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Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA).

ABSTRACT: OBJECTIVES:While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5-9 prescribed medications) and hyperpolypharmacy prevalence (?10?prescribed medications), among older people living in England. DESIGN:Cross-sectional study. SETTING:The English Longitudinal Study of Ageing Wave 6 (2012-2013). PARTICIPANTS:7730 participants aged over 50?years. DATA SYNTHESIS:Two multivariate models were created. HR with corresponding 95% CI, for polypharmacy and hyperpolypharmacy, were calculated after adjusting for gender, age, wealth, smoking, alcohol consumption, BMI, self-rated health and the presence of a chronic health condition. RESULTS:Lower wealth (lowest wealth quintile vs highest wealth quintile, adjusted HR 1.28; 95%?CI 1.04 to 1.69, P=0.02) and obesity (adjusted HR 1.81; 95%?CI 1.53 to 2.15, p<0.01) were significantly associated with polypharmacy. Increasing age (50-59?years vs 70-79?years, adjusted HR 3.42; 95%?CI 2.81 to 4.77, p<0.01) and the presence of a chronic health condition (adjusted HR 2.94; 95%?CI 2.55 to 3.39, p<0.01) were also associated with polypharmacy. No statistically significant association between smoking and polypharmacy (adjusted HR 1.06; 95%?CI 0.86 to 1.29, P=0.56) was established; while, very frequent alcohol consumption (consuming alcohol >5?times per week) was inversely associated with polypharmacy (never drank alcohol vs very frequently, adjusted HR 0.64; 95%?CI 0.52 to 0.78, p<0.01). The adjusted HR for hyperpolypharmacy was accentuated, compared with polypharmacy. CONCLUSION:This study has identified that lower wealth, obesity, increasing age and chronic health conditions are significantly associated with polypharmacy and hyperpolypharmacy prevalence. The effect of these factors, on polypharmacy and especially hyperpolypharmacy prevalence, is likely to become more pronounced with the widening gap in UK wealth inequalities, the current obesity epidemic and the growing population of older people. The alcohol findings contribute to the debate on the relationship between alcohol consumption and health.

SUBMITTER: Slater N

PROVIDER: S-EPMC5857661 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA).

Slater Natasha N White Simon S Venables Rebecca R Frisher Martin M

BMJ open 20180314 3

<h4>Objectives</h4>While older age and ill health are known to be associated with polypharmacy, this paper aims to identify whether wealth, body mass index (BMI), smoking and alcohol consumption are also associated with polypharmacy (5-9 prescribed medications) and hyperpolypharmacy prevalence (≥10 prescribed medications), among older people living in England.<h4>Design</h4>Cross-sectional study.<h4>Setting</h4>The English Longitudinal Study of Ageing Wave 6 (2012-2013).<h4>Participants</h4>7730 ...[more]

PMID: 29540422

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Project description:ObjectivesMany central nervous system (CNS) medications are considered potentially inappropriate for prescribing in older people; however, these medications are common in polypharmacy (≥5 medicines) regimens. This paper aims to determine the prevalence of CNS drug classes commonly taken by older people. Furthermore, this paper aims to determine whether polypharmacy and other factors, previously found to be associated with overall polypharmacy, are associated with the most common CNS drug classes.DesignCross-sectional study.SettingEnglish Longitudinal Study of Ageing (wave 6).Participants7730 participants (≥50 years).Main outcome measuresAdjusted Odds Ratios (OR) and 95% confidence intervals (CI) for CNS drug classes.Results31% of the sample were currently taking ≥5 medications (polypharmacy), of whom 58% (n=1362/2356) were taking CNS medicines as part of their regimen. The most common CNS drug classes in polypharmacy regimens were non-opioid analgesics, opioid analgesics, tricyclic and related antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) (34.6%, 13.2%, 10.9% and 10.4%, respectively). Compared with people currently taking 1-4 prescribed medicines, polypharmacy was associated with adjusted ORs of 5.71 (95% CI: 4.29 to 7.61, p<0.01) for opioid analgesics, 3.80 (95% CI: 3.25 to 4.44, p<0.01) for non-opioid analgesics, 3.11 (95% CI: 2.43 to 3.98, p<0.01) for TCAs and 2.30 (95% CI: 1.83 to 2.89, p<0.01) for SSRIs. Lower wealth was also associated with the aforementioned CNS drug classes.ConclusionOpioid and non-opioid analgesics were the most prevalent classes of CNS medicines in this study. Polypharmacy is strongly associated with the aforementioned classes of analgesics. Polypharmacy is also associated with TCAs and SSRIs, although to a lesser extent than for analgesics. For all CNS medicine classes, polypharmacy may need to be considered in relation to reducing the risk of potential adverse events. After adjustment, lower wealth is associated particularly with analgesics, highlighting that socioeconomic factors may play a role in the prescribing of CNS medicines. These findings provide a baseline for future research into this area.

