Physiological Stress Responses Associated with High-Risk Occupational Duties

Occupational stress is a pervasive problem that is relevant across the world. Stress, in combination with occupational hazards, may pose additive risks for health and wellbeing. This chapter discusses the influence of physical and psychosocial stressors on basal cortisol regulation as associated with higher-risk occupational duties among two subspecialties of police officers (frontline and special tactical unit officers). Results reveal significant differences in dysregulated cortisol awakening response associated with the higher risk duties among special tactical unit officers. In contrast, frontline officers with a lower objective occupational risk profiles report higher subjective stress levels. Dysregulated or maladaptive cortisol levels are associated with increased health risk. Thus, individuals working in high stress occupations with elevated cortisol profiles may be at increased risk of chronic health conditions. Results suggest that considering both objective physiological markers and subjective reports of stress are dually important aspects in designing interventions for police officers of differing subspecialties.

Is polypharmacy beneficial or detrimental for older adults with cardiometabolic multimorbidity? Pooled analysis of studies from Hong Kong and Europe

Background Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases). Objective To examine combined effects of multimorbidity and polypharmacy on hospitalization and frailty and to determine whether effect sizes of polypharmacy vary with numbers of cardiometabolic diseases Methods We pooled longitudinal data of community-dwelling older adults in Hong Kong, Israel, and 17 European countries. They completed questionnaires for baseline assessment from 2015 to 2018 and reassessment at 1–2-year follow-up. We performed regression analyses to address the objective. Results Among 44 818 participants (mean age: 69.6 years), 28.3% had polypharmacy and 34.8% suffered from cardiometabolic multimorbidity. Increased risks of hospitalization and worsening frailty were found in participants with ‘multimorbidity alone’ [adjusted odds ratio (AOR) 1.10 and 1.26] and ‘polypharmacy alone’ (AOR 1.57 and 1.68). With ‘multimorbidity and ‘polypharmacy’ combined, participants were not at additive risks (AOR 1.53 and 1.47). In stratified analysis, with increasing numbers of cardiometabolic diseases, associations of polypharmacy with hospitalization and frailty were attenuated but remained statistically significant. Conclusion Polypharmacy is less detrimental, yet still detrimental, for older adults living with cardiometabolic multimorbidity. Physicians should optimize prescription regardless of the number of diseases. Health policymakers and researchers need to consider their interrelationship in hospitalization risk predictions and in developing frailty scales.