More adults in England are avoiding alcohol-what's behind the trend?

Polly Bhambra explains how to tackle decay rates amongst adults in England.

Seeking evidence of intersectional effects in emergency hospital readmissions of adults in England (2016-2019).

Cost-effectiveness and return on investment of 20-valent pneumococcal conjugate vaccine use among adults in England: analysis from the societal perspective.

Objective To examine how variation in clinical coding systems and the number of conditions included under different study criteria influence estimates of multimorbidity prevalence in a nationally representative adult population in England. Methods and analysis We conducted a cross-sectional analysis of anonymised records from 7.2 million adults in the Clinical Practice Research Datalink, linked to Hospital Episode Statistics, covering the period from 1987 to 2020. Adults were included if they had at least two recorded health conditions. Multimorbidity was defined as ≥2 health conditions selected from a list of 54 conditions. Prevalence was estimated separately using general practice (GP) data, hospital data and combined sources, and stratified by age, sex, ethnicity and deprivation. A stepwise inclusion approach assessed the impact of expanding the number of conditions included after different study criteria. Gradient boosting (XGBoost) with Shapley Additive Explanations values identified predictors of multimorbidity recorded only in GP data. Directionality was examined using Pearson correlations. Results Multimorbidity prevalence was 92.3% using GP data, 63.2% using hospital data and 100% when both sources were combined. Prevalence increased consistently as more conditions were included under different study criteria and was always higher in GP data. Discrepancies were most pronounced among younger adults and ethnic minority groups. GP-only coding was associated with younger age, female sex, shorter hospital stays, absence of Accident & Emergency use, no palliative care coding and lower deprivation. Conclusion Estimates of multimorbidity prevalence are highly sensitive to both the clinical coding system used and the number of conditions included under different study criteria. Standardised approaches to condition selection and the integration of data sources are essential to ensure accurate measurement and equitable representation.

ABSTRACTDisease control measures during the COVID‐19 pandemic may have intensified loneliness among older adults, though experiences varied based on individual vulnerabilities and resources. This study examines loneliness trajectories among older adults using the English Longitudinal Study of Ageing, spanning four waves: two pre‐pandemic (Wave 8: 2016–2017; Wave 9: 2018–2019) and two COVID‐19 substudies (June–July and November–December 2020). The sample included 4492 respondents (17,968 observations). Latent class growth analysis identified four loneliness trajectories: ‘not lonely’ (73.5%), ‘pandemic loneliness’ (12.7%), ‘transitioned out of loneliness’ (6.9%) and ‘enduring loneliness’ (6.8%). Multinomial regression analysis explored predictors of trajectory membership. Younger age (50–74), being female, depression, COVID‐related worries and disrupted daily routines increased the likelihood of belonging to ‘pandemic loneliness’ rather than ‘not lonely’. Optimism and strong partner support increased the likelihood of remaining ‘not lonely’ or transitioning out of loneliness. The pandemic's unintended effects, including routine disruptions and financial concerns, heightened loneliness risks, whereas psychosocial resources provided critical resilience. To prepare for future public health crises, policies should strengthen mental health support, promote social and economic stability and enhance social connection and resilience. Addressing psychosocial factors is essential to reducing loneliness and protecting older adults' well‐being during and beyond periods of crisis.

Cultural differences in autonomy, social contacts, and sensory function for depression: A cross-national network analysis of older adults in England and South Korea.

Commissioning of 'joint care' across teenage and young adult (TYA) principal treatment centres (PTC) and regional designated hospitals was introduced to enable cancer care closer to home, while providing support through the TYA multidisciplinary team. We aimed to explore the processes being used to enable inter-organisational collaboration under joint care models through rapid ethnography. Healthcare professionals in TYA PTCs in England and Wales between June 2022 and December 2023 were identified by the TYA lead in each PTC as delivering TYA cancer care. Semi-structured interviews were conducted virtually or by telephone based on the structuration model of collaboration proposed by D'Amour. Data were analysed against the model through framework analysis. Our study highlighted variation across the different dimensions of inter-organisational collaboration. We found that healthcare professionals delivering TYA cancer care were working toward a shared goal but this was not always achieved. Social interaction between professionals was required to develop relationships and trust, but opportunities for social interaction were not regularly available. Processes for sharing information were not streamlined, so there were instances when information could not be shared between organisations. Interventions to achieve coordinated care, such as an outreach team, supported the delivery of joint care but these were not available in every region. While there were some levels of leadership within aspects of services, there were limited examples nationally or across geographical regions, which hindered the development of coordinated care. Coordination of care is mostly developing; however, the shared vision and goals dimension did achieve full active collaboration. The implementation of a service specification will address regional leadership requirements, but resources are required to extend the delivery of interventions to support coordination and collaboration, allowing the commissioned model of care to be delivered safely.

