Publications by year
In Press
Zirk-Sadowski J, Masoli J, Strain WD, Delgado J, Henley W, Hamilton W, Melzer D, Ble A (In Press). Proton-Pump Inhibitors and Fragility Fractures in Vulnerable Older Patients.
The American Journal of Gastroenterology (Elsevier) Full text.
Zirk-Sadowski J, Masoli JAH, delgado J, Strain W, Hamilton W, Henley W, Melzer D, Ble A (In Press). Risks of Longer Term Proton Pump Inhibitor Exposure in 228,752 Older Adults. International Congress of the European Union Geriatric Society.
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Risks of Longer Term Proton Pump Inhibitor Exposure in 228,752 Older Adults
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Masoli JAH, Correa Delgado J, Bowman K, Ble A, Han Y, Henley W, welsh S, kuchel G, ferrucci L, Melzer D, et al (In Press). Twenty Year Blood Pressure Trajectories in 46,634 Older Patients. International Congress of the European Union Geriatric Society.
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Twenty Year Blood Pressure Trajectories in 46,634 Older Patients
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2018
Delgado J, Bowman K, Ble A, Masoli J, Han Y, Henley W, Welsh S, Kuchel GA, Ferrucci L, Melzer D, et al (2018). Blood Pressure Trajectories in the 20 Years Before Death.
JAMA Intern Med,
178(1), 93-99.
Abstract:
Blood Pressure Trajectories in the 20 Years Before Death.
Importance: There is mixed evidence that blood pressure (BP) stabilizes or decreases in later life. It is also unclear whether BP trajectories reflect advancing age, proximity to end of life, or selective survival of persons free from hypertension. Objective: to estimate individual patient BP for each of the 20 years before death and identify potential mechanisms that may explain trajectories. Design, Study, and Participants: We analyzed population-based Clinical Practice Research Datalink primary care and linked hospitalization electronic medical records from the United Kingdom, using retrospective cohort approaches with generalized linear mixed-effects modeling. Participants were all available individuals with BP measures over 20 years, yielding 46 634 participants dying aged at least 60 years, from 2010 to 2014. We also compared BP slopes from 10 to 3 years before death for 20 207 participants who died, plus 20 207 birth-year and sex-matched participants surviving longer than 9 years. Main Outcomes and Measures: Clinically recorded individual patient repeated systolic BP (SBP) and diastolic BP (DBP). Results: in 46 634 participants (51.7% female; mean [SD] age at death, 82.4 [9.0] years), SBPs and DBPs peaked 18 to 14 years before death and then decreased progressively. Mean changes in SBP from peak values ranged from -8.5 mm Hg (95% CI, -9.4 to -7.7) for those dying aged 60 to 69 years to -22.0 mm Hg (95% CI, -22.6 to -21.4) for those dying at 90 years or older; overall, 64.0% of individuals had SBP changes of greater than -10 mm Hg. Decreases in BP appeared linear from 10 to 3 years before death, with steeper decreases in the last 2 years of life. Decreases in SBP from 10 to 3 years before death were present in individuals not treated with antihypertensive medications, but mean yearly changes were steepest in patients with hypertension (-1.58; 95% CI, -1.56 to -1.60 mm Hg vs -0.70; 95% CI, -0.65 to -0.76 mm Hg), dementia (-1.81; 95% CI, -1.77 to -1.87 mm Hg vs -1.41; 95% CI, -1.38 to -1.43 mm Hg), heart failure (-1.66; 95% CI, -1.62 to -1.69 mm Hg vs -1.37; 95% CI, -1.34 to -1.39 mm Hg), and late-life weight loss. Conclusions and Relevance: Mean SBP and DBP decreased for more than a decade before death in patients dying at 60 years and older. These BP decreases are not simply attributable to age, treatment of hypertension, or better survival without hypertension. Late-life BP decreases may have implications for risk estimation, treatment monitoring, and trial design.
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Atkins JL, Delgado J, Pilling L, Bowman K, Masoli J, Kuchel G, Ferrucci L, Melzer D (2018). Impact of Low Cardiovascular Risk Profiles on Geriatric Outcomes: Evidence from 421,000 Participants in Two Cohorts.
Journals of Gerontology: Medical Sciences Full text.
Zirk-Sadowski J, Masoli JA, Delgado J, Hamilton W, Strain WD, Henley W, Melzer D, Ble A (2018). Proton-Pump Inhibitors and Long-Term Risk of Community-Acquired Pneumonia in Older Adults.
J Am Geriatr Soc,
66(7), 1332-1338.
Abstract:
Proton-Pump Inhibitors and Long-Term Risk of Community-Acquired Pneumonia in Older Adults.
