Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing

Background

Falls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults.

Methods

Data from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1–4 medications, 5–9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs.

Results

The prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1–4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1–4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications.

Conclusions

The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.

Insulin-like growth factor 1 and risk of depression in older people: the English Longitudinal Study of Ageing

Depressive disorders are a leading cause of disability in older age. Although the role of psychosocial and behavioural predictors has been well examined, little is known about the biological origins of depression. Findings from animal studies have implicated insulin-like growth factor 1 (IGF-1) in the aetiology of this disorder. A total of 6017 older adults (mean age of 65.7 years; 55% women) from the English Longitudinal Study of Ageing provided serum levels of IGF-1 (mean=15.9 nmol l(-1), s.d. 5.7) during a nurse visit in 2008. Depression symptoms were assessed in the same year and again in 2012 using the eight-item Center for Epidemiologic Studies Depression Scale. Self-reports of a physician-diagnosis of depression were also collected at both time points. In separate analyses for men and women, the results from both the cross-sectional and longitudinal analyses revealed a 'U'-shaped pattern of association, such that lower and higher levels of IGF-1 were associated with a slightly elevated risk of depression, whereas the lowest risk was seen around the median levels. Thus, in men, with the lowest quintile of IGF-1 as the referent, the age-adjusted odds ratios (95% confidence interval) of developing depression symptoms after 4 years of follow-up, for increasing quintiles of IGF-1, were: 0.51 (0.28-0.91), 0.50 (0.27-0.92), 0.63 (0.35-1.15) and 0.63 (0.35-1.13) (P-value for quadratic association 0.002). Some attenuation of these effects was apparent after adjustment for co-morbidity, socioeconomic status and health behaviours. In conclusion, in the present study of older adults, there was some evidence that moderate levels of IGF-1 levels conferred a reduced risk of depression.

Severity of depressive symptoms as a predictor of mortality: the English longitudinal study of ageing

BACKGROUND

Major depressive disorder and subthreshold depression have been associated with premature mortality. We investigated the association between depressive symptoms and mortality across the full continuum of severity.

METHOD

We used Cox proportional hazards models to examine the association between depressive symptom severity, assessed using the eight-item Center for Epidemiological Studies Depression Scale (CES-D; range 0-8), and the risk of all-cause mortality over a 9-year follow-up, in 11 104 members of the English Longitudinal Study of Ageing.

RESULTS

During follow-up, one fifth of study members died (N = 2267). Depressive symptoms were associated with increased mortality across the full range of severity (p trend < 0.001). Relative to study members with no symptoms, an increased risk of mortality was found in people with depressive symptoms of a low [hazard ratio (HR) for a score of 2 was 1.59, 95% confidence interval (CI) 1.40-1.82], moderate (score of 4: HR 1.80, 95% CI 1.52-2.13) and high (score of 8: HR 2.27, 95% CI 1.69-3.04) severity, suggesting risk emerges at low levels but plateaus thereafter. A third of participants (36.4%, 95% CI 35.5-37.3) reported depressive symptoms associated with an increased mortality risk. Adjustment for physical activity, physical illnesses, and impairments in physical and cognitive functioning attenuated this association (p trend = 0.25).

CONCLUSIONS

Depressive symptoms are associated with an increased mortality risk even at low levels of symptom severity. This association is explained by physical activity, physical illnesses, and impairments in physical and cognitive functioning.

Time trends in childhood and adolescent obesity in England from 1995 to 2007 and projections of prevalence to 2015

BACKGROUND

The aim was to examine the 1995-2007 childhood and adolescent obesity trends and project prevalence to 2015 by age group and social class.

METHODS

Participants were children aged 2-10 and adolescents aged 11-18 years from general population households in England studied using repeated cross-sectional surveys. Obesity was computed using international standards. Prevalence projections to 2015 were based on extrapolation of linear and non-linear trends.

RESULTS

Obesity prevalence increased from 1995 to 2007 from 3.1% to 6.9% among boys, and 5.2% to 7.4% among girls. There are signs of a levelling off trend past 2004/5. Assuming a linear trend, the 2015 projected obesity prevalence is 10.1% (95% CI 7.5 to 12.6) in boys and 8.9% (5.8 to 12.1) in girls, and 8.0% (4.5, 11.5) in male and 9.7% (6.0, 13.3) in female adolescents. Projected prevalence in manual social classes is markedly higher than in non-manual classes [boys: 10.7% (6.6 to 14.9) vs 7.9% (3.7 to 12.1); girls: 11.2% (7.0 to 15.3) vs 5.4% (1.3 to 9.4); male adolescents: 10.0% (5.2 to 14.8) vs 6.7% (3.4 to 10.0); female adolescents: 10.4% (5.0 to 15.8) vs 8.3% (4.3 to 12.4)].

CONCLUSION

If the trends in young obesity continue, the percentage and numbers of obese young people in England will increase considerably by 2015 and the existing obesity gap between manual and non-manual classes will widen further. This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.

A cross-national comparative study of blood pressure and hypertension between English and Dutch South-Asian- and African-origin populations: the role of national context

BACKGROUND

We compare patterns of blood pressure (BP) and prevalence of hypertension between white-Dutch and their South-Asian and African minority groups with their corresponding white-English and their South-Asian and African ethnic minority groups; and the contribution of physical activity, body sizes, and socioeconomic position (SEP); and the quality of BP treatment that may underlie differences in mean BP.

