Living longer, but with more care needs: late-life dependency and the social care crisis

Solving the crisis in social care provision for older people is not just a matter of building more care homes, argues Carol Jagger. She explains the various ways in which dependency has changed compared to 20 years ago, and suggests some of the solutions the government should consider

Relative risk of gastrointestinal bleeding according to dose of aspirin use^†.

†<p>Relative risks (RR) are compared to non-users as reference group.</p><p>*Includes 101 individuals with unknown or unspecified location of GI bleeding.</p><p>**P trend calculated using median aspirin dose of each category as continuous variable.</p>‡<p>Multivariate RR model is adjusted for age, NSAID use (yes or no), smoking status (never, past, current), body mass index (<21. 21–22.9, 23–24.9, 25–29.9, ≥30 kg/m²), exercise (<1.7, 1.7–4.5, 4.6–10.5, 10.6–22.0, ≥22.1 mets/week), alcohol (0, 0.1–4.9, 5–14.9, ≥15 g/day).</p><p>§Multivariate RR model is also adjusted for aspirin duration (continuous use in years).</p><p>§§Multivariate RR model is also adjusted for aspirin frequency (median aspirin frequency of each category as continuous variable).</p

Relative risk of gastrointestinal bleeding according to dose of aspirin use^†.

†<p>Relative risks (RR) are compared to non-users as reference group.</p>‡<p>Multivariate RR model is adjusted for age, NSAID use (yes or no), smoking status (never, past, current), body mass index (<21. 21–22.9, 23–24.9, 25–29.9, ≥30 kg/m²), exercise (<1.7, 1.7–4.5, 4.6–10.5, 10.6–22.0, ≥22.1 mets/week), alcohol (0, 0.1–4.9, 5–14.9, ≥15 g/day).</p><p>**P trend calculated using median aspirin dose of each category as continuous variable.</p>§<p>Reference group for both short-term and long-term analyses are individuals who reported no use of aspirin (0 years and 0 tablets/week).</p

Relative risk of gastrointestinal bleeding according to duration of regular aspirin use^†.

†<p>Relative risks (RR) are compared to those without any continuous aspirin use as reference group.</p><p>*Includes 101 individuals with unknown or unspecified location of GI bleeding.</p><p>**P trend calculated using median aspirin dose of each category as continuous variable.</p>‡<p>Multivariate RR model is adjusted for age, NSAID use (yes or no), smoking status (never, past, current), body mass index (<21. 21–22.9, 23–24.9, 25–29.9, ≥30 kg/m²), exercise (<1.7, 1.7–4.5, 4.6–10.5, 10.6–22.0, ≥22.1 mets/week), alcohol (0, 0.1–4.9, 5–14.9, ≥15 g/day).</p>§<p>Multivariate RR model is adjusted for aforementioned variables as well as aspirin dose (continuous use in tablets per week).</p

A Prospective Study of Alcohol Consumption and Smoking and the Risk of Major Gastrointestinal Bleeding in Men

<div><p>Background and Aims</p><p>Data regarding smoking and alcohol consumption and risk of gastrointestinal bleeding (GIB) are sparse and conflicting. We assessed the risk of major GIB associated with smoking and alcohol consumption in a large, prospective cohort.</p><p>Methods</p><p>We prospectively studied 48,000 men in the Health Professional follow-up Study (HPFS) who were aged 40–75 years at baseline in 1986. We identified men with major GIB requiring hospitalization and/or blood transfusion via biennial questionnaires and chart review.</p><p>Results</p><p>We documented 305 episodes of major GIB during 26 years of follow-up. Men who consumed >30 g/day of alcohol had a multivariable relative risk (RR) of 1.43 (95% confidence interval (CI), 0.88–2.35; <i>P</i> for trend 0.006) for major GIB when compared with nondrinkers. Alcohol consumption appeared to be primarily related to upper GIB (multivariable RR for >30 g/day vs. nondrinkers was 1.35; 95% CI, 0.66–2.77; <i>P</i> for trend 0.02). Men who consumed ≥ 5 drinks/week vs. < 1 drink/month of liquor had a multivariable RR of 1.72 (95% CI, 1.26–2.35, <i>P</i> for trend <0.001). Wine and beer were not significantly associated with major GIB. The risk of GIB associated with NSAIDs/aspirin use increased with greater alcohol consumption (multivariable RR 1.37; 95% CI, 0.85–2.19 for 1-14g/day of alcohol, RR 1.75; 95% CI, 1.07–2.88 for ≥ 15g/day compared to nondrinkers). Smoking was not significantly associated with GIB.</p><p>Conclusions</p><p>Alcohol consumption, but not smoking, was associated with an increased risk of major GIB. Associations were most notable for upper GIB associated with liquor intake. Alcohol appeared to potentiate the risk of NSAID-associated GIB.</p></div

Relative risk of gastrointestinal bleeding according to regular use of aspirin^†.

†<p>Regular aspirin use is defined as consumption of ≥2 times per week<b>.</b> Non-regular use is defined as consumption of <2 times per week. Relative risks (RR) are compared to non-regular users as reference group.</p><p>*Includes 101 individuals with unknown or unspecified location of GI bleeding.</p>‡<p>Multivariate RR model is adjusted for age, NSAID use (yes or no), smoking status (never, past, current), body mass index (<21. 21–22.9, 23–24.9, 25–29.9, ≥30 kg/m²), exercise (<1.7, 1.7–4.5, 4.6–10.5, 10.6–22.0, ≥22.1 mets/week), alcohol (0, 0.1–4.9, 5–14.9, ≥15 g/day).</p

Aspirin dose and risk of gastrointestinal bleeding (2000–08).

†<p>Individuals reported taking 50–99 mg of aspirin.</p>§<p>Individuals reported taking 250–349 mg of aspirin.</p><p>*Includes 49 bleeding cases which were unspecified. Includes non-daily and daily users.</p>‡<p>Multivariate RR model is adjusted for age, NSAID use (yes or no), smoking status (never, past, current), body mass index (<21. 21–22.9, 23–24.9, 25–29.9, ≥30), exercise (<1.7, 1.7–4.5, 4.6–10.5, 10.6–22.0, ≥22.1 mets/week), alcohol (0, 0.1–4.9, 5–14.9, ≥15 g/day).</p

The relative risks of colorectal cancer and sub-sites according to lifetime number of blood donations in the Health Professionals Follow-up Study (1992–2008).

1<p>adjusted for age (in months).</p>2<p>adjusted for age (in months), smoking before age 30 (0, 1–4, 5–10, or >10 pack-years), history of colorectal cancer in a parent or sibling (yes, no), history of colonoscopy or sigmoidoscopy (yes, no), regular aspirin use (yes, no), body mass index (<25, 25–<30, ≥30 kg/m²), physical activity (<3, 3–<27, ≥27 MET-hrs/wk).</p>3<p>adjusted for age (in months), factors listed in model 2, consumption of processed meat (quintiles), consumption of beef, pork, or lamb as a main dish (quintiles), alcohol consumption (0–<5, 5–<10, 10–<15, or ≥15 g/d), multivitamin use (yes, no), energy-adjusted total calcium intake (quintiles), total folate intake (quintiles), and total vitamin D intake (quintiles).</p

Study Flow Diagram.

<p>GIB, Gastrointestinal bleeding.</p

Baseline characteristics of the study cohort in 1994.

†<p>One standard tablet is 325 mg of aspirin.</p>‡<p>Body mass index is weight in kilograms divided by the square of the height in meters.</p>§<p>Current NSAID use is defined as regular intake of at least 2 times per week.</p