EE612 Potential Public Health Benefits of Recombinant Influenza Vaccines in Older Adults in England and Wales

Abstract Older adults are among the most vulnerable to the effects of climate change, yet their perspectives, behaviours, and potential contributions to climate action remain underexplored. This symposium brings together new research on attitudes, motivations, and engagement with climate change among older adults, offering insights into how this growing demographic perceives climate risks and contributes to environmental sustainability. The session will open with findings from the English Longitudinal Study of Ageing (ELSA), highlighting distinct attitudes towards climate change risk among older adults in England and their demographic, social, and economic correlates. Next, we explore eco-generativity, how exposure to nature fosters both social and environmental responsibility, and its implications for promoting pro-environmental behaviours across the lifespan. We then turn to older climate activists, examining the key motivational pathways driving their engagement and the role of social connections, emotional ties to nature, and lifelong learning in sustaining their activism. A comparative study of older adults in Italy and Sweden further contextualises these themes, shedding light on the interplay between environmental attitudes, generational responsibilities, and activism. Finally, we present a new set of validated measures designed to assess climate knowledge, concerns, and actions among older adults, providing tools to better integrate climate change into ageing research and policy. By weaving together these diverse yet complementary perspectives, this symposium advances our understanding of older adults as active agents in climate resilience and sustainability, challenging assumptions of disengagement and highlighting strategies to enhance their involvement in environmental action. Climate and Aging Interest Group Sponsored Symposium

Are there differences in gradual versus abrupt smoking cessation quit attempts and success by social grade? A population study in England.

ABSTRACTIntroductionFeelings of guilt and remorse after drinking alcohol may act as barriers to seeking support. This study aimed to estimate the prevalence and frequency of such feelings among adults in England who drink at increasing and higher‐risk levels, and differences by socio‐demographic and drinking subgroups.MethodsWe analysed data from 40,708 adults (≥ 18 years) who drink at increasing and higher‐risk levels (AUDIT‐C score ≥ 5) from a monthly cross‐sectional survey in England from 2014 to 2022. Feelings of guilt and remorse after drinking in the past 6 months were assessed using the AUDIT. Logistic regression models were used to examine associations with socio‐demographic characteristics, alcohol consumption and harm to oneself or others as a result of drinking.ResultsOverall, 13.3% (95% CI 12.9%–13.6%) reported experiencing feelings of guilt or remorse after drinking in the past 6 months. Among those who reported such feelings, 95.3% (95% CI 91.4%–94.9%) experienced them less than once a month. The prevalence of guilt and remorse increased non‐linearly with higher AUDIT‐C scores from 9.3% (95% CI 8.8%–9.9%) among those drinking at the lightest levels within the increasing/higher‐risk range [AUDIT‐C = 5] to 20.9% (95% CI 17.2%–24.8%) among the heaviest [AUDIT‐C = 12]. After adjusting for alcohol consumption and alcohol‐related injury, these feelings were more common among women (aOR 1.38; 95% CI 1.31–1.46) and people from more advantaged social grades (aOR 1.27; 95% CI 1.20–1.36), and much less common among older than younger adults (e.g., ≥ 65 vs. 16–24 years: aOR 0.23; 95% CI 0.20–0.26).Discussion and ConclusionsIn England, around one in eight adults who drink at increasing and higher‐risk levels report experiencing guilt or remorse after drinking. These feelings are more common in women, younger adults and those of a more advantaged social grade.

