Volume 8 - 2021 | https://doi.org/10.3389/fmed.2021.650259
This article is part of the Research TopicThe Biology and Management of Chronic Diseases in Mexican AmericansView all 7 articles
Frailty is the age-related decline in well-being
The Frailty index (FI) measures the accumulation of health deficits and reflects biopsychosocial and cultural determinants of well-being
Frailty is measured as a static phenotype or as a Frailty Index comprising a ratio of suffered health deficits and total deficits
We report a Frailty Index calculated from routinely measured clinical variables gathered from residents of two Colonias (neighborhoods) in South Texas
We analyzed retrospective data from 894 patients that live in two Colonias located on the Texas-Mexico border
We calculated the FI with seven physiological variables
and the 11 domain-specific Duke Profile scores
for a total of 19 possible health deficits
FI against age separately in males (n = 272) and females (n = 622) was regressed
Females had a significantly higher starting frailty
and males had a significantly greater change rate with age
FI against age for Cameron Park Colonia and Indian Hills Colonia was regressed
We calculated a significantly higher starting FI in Indian Hills and a significantly greater change rate in Cameron Park residents
Frailty's contributors are complex
We report baseline Frailty Index data from two Colonias in South Texas and the clinical and research implications
The Frailty Index's flexibility applied to a population can identify deficits unique to the region served
These Colonias are identified as “green” (low public health risk) and “yellow” (intermediate risk with inadequate city services
Demographic characteristics of this self-selected cross-sectional cohort and description of services provided are reported in earlier work completed by our research team (31)
The purpose of our community case study is to describe a Frailty Index calculated from data routinely collected by primary care teams
We then use the Frailty Index to identify contributors to Frailty in predominantly Mexican American Communities residing on the Texas-Mexico border
The results can be used to design future research on the development of a clinical Frailty Index and identify interventions to reduce Frailty in vulnerable populations
The protocol was approved by the University of Texas Institutional Review Board
VIDAS (Valley Interprofessional Dedicated Access and Service) was funded through a grant to develop a Colonia Care Program
VIDAS's clinical arm serves to unite the region by building a consortium of professionals collaborating as a team to create a healthcare model for the community's most vulnerable members
The UniMóvil mobile clinic was created to address access to healthcare across the Colonias throughout the region
The UniMóvil provides care in two Colonias
Cameron Park was selected as the representative “green” Colonia because of a long history of an established indigent care model and the proximity to the Mexico border that facilitates ready access to affordable healthcare in Mexico
was chosen because of the location (distance from the border and poor healthcare access)
The interprofessional team works with existing resources and services to augment care
and develop a multi-system healthcare service
Logistic regression analysis and factor component analysis were used to determine potential associations between clinical variables and candidate predictor variables and seven physiological health variables and two survey instruments: The PHQ-9 surveys
and the Duke Health-Related-Quality-of-Life survey consisting of 11 domains
The FI was computed over the seven physiological variables
and the 11 domain-specific Duke scores for a total of 19 possible variables
We used the seven physiological health variables, 17 item scores of the Duke Health Profile, and the PHQ-9 score to calculate the FI. Regressions of the Frailty Index against age were performed in subsamples of males, females, Cameron Park patients, and Indian Hills patients. We assessed the difference between males and females and between Colonias, using the difference between slope and intercept tests (35)
we examined the difference between the vectors of means for all the variables considered by way of Hotelling's T2 given as the squared difference of mean vectors scaled against the sample covariance matrix while taking sample size differences into account
Hotelling's T2 was computed and then transformed into an F-statistic for statistical inference in r (Version 3.2.3)
Total and sex-specific prevalence statistics for clinical outcomes
Duke health profile by total and sex-specific samples
Differences between means between cameron park and Indian hills
The plot of the difference of means as calculated by hoteling T2 is the squared difference of mean vectors scaled against the co-variance matrix for age (yrs)
Above zero reflects a higher Cameron Park (red) and below zero reflects a higher Indian Hills Value (orange)
Triglyceride means do not fit on the graph and are defined by the means across Colonia
Differences of means between males and females
Above zero reflects a higher male value (red) and below zero reflects a higher female value (orange)
Triglyceride means do not fit on the graph and are defined by the means across gender
