Huang, Yun-Ting;
(2022)
Polypharmacy in older adults – prevalence, risk factors, and associations with mortality – and the role of diabetes.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Polypharmacy is common in ageing populations, but its impact on older adults’ health and the role of diabetes are uncertain. This PhD aimed to better understand the prevalence and risk factors of polypharmacy and its associations with mortality, and to explore the role of diabetes in those relationships. Using data from the English Longitudinal Study of Ageing (2004–05 to 2012–13), this work comprised four studies. The first investigated the prevalence and risk factors of undiagnosed diabetes. The prevalence of diagnosed (7.7% and 11.5%) and undiagnosed (2.4% and 3.4%) diabetes increased between 2004 and 2012. However, men aged 50–74 reported a stable prevalence of undiagnosed diabetes and improved awareness. The second examined the prevalence and risk factors of polypharmacy according to diabetes status (diagnosed and undiagnosed). Older adults with diabetes had a higher prevalence of polypharmacy (41.1% versus 14.8%) and heightened polypharmacy (5.8% versus 1.7%) compared with those without diabetes, even excluding antihyperglycemic drugs. People with diabetes who were men and obese were more likely to show polypharmacy and heightened polypharmacy. The third investigated associations between different levels of polypharmacy and all-cause and cause-specific mortality over six years. Polypharmacy and heightened polypharmacy showed dose-response relationships with all-cause (hazard ratio (HR) 1.51, 2.29) and cardiovascular disease (CVD) (subdistribution hazard ratio (SHR) 2.45, 3.67) mortality. Diabetes was a confounder in this relationship and independently related to all-cause mortality. The fourth explored associations between high-risk medications and all-cause and cause-specific mortality among older adults with polypharmacy. Older adults with polypharmacy who took mental health drugs, opioids and muscle relaxants were at higher risk of all-cause (HR 1.55) and CVD (SHR 2.11) mortality. These findings highlight the importance of greater awareness of polypharmacy among older adults in England, especially those on specific high-risk medications, and special care for older people with diabetes
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Polypharmacy in older adults – prevalence, risk factors, and associations with mortality – and the role of diabetes |
| Event: | UCL (University College London) |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10142408 |
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