Polypharmacy is widespread among older people, but the adverse outcomes associated with it are unclear. We aim to synthesize current evidence on the adverse health, social, medicines management, and ...health care utilization outcomes of polypharmacy in older people.
A systematic review, of systematic reviews and meta-analyses of observational studies, was conducted. Eleven bibliographic databases were searched from 1990 to February 2018. Quality was assessed using AMSTAR (A Measurement Tool to Assess Systematic Reviews).
Older people in any health care setting, residential setting, or country.
Twenty-six reviews reporting on 230 unique studies were included. Almost all reviews operationalized polypharmacy as medication count, and few examined medication classes or disease states within this. Evidence for an association between polypharmacy and many adverse outcomes, including adverse drug events and disability, was conflicting. The most consistent evidence was found for hospitalization and inappropriate prescribing. No research had explored polypharmacy in the very old (aged ≥85 years), or examined the potential social consequences associated with medication use, such as loneliness and isolation.
The literature examining the adverse outcomes of polypharmacy in older people is complex, extensive, and conflicting. Until polypharmacy is operationalized in a more clinically relevant manner, the adverse outcomes associated with it will not be fully understood. Future studies should work toward this approach in the face of rising multimorbidity and population aging.
Existing models for forecasting future care needs are limited in the risk factors included and in the assumptions made about incoming cohorts. We estimated the numbers of people aged 65 years or ...older in England and the years lived in older age requiring care at different intensities between 2015 and 2035 from the Population Ageing and Care Simulation (PACSim) model.
PACSim, a dynamic microsimulation model, combined three studies (Understanding Society, the English Longitudinal Study of Ageing, and the Cognitive Function and Ageing Study II) to simulate individuals' sociodemographic factors, health behaviours, 12 chronic diseases and geriatric conditions, and dependency (categorised as high 24-h care, medium daily care, or low less than daily dependency; or independent). Transition probabilities for each characteristic were estimated by modelling state changes from baseline to 2-year follow-up. Years in dependency states were calculated by Sullivan's method.
Between 2015 and 2035 in England, both the prevalence of and numbers of people with dependency will fall for young-old adults (65–74 years). For very old adults (≥85 years), numbers with low dependency will increase by 148·0% (range from ten simulations 140·0–152·0) and with high dependency will almost double (increase of 91·8%, range 87·3–94·1) although prevalence will change little. Older adults with medium or high dependency and dementia will be more likely to have at least two other concurrent conditions (increasing from 58·8% in 2015 to 81·2% in 2035). Men aged 65 years will see a compression of dependency with 4·2 years (range 3·9–4·2) of independence gained compared with life expectancy gains of 3·5 years (3·1–4·1). Women aged 65 years will experience an expansion of mainly low dependency, with 3·0 years (3·0–3·6) gained in life expectancy compared with 1·4 years (1·2–1·4) with low dependency and 0·7 years (0·6–0·8) with high dependency.
In the next 20 years, the English population aged 65 years or over will see increases in the number of individuals who are independent but also in those with complex care needs. This increase is due to more individuals reaching 85 years or older who have higher levels of dependency, dementia, and comorbidity. Health and social care services must adapt to the complex care needs of an increasing older population.
UK Economic and Social Research Council and the National Institute for Health Research.
Abstract
Objectives
To examine the association of protein intake with frailty progression in very old adults.
Design
The Newcastle 85+ study, a prospective longitudinal study of people aged 85 years ...old in Northeast England and followed over 5 years.
Setting and Participants
668 community-dwelling older adults (59% women) at baseline, with complete dietary assessment and Fried frailty status (FFS).
Measures
Dietary intake was estimated with 2 × 24-h multiple pass recalls at baseline. FFS was based on five criteria: shrinking, physical endurance/energy, low physical activity, weakness and slow walking speed and was available at baseline and 1.5, 3 and 5 years. The contribution of protein intake (g/kg adjusted body weight/day g/kg aBW/d) to transitions to and from FFS (robust, pre-frail and frail) and to death over 5 years was examined by multi-state models.