OBJECTIVES: to estimate associations between long-term use of proton pump inhibitors (PPIs) and pneumonia incidence in older adults in primary care. DESIGN: Longitudinal analyses of electronic medical records. SETTING: England PARTICIPANTS: Individuals aged 60 and older in primary care receiving PPIs for 1 year or longer (N=75,050) and age- and sex-matched controls (N=75,050). MEASUREMENTS: Net hazard ratios for pneumonia incidence in Year 2 of treatment were estimated using the prior event rate ratio (PERR), which adjusts for pneumonia incidence differences before initiation of treatment. Inverse probability weighted models adjusted for 78 demographic, disease, medication, and healthcare usage measures. RESULTS: During the second year after initiating treatment, PPIs were associated with greater hazard of incident pneumonia (PERR-adjusted hazard ratio=1.82, 95% confidence interval=1.27-2.54), accounting for pretreatment pneumonia rates. Estimates were similar across age and comorbidity subgroups. Similar results were also obtained from propensity score- and inverse probability-weighted models. CONCLUSION: in a large cohort of older adults in primary care, PPI prescription was associated with greater risk of pneumonia in the second year of treatment. Results were robust across alternative analysis approaches. Controversies about the validity of reported short-term harms of PPIs should not divert attention from potential long-term effects of PPI prescriptions on older adults.
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2017
Stephenson J, Masoli J, Leitch M, Baines R (2017). P-49 ‘Is home where i want to die?’ – prognostication and preferred place of care at the end of life in older hospital inpatients. BMJ Supportive & Palliative Care, 7(Suppl 1), A18.1-A18.
Ble A, Hughes PM, Delgado J, Masoli JA, Bowman K, Zirk-Sadowski J, Mujica Mota RE, Henley WE, Melzer D (2017). Safety and Effectiveness of Statins for Prevention of Recurrent Myocardial Infarction in 12 156 Typical Older Patients: a Quasi-Experimental Study.
J Gerontol a Biol Sci Med Sci,
72(2), 243-250.
Abstract:
Safety and Effectiveness of Statins for Prevention of Recurrent Myocardial Infarction in 12 156 Typical Older Patients: a Quasi-Experimental Study.
BACKGROUND: There is limited evidence on statin risk and effectiveness for patients aged 80+. We estimated risk of recurrent myocardial infarction, muscle-related and other adverse events, and statin-related incremental costs in "real-world" older patients treated with statins versus no statins. METHODS: We used primary care electronic medical records from the UK Clinical Practice Research Datalink. Subhazard ratios (competing risk of death) for myocardial infarction recurrence (primary end point), falls, fractures, ischemic stroke, and dementia, and hazard ratios (Cox) for all-cause mortality were used to compare older (60+) statin users and 1:1 propensity-score-matched controls (n = 12,156). Participants were followed-up for 10 years. RESULTS: Mean age was 76.5±9.2 years; 45.5% were women. Statins were associated with near significant reduction in myocardial infarction recurrence (subhazard ratio = 0.84, 0.69-1.02, p =. 073), with protective effect in the 60-79 age group (0.73, 0.57-0.94) but a nonsignificant result in the 80+ group (1.06, 0.78-1.44; age interaction p =. 094). No significant associations were found for stroke or dementia. Data suggest an increased risk of falls (1.36, 1.17-1.60) and fractures (1.33, 1.04-1.69) in the first 2 years of treatment, particularly in the 80+ group. Treatment was associated with lower all-cause mortality. Statin use was associated with health care cost savings in the 60-79 group but higher costs in the 80+ group. CONCLUSIONS: Estimates of statin effectiveness for the prevention of recurrent myocardial infarction in patients aged 60-79 years were similar to trial results, but more evidence is needed in the older group. There may be an excess of falls and fractures in very old patients, which deserves further investigation.
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2016
correa delgado, masoli, Bowman K, strain, Kuchel G, Walters K, Lafortune L, Brayne C, Melzer D, ble, et al (2016). OUTCOMES OF TREATED HYPERTENSION AT AGES 80 YEARS AND OLDER: COHORT ANALYSIS OF 79,376 PATIENTS.
Journal of the American Geriatrics Society,
65, 995-1003.
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Bowman K, Correa Delgado J, Henley W, Masoli J, Kos K, Brayne C, Thokala P, Lafortune L, Kuchel G, Ble A, et al (2016). Obesity in Older People with and Without Conditions Associated with Weight Loss: Follow-up of 955,000 Primary Care Patients.
J Gerontol a Biol Sci Med Sci Full text.
2015
Ble A, Masoli JAH, Barry HE, Winder RE, Tavakoly B, Henley WE, Kuchel GA, Valderas JM, Melzer D, Richards SH, et al (2015). Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12.
BMC Geriatr,
15Abstract:
Any versus long-term prescribing of high risk medications in older people using 2012 Beers Criteria: results from three cross-sectional samples of primary care records for 2003/4, 2007/8 and 2011/12.