Frailty increases with age and peaks between the ages of 40 and 60 years (Figure 3). The proportion of patients with a non-zero Frailty Index increased significantly (p < 0.001) from the younger to older age groups (20–45 vs. 46–93). The initial Frailty Index for women is higher than men, but as men age, they decline faster than women (Supplementary Figure 1)
The mean Frailty Index for women is higher than that for men (p < 0.01)
which is consistent with their significantly different mean vectors as inferred from the Hotelling's T-squared result (p < 0.001)
Proportion of FI = 0 and FI greater than zero
The proportion of patients with a non-zero Frailty Index increased significantly (p < 0.001) from the younger to other age groups (20–45 vs
The Frailty Index in Indian Hills remained stable with increasing age (Supplementary Figure 2) when compared to Cameron Park (p < 0.001)
and the Frailty Index was significantly higher in Cameron Park (p < 0.02)
consistent with their significantly different mean vector (p < 0.001)
We developed a Frailty Index calculated with 19 variables from two surveys (Health-related Quality of Life and Depression) and seven clinical measurements
We chose the seven clinical measurements and the two surveys because they are evidence-based screening metrics routinely used in primary care to evaluate for health and quality of life
The prevalence of chronic disease in the region is high
The residents from Cameron Park Colonia are older
and hyperlipidemia and hypertension are more prevalent in this population than in Indian Hills Colonia
The prevalence of diabetes and obesity (high) are similar in both Colonias
A cross-sectional representation of residents of Indian Hills demonstrated little change of Frailty with age
whereas Frailty increased dramatically with age in the more established Cameron Park
with the peak frailty index scores occurring between 40 and 60 years of age
Cameron Park is located on the US-Mexico border and is within the boundaries of the city of Brownsville
The proximity of Cameron Park to the border means that many residents can find affordable healthcare a few minutes away in Mexico
most residents live in constructed houses rather than manufactured homes
and life in Indian Hills are more problematic
and most residents live in trailers and make-shift housing without central air conditioning
The Frailty Index was calculated against age
Indian Hills had a significantly higher starting frailty
while Cameron Park had a significantly greater change rate with age
We propose living in a Colonia located within a city exposes residents to worse food choices
The rate of decline in Frailty in Cameron Park may be related to social factors
and increased availability of high caloric foods
Residents of Indian Hills may retain a more traditional diet than Cameron Park
Perhaps living day-to-day forces residents in Indian Hills to ration their money
The Frailty Index can be used to identify at-risk patients that live in vulnerable environments
Those residents who score high in depression or low in domains of quality of life and suffer from obesity
and depression may be identified earlier and focused interventions provided at the healthcare and public health level
The Frailty Index is easy to calculate with evidence-based data routinely collected
The findings in this report are subject to several limitations
and the community case study represents a picture of what is going on in the Colonias
The acute decline of Frailty in men could be related to early death
and decreased healthcare access and there may be other contributors (social
and biological) that influence decline to frailty
the variables used to calculate may be insufficient to measure Frailty in our population
Evidence-based research is required to determine the significant contributors to Frailty and determine a causal link
Patients seeking care through a mobile clinic serving Colonias in South Texas suffer from a high prevalence of diabetes
The Frailty Index is suggested by the US Preventive Services Task Force Recommendations for Primary Care Practice as a measure and is a good predictor of Frailty
Although social determinants of health and health equity are strong predictors of chronic disease
it is essential to study how these stressors affect immigrants living in underserved areas
Life stressors for vulnerable populations contribute to increased Frailty with age
and the variables are biopsychosocial based
The prevalence of chronic disease and depression in our region is epidemic
Hispanic patients that seek healthcare from a mobile clinic serving Colonias in South Texas suffer from high rates of diabetes
and they score poorly on health-related quality of life measures
such as residents of the Colonias of the US-Mexico border
These preliminary data can serve as background evidence to design future research to incorporate stressors and social support in examining those who become frail
Although social determinants of health and health equity are strong predictors of risk for chronic disease
it is crucial to study how these stressors affect minority residents and immigrants living in medically underserved areas
provides information for the accumulation of deficits and may help clinicians to focus on interventions to prevent eventual Frailty