Results
Increase in one unit of protein intake (g/kg aBW/d) decreased the likelihood of transitioning from pre-frail to frail after adjusting for age, sex, education and multimorbidity (hazard ratios HR: 0.44, 95% confidence interval CI: 0.25–0.77) but not for the other transitions. Reductions in incident frailty were equally present in individuals with protein intake ≥0.8 (HR: 0.60, 95% CI: 0.43–0.84) and ≥1 g/kg aBW/d (HR: 0.63, 95% CI: 0.44–0.90) from 85 to 90 years. This relationship was attenuated after adjustment for energy intake, but the direction of the association remained the same (e.g. g/kg aBW/d model: HR: 0.71, 95% CI: 0.36–1.41).
Conclusion
High protein intake, partly mediated by energy intake, may delay incident frailty in very old adults. Frailty prevention strategies in this age group should consider adequate provision of protein and energy.
Although retirement ages are rising in the United Kingdom and other countries, the average number of years people in England can expect to spend both healthy and work from age 50 (Healthy Working ...Life Expectancy; HWLE) is less than the number of years to the State Pension age. This study aimed to estimate HWLE with the presence and absence of selected health, socio-demographic, physical activity, and workplace factors relevant to stakeholders focusing on improving work participation. Data from 11,540 adults in the English Longitudinal Study of Ageing were analysed using a continuous time 3-state multi-state model. Age-adjusted hazard rate ratios (aHRR) were estimated for transitions between health and work states associated with individual and combinations of health, socio-demographic, and workplace factors. HWLE from age 50 was 3.3 years fewer on average for people with pain interference (6.54 years with 95% confidence interval 6.07, 7.01) compared to those without (9.79 9.50, 10.08). Osteoarthritis and mental health problems were associated with 2.2 and 2.9 fewer healthy working years respectively (HWLE for people without osteoarthritis: 9.50 years 9.22, 9.79; HWLE with osteoarthritis: 7.29 years 6.20, 8.39; HWLE without mental health problems: 9.76 years 9.48, 10.05; HWLE with mental health problems: 6.87 years 1.58, 12.15). Obesity and physical inactivity were associated with 0.9 and 2.0 fewer healthy working years respectively (HWLE without obesity: 9.31 years 9.01, 9.62; HWLE with obesity: 8.44 years 8.02, 8.86; HWLE without physical inactivity: 9.62 years 9.32, 9.91; HWLE with physical inactivity: 7.67 years 7.23, 8.12). Workers without autonomy at work or with inadequate support at work were expected to lose 1.8 and 1.7 years respectively in work with good health from age 50 (HWLE for workers with autonomy: 9.50 years 9.20, 9.79; HWLE for workers lacking autonomy: 7.67 years 7.22, 8.12; HWLE for workers with support: 9.52 years 9.22, 9.82; HWLE for workers with inadequate support: 7.86 years 7.22, 8.12). This study identified demographic, health, physical activity, and workplace factors associated with lower HWLE and life expectancy at age 50. Identifying the extent of the impact on healthy working life highlights these factors as targets and the potential to mitigate against premature work exit is encouraging to policy-makers seeking to extend working life as well as people with musculoskeletal and mental health conditions and their employers. The HWLE gaps suggest that interventions are needed to promote the health, wellbeing and work outcomes of subpopulations with long-term health conditions.
Polypharmacy is potentially harmful and under-researched amongst the fastest growing subpopulation, the very old (aged ≥85). We aimed to characterise polypharmacy using data from the Newcastle 85+ ...Study-a prospective cohort of people born in 1921 who turned 85 in 2006 (n = 845).
The prevalence of polypharmacy at baseline (mean age 85.5) was examined using cut-points of 0, 1, 2-4, 5-9 and ≥10 medicines-so-called 'no polypharmacy', 'monotherapy', 'minor polypharmacy', 'polypharmacy' and 'hyperpolypharmacy.' Cross-tabulations and upset plots identified the most frequently prescribed medicines and medication combinations within these categories. Mixed-effects models assessed whether gender and socioeconomic position were associated with prescribing changes over time (mean age 85.5-90.5). Participant characteristics were examined through descriptive statistics.
