A5001583678- Frailty in Older Adults
- Health Systems, Economic Evaluations, Quality of Life
- Chronic Disease Management Strategies
- COVID-19 Clinical Research Studies
- SARS-CoV-2 and COVID-19 Research
- Blood Pressure and Hypertension Studies
- Genetic Associations and Epidemiology
- Lipoproteins and Cardiovascular Health
- Pharmaceutical Practices and Patient Outcomes
- COVID-19 and healthcare impacts
- Long-Term Effects of COVID-19
- Intensive Care Unit Cognitive Disorders
- Pneumonia and Respiratory Infections
- SARS-CoV-2 detection and testing
- COVID-19 epidemiological studies
- Genomics and Rare Diseases
- Diabetes Treatment and Management
- Gastroesophageal reflux and treatments
- Geriatric Care and Nursing Homes
- Antiplatelet Therapy and Cardiovascular Diseases
- Cardiovascular Health and Disease Prevention
- Animal Virus Infections Studies
- Pharmacogenetics and Drug Metabolism
- Cardiac, Anesthesia and Surgical Outcomes
- Cardiovascular Syncope and Autonomic Disorders
University of Exeter
2016-2025
Royal Devon & Exeter NHS Foundation Trust
2014-2025
University of Leicester
2024
University of Lincoln
2024
Lincolnshire Community Health Services NHS Trust
2024
World Organisation of Family Doctors
2024
Northern Devon Healthcare NHS Trust
2023
University of Birmingham
2023
Royal Devon and Exeter Hospital
2017-2022
Exeter Hospital
2021
Abstract Background Hospitalized COVID-19 patients tend to be older and frequently have hypertension, diabetes, or coronary heart disease, but whether these comorbidities are true risk factors (ie, more common than in the general population) is unclear. We estimated associations between preexisting diagnoses hospitalized alone with mortality, a large community cohort. Methods UK Biobank (England) participants baseline assessment 2006–2010, followed hospital discharge records 2017 death 2020....
The novel respiratory disease COVID-19 produces varying symptoms, with fever, cough, and shortness of breath being common. In older adults, we found that pre-existing dementia is a major risk factor (OR = 3.07, 95% CI: 1.71 to 5.50) for severity in the UK Biobank (UKB). another study 16,749 patients hospitalized COVID-19, was among common comorbidities associated higher mortality. Additionally, impaired consciousness, including delirium, severe cases. ApoE e4 genotype both e4e4 (homozygous)...
Abstract Introduction Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty unclear. Methods This multi-centre cohort study involved patients aged 18 years and hospitalised COVID-19, using routinely collected data. We used Cox regression analysis to assess impact age, delirium on risk inpatient mortality, adjusting for sex, illness severity, inflammation co-morbidities. ordinal logistic Clinical Frailty Scale (CFS)...
There is mixed evidence that blood pressure (BP) stabilizes or decreases in later life. It also unclear whether BP trajectories reflect advancing age, proximity to end of life, selective survival persons free from hypertension.To estimate individual patient for each the 20 years before death and identify potential mechanisms may explain trajectories.We analyzed population-based Clinical Practice Research Datalink primary care linked hospitalization electronic medical records United Kingdom,...
Abstract Background Blood pressure (BP) management in frail older people is challenging. An randomised controlled trial of largely non-frail found cardiovascular and mortality benefit with systolic (S) BP target <120 mmHg. However, all-cause by attained routine care adults aged above 75 unclear. Objectives To estimate observational associations between baseline mortality/cardiovascular outcomes a primary-care population 75, stratified frailty. Methods Prospective analysis using...
Background Higher continuity of GP care (CGPC), that is, consulting the same doctor consistently, can improve doctor–patient relationships and increase quality care; however, its effects on patients with dementia are mostly unknown. Aim To estimate associations between CGPC potentially inappropriate prescribing (PIP), incidence adverse health outcomes (AHOs) in dementia. Design setting A retrospective cohort study 1 year follow-up anonymised medical records from 9324 dementia, aged ≥65 years...
Current emergency care systems are not optimized to respond multiple and complex problems associated with frailty. Services may require reconfiguration effectively deliver comprehensive frailty care, yet its prevalence variation poorly understood. This study primarily determined the of among older people attending care.
Background: the oldest old (85+) pose complex medical challenges. Both underdiagnosis and overdiagnosis are claimed in this group.
To estimate associations between long-term use of proton pump inhibitors (PPIs) and pneumonia incidence in older adults primary care.Longitudinal analyses electronic medical records.England PARTICIPANTS: Individuals aged 60 care receiving PPIs for 1 year or longer (N=75,050) age- sex-matched controls (N=75,050).Net hazard ratios Year 2 treatment were estimated using the prior event rate ratio (PERR), which adjusts differences before initiation treatment. Inverse probability weighted models...
The novel respiratory disease COVID-19 produces varying symptoms, with fever, cough, and shortness of breath being common. In older adults, we found that pre-existing dementia is a major risk factor (OR = 3.07, 95% CI: 1.71 to 5.50) for hospitalization in the UK Biobank (UKB). another study 16,749 patients hospitalized COVID-19, was among common comorbidities associated higher mortality. Additionally, impaired consciousness, including delirium, severe cases. ApoE e4 genotype both e4e4...