The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: manusov, eron (2021), “Mobile Medical Van in the South Texas Colonias”, Mendeley Data, V2, 10.17632/zz2b3wdf5r.2
The studies involving human participants were reviewed and approved by University of Texas Rio Grande Valley Institutional Review Board
The patients/participants provided their written informed consent to participate in this study
EM was the Principal Investigator on the United Health Foundation grant
and was substantially involved in editing the manuscript
VD analyzed data and completed the statistical analysis
SW-B analyzed data and was substantially involved in editing
All authors listed have made a substantial
direct and intellectual contribution to the work
A grant from the United Health Foundation funded the UniMóvil project
The financial sponsors played no role in interpreting data and did not participate in writing the manuscript
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
We acknowledge the support of all members of STITCH
the relentless clinical work of Linda Nelson
and the tireless efforts of the staff of the UniMóvil
Dan Limbago of the United Health Foundation for support of our efforts to care for the vulnerable population of the Rio Grande Valley
We thank the residents of Cameron Park and Indian Hills for their collaboration in this study
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2021.650259/full#supplementary-material
Cardiovascular health study collaborative research group
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Munoz-Monaco G and Williams-Blangero S (2021) Frailty Index in the Colonias on the US-Mexico Border: A Special Report
Received: 06 January 2021; Accepted: 14 July 2021; Published: 18 August 2021
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*Correspondence: Eron G. Manusov, ZXJvbi5tYW51c292QHV0cmd2LmVkdQ==
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spending Holy Week with a community of Jesuits who minister to migrants throughout the Rio Grande Valley
tidy house in the colonia of Cameron Park that they’ve named for Miguel Pro
the joyful Jesuit martyr executed during Mexico’s Cristero War
Our car inches across Gateway International Bridge toward Matamoros
have transformed border cities like Matamoros into sites of desperation for migrants driven from home by gang violence and economic collapse
The migrant camp first appeared there in 2018 and disbanded in 2021
after the termination of the Trump-era Remain in Mexico program
the priests began to hear rumors that the Matamoros camp had reappeared
A trans-border network of NGOs and faith-based organizations
including Catholic Charities Rio Grande Valley
collaborated with Mexican authorities to provide access to showers
But government officials had lost patience with the camp
Prohibited from pitching tents in the plaza
thousands are surviving in makeshift shelters down a steep embankment covered with mesquite trees and trash along the muddy bank of the Rio Grande
The car is packed full of liturgical things and things made liturgical
A monstrance on loan from another church is zipped into the laptop pocket of a backpack
and the bells adorning its chains jingle every time we hit a bump
The trunk holds other treasures: a stack of bilingual hymnals; metal folding chairs; a suitcase filled with vestments
and tiny vials of water and wine; a giant speaker; sliced bread and bags full of grapes; a basket of white pipe-cleaner bracelets that Brian and Louie have strung with craft-store jingle bells for people to ring during the Gloria
wooden pallets stacked beneath a twisted mesquite tree become an altar
Extension cords run like rivers down from the base of each streetlight and fan out into deltas of cords on cords
and Flavio hooks up the speaker to the web of pirated electricity
We arrange the folding chairs next to the altar for the washing of the feet
At this point we realize we’ve forgotten a critical element: water
We hear about a fight that broke out over water the night before
but some people say that the water makes them sick
“¿Quién tiene agua?” Flavio calls out in a voice that sounds more like an invitation than a request
Someone comes forward with their jug and a plastic ladle
It’s the ultimate act of generosity—an act of holy waste
anointing people’s feet with it one ladle at a time
A grinning seven-year-old girl hops into the chair first
wiggling off her shoes and swinging her legs
A young woman with a toddler takes the seat beside her and the people around her help remove the little boy’s shoes as she removes her own
People dig trenches around their tents to try to divert the water
but nothing can stop the rain from lashing apart shelters
the road into Matamoros is flooded and chaotic
people stand huddled with their arms pulled into their shirts
A mother named Yanetzy sits on an overturned bucket
her three-year-old daughter curled in a damp blanket on her lap
Yanetzy’s cherry-red hair is streaked with brown
and I can tell how long ago she left home in Venezuela by how far her roots have grown out
All I can think is that she is the most tired person I have ever seen
This morning a woman finally received her cita—her appointment for asylum processing by border patrol
Asylum-seekers are required to use a smartphone app called CBP One to request entry into the United States
The system is effectively a lottery: every day at 10 a.m.