Complex multimorbidity (44.4%, 344/775) was widespread but hyperpolypharmacy was not (16.0%, 135/845). The median medication count was six (interquartile range 4-8). Preventative medicines were common to all polypharmacy categories, and prescribing regimens were diverse. Nitrates and oral anticoagulants were more frequently prescribed for men, whereas bisphosphonates, non-opioid analgesics and antidepressants were more common in women. Cardiovascular medicines, including loop diuretics, tended to be more frequently prescribed for socioeconomically disadvantaged people (<25th centile Index of Multiple Deprivation (IMD)), despite no difference in the prevalence of cardiovascular disease (p = 0.56) and diabetes (p = 0.92) by IMD.
Considering their complex medical conditions, prescribing is relatively conservative amongst 85-year-olds living in North East England. Prescribing shows significant gender and selected socioeconomic differences. More support for managing preventative medicines, of uncertain benefit, might be helpful in this population.
The costs of dementia in England Wittenberg, Raphael; Knapp, Martin; Hu, Bo ...
International journal of geriatric psychiatry,
July 2019, Volume:
34, Issue:
7
Journal Article
Peer reviewed
Open access
Objectives
This study measures the average per person and annual total costs of dementia in England in 2015.
Methods/Design
Up‐to‐date data for England were drawn from multiple sources to identify ...prevalence of dementia by severity, patterns of health and social care service utilisation and their unit costs, levels of unpaid care and its economic impacts, and other costs of dementia. These data were used in a refined macrosimulation model to estimate annual per‐person and aggregate costs of dementia.
Results
There are around 690 000 people with dementia in England, of whom 565 000 receive unpaid care or community care or live in a care home. Total annual cost of dementia in England is estimated to be £24.2 billion in 2015, of which 42% (£10.1 billion) is attributable to unpaid care. Social care costs (£10.2 billion) are three times larger than health care costs (£3.8 billion). £6.2 billion of the total social care costs are met by users themselves and their families, with £4.0 billion (39.4%) funded by government. Total annual costs of mild, moderate, and severe dementia are £3.2 billion, £6.9 billion, and £14.1 billion, respectively. Average costs of mild, moderate, and severe dementia are £24 400, £27 450, and £46 050, respectively, per person per year.
Conclusions
Dementia has huge economic impacts on people living with the illness, their carers, and society as a whole. Better support for people with dementia and their carers, as well as fair and efficient financing of social care services, are essential to address the current and future challenges of dementia.
Ghost tomography Kingston, Andrew. M.; Pelliccia, Daniele; Rack, Alexander ...
Optica,
12/2018, Volume:
5, Issue:
12
Journal Article
Peer reviewed
Open access
The quest for imaging protocols with ever-reduced dose is one of the most powerful motivators driving the currently exploding field of ghost imaging (GI). Ghost tomography (GT) using single-pixel ...detection extends the burgeoning field of GI to 3D, with the use of penetrating radiation. For hard x-rays, GT has the potential to relax the constraints that dose rate and detector performance impose on image quality and resolution. In this work, spatially random x-ray intensity patterns illuminate a specimen from various view-angles; in each case, the total transmitted intensity is recorded by a single-pixel (or bucket) detector. These readings, combined with knowledge of the corresponding 2D illuminating patterns and specimen orientations, are sufficient for 3D specimen reconstruction. The experimental demonstration of GT is presented here using synchrotron hard x-rays. This result significantly expands the scope of GI to encompass volumetric imaging (i.e., tomography), of optically opaque objects using penetrating radiation. (c) 2018 Optical Society of America under the terms of the OSA Open Access Publishing Agreement
Chaotic Sensing Chandra, Shekhar S.; Ruben, Gary; Jin Jin ...
