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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
P. Zaninotto ◽  
Y. T. Huang ◽  
G. Di Gessa ◽  
J. Abell ◽  
C. Lassale ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Older People ◽  
Hospital Admission ◽  
Prescription Drugs ◽  
Hospital Admissions ◽  
Competing Risk ◽  
Risk Of Falls ◽  
Nationally Representative ◽  
English Longitudinal Study

Abstract 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.

scholarly journals SOCIAL AND BIOLOGICAL PREDICTORS OF HOSPITAL ADMISSIONS FOR A FALL IN THE ENGLISH LONGITUDINAL STUDY OF AGEING (ELSA)

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Jessica G Abell ◽  
Camille Lassale ◽  
Andrew Steptoe ◽  
G David Batty ◽  
Paola Zaninotto
Keyword(s):  
Longitudinal Study ◽  
Older People ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Premature Mortality ◽  
Care Services ◽  
Health And Social Care ◽  
Icd 10 ◽  
First Occurrence ◽  
English Longitudinal Study

Abstract Falls are the most frequent type of accidents among older people, with one in three people aged over 65 falling each year. Falls serious enough to result in hospital admission are especially problematic, since they can lead to an increased likelihood of future disability, loss of independence, and premature mortality. Understanding the factors that may determine the risk of experiencing a fall, which requires admission to hospital, is therefore an important priority. This paper seeks to examine this issue using Hospital Episode Statistics (HES) data – administrative data from English hospitals in the National Health Service (NHS). These data have recently been linked with the English Longitudinal Study of Ageing (ELSA). We examine the association between a range of predictors (demographic, social environment, physical and mental functioning) drawn from wave 4 of ELSA with the first occurrence of hospitalisation due to an accidental fall, identified using ICD-10 codes. Analysis using Cox regression suggest a range of factors are negatively associated with admission to hospital with diagnosis of a fall, such as living alone (HR=1.42; 95% CI: 1.19, 1.68), urinary incontinence (HR=1.33; 95% CI: 1.09, 1.61) and depressive symptoms (HR=1.50; 95% CI: 1.23, 1.82). High walking speed (HR=0.30; 95% CI: 0.23, 0.39) and good hand-grip strength (HR=0.97; 95% CI: 0.96, 0.98) were found to be protective. The prevention of serious falls amongst older people will require determinants to be identified and managed effectively by health and social care services.

scholarly journals Multimorbidity patterns and memory trajectories in older adults: Evidence from the English Longitudinal Study of Ageing

2021 ◽  
Author(s):  
Rebecca Bendayan ◽  
Yajing Zhu ◽  
A D Federman ◽  
R J B Dobson
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Latent Class ◽  
Health Behaviours ◽  
Health Conditions ◽  
Delayed Recall ◽  
Class 1 ◽  
English Longitudinal Study ◽  
Psychiatric Problems

Abstract Background We aimed to examine the multimorbidity patterns within a representative sample of UK older adults and their association with concurrent and subsequent memory. Methods Our sample consisted of 11,449 respondents (mean age at baseline was 65.02) from the English Longitudinal Study of Ageing (ELSA). We used fourteen health conditions and immediate and delayed recall scores (IMRC and DLRC) over 7 waves (14 years of follow up). Latent class analyses were performed to identify the multimorbidity patterns and linear mixed models were estimated to explore their association with their memory trajectories. Models were adjusted by socio-demographics, BMI and health behaviors. Results Results showed 8 classes: Class 1:Heart Disease/Stroke (26%), Class 2:Asthma/Lung Disease (16%), Class 3:Arthritis/Hypertension (13%), Class 4:Depression/Arthritis (12%), Class 5:Hypertension/Cataracts/Diabetes (10%), Class 6:Psychiatric Problems/Depression (10%), Class 7:Cancer (7%) and Class 8:Arthritis/Cataracts (6%). At baseline, Class 4 was found to have lower IMRC and DLRC scores and Class 5 in DLRC, compared to the no multimorbidity group (n=6380, 55.72% of total cohort). For both tasks, in unadjusted models, we found an accelerated decline in Classes 1, 3 and 8; and, for DLRC, also in Classes 2 and 5. However, it was fully attenuated after adjustments. Conclusions These findings suggest that individuals with certain combinations of health conditions are more likely to have lower levels of memory compared those with no multimorbidity and their memory scores tend to differ between combinations. Socio-demographics and health behaviours have a key role to understand who is more likely to be at risk of an accelerated decline.

scholarly journals Validation of Self‐Reported Rheumatoid Arthritis Using Medicare Claims: A Nationally Representative Longitudinal Study of Older Adults

2021 ◽  
Vol 3 (4) ◽  
pp. 239-249
Author(s):  
Michael J. Booth ◽  
Daniel Clauw ◽  
Mary R. Janevic ◽  
Lindsay C. Kobayashi ◽  
John D. Piette
Keyword(s):  
Rheumatoid Arthritis ◽  
Older Adults ◽  
Longitudinal Study ◽  
Medicare Claims ◽  
Nationally Representative

scholarly journals Association between polypharmacy and falls in older adults: a longitudinal study from England

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016358 ◽  
Author(s):  
Nafeesa N Dhalwani ◽  
Radia Fahami ◽  
Harini Sathanapally ◽  
Sam Seidu ◽  
Melanie J Davies ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Total Population ◽  
Incidence Rate Ratio ◽  
The Past ◽  
Longitudinal Association ◽  
Falls In Older Adults ◽  
Nationally Representative ◽  
English Longitudinal Study ◽  
Complex Drug

