Few data are available examining the determinants of vitamin D status exclusively in older adults. We aimed to investigate the prevalence and determinants of vitamin D deficiency in a representative sample of the older Irish population (aged 50–98 years). The concentration of 25-hydroxyvitamin D (25(OH)D) was measured in 5,356 community-dwelling older Irish adults from The Irish Longitudinal Study on Ageing (TILDA). Detailed demographic, geographic, lifestyle, and socioeconomic factors were assessed by questionnaire. Proportions of deficiency prevalence were generated by season sampled. Linear regression was used to investigate the association between 25(OH)D concentration and reported risk factors. The prevalence of deficiency (25(OH)D < 30 nmol/L) was 13.1% (95% CI: 12.1–14.2). Deficiency status was more prevalent in nonsupplement users, in winter, in smokers, in obese adults, the physically inactive, those living alone, and in the oldest old (>80 years). The main predictors (p < .05) of 25(OH)D concentration were supplement use (coefficient nmol/L: 27.2 [95% CI: 15.3–39.2]), smoking (−8.9 [−12.6–−5.2]), summer season (5.9 [2.7–9.1]), and obesity (−4.0 [−6.3–−1.7]). Vitamin D deficiency is common among older Irish adults. These data indicate the need for targeted strategies within sections of the older population to improve vitamin D status.

The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that treating adults 75 years of age or older with hypertension to reach a systolic blood pressure target of less than 120 mm Hg compared with a systolic blood pressure target of less than 140 mm Hg reduced the numbers of cardiovascular events and death without a significant increase in the number of injurious falls or syncope.¹ However, prior to the adoption of an intensive strategy to lower systolic blood pressure in the oldest segment of the population, it is prudent to determine if individuals meeting inclusion criteria for SPRINT outside the clinical trial context are similar to trial participants, especially with regard to risk for adverse outcomes. We used The Irish Longitudinal Study on Ageing^2,3 (TILDA) to compare baseline rates of injurious falls and syncope in community-dwelling older adults with the rates in the standard care group of SPRINT.

The objective is to understand what really drives prescription expenditure at the end of life in order to inform future expenditure projections and service planning. To achieve this objective an empirical analysis of public medication expenditure on the older population (individuals ≥ 70 years of age) in Ireland (n = 231,780) was undertaken. A two part model is used to analysis the individual effects of age, proximity to death (PTD) and morbidity using individual patient-level data from administrative pharmacy records for 2006-2009 covering the population of community medication users. Decedents (n = 14,084) consistently use more medications and incur larger expenditures than similar survivors, especially in the last 6 months of life. The data show a positive and statistically significant impact of PTD on prescribing expenditures with minimal effect for age alone even accounting for patient morbidities. Nevertheless improved measures of morbidity are required to fully test the hypothesis that age and PTD are proxies for morbidity. The evidence presented refutes age as a driver of prescription expenditure and highlights the importance of accounting for mortality in future expenditure projections.

There is extensive empirical evidence that personality is associated with many outcomes and behaviours, such as educational outcomes, labour market participation, savings behaviour, health behaviours, physical health status and mortality. Use of preventive healthcare services (e.g., vaccinations, screening, etc.) is a potential pathway explaining the link between personality and health, and is an important component of healthy ageing. We examine the association between personality traits (the 'Big Five') and a variety of preventive healthcare utilisation measures in the older population. Using data from the Irish Longitudinal Study on Ageing (TILDA), we estimate Poisson models of preventive healthcare utilisation (influenza vaccination, blood cholesterol test, breast lump check, mammogram, prostate examination, prostate-specific antigen (PSA) test). We find that openness to experience is a significant predictor of breast lump check and mammogram in women aged 65+ after adjustment for other confounders and multiple hypothesis testing. While uptake of many preventive healthcare services remains below national recommendations for the older population, with the exception of breast lump checks and mammograms for women aged 65+, we find little evidence to link this heterogeneity in uptake to personality.

Background: Substantial increases in UK consulting rates, mean consultation duration, and clinical workload were observed between 2007 and 2014. To the authors’ knowledge, no analysis of more recent trends in clinical workload has been published to date. This study updates and builds on previous research, identifying underlying changes in population morbidity levels affecting demand for primary health care.Aim: To describe the changes in clinical workload in UK primary care since 2005.Design and setting: Retrospective cohort study using GP primary care electronic health records data from 824 UK general practices.Method: Over 500 million anonymised electronic health records were obtained from IQVIA Medical Research Data to examine consulting rates with GPs and practice nurses together with the duration of these consultations to determine total patient-level workload per person–year.Results: Age-standardised mean GP direct (face-to-face and telephone) consulting rates fell steadily by 2.0% a year from 2014 to 2019. Between 2005 and 2019 mean GP direct consulting rates fell by 5.8% overall whereas mean workload per person–year increased by 25.8%, owing in part to a 36.9% increase in mean consultation duration. Indirect GP workload almost tripled over the 15 years, contributing to a 48.3% increase in overall clinical workload per person–year. The proportion of the study population with ≥3 serious chronic conditions increased from 9.7% to 16.1%, accounting for over a third of total clinical workload in 2019.Conclusion: Findings show sustained increases in consulting rates, consultation duration, and clinical workload until 2014. From 2015, however, rising demand for health care and a larger administrative workload have led to capacity constraints as the system nears saturation.