To assess the relationship between common mental disorder and oral health in a representative sample of older adults in England. We analyzed cross-sectional data from 8620 individuals aged 50 years and over who participated in the English Longitudinal Study of Ageing, wave 3 (2006-2007). Common mental disorder (no/yes) was assessed using the 12-Item General Health Questionnaire (GHQ-12). Oral health outcomes were oral impact on daily performance (no impacts/at least one impact), self-rated oral health (excellent; very good; good/fair; poor), and edentulousness (dentate/edentate). Associations were assessed using Poisson regression with robust variance, controlling for demographic, socioeconomic, and health factors. Reporting at least one oral impact on daily performance was more prevalent among those with a common mental disorder than those without (PR = 1.60; 95% CI 1.32-1.96), as was reporting fair/poor self-rated oral health (PR = 1.23; 95% CI 1.09-1.40) in fully adjusted analyses. We found no association between common mental disorder and edentulousness. In this sample of UK older adults, common mental disorder was associated with poorer oral health. To promote healthy ageing, older adults with a common mental disorder should be supported to maintain good oral health.

Objectives: The aim of this study was to examine the association between social support and functional dentition among older adults in England. Methods: A cross-sectional analysis was conducted using data from Wave 7 (2014/15) of the English Longitudinal Study of Ageing (ELSA). Functional dentition, defined as having 20 or more natural teeth was the outcome. Positive and negative social support scores were included as exposures. Smoking and socioeconomic factors were included as covariates. Poisson regression models with robust variance estimators were used to estimate prevalence ratios (PRs) for functional dentition, adjusting sequentially for demographic, socioeconomic, and behavioural factors. Results: A total of 6457 participants were included. Most participants in the sample were female, white, had less than O-Level education, were in higher wealth groups, had never smoked, and reported having functional dentition. The majority reported higher levels of positive social support and lower levels of negative social support. In the fully adjusted Poisson model, each one-point increase in positive social support score was associated with a 1% higher prevalence of functional dentition (PR = 1.01, 95% CI: 1.01–1.01), while negative social support was not significantly associated with functional dentition after adjustment. Conclusions: Positive social support was significantly associated with maintaining functional dentition among older English adults, independent of socioeconomic and behavioural factors. However, as this study was cross-sectional and based on self-reported data, causal relationships cannot be inferred. Interventions in community and healthcare settings that encourage social engagement, reduce isolation, and integrate oral health promotion within wider social care strategies may contribute to preserving functional dentition and reducing oral health inequalities. Future research should explore how these relationships evolve across the life course and interact with behavioural and socioeconomic determinants of health.

AimTo evaluate the association between the presence or absence of comorbid mental health disorders and the risk of asthma exacerbations in adults with prevalent asthma.MethodsThis was a cohort study of adults in England with prevalent asthma and mental health disorders (depression, anxiety, bipolar disorder and schizophrenia) between 2017 and 2019 using primary care electronic healthcare records.Adult asthma patients with mental health disorders (exposed) were matched by age, sex, ethnicity and general practice to asthma patients without a mental health disorder (unexposed) in a 1:1 ratio. The primary outcome was an exacerbation of asthma documented in primary care records. Poisson regression was used to estimate adjusted incidence rate ratios (IRR).Results873 482 adults with asthma were followed up for a total of 1 580 157 years.Mean age was 49 years; 66% were female, and 78% were white. Adults with asthma and any mental health disorder had an asthma exacerbation incidence rate of 56 per 1000 person years compared with 34 per 1000 person years for those without a mental health disorder.Adults with asthma and any mental health disorder had an adjusted IRR of 1.46 (95% CI 1.44 to 1.48) compared with matched controls. The highest IRR was in those with depression (IRR 1.34, 95% CI 1.32 to 1.37), followed by those with anxiety (IRR 1.20, 95% CI 1.18 to 1.22). There were no significant differences in patients with bipolar disorder or schizophrenia compared with matched controls (IRR 1.00, 95%CI 0.93 to 1.07; and 1.03, 95% CI 0.95 to 1.11, respectively).ConclusionThis study shows a significant increased risk of asthma exacerbations in asthma patients with depression or anxiety compared with those with asthma without comorbid mental health disorders.

