Marianne Weber gave an update on her research using the 45 and Up Study data at the Sax Institute's 45 and Up Study Collaborators' Meeting. This meeting is an annual event that offers our research partners, supporters and other interested parties the opportunity to receive a comprehensive update on the 45 and Up Study’s progress and updates on research projects that are using the Study resource. The meeting is also an opportunity for researchers, health decision makers and evaluators to engage and discuss the potential for maximising the Study’s value. For more information, visit www.saxinstitute.org.au.

1. 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

2. 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:

3. Correlates of Erectile Dysfunction
Lower urinary tract symptoms
education
prostatectomy
vascular disease
neurological & psychiatric disease
psychological stress
digoxin
income
thyroid disorders
thiazide diurectics
diabetes
urethroplasty
unemployment
psoriasis
disk herniation physical inactivity hypertension
restless leg syndrome
depression metabolic syndrome
obesity
being single
antidepressants
smoking rectal surgery/chemoradiation
cycling
alcohol
haemodialysis

4. 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

5. 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

6. Distribution of ED
How often are you able to get and keep an erection that is
firm enough for satisfactory sexual activity?
35
30
25
%
20
15
10
5
0
32.6
21.2
16.4
17.5
8.9
3.4
Always
(no ED)
Usually
(minimal/episodic
ED)
Sometimes
(moderate ED)
Never
(complete ED)
I would rather not
answer the
question
Missing/Invalid

7. Age, Disease & Lifestyle
Proportion moderate/complete ED Group
Percent (Std Err)
22.3
1.26
1.20-1.33
44.3
1.96
1.87-2.06
62.5
4.08
3.83-4.34
Prostate Cancer
60
Ref
Diabetes
70
1
Co-morbidity
80
23.1
Risk Factors
90
OR* 95% CI
Healthy
100
%
85.1
9.24
8.50-10.05
*Adjusted for
age, education, income, health insurance
status, place of residence, & relationship
status
50
40
30
Healthy men without risk factors (n=15475)
The Healthy of ED increased 11% with
odds men with risk factors (n=34187)
Co-morbidity (n=41381)
every year increase in age.
Diabetes (n=10631)
Prostate Cancer (n=6803)
20
10
0
45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84
85+
85+ vs. 45-49:
OR = 150.8 (126.2-180.3)
Age Group
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)

8. ED: Demographic characteristics

9. ED and morbidity
Minimal Adjustment:
age, education, incom
e, place of
residence, health
insurance
status, relationship
status

10. Lifestyle Risk Factors in 10 year
age strata
All models adjusted for socio-demographic
characteristics and all other lifestyle risk
factors

12. 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

13. Where to next?
„Healthy men last longer‟
• 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!