Effect of sensory impairments in older adults taking multiple medications
Smith et al (2019) cite data showing that in Scotland, where 89% of older adults take one or more prescribed medications, there is a projected 25% increase in over-75s with complex health and social care needs. The authors identify sensory impairments (SIs) in older adults—visual, hearing or dual—as exerting significant impacts on the function and quality of life. This qualitative study explored the experiences and perspectives of 23 older adults with SIs receiving polypharmacy in 7 of Scotland's 14 Health Boards. Twelve participants had dual SI, 6 had visual impairment and 5 had hearing impairment.
Three main themes emerged: facilitators and barriers to prescription ordering and collection; medicine storage; and medication administration. For instance, participants with hearing impairment did not always hear medication instructions with clarity and predicted what had been said; participants with visual impairment relied on the texture and colours of medicine boxes or tablets; and changing medicine brands meant changing the shapes and colours that people with visual impairment depended upon, posing a risk to safe administration.
The authors conclude that a tailor-made initiative that involved collaboration ‘with home-dwelling older adults, carers, general practitioners and community pharmacists in urban and rural communities in co-designing support systems could complement this work’.
Future prospects for male contraceptive methods
In this open access review, Reynolds-Wright and Anderson (2019) explain the history of, and future prospects for, male contraception, noting that while condoms and vasectomy are effective, they ‘are not sufficient for many sexually active men who wish to have control over their fertility, and for their partners who wish to share the burden of contraception’.
In 1965, the World Health Organization created a task force to develop methods to regulate male fertility and from the mid-1980s, landmark studies were undertaken using weekly injections of testosterone enanthate, the first of which showed that 70% of men became azoospermic when given 200 mg/week of testosterone enanthate. However, ‘subsequent studies have focused on a combination with progestogens, which are potent gonadotrophin suppressors in men as they are in women’. Recently, a gel comprising nestorone—a potent progestogen— and testosterone has entered an international phase IIb clinical trial to establish both efficacy and side-effects.
The authors cite evidence not only showing the acceptability of a male contraceptive to many men, but that women would rely on their male partners to use it properly: ‘… many women rely on their male partner for contraception already— approximately 54% of women in the UK use either male sterilisation, male condom or withdrawal method as their main method of contraception.’
Significant alcohol-related harm remains in Europe despite overall downward trend
Noting that alcohol consumption is the seventh leading avoidable risk factor for premature mortality, morbidity and social harm globally, Pruckner et al (2019) state that the disorders most directly related to alcohol consumption are liver diseases like cirrhosis and alcoholic hepatitis. To determine alcohol-related mortality in the World Health Organization (WHO) European region over the last four decades, the authors evaluated 29 countries using data available from the WHO Health for All database.
Although a significant decline in alcohol-related mortality rates was found for all 29 countries, a West–East gradient was evident, with higher rates in countries like Hungary and the Baltic states. Although there was little difference between men and women in the declining trends in alcohol-related deaths observed, ‘there were marked differences in absolute values of standardised death rates between sexes with men showing higher rates than women’.
For liver cirrhosis rates, while Mediterranean and central European countries (eg France, Greece, Austria, Germany) saw significant decreases, there was ‘an increase in Eastern countries such as Hungary and the Republic of Moldova, but also the UK and Ireland’.
Possible reasons for decreased alcohol-related mortality include increased liver transplantation; higher alcohol beverage pricing; and stricter drink-driving controls and law enforcement.
Socioeconomic position affects risk of adverse childhood experiences
Adverse childhood experiences (ACEs) include child maltreatment (abuse and neglect) and those related to dysfunctional households, which include adult domestic violence, substance misuse or having an adult household member in prison. In this study, Walsh et al (2019) systematically reviewed the literature on the relationship between childhood socioeconomic position (SEP) and ACEs.
They found a clear relationship between SEP in childhood and the risk of experiencing ACEs and maltreatment. This relationship appears to be ‘robust across countries, measures of SEP and adversity and the age at which adversity is measured’. The authors note that there is substantially more research on childhood SEP and child maltreatment, leading them to suggest that ‘the role of SEP in childhood is not integrated into the understanding of what causes ACEs’.
The authors state that policy not only needs to help those currently affected by childhood adversity, but that to prevent further adversity, policy makers ‘must also understand the relationship between SEP and ACEs, and reduce socioeconomic inequality and poverty’. They are also clear that while policy and practice are needed to help those affected by childhood adversity, any policy that fails to acknowledge the wider socioeconomic context will be flawed: ‘This is particularly important for UK policy makers to understand, given both the recent increases, and projected future rises, in levels of child poverty’.