METHODS

Secondary analyses of population-based studies of 13,999 participants from the United Kingdom and the Netherlands.

RESULTS

Compared with Dutch South-Asians, all English South-Asian men and women had lower BP and prevalence of hypertension except for systolic BP in English-Indian men. Among Africans, the systolic BP did not differ, but the diastolic BP levels were lower in English-Caribbean and English- (sub-Sahara) African men and women than in their Dutch-African counterparts. English-Caribbeans had a lower prevalence of hypertension than Dutch-Africans. Compared with white-Dutch, white-English men and women had higher systolic BP levels, but lower diastolic BP levels. There were no differences in the prevalence of hypertension between the white groups. Most differences remained unchanged after adjustment for SEP, lifestyle, and body sizes in all ethnic groups. BP control rates were substantially lower among Dutch-African and Dutch South-Asian hypertensives than among their English counterparts (except Indians).

CONCLUSIONS

We found marked variations in BP and hypertension prevalence between comparable ethnic groups in England and the Netherlands. Poor BP control among Dutch South-Asians and Africans contributed to their disadvantage of the relatively high BP levels.

Undiagnosed diabetes-data from the English longitudinal study of ageing

AIMS

Diabetes UK estimates a quarter of UK cases of diabetes are undiagnosed; 750,000 people have undiagnosed diabetes in addition to 2.25 million with known diabetes, but research studies examining this are contradictory. The aim was to determine the prevalence of, and risk factors for, undiagnosed diabetes in the population of England aged > 50 years and to calculate the percentage of cases of undiagnosed diabetes.

METHODS

This was a cross-sectional study in a nationally representative sample of 6739 people aged 52-79 years from the English Longitudinal Study of Ageing (ELSA) 2004/2005. Diabetes cases were ascertained by self-reported doctor diagnosis of diabetes. A fasting plasma glucose measurement after a minimum of 8-h fast was available for 2387 (38% of the participants without diabetes). Undiagnosed diabetes cases were based on a fasting plasma glucose >or= 7.0 mmol/l.

RESULTS

The overall weighted prevalence of diabetes was 9.1%; 502 people (7.5%) had self-reported diabetes (9.0% of men and 6.0% of women); 36 (1.7%) had undiagnosed diabetes (2.6% of men and 0.8% of women). Of cases of diabetes, 18.5% were undiagnosed (22% in men, 12% in women). Significant risk factors for undiagnosed diabetes were male sex, higher body mass index, waist circumference, systolic blood pressure and triglycerides.

CONCLUSIONS

In 2004 the prevalence of undiagnosed diabetes, and the proportion of cases of diabetes that were undiagnosed, appear smaller than in previous studies. This is likely to be due to increased awareness of diabetes and improved clinical care resulting in many of those with previously undetected disease having been diagnosed.

Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012

BACKGROUND

This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys were carried out of representative samples of the general population living in households in England conducted annually (1993 to 2004).

METHODS

Participants were classified as obese if their body mass index was over 30 kg/m(2). Projections of obesity prevalence by 2012 were based on three scenarios: extrapolation of linear trend in prevalence from 1993 to 2004; acceleration (or slowing down) in rate of change based on the best fitting curve (power or exponential); and extrapolation of linear trend based on the six most recent years (1999 to 2004).

RESULTS

The prevalence of obesity increased significantly from 1993 to 2004 from 13.6% to 24.0% among men and from 16.9% to 24.4% among women. If obesity prevalence continues to increase at the same rate, it is projected that the prevalence of obesity in 2012 will be 32.1% (95% CI 30.4 to 34.8) in men and 31.0% (95% CI 29.0 to 33.1) in women. The projected 2012 prevalence for adults in manual social classes is higher (43%) than for adults in non-manual social classes (35%).

CONCLUSION

If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012. Of these, around 43% are from manual social classes, thereby adding to the public health burden of obesity-related illnesses. This highlights the need for public health action to halt or reverse current trends and narrow social class inequalities in health.

Prevalence of cardiovascular risk factors among ethnic groups: results from the Health Surveys for England

OBJECTIVE

To identify independent risk factors associated with cardiovascular disease (CVD) and diabetes for each minority ethnic group and the general population in England and explore the independent association of ethnicity and CVD and diabetes.

PARTICIPANTS

Nationally representative samples of 2362 Black Caribbean, 2467 Indian, 2204 Pakistanis, 1985 Bangladeshis, 1385 Chinese, 2398 Irish, and 30,744 adults from the general population living in private households.

RESULTS

CVD was relatively more common among: Indian and Chinese men with high waist-hip ratio; Indian, Bangladeshi and Irish with diabetes; Black Caribbean, Indian and Pakistani with hypertension; Bangladeshi and Pakistani ex-smokers and Indian ex-smokers and current-smokers; Pakistani that were moderate-drinkers and Indian heavy drinkers; Black Carribean Indian, Pakistani and Irish physically inactive; Pakistani in manual social class; and Bangladeshi in low income. Black Caribbean, Bangladeshi and Chinese participants and Indian and Pakistani women had significantly lower odds ratios of having CVD, compared with the general population. The odds of having diabetes were significantly higher for Black Caribbean, Indian, Pakistani and Bangladeshi, Chinese (men only) than participants from the general population.

CONCLUSIONS

CVD prevention through control of risk factors, especially diabetes and hypertension, should not only address the general population, but also target people from these groups.