Project description:ObjectivesAims were (1) to examine whether socioeconomic position (SEP) is associated with hearing loss (HL) among older adults in England and (2) whether major modifiable lifestyle factors (high body mass index, physical inactivity, tobacco consumption and alcohol intake above the low-risk-level guidelines) are associated with HL after controlling for non-modifiable demographic factors and SEP.SettingWe used data from the wave 7 of the English Longitudinal Study of Ageing, which is a longitudinal household survey dataset of a representative sample of people aged 50 and older.ParticipantsThe final analytical sample was 8529 participants aged 50-89 that gave consent to have their hearing acuity objectively measured by a screening audiometry device and did not have any ear infection.Primary and secondary outcome measuresHL defined as >35 dBHL at 3.0 kHz (better-hearing ear). Those with HL were further subdivided into two categories depending on the number of tones heard at 3.0 kHz.ResultsHL was identified in 32.1% of men and 22.3% of women aged 50-89. Those in a lower SEP were up to two times more likely to have HL; the adjusted odds of HL were higher for those with no qualifications versus those with a degree/higher education (men: OR 1.87, 95%CI 1.47 to 2.38, women: OR 1.53, 95%CI 1.21 to 1.95), those in routine/manual occupations versus those in managerial/professional occupations (men: OR 1.92, 95%CI 1.43 to 2.63, women: OR 1.25, 95%CI 1.03 to 1.54), and those in the lowest versus the highest income and wealth quintiles (men: OR 1.62, 95%CI 1.08 to 2.44, women: OR 1.36, 95%CI 0.85 to 2.16, and men: OR1.72, 95%CI 1.26 to 2.35, women: OR 1.88, 95%CI 1.37 to 2.58, respectively). All regression models showed that socioeconomic and the modifiable lifestyle factors were strongly associated with HL after controlling for age and gender.ConclusionsSocioeconomic and lifestyle factors are associated with HL among older adults as strongly as core demographic risk factors, such as age and gender. Socioeconomic inequalities and modifiable lifestyle behaviours need to be targeted by the health policy strategies, as an important step in designing interventions for individuals that face hearing health inequalities.

Project description:BackgroundDepressive symptoms and physical performance are inversely associated, but it is unclear whether their association is bidirectional. We examined whether the association between depressive symptoms and physical performance measured using gait speed is bidirectional.MethodsWe used a national sample of 4,581 community-dwelling people aged 60 years and older from the English Longitudinal Study of Ageing (from 2002-03 to 2008-09). We fitted Generalized Estimating Equation (GEE) regression models to analyse repeated measurements of gait speed (m/sec) and elevated depressive symptoms (defined as a score of ?4 on the eight-item Center for Epidemiological Studies-Depression scale).ResultsSlower gait speed was associated with elevated depressive symptoms both concurrently and two years later. After adjustment for previous depressive symptoms and sociodemographic, clinical, lifestyle, psychosocial, and cognitive factors the concurrent association was partially explained (Odds Ratio [OR] 0.42, 95% confidence interval [CI], 0.30 to 0.59, per 1m/sec increase in gait speed) and the two-year lagged association fully (OR 0.75, 95% CI, 0.56 to 1.00). Elevated depressive symptoms were associated with slower gait speed. Full adjustment for covariates (including previous gait speed) partially explained both the concurrent (? regression coefficient [?] -0.038, 95% CI, -0.050 to -0.026, for participants with elevated depressive symptoms compared with those with no or one symptom) and the two-year lagged associations (? -0.017, 95% CI, -0.030 to -0.005). Subthreshold depressive symptoms (defined as a score of two or three on the eight-item Center for Epidemiological Studies-Depression scale) were also associated with slower gait speed. Full adjustment for covariates partially explained both the concurrent (? -0.029, 95% CI, -0.039 to -0.019, for participants with subthreshold symptoms compared with those with no or one symptom) and the two-year lagged associations (? -0.011, 95% CI, -0.021 to -0.001).ConclusionsThe inverse association between gait speed and depressive symptoms appears to be bidirectional.

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Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA).

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Factors associated with polypharmacy in primary care: a cross-sectional analysis of data from The English Longitudinal Study of Ageing (ELSA).

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