migrants enter their information into the glitchy app in the hopes of securing a coveted appointment at a port of entry
with no other choice but to try again the next day
Louie and Flavio had packed the car with a stack of flattened cardboard boxes that had been accumulating against their kitchen wall
they spread the boxes on the ground and lean a crucifix retrieved from the trunk against the makeshift altar
the priests step forward in silence and flatten their bodies onto the cardboard on top of the mud
they press their faces into the same unforgiving ground on which everyone else has spent a sleepless night
The liturgy ends with a via crucis through the middle of the camp
The procession winds up the mud-slicked hill and into the flooded street
and into the plaza at the foot of the international bridge
We carry a ten-foot cross that a man in the camp has built from two giant pieces of scrap wood
He wants to know if he can keep the cardboard for the floor of his tent
The bishop has given the Jesuits permission to celebrate the Easter Vigil early
so on Saturday we leave for Matamoros after lunch
There is a stainless-steel mixing bowl covered with a baking sheet on the floor of the passenger seat
and I’m instructed to make sure it doesn’t tip over
“Epsom salt and rubbing alcohol,” Louie explains before I have a chance to inquire about the science experiment at my feet
CPB One is giving everyone the same error message: “You must be near the southwest border of the United States to make an appointment at a port of entry.” The app uses geolocation to require that users be north of Mexico City to apply
Any closer to the border and we would all be in the water
The app isn’t the only thing malfunctioning
The electricity isn’t working in the usual spot
A group of men across the way summon us over to their electrical strip
A man offers to hold the towering scrap-wood cross
and we stand in a circle in the middle of the camp
and silky red flames erupt from the ground between us
He lowers a candle into the paschal fire and raises it to the sky
falling into a procession behind the Easter candle
We light our candles from the flame and splotches of wax fall like raindrops onto the gray-brown earth
children playing on the hillside decide to become a band of altar servers
and they are visibly enthralled to discover that their newly assumed responsibilities include retrieving the smoldering thurible from the tree branch where it hangs
Then he walks to the front of the altar to bless the people
gently swinging the thurible before each person
who sometimes ask the question that any rational person faced with reality asks: What good are candles and incense and bells when people are starving
I usually reply that we would do well to be suspicious of the capitalist assumption that prayer is only for people who can afford things
I see now that the real answer is whatever I just witnessed
when the last fire burns itself out and the last mesquite tree falls and the final light goes out
when the rain washes away the trash and the mud and the shit and the last bridge is crossed and the last detention center closed and Christ who died and rose comes again
Susan Bigelow Reynolds is assistant professor of Catholic Studies at Candler School of Theology at Emory University.
Attend any grassroots social justice event in the Rio Grande Valley and chances are Mike Seifert helped organize or promote it
Seifert is the seemingly tireless organizer for RGV Equal Voice Network
a coalition of nonprofits that tackles issues in the region from education to immigration reform and health care
“It’s a privilege to be here and work with so many strong leaders
almost all of them women living in the colonias
They are the ones who really get things done.”
