BERKELEY, CA (UroToday.com) -
Why are older men with ED not treated?
The prevalence of erectile dysfunction (ED) increases with age. This may seem empirically or intuitively obvious, but the extent and the implications are topics that warrant further consideration. A large sample of anonymous questionnaires completed by males, regardless of age or history of ED, helps to shed light on some of these considerations. The primary finding of this analysis is that the prevalence of ED does indeed increase with age.
Further, our study[1] found that a surprising percentage of those who reported having ED had never discussed it with their provider. Erectile dysfunction is in some instances a vascular condition, with etiology very much like that of atherosclerosis. However, because the penile artery is much narrower than other arteries, a thickening of the arterial wall would have a much greater effect on flow than would the same degree of thickening in a larger artery. As such, the presence of ED may indicate atherogenesis before it becomes evident elsewhere, and should prompt further investigation, even in those patients for whom “it doesn’t matter.” This makes the finding that men who have ED are not discussing it with their healthcare provider a legitimate cause for concern.
The study also found that among those who reported having experienced ED, younger men were more likely to receive treatment for ED. This may be contrasted with previous research, based on medical insurance claims representing 5 million life-years of insured adults, regardless of ED, which indicated that the use of sildenafil was more frequent in younger than older populations.[2]
We ponder why older men are not treated. We offer several hypotheses:
- If they are not even discussing the condition with their health care provider, as we found in our study, then they are obviously not getting treatment.
- The perceived need for treatment or performance may be greater in younger patients.
- Younger patients are more likely to have insurance coverage for PDE 5 inhibitors, whereas Medicare coverage for seniors is limited.
- Younger spouses/partners may drive demand.
Older patients are not often offered a cardiovascular work-up based on a complaint or diagnosis or erectile dysfunction because of conflicting guidelines, time constraints, and reimbursement issues.
This report was part of a larger project examining opinions of men regarding the gender of healthcare providers for the management of ED. The larger project found that most patients did not state a preference, but among those who did, significantly more would prefer to have the condition managed by a male health care provider. The project also looked at a number of other questions, including whether men had an opinion as to whether one gender was better trained to treat ED. Again, most respondents stated that they did not believe there to be a difference; however among those who did believe there was a difference, the majority believed it was males who were better trained. Other questions dealt with opinions regarding “appropriateness” and “comfort;” it may be nearly impossible to change these opinions. However, any perception that men receive better medical education than women is a cause for concern and an area where appropriate interventions may make a difference. One of the more remarkable findings in our study was the response rate to the questionnaire, which was distributed for self-administration in a clinic waiting area. The response rate of 95% indicates that men are willing to discuss this topic, if only they are asked.
References:
- Wagle KC, Carrejo MH, Tan RS. The implications of increasing age on erectile dysfunction. Am J Mens Health. 2012 Jul; 6(4):273-9
- Delate T, Simmons VA, Motheral BR. Patterns of use of sildenafil among commercially insured adults in the United States: 1998-2002. Int J Impot Res. 2004 Aug;16(4):313-8.
Written by:
Robert S. Tan, MD and Maurita H. Carrejo, MS as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Michael DeBakey VAMC
Opal Medical Clinic
Baylor College of Medicine
University of Texas, USA
The implications of increasing age on erectile dysfunction - Abstract
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