Age-related patterns of erectile
dysfunction among older men
Marianne Weber, David Smith, Dianne O’Connell, Manish Patel,
Paul de Souza, Freddy Sitas, Emily Banks
45 and Up Study Annual Collaborator’s Meeting, 11th October, 2013
Med J Aust 2013, 199:107-111
Erectile Dysfunction (ED)
• The first major community-based study
on ED was the Massachusetts Male
Aging Study (1987 – 89)
• This study yielded, for the first time, an
understandable concept of ED which
could be captured in a single question:
Correlates of Erectile Dysfunction
being single
income
unemployment
education
diabetes
vascular disease
hypertensionphysical inactivity
depression
neurological & psychiatric disease
thyroid disorders
metabolic syndrome
haemodialysis
Lower urinary tract symptomsprostatectomy
urethroplasty
smoking
antidepressants
thiazide diurectics
digoxin
rectal surgery/chemoradiation
cycling alcohol
obesity
psychological stress
psoriasis
disk herniation
restless leg syndrome
ED and Cancer??
• ED is important to understand in relation to
treatment outcomes for prostate cancer
• Around 75% of men are impotent after treatment
with radical prostatectomy
• Treatment? Or Active surveillance?
• The 45 and Up Study provided a way of “bench
marking” ED in terms of age, co-morbid
conditions and lifestyle
Analyses
• Unconditional logistic regression
was used to estimate the odds
ratios of complete/moderate ED
(vs. no/minimal) in relation to
demographic, health, and lifestyle
characteristics
• A focus on lifestyle factors within
10 year age strata
Distribution of ED
32.6 21.2 16.4 17.5 8.9 3.40
5
10
15
20
25
30
35
Always(no ED)
Usually(minimal/episodic
ED)
Sometimes(moderate ED)
Never(complete ED)
I would rather not answer the
question
Missing/Invalid
%
How often are you able to get and keep an erection that is firm enough for satisfactory sexual activity?
0
10
20
30
40
50
60
70
80
90
100
45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Pe
rce
nt
(Std
Err
)
Age Group
Proportion moderate/complete ED
Healthy men without risk factors (n=15475)
Healthy men with risk factors (n=34187)
Co-morbidity (n=41381)
Diabetes (n=10631)
Prostate Cancer (n=6803)
*Adjusted for
age, education, income, health insurance
status, place of residence, & relationship
status
Age, Disease & Lifestyle
Group % OR* 95% CI
Healthy 23.1 1 Ref
Risk Factors 22.3 1.26 1.20-1.33
Co-morbidity 44.3 1.96 1.87-2.06
Diabetes 62.5 4.08 3.83-4.34
Prostate Cancer 85.1 9.24 8.50-10.05
Co-morbidity: heart disease, stroke, Parkinson‟s disease, asthma, high blood pressure, high
blood cholesterol, osteoporosis, depression, anxiety, thyroid problems, arthritis, blood
clotting problems, cancer (not prostate)
The odds of ED increased 11% with
every year increase in age.
85+ vs. 45-49:
OR = 150.8 (126.2-180.3)
ED: Demographic characteristics
ED and morbidity
Minimal Adjustment:
age, education, incom
e, place of
residence, health
insurance
status, relationship
status
Lifestyle Risk Factors in 10 year
age strata
All models adjusted for socio-demographic
characteristics and all other lifestyle risk
factors
Conclusions
• Age is the largest independent risk factor for ED
– The odds of severe/moderate ED increased by 11% with every year
increase in age
• Lifestyle beneficial up to a point
– Physical activity seemed to be effective at all ages
• Results very similar to other population-based
studies in Australia
Where to next?
• Brochure for GPs
• prescribe appropriate treatments and monitor heart health
• prevent the use of „quick-fix‟ companies offering unproven
and costly alternatives
• Infographic
• perceived sexual inadequacy among younger men could be
a powerful tool to motivate them to stop smoking, lose
some weight and exercise regularly – for a longer lasting,
cancer-free life!
„Healthy men last longer‟
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