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‟