Seifert was busy setting up a room at the Harlingen Public Library for a conference on militarization at the border
Out-of-state congressional members were in Cameron County to attend a fundraiser for Democratic Congressman Filemon Vela
Seifert and RGV had seized the opportunity to educate the elected officials about the negative effects the border security buildup is having on families
The recent increases in Border Patrol agents
and Texas state troopers’ use of gunboats and spy planes
in addition to an already heavily armed federal presence on the border
means there are a lot of people with guns near residential areas
tells the audience he’s never thought about the issue of border militarization and its impact on communities
“I’ve never looked at the immigration reform debate from the militarization point of view,” he says
“It was worthwhile enough just for me to be here for that
because it’s not something we talk about in New Jersey.”
a young community and it’s a mistake for any politician to ignore this region,” he says
and those politicians are working on borrowed time.”
Border communities also need to participate in elections and engage with their elected officials
“It’s a steep climb getting there,” he says
“But what keeps me going is the energy of the youth and the wisdom from the veterans.”
As a former priest who worked for many years in Mexico and Brownsville’s Cameron Park colonia
Seifert says he learned two important things: “You need to be a citizen of the community you are working in,” he says
society assigns undeserved credit to people like priests
doctors and lawyers when they haven’t earned it.”
The 59-year-old has taken those lessons to heart
He’s exceedingly humble about his contributions to the Valley
“The best thing I can do is stay out of the way,” he jokes
chief of pediatrics at the Brownsville Community Health Center
the two are a dynamic and potent force in supporting social justice causes in the region and abroad
“It’s a privilege to be here,” Seifert says
“This is one of the poorest communities in the country
but you don’t see homeless people in the streets
Melissa del Bosque is a longtime border journalist
investigations editor at Lighthouse Reports
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Forecasters say Dolly has weakened to a tropical depression with 35 mph winds as it moves north over Texas
and was centered about 35 miles south of Eagle Pass at 5 p.m
Residents across south Texas slogged through knee-deep muddy waters
tiptoed around downed power lines and dug through debris but were thankful that the storm didn't pack the wallop they had feared
The downed power lines remained the greatest danger
Rain and wind from Dolly probably doomed much of the cotton crop in Texas' Rio Grande Valley
Downed power lines remained the greatest danger
and officials urged people to stay home one more day "unless it's life or death." One person in Matamoros
died after walking past a power line on the ground
Residents picked up the pieces of their houses and businesses blown apart by the storm
they were struck by relief that the storm didn't take many lives
there will be substantial cleanup: President Bush declared south Texas a disaster area to release federal funding to 15 counties
and insurance estimators put the losses at $750 million
Down by the U.S.-Mexico border in Brownsville
the city that expected the worst had some of the least to fear
Residents in the Cameron Park colonia cleared their yards of shingles and tree debris while mosquitoes feasted
and residents were thankful the damage wasn't so bad
"I thought it was going to be worse than it was," Moses Izaguirre said
A group of Harlingen residents battled a live power line lying on the driveway between two homes
Neighbors rushed to bang on doors and call for people to get out
"Stay out of the water!" a man yelled at children playing in the muddy mix
a fire truck arrived minutes after a call to 911
power was restored to large parts of Brownsville's sister city
Eugenio Hernandez said the lights would be on by the end of the day
Gas stations and factories reopened as about 2,500 police and soldiers patrolled to prevent looting while many of the 13,000 people who had taken shelter returned home
After crashing ashore on South Padre Island midday Wednesday
leaving towns on the northern tip of the Rio Grande Valley with a surprise
Officials had feared the Rio Grande levees would breach
but the storm veered from its predicted path and they held strong
The river rose steadily Wednesday in Brownsville
"We're not experiencing any issues with the levees right now," Sally Spener