IEEE transactions on image processing,
12/2018, Volume:
27, Issue:
12
Journal Article
Peer reviewed
Open access
We propose a sparse imaging methodology called chaotic sensing (ChaoS) that enables the use of limited yet deterministic linear measurements through fractal sampling. A novel fractal in the discrete ...Fourier transform is introduced that always results in the artifacts being turbulent in nature. These chaotic artifacts have characteristics that are image independent, facilitating their removal through dampening (via image denoising), and obtaining the maximum likelihood solution. In contrast with existing methods, such as compressed sensing, the fractal sampling is based on digital periodic lines that form the basis of discrete projected views of the image without requiring additional transform domains. This allows the creation of finite iterative reconstruction schemes in recovering an image from its fractal sampling that is also new to discrete tomography. As a result, ChaoS supports linear measurement and optimization strategies, while remaining capable of recovering a theoretically exact representation of the image. We apply the method to the simulated and experimental limited magnetic resonance (MR) imaging data, where restrictions imposed by MR physics typically favor linear measurements for reducing acquisition time.
Objectives
To determine whether protein intake is associated with better disability trajectories in the oldest adults (≥85) and whether muscle mass and muscle strength would partially mediate this.
...Design
Prospective cohort study.
Setting
Newcastle‐upon‐Tyne and North Tyneside, United Kingdom.
Participants
Community‐dwelling older adults aged 85 at baseline (N=722).
Methods
Protein intake was estimated using two 24‐hour multiple‐pass recalls at baseline. Disability was measured as difficulty performing 17 activities of daily living at baseline and 18, 36, and 60 months. Trajectories were derived using mortality‐adjusted group‐based trajectory modelling. The effect of protein intake (g/kg of adjusted body weight (aBW)/d) on disability trajectories was examined using multinomial logistic regression.
Results
Participants had 4 distinct disability trajectories (between the ages of 85 and 90: constant very low (AT1), mild (AT2), moderate (AT3), and severe (AT4). Each unit increase in protein (g) per kg of aBW/d was associated with greater odds of AT1 (odds ratio (OR=7.97, 95% confidence interval (CI)=1.96–32.43, p = .004) and AT2 (OR=3.28, 95% CI=1.09–9.87, p = .03) than of AT4 over 5 years in models adjusted for selected covariates. Participants with protein intake of 1.0 g/kg aBW/d or more were more likely to belong to AT1 (OR=3.65, 95% CI=1.59–8.38, p = .009) and AT2 (OR=2.12, 95% CI=1.16–3.90, p = .01) than to AT4.
Conclusion
Higher protein intake, especially 1.0 g/kg aBW/d or more, was associated with better disability trajectories in the oldest adults. These findings will inform new dietary strategies to support active, healthy ageing. J Am Geriatr Soc 67:50–56, 2019.
Telomere length is a putative biomarker of ageing, morbidity and mortality. Its application is hampered by lack of widely applicable reference ranges and uncertainty regarding the present limits of ...measurement reproducibility within and between laboratories.
We instigated an international collaborative study of telomere length assessment: 10 different laboratories, employing 3 different techniques Southern blotting, single telomere length analysis (STELA) and real-time quantitative PCR (qPCR) performed two rounds of fully blinded measurements on 10 human DNA samples per round to enable unbiased assessment of intra- and inter-batch variation between laboratories and techniques.
Absolute results from different laboratories differed widely and could thus not be compared directly, but rankings of relative telomere lengths were highly correlated (correlation coefficients of 0.63-0.99). Intra-technique correlations were similar for Southern blotting and qPCR and were stronger than inter-technique ones. However, inter-laboratory coefficients of variation (CVs) averaged about 10% for Southern blotting and STELA and more than 20% for qPCR. This difference was compensated for by a higher dynamic range for the qPCR method as shown by equal variance after z-scoring. Technical variation per laboratory, measured as median of intra- and inter-batch CVs, ranged from 1.4% to 9.5%, with differences between laboratories only marginally significant (P = 0.06). Gel-based and PCR-based techniques were not different in accuracy.
Intra- and inter-laboratory technical variation severely limits the usefulness of data pooling and excludes sharing of reference ranges between laboratories. We propose to establish a common set of physical telomere length standards to improve comparability of telomere length estimates between laboratories.
PDF
