Iván Palacios

Introduction: Social determinants of health shape dementia risk in Latin America, particularly in rural and Indigenous populations. Methods: This cross-sectional study examined cognitive impairment and associated social factors in 75 adults aged 60 years or older in Cotacachi, Ecuador, identifying as Indigenous, Mestizo, or Other. Cognition was assessed with the RUDAS using education-adjusted cutoffs, alongside daily functioning and depression. Results: Cognitive impairment affected 22.7% and was more frequent among Indigenous participants. Limited early education emerged as a key social factor. In adjusted analyses, older age and depression were associated with impairment, whereas vascular conditions were not; ethnicity could not be disentangled from rurality. Discussion: These findings suggest that observed ethnic differences are embedded within structural inequalities, particularly educational and territorial disadvantage, supporting dementia prevention strategies addressing social inequities and mental health in rural Andean communities.

Social integration is an essential element to the maintenance of health and well-being in elderly populations. In the Cumbaya Valley of Quito, Ecuador, community health clinics sponsor social clubs for specific populations to address this important aspect of health. Men, who tend to be less socially integrated than women, are largely absent from these programs. This paper investigates the quality and extent of men’s social integration in the Cumbaya Valley of Quito to understand why men are less likely to attend the community health center clubs and to develop ideas for increasing male participation, which may differ from current methods. A composite survey was used to interview 100 men over the age of 40 to collect data on their social health and information regarding their interaction with community health center clubs and other local social groups. Social integration scores were varied, with some men having high social scores and others having low scores. Men generally had greater access to affectionate and tangible support but lower access to emotional support and positive social interaction. Men spend far more social time with their families and much less with friends and neighbors. Regression analysis revealed that social scores have a relationship with age and education. Qualitative results suggest gendered expectations of men in the community have negatively impacted their willingness to engage in community health groups. Participants also provided suggestions, including specific sports, gardening, and meal distribution, to promote male participation. There is a strong need to increase services, strategies, and programs that address the lack of social integration experienced by men. This paper presents the particular role community clinics can play in increasing the social well-being of its male patients.