ObjectivesAssess the longitudinal association between polypharmacy and falls and examine the differences in this association by different thresholds for polypharmacy definitions in a nationally representative sample of adults aged over 60 years from England.DesignLongitudinal cohort study.SettingThe English Longitudinal Study of Ageing waves 6 and 7.Participants5213 adults aged 60 or older.Main outcome measuresRates, incidence rate ratio (IRR) and 95% CI for falls in people with and without polypharmacy.ResultsA total of 5213 participants contributed 10 502 person-years of follow-up, with a median follow-up of 2.02 years (IQR 1.9–2.1 years). Of the 1611 participants with polypharmacy, 569 reported at least one fall within the past 2 years (rate: 175 per 1000 person-years, 95% CI 161 to 190), and of the 3602 participants without polypharmacy 875 reported at least one fall (rate: 121 per 1000 person-years, 95% CI 113 to 129). The rate of falls was 21% higher in people with polypharmacy compared with people without polypharmacy (adjusted IRR 1.21, 95% CI 1.11 to 1.31). Using ≥4 drugs threshold the rate of falls was 18% higher in people with polypharmacy compared with people without (adjusted IRR 1.18, 95% CI 1.08 to 1.28), whereas using ≥10 drugs threshold polypharmacy was associated with a 50% higher rate of falls (adjusted IRR 1.50, 95% CI 1.34 to 1.67).ConclusionsWe found almost one-third of the total population using five or more drugs, which was significantly associated with 21% increased rate of falls over a 2-year period. Further exploration of the effects of these complex drug combinations in the real world with a detailed standardised assessment of polypharmacy is greatly required along with pragmatic studies in primary care, which will help inform whether the threshold for a detailed medication review should be lowered.

scholarly journals Orientation and verbal fluency in the English Longitudinal Study of Ageing: modifiable risk factors for falls?

2018 ◽  
Vol 31 (10) ◽  
pp. 1491-1498 ◽  
Author(s):  
T. O. Smith ◽  
S. R. Neal ◽  
G. Peryer ◽  
K. J. Sheehan ◽  
M. P. Tan ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Verbal Fluency ◽  
Functional Performance ◽  
Community Dwelling ◽  
Cognitive Domain ◽  
Cognitive Domains ◽  
Risk Factors For Falls ◽  
Prospective Longitudinal ◽  
English Longitudinal Study

ABSTRACTObjectives:To determine the relationship between falls and deficits in specific cognitive domains in older adults.Design:An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.Setting:United Kingdom community-based.Participants:5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.Measurements:Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.Results:Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65–0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96–1.00; p = 0.05) remained significant for predicting recurrent falls.Conclusions:The cognitive phenotype rather than cognitive impairmentper semay predict future falls in those presenting with more than one fall.

scholarly journals Subjective wellbeing as a determinant of glycated hemoglobin in older adults: longitudinal findings from the English Longitudinal Study of Ageing

2019 ◽  
Vol 50 (11) ◽  
pp. 1820-1828 ◽  
Author(s):  
Lydia Poole ◽  
Ruth A. Hackett ◽  
Laura Panagi ◽  
Andrew Steptoe
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Subjective Wellbeing ◽  
Glycated Hemoglobin ◽  
Linear Regression Models ◽  
Clinical Factors ◽  
Subclinical Disease ◽  
The Relationship ◽  
English Longitudinal Study

AbstractBackgroundPrevious research has shown an association between subjective wellbeing and incident diabetes. Less is known about the role of wellbeing for subclinical disease trajectories as captured via glycated hemoglobin (HbA1c). We aimed to explore the association between subjective wellbeing and future HbA1c levels, and the role of sociodemographic, behavioral and clinical factors in this association.MethodsWe used data from the English Longitudinal Study of Ageing for this study (N = 2161). Subjective wellbeing (CASP-19) was measured at wave 2 and HbA1c was measured 8 years later at wave 6. Participants were free from diabetes at baseline. We conducted a series of analyses to examine the extent to which the association was accounted for by a range of sociodemographic, behavioral and clinical factors in linear regression models.ResultsModels showed that subjective wellbeing (CASP-19 total score) was inversely associated with HbA1c 8 years later after controlling for depressive symptoms, age, sex, and baseline HbA1c (B = −0.035, 95% CI −0.060 to –0.011, p = 0.005). Inclusion of sociodemographic variables and behavioral factors in models accounted for a large proportion (17.0% and 24.5%, respectively) of the relationship between wellbeing and later HbA1c; clinical risk factors explained a smaller proportion of the relationship (3.4%).ConclusionsPoorer subjective wellbeing is associated with greater HbA1c over 8 years of follow-up and this relationship can in part be explained by sociodemographic, behavioral and clinical factors among older adults.

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

2019 ◽  
Vol 32 (1) ◽  
pp. 97-104
Author(s):  
Pei-Chao Lin ◽  
Li-Chan Lin ◽  
Hsiu-Fen Hsieh ◽  
Yao-Mei Chen ◽  
Pi-Ling Chou ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Retrospective Study ◽  
Older People ◽  
Hospital Admission ◽  
Emergency Department Visits ◽  
Urban Setting ◽  
Research Database ◽  
Patient Records ◽  
People With Dementia

ABSTRACTObjectives:The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.Design and Setting:This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.Participants:The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.Measurements:The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.Results:A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.Conclusions:Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

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