spokeswoman for the International Boundary and Water Commission
The storm dumped as much as a foot of rain in places and brought 100 mph winds
Those winds had dropped by half Thursday morning
and forecasters canceled the tropical storm warning for the Texas coast by late morning
The storm was expected to break up by Friday
and was centered near Laredo with maximum sustained winds of around 45 mph at 11 a.m
authorities rescued about 30 families from high water in Cameron County and power
including to the 911 emergency call system
remained out to about 60 percent of customers in Hidalgo County
"The power grid is not doing too well," said Hidalgo County spokeswoman Cari Lambrecht
Rick Perry was scheduled to fly over the region with U.S
The community of Laureles north of Los Fresnos had been reduced to a chain of sunken islands
separated from the main roads by floodwaters of two feet or more in places
wind-swept waters where neighborhood loops met county roads
More than 5,000 people moved to public shelters in the three hardest-hit counties and the numbers were expected to grow Thursday as more people became stranded by floodwaters
Pena said there were several incidents late Wednesday requiring emergency personnel to rescue people from homes
One family was left huddling in their topless house after winds blew the roof off
sheriff's deputies rescued a family of eight from Los Fresnos after floodwaters surrounded their home
The wind knocked a 17-year-old boy from a seventh-story balcony on South Padre Island
leg and a head injury but could not be transported off the island until about 5 p.m
The causeway linking the island to the mainland had reopened
which came ashore in southeast Texas last September
The busiest part of the Atlantic hurricane season is usually in August and September
Federal forecasters predict a total of 12 to 16 named storms and six to nine hurricanes this season
Associated Press writers Christopher Sherman in Brownsville and Mark Walsh in Matamoros
Texas | Residents across south Texas slogged through knee-deep muddy waters
tiptoed around downed power lines and dug through debris Thursday
but were thankful that Hurricane Dolly didn’t pack the wallop they had feared
and South Texas officials urged people to stay home one more day “unless it’s life or death.” One person in Matamoros
died from electrocution after walking past a power line on the ground
they were struck by relief that the storm didn’t take many lives
Rain and wind from Dolly probably doomed much of the cotton crop in Texas’ Rio Grande Valley
About 92,000 acres of cotton in the region was awaiting harvest but driving rains and high winds knocked bolls to the ground
Texas Agri Life Extension agent Rod Santa Ana said
Sorghum acres damaged by rain in early July also could be doomed
and was centered about 30 miles northwest of Laredo with maximum sustained winds of around 40 mph at 2 p.m
A remnant on Thursday blew several roofs off houses and businesses on San Antonio’s south side
about 300 miles northwest of where the storm made landfall
There were no immediate reports of injuries
and the National Weather Service sent a storm survey team to determine whether it was a tornado or strong winds
and residents were thankful the damage wasn’t so bad
“I thought it was going to be worse than it was,” Moses Izaguirre said
A group of Harlingen residents battled a flaming live power line lying on the driveway between two homes
“Stay out of the water!” a man yelled at children playing in the muddy mix
curfew was set for the second night in row
and the National Guard and FEMA were distributing ice
Residents and visitors recalled a wild ride
rode out Hurricane Dolly with five friends on a 65-foot double-decker party boat moored at the south end of South Padre Island
“It was throwing us around like a beanbag,” The thrashing began at 9 a.m
the strip of water between the mainland and the island
North Texas residents Becky Wacasey and her husband
rode out the storm in their room at the South Padre Island Beach Resort hotel
which had many of its sliding glass doors blown out
and it appeared some tourists had barricaded broken windows by standing box springs in the openings
“We kept saying ’where’s the eye?’ because that’s when we were going to leave but the eye never came,” Wacasey said
“We thought it was just going to be a little tropical storm.”
power was restored to large parts of Brownsville’s sister city
“The power grid is not doing too well,” said Hidalgo County spokeswoman Cari Lambrecht
Associated Press writers Christopher Sherman in Brownsville
Betsey Blaney in Lubbock and Mark Walsh in Matamoros