Late-life and life history predictors of older adults' high-risk alcohol consumption and drinking problems

AIMS

This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85.

DESIGN, SETTING, PARTICIPANTS

A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later.

MEASUREMENTS

At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking.

RESULTS

Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems.

CONCLUSION

Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Social and financial resources and high-risk alcohol consumption among older adults

BACKGROUND

This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life.

METHOD

A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption.

RESULTS

Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members.

CONCLUSIONS

These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

Older adults' health and late-life drinking patterns: a 20-year perspective

OBJECTIVES

This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems.

METHODS

A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later.

RESULTS

Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems.

CONCLUSION

Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective

AIMS

The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. DESIGN, PARTICIPANTS AND MEASURES: A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.

FINDINGS

The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75-85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.

CONCLUSIONS

A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.

Depressive symptoms, drinking problems, and smoking cessation in older smokers

This study modeled the predictive association between depressive symptoms and smoking cessation in a sample of 442 late-middle-aged smokers; assessments occurred at four time-points across a 10-year period. In addition, the study examined the role of baseline drinking problems in moderating the relationship between depressive symptoms and smoking cessation. Findings supported hypotheses. More depressive symptoms prospectively predicted a lower likelihood of smoking cessation. In addition, the presence of baseline drinking problems strengthened the relationship between depressive symptoms and a lower likelihood of smoking cessation. Understanding the mechanisms underlying depression and cigarette smoking among older adults is applicable to secondary prevention and treatment and suggests additional public health benefits from treating depression in older persons.

Treated and untreated remission from problem drinking in late life: post-remission functioning and health-related quality of life

OBJECTIVE

To evaluate the post-remission status of older remitted problem drinkers who achieved stable remission without treatment.

METHOD

The post-remission drinking behavior, health-related functioning, life context, coping, and help-seeking of older, untreated (n=330) and treated (n=120) former problem drinkers who had been remitted for a minimum of 6 years were compared twice over the course of 6 years to each other and to lifetime nonproblem drinkers (n=232). Analyses considered the impact of severity of drinking problem history.

RESULTS

Untreated remitters were more likely than treated remitters to continue to drink, exhibited fewer chronic health problems and less depressive symptomatology, and were less likely to smoke. Untreated remitters' life contexts were somewhat more benign than those of treated ones, and they were less likely to describe a coping motive for drinking and engage in post-remission help-seeking. Although untreated remitters more closely resembled lifetime nonproblem drinkers than did treated remitters, both untreated and treated remitter groups exhibited worse health-related functioning, more financial and interpersonal stressors, and more post-remission help-seeking than did lifetime nonproblem drinkers.

CONCLUSIONS

Regardless of whether late-life remission was gained without or with treatment, prior drinking problems conveyed a legacy of health-related and life context deficits.

Gender differences in social influences and stressors linked to increased drinking

OBJECTIVE

To explore reasons for gender differences in problem-drinking prevalence and to compare the experiences of problem-drinking women and men, this article examines gender differences in exposure and drinking reactivity to social influences and stressors during adulthood.

METHOD

A community sample of 831 older adults (347 women and 484 men; average age=69), comprising problem and nonproblem drinkers, provided information about their drinking histories. Respondents indicated whether they had experienced particular social influences and stressors during adulthood (exposure) and, if so, whether they had increased alcohol consumption in response (reactivity).

RESULTS

Overall, women were more likely than men to report exposure to a partner's drinking, family interpersonal problems, death of someone close, and emotional distress. Men reported more exposure to peers' drinking and workplace problems and were more likely to report drinking reactivity to social influences and stressors. Among problem drinkers, gender differences in exposure to social influences and stressors paralleled those in the overall sample, but gender differences in reactivity were minimal.

CONCLUSIONS

Gender differences in exposure to social influences and stressors generally do not help explain men's higher problem-drinking prevalence, but men's overall greater drinking reactivity corresponds with their propensity to develop problem drinking. Problem-drinking women and men tend to be exposed to somewhat different social influences and stressors but share a tendency to respond to these experiences with increased drinking. Information about experiences that may place upward pressure on drinking for men and women can inform efforts to prevent and treat alcohol-use disorders.

Upward Pressures on Drinking: Exposure and Reactivity in Adulthood

OBJECTIVE

The purpose of this study was to identify the situations most commonly linked with increased drinking for different life periods and for nonproblem and problem drinkers.

METHOD

A community sample of older adults (average age 69 years; 42% women), consisting of 480 nonproblem and 351 problem drinkers, provided information about their life history of drinking. For each of three life periods (early adulthood, early middle age, and late middle age), respondents indicated whether they experienced particular situations (exposure) and, if so, whether they increased their alcohol consumption in response to these situations (reactivity). These situations included social influences and stressors.

RESULTS

Exposure to social influences and to stressors varied across life periods, as did drinking reactivity. Overall, the social influences of having peers or a partner who drank and the stressors of family interpersonal problems and emotional distress were common experiences and also were among the most likely to be linked with increased alcohol consumption. Compared with nonproblem drinkers, problem drinkers reported significantly higher levels of exposure to social influences and to stressors and also were much more reactive to them.

CONCLUSIONS

Prevention and treatment of alcohol use disorders can be tailored to take into account variations in exposure and reactivity to situations that may place upward pressure on drinking.

Long-Term Patterns and Predictors of Successful Stressor Resolution in Later Life

At 1 year, 4 years, and 10 years after baseline, late-middle-aged adults reported whether they had successfully resolved their most important stressor of the past year. Compared to individuals who never resolved focal stressors over the 10-year interval, those who always did consistently showed less negative stressor appraisal, less reliance on avoidance coping, and less use of exploratory relative to directed coping responses, independent of type and severity of focal stressor. Less use of exploratory relative to directed coping and having more social resources, fewer health problems, and fewer depressive symptoms at baseline predicted more stressor resolution over the next 10 years. These predictors are promising foci for prospective efforts to optimize ways in which aging adults manage late-life stressors.

Older adults' coping with negative life events: common processes of managing health, interpersonal, and financial/work stressors

This study examined how older adults cope with negative life events in health, interpersonal, and financial/work domains and whether common stress and coping processes hold across these three domains. On three occasions, older adults identified the most severe negative event they faced in the last year and described how they appraised and coped with that event, their ambient chronic stressors, and event and functioning outcomes. The stress and coping process was largely consistent across the three life domains. Individuals who appraised events as challenging and relied more on approach coping were more likely to report some benefit from those events. Individuals who experienced more chronic stressors and favored avoidance coping were more likely to be depressed and to have late-life drinking problems. Chronic stressors, as well as approach and avoidance coping, were predictably associated with overall outcomes in all three event domains. These findings provide a basis for preventive interventions that may help older adults' address the most prevalent stressors of aging more effectively.

Predictors of Untreated Remission From Late-Life Drinking Problems

OBJECTIVE

Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally", without formal treatment. We sought to describe the life history predictors of untreated remission among older adults.

METHOD

We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters.

RESULTS

A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption.

CONCLUSIONS

Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.

Stress generation, avoidance coping, and depressive symptoms: a 10-year model

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

Functioning, problem behavior and health services use among nursing home residents with alcohol-use disorders: nationwide data from the VA minimum data set

OBJECTIVE

We examined (1) whether nursing home residents with alcohol-use disorders (AUDs) function more poorly, have more behavioral problems and use more health services than do demographically matched controls without such disorders, and (2) whether AUDs interact with alcohol consumption to predict poorer behavioral and health services outcomes among nursing home residents.

METHOD

We used Department of Veterans Affairs (VA) Patient Treatment File data to identify a nationwide sample of older VA nursing home residents with recent AUD diagnoses (n = 3,336) and a demographically matched sample without such diagnoses (n = 3,336). The groups were compared on the Resident Assessment Instrument Minimum Data Set indices of health-related functioning, substance use, problem behavior and health services use. We conducted two-way analyses of variance to determine interactions between presence of an AUD and alcohol consumption on problem behavior and health services use.

RESULTS

Residents with AUD diagnoses functioned somewhat better than demographically matched controls. However, they were more likely to have falls and fractures, difficulties in social functioning and to use more health services. AUD diagnoses interacted with alcohol consumption to predict an elevated risk of falls and fractures and more mental health services use.

CONCLUSIONS

Older residents with an AUD form a distinct nursing home population that functions somewhat better than residents without such disorders but they may pose more challenges to staff and use more health care services. Residents' drinking histories should be considered in formulating nursing home policies about alcohol consumption.

Sequencing the lifetime onset of alcohol-related symptoms in older adults: is there evidence of disease progression?

OBJECTIVE

The purpose of this study was to evaluate evidence of orderly symptom progression in alcohol-use disorders (disease-progression model).

METHOD

A sample of community-residing older problem drinkers provided information about their life history of drinking, including the age at which they had experienced alcohol-related symptoms that correspond to criteria for alcohol abuse and dependence. Symptom sets and possible sequences were formulated separately for women and men, based on the average number of years from drinking initiation to symptom onset and on symptom prevalence. We assessed how well the ordering of symptoms experienced by individual respondents matched the sequences derived with these group-level measures; we also assessed whether individuals progress from alcohol abuse to dependence as is implied in some conceptualizations of alcohol-use disorders.

RESULTS

Half or more of these older adults experienced symptom onset in an order that was inconsistent with the possible symptom sequences derived from group-level analysis (e.g., reversals from the expected order or concurrent onset of symptoms expected to occur sequentially). Similarly, alcohol abuse did not appear to be a precursor to the development of alcohol dependence in individual patterns of symptom onset.

CONCLUSIONS

Although group-level results based on the number of years from drinking initiation to symptom onset or on symptom prevalence may seem to point to orderly progression in the development of alcohol-related symptoms, these group-level results do not capture individual experiences very well. In this community-residing sample of problem drinkers, most of whom had never sought treatment, there was marked variability in the course of symptom development, which raises questions about the utility of a disease-progression model.

The interplay between life stressors and depressive symptoms among older adults

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.

Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers

AIMS

Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol.

DESIGN

Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury.

FINDINGS

At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later.

CONCLUSIONS

The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.

Functioning and health service use among elderly nursing home residents with alcohol use disorders: findings from the National Nursing Home Survey

OBJECTIVE

The author asked whether older nursing home residents with alcohol use disorders differ from demographically-matched residents without alcohol use disorders on functioning, admission characteristics, and health services use.

METHOD

National Nursing Home Survey data were used to compare nursing home residents with alcohol use disorders (N=216) with demographically-matