is an important step towards reducing health disparities.Methods We used data from HealthStreet, a University...

Background and Objectives Depression among older Mexican adults is under-recognized and of increasing concern due to its association with comorbidities including cognitive and functional impairments. Prior studies have found an association between low involvement levels in social activities and depression. We aimed to examine the association of tim...

Background: Non-medical use of prescription drugs is a major public health concern in the United States. Prescription opioids and sedatives are among the most widely abused drugs and their combined use can be lethal. Increasingly rigid prescribing guidelines may contribute to the changing context of opioid use and increase drug diversion. Objective...

In Mexico, palliative care and pain relief was recently added to the essential health services offered through Seguro Popular. Pain is more frequent in older adults, a growing segment of this population, and is a major contributor to decreased quality of life and increased morbidity. However, Mexico only has enough opioid analgesics to treat 36% of...

Background Many older adults become physically and cognitively impaired. However, Methods Data came from the Mexican Health and Aging Study. The sample included 1,283 participants aged ≥60 who were physically and cognitively unimpaired in 2001. Multinomial logistic regression was used to estimate probabilities of being unimpaired, cognitively impa...

Introduction: The Montreal Cognitive Assessment (MoCA) is a popular screening tool for Mild Cognitive Impairment (MCI). The psychometric properties of the MoCA have not been widely examined in minority groups. We aimed to analyze the discriminate ability of subtests and items by race and ethnicity given gold-standard clinical diagnosis of cognitiv...

Objective: To compare Alzheimer's disease (AD) knowledge by race and ethnicity in a community sample of middle-aged and older adults aged 50 and over in Florida. Method: Data from HealthStreet, a University of Florida community engagement program, which uses community health workers to assess the health conditions, concerns, and knowledge of com...

Introduction The Montreal Cognitive Assessment (MoCA), scored from 0 to 30, is used as a screening tool for mild cognitive impairment (MCI). The current cutoff (26) may not be optimal among minorities. Methods Data from the National Alzheimer's Coordinating Center Uniform Data Set March 2018 data freeze was used to calculate optimal cutoffs for de...

Introduction: Research progress on neurocognitive disorders requires donation of both healthy and diseased brains. Here, we describe attitudes toward brain donation among a large community sample in Florida. Methods: HealthStreet, a community engagement program at the University of Florida, used community health workers to assess community attit...

Objectives: The objectives were to examine the association between multimorbid chronic disease and frequency of past 6 months emergency department (ED) visits, by sex, in a community sample of adults from North Florida (N=7143). Methods: Data came from HealthStreet, a community engagement program at the University of Florida which uses the Commu...