ObjectivesWe compared associations between self-reported and HearCheck screening device measures of hearing difficulty with subsequent general and domain-specific cognitive function in a population-based sample of older English adults.DesignObservational cohort study.SettingPopulation-based sample of older adults in wave 7 of the English Longitudinal Study of Ageing (ELSA) in 2014/15 and its Healthy Cognitive Ageing Project (HCAP) in 2018.ParticipantsN=1119 adults aged ≥62 years.Primary outcome measuresFactor scores for general cognitive function and domains of memory, language, orientation and executive function were derived from the HCAP neuropsychological test battery (mean of 0 and SD of 1 for each). Hearing difficulty was assessed using a self-reported 5-point Likert-type scale and the HearCheck screening device, which administered a series of six tones in each ear.ResultsAccording to the HearCheck device, 48% of participants had a mild or moderate-to-severe hearing difficulty, while 25% self-reported fair or poor hearing. In multivariable-adjusted, population-weighted linear regression models, hearing difficulty identified via HearCheck was associated with worse general cognitive function (β=−0.34 SD units; 95% CI −0.60 to –0.07 for moderate-to-severe hearing difficulty vs good hearing) as well as worse function in domains of memory, language and executive function, each with a dose-response relationship. Self-reported hearing difficulty was not associated with general or domain-specific cognitive function.ConclusionsPeripheral hearing ability, as captured by the HearCheck screening device, may have stronger relevance for later-life cognitive outcomes than the broader construct of perceived hearing difficulty in one’s daily environment that is captured by a self-reported measure.

Are anxious Mondays associated with HPA-axis dysregulation? A longitudinal study of older adults in England.

Various key events characterise experiences in later life, such as retirement, bereavement, caregiving, developing long-term conditions and hospital admission. Given their potential to disrupt lives, such events may affect older people's mental health, but research on the associations between such events and depression has produced inconsistent findings. To investigate the impact of key events in later life on depression trajectories in a representative cohort of people aged 50-69 in England. Our sample draws on 6890 respondents aged 50-69 in Wave 1 (2002/2003) of the English Longitudinal Study of Ageing, following them through to Wave 9 (2018/2019). We measured depression using the eight-item Center for Epidemiological Studies Depression scale. Later life events included retirement, spouse/partner death, becoming an unpaid caregiver, developing a limiting long-term illness and hospital admissions because of a fall or non-fall causes. Piecewise mixed-effects logistic regression models tested for changes in the trajectories of depression before and after each event. Statistically significant improvements in the trajectory of depression were observed following spousal bereavement, one's own retirement and hospital admission because of causes other than falls, with reductions in the odds of depression of 48% (odds ratio: 0.52 (95% CI: 0.44-0.61)), 15% (0.85 (0.78-0.92)) and 4% (0.96 (0.94-0.99)), respectively. No changes were associated with developing a limiting long-term illness, becoming an unpaid caregiver or following spousal retirement or a hospital admission because of a fall. The findings highlight the relative resilience among older adults in England in terms of depression following key later life events. There is still a role to play in delivering mental health support for older people following such events, particularly by improving the identification of those at risk of certain events as part of a broader strategy of prevention. Findings also underscore the importance of partner/spousal circumstances on individual mental health.

Health literacy: Reducing inequalities in healthcare access through improving the readability of healthcare material in the Northeast of England-a qualitative evaluation.

BackgroundExperience of racism is considered a predictor of ill health and poor well-being at all ages. Few studies examining the relationship between racism, mental health and self-harm are longitudinal. The aim of this study was to examine these associations longitudinally among youth in England.MethodsThe data were obtained from the Next Steps Longitudinal Study on participants born in 1989–1990 in England. Waves 4 (2007) and 8 (2015) were used to measure associations between experiencing racism at age 17 and mental health outcomes at age 25. Logistic regression analyses were conducted. Multiple imputation was used to address missing data.FindingsCompared with those who did not experience racism, participants who experienced racism at 17 years scored 0.58 (95% CI 0.16 to 1.00) points higher in psychological distress (General Health Questionnaire-12) at age 25. No clear associations were found for overall life satisfaction (OR 1.06, 95% CI 0.85 to 1.34, p=0.597), self-harm (OR 0.79, 95% CI 0.40 to 1.56, p=0.494) or longstanding mental illness (OR 1.31, 95% CI 0.80 to 2.13, p=0.280).ConclusionExposure to racism at youth increased the risk of psychological distress, but not life satisfaction, self-harm or longstanding mental illnesses for young adults in England. Ongoing and future longitudinal studies exploring racism and mental health should incorporate electronic health records and validated measures of racism to better understand its effects on mental health across the life course.