BACKGROUND: High risk medications are commonly prescribed to older US patients. Currently, less is known about high risk medication prescribing in other Western Countries, including the UK. We measured trends and correlates of high risk medication prescribing in a subset of the older UK population (community/institutionalized) to inform harm minimization efforts. METHODS: Three cross-sectional samples from primary care electronic clinical records (UK Clinical Practice Research Datalink, CPRD) in fiscal years 2003/04, 2007/08 and 2011/12 were taken. This yielded a sample of 13,900 people aged 65 years or over from 504 UK general practices. High risk medications were defined by 2012 Beers Criteria adapted for the UK. Using descriptive statistical methods and regression modelling, prevalence of 'any' (drugs prescribed at least once per year) and 'long-term' (drugs prescribed all quarters of year) high risk medication prescribing and correlates were determined. RESULTS: While polypharmacy rates have risen sharply, high risk medication prevalence has remained stable across a decade. A third of older (65+) people are exposed to high risk medications, but only half of the total prevalence was long-term (any = 38.4 % [95 % CI: 36.3, 40.5]; long-term = 17.4 % [15.9, 19.9] in 2011/12). Long-term but not any high risk medication exposure was associated with older ages (85 years or over). Women and people with higher polypharmacy burden were at greater risk of exposure; lower socio-economic status was not associated. Ten drugs/drug classes accounted for most of high risk medication prescribing in 2011/12. CONCLUSIONS: High risk medication prescribing has not increased over time against a background of increasing polypharmacy in the UK. Half of patients receiving high risk medications do so for less than a year. Reducing or optimising the use of a limited number of drugs could dramatically reduce high risk medications in older people. Further research is needed to investigate why the oldest old and women are at greater risk. Interventions to reduce high risk medications may need to target shorter and long-term use separately.
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Melzer D, Tavakoly B, Winder RE, Masoli JAH, Henley WE, Ble A, Richards SH (2015). Much more medicine for the oldest old: trends in UK electronic clinical records.
Age Ageing,
44(1), 46-53.
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Much more medicine for the oldest old: trends in UK electronic clinical records.
BACKGROUND: the oldest old (85+) pose complex medical challenges. Both underdiagnosis and overdiagnosis are claimed in this group. OBJECTIVE: to estimate diagnosis, prescribing and hospital admission prevalence from 2003/4 to 2011/12, to monitor trends in medicalisation. DESIGN AND SETTING: observational study of Clinical Practice Research Datalink (CPRD) electronic medical records from general practice populations (eligible; n = 27,109) with oversampling of the oldest old. METHODS: we identified 18 common diseases and five geriatric syndromes (dizziness, incontinence, skin ulcers, falls and fractures) from Read codes. We counted medications prescribed ≥1 time in all quarters of studied years. RESULTS: there were major increases in recorded prevalence of most conditions in the 85+ group, especially chronic kidney disease (stages 3-5: prevalence
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2014
Masoli J, Winder R, Tavakoly B, Henley W, Ble A, Richards S, Melzer D (2014). 63. OVERDIAGNOSING AND MISSING THE POINT?. Age and Ageing, 43(suppl 2), ii19-ii19.
2013
Butt E, Foster JAH, Keedwell E, Bell JEA, Titball RW, Bhangu A, Michell SL, Sheridan R (2013). Derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with Clostridium difficile infection.
BMC Infect Dis,
13Abstract:
Derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with Clostridium difficile infection.
BACKGROUND: Clostridium difficile infection poses a significant healthcare burden. However, the derivation of a simple, evidence based prediction rule to assist patient management has not yet been described. METHOD: Univariate, multivariate and decision tree procedures were used to deduce a prediction rule from over 186 variables; retrospectively collated from clinical data for 213 patients. The resulting prediction rule was validated on independent data from a cohort of 158 patients described by Bhangu et al. (Colorectal Disease, 12(3):241-246, 2010). RESULTS: Serum albumin levels (g/L) (P = 0.001), respiratory rate (resps /min) (P = 0.002), C-reactive protein (mg/L) (P = 0.034) and white cell count (mcL) (P = 0.049) were predictors of all-cause mortality. Threshold levels of serum albumin ≤ 24.5 g/L, C- reactive protein >228 mg/L, respiratory rate >17 resps/min and white cell count >12 × 10(3) mcL were associated with an increased risk of all-cause mortality. A simple four variable prediction rule was devised based on these threshold levels and when tested on the initial data, yield an area under the curve score of 0.754 (P
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Foster JAH, Carmichael C, Cawston C, Homewood S, Leitch M (2013). PALLIATIVE DISCHARGE TEAM IN OLDER PEOPLE: DO OLDER INPATIENTS WANT TO DIE AT HOME?.
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2012
Foster JAH, Butt JEC, Bell J, Goff A, Morgan C, Hancock J, Carmichael C, Keedwell EC, Michell SLI, Sheridan RP, et al (2012). IMPROVING CLINICAL MANAGEMENT IN CLOSTRIDIUM DIFFICILE: FAECAL CALPROTECTIN DOES NOT PREDICT SEVERITY, RECURRENCE OR MORTALITY.
AGE AND AGEING,
41, 72-72.
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