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Articles by R Hubbard
Total Records ( 3 ) for R Hubbard
  J Gribbin , R Hubbard , J. R. F Gladman , C Smith and S. Lewis

Background: antihypertensive medications have long been implicated as a potential cause of falls in older people but, despite their widespread prescribing, the size of class-specific adverse effects remains unclear.

Aim: to determine the role of antihypertensive medications in older people with a recorded fall in primary care.

Design: case–control study.

Setting: UK general practices contributing data to The Health Improvement Network primary care database.

Methods: patients over 60 years of age with a first fall recorded between 2003 and 2006 were selected, and up to six controls per case matched by age, gender and general practice. We used conditional logistic regression to estimate odds ratios for ever exposure, and current/previous exposure to the main classes of antihypertensives, adjusting for co-morbidity. We also examined the effect of the time interval from first prescription to first fall.

Results: amongst our 9,682 cases, we found an increased risk of current prescribing of thiazides (odds ratio (OR) 1.25; 95% confidence interval 1.15–1.36). At 3 weeks after first prescribing the risk remained 4.28 (1.19–15.42). We found a reduced risk for current prescribing of beta blockers (OR 0.90; 0.85–0.96). There was no significant association with current prescribing of any other class of antihypertensive.

Conclusions: the study provides evidence that current prescribing of thiazides is associated with an increased risk of falling and that this is strongest in the 3 weeks following the first prescription.

  S. M Shah , I. M Carey , T Harris , S DeWilde , R Hubbard , S Lewis and D. G. Cook

Objectives: to enhance identification of older nursing and residential home residents in a national sample and describe their chronic disease prevalence.

Design: cross-sectional analysis of an established primary care database (The Health Improvement Network).

Setting: 326 English and Welsh general practices.

Subjects: 435,568 patients aged ≥ 65. Care home residents were identified by either a Read code for care home residence or multiple care home residence markers (postcode linkage, household size identifier and location of consultation).

Comparisons: nursing and residential home residents were compared with a community control group with no markers of care home residence using age and sex standardised chronic disease prevalence ratios.

Main outcome measures: chronic disease prevalence using definitions from the national primary care contract.

Results: 11,547 (2.7%) older people were identified as care home residents, of whom only 4,403 (38.1%) were directly identified by their primary care record. Mean age for nursing and residential homes was 84.9 and 86.1 years compared to 74.7 for controls. Prevalence ratios for dementia were 14.8 (95% CI 13.4–16.4) for nursing and 13.5 (12.4–14.8) for residential homes compared to controls. Stroke and severe mental illness were commoner in nursing and residential homes but hypertension, respiratory and cancer diagnoses were slightly less common. Recorded disease prevalences in nursing and residential homes were similar.

Conclusions: recording of care home residence is limited in primary care and this is a barrier to routine monitoring of this group. Higher dementia and stroke prevalence in care home residents confirms high clinical need, but the small differences in disease prevalence between nursing and residential homes have implications for delivering medical and nursing care to residential homes. Lower prevalence of some chronic diseases suggests incomplete recording or case finding. Routine flagging of care home residents in health care systems is a potential tool for improving monitoring and outcomes.

  J Gribbin , R Hubbard , C Smith , J Gladman and S. Lewis

Background: Despite the role of primary care in the falls care pathway, there are almost no data on the extent of falls seen in general practices.

Aim: To quantify the incidence and mortality of falls amongst older people in primary care in the UK.

Methods: Cohort study of people aged >=60 years and registered in a UK practice contributing data to The Health Improvement Network primary care database (THIN) throughout 2003–06. Analysis of crude incidence and estimation of incidence rate ratios using negative binomial regression, and survival using Cox regression. Sensitivity analysis of criteria for distinguishing discrete fall events from follow-up appointments.

Results: Amongst people aged >=60 years the overall crude incidence rate of recorded falls was 3.58/100 person-years (95% CI 3.56–3.61). The rate of recurrent falls was 0.67/100 person-years (95% CI 0.66–0.68). The incidence rate of recorded falls and recurrent falls was higher in older age groups, in women and least advantaged social groups. Incidence of recorded falls was constant through the time period 2003–06. Mortality for recurrent fallers was about twice that of general population controls.

Conclusions: These data suggest that more than 475 000 fall events in older people are recorded in general practice each year in the UK, and are associated with increased mortality and relative deprivation. The underlying incidence rate has remained stable in recent years.

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