Abstract Background Older COVID-19 hospitalized patients frequently have hypertension, diabetes or coronary heart disease (CHD), but whether these are more common than in the population is unclear. During initial epidemic England, virus testing for older adults was restricted to symptomatic patients. We aimed estimate associations between pre-existing diagnoses and status, a large community cohort. Methods UK Biobank (England) participants assessed 2006 2010, followed hospital discharge...
<h3>Importance</h3> Hereditary hemochromatosis is predominantly caused by the<i>HFE</i>p.C282Y homozygous pathogenic variant. Liver carcinoma and mortality risks are increased in individuals with clinically diagnosed hereditary hemochromatosis, but unclear mostly undiagnosed p.C282Y homozygotes identified community genotyping. <h3>Objective</h3> To estimate the incidence of primary hepatic death by<i>HFE</i>variant status. <h3>Design, Setting, Participants</h3> Cohort study 451 186 UK...
Abstract Background Age and disease prevalence are the 2 biggest risk factors for Coronavirus 2019 (COVID-19) symptom severity death. We therefore hypothesized that increased biological age, beyond chronological may be driving disease-related trends in COVID-19 severity. Methods Using UK Biobank England data, we tested whether a age estimate (PhenoAge) measured more than decade prior to pandemic was predictive of outcomes (inpatient test positivity COVID-19-related mortality with inpatient...
Moderate obesity in later life may improve survival, prompting calls to revise control policies. However, this paradox be due confounding from smoking, diseases causing weight-loss, plus varying follow-up periods. We aimed estimate body mass index (BMI) associations with mortality, incident type 2 diabetes, and coronary heart disease older people without the above confounders. Cohort analysis Clinical Practice Research Datalink primary care, hospital death certificate electronic medical...
Abstract With no known treatments or vaccine, COVID-19 presents a major threat, particularly to older adults, who account for the majority of severe illness and deaths. The age-related susceptibility is partly explained by increased comorbidities including dementia type II diabetes [1]. While it unclear why these diseases predispose risk, we hypothesize that biological age, rather than chronological may be driving disease-related trends in severity with age. To test this hypothesis, applied...
Abstract Hospitalized COVID-19 patients tend to be older and frequently have hypertension, diabetes or CHD, but whether these co-morbidities are more common than in the general population is unclear. We estimated associations between pre-existing diagnoses hospitalized alone with mortality (during first outbreak, tests performed March 16 April 26, 2020). In 269,070 UK Biobank participants aged 65+, 507 (0.2%) became hospital inpatients, of which 141 (27.8%) died. Common preexisting...
Background: Statins are commonly prescribed to lower LDL cholesterol. Clinical guidelines recommend 30-50% reduction within 3 months, yet many patients do not achieve this. We investigated the impact of patient characteristics and genetics on LDL-c reduction, treatment adherence, adverse clinical outcomes. Methods: analysed 76,000 UK Biobank participants atorvastatin or simvastatin in primary care: 41,000 had measurements before statin initiation (median=16 days prior, IQR=28) a year...
Objectives To estimate outcomes according to attained blood pressure ( BP ) in the oldest adults treated for hypertension routine family practice. Design Cohort analysis of primary care inpatient and death certificate data individuals with hypertension. Setting Primary practices England (Clinical Practice Research Datalink). Participants Individuals aged 80 older taking antihypertensive medication free dementia, cancer, coronary heart disease, stroke, failure, end‐stage renal failure at...
Individuals with low cardiovascular risk factor profiles experience lower rates of diseases, but associations geriatric syndromes are unclear. We tested whether individuals disease risk, aged 60–69 years old at baseline in two large cohorts, were less likely to develop aging-related adverse health outcomes. Data from population representative medical records (Clinical Practice Research Datalink [CPRD] England, n = 239,591) and healthy volunteers (UK Biobank [UKB], 181,820), followed for ≤10...
As people age they are at increased risk of cardiovascular disease, the leading cause mortality and morbidity worldwide. Understanding ageing is essential to preserving healthy preventing serious health outcomes. This collection papers published in Age Ageing since 2011 cover key themes ageing, with a separate on stroke atrial fibrillation planned. Treating high blood pressure remains important as reduces strokes heart attacks. That said, more personalised approach may be even lower tight...
Abstract Background The observational Frailty in European Emergency Departments (FEED) study found 40% of older people attending for care to be living with frailty. Older frailty have poorer outcomes from emergency care. Current best practice calls early identification and holistic multidisciplinary assessment. This survey FEED sites explores variations frailty-attuned service definitions provision. Methods cross-sectional included across Europe identified through snowball recruitment. Site...
BACKGROUND/OBJECTIVES Delirium is common in older adults, especially following hospitalization. Because low vitamin D levels may be associated with increased delirium risk, we aimed to determine the prognostic value of blood levels, extending our previous genetic analyses this relationship. DESIGN Prospective cohort analysis. SETTING Community‐based study adults from 22 cities across United Kingdom (the UK Biobank). PARTICIPANTS Adults aged 60 and by end follow‐up linked hospital inpatient...
Abstract Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It common, particularly older adults, but poorly recognised. Frailty the accumulation of deficits conferring increased risk adverse outcomes. We set out to determine how severity frailty, as measured using CFS, affected delirium rates, recognition hospitalised people United Kingdom. Methods Adults over 65 years were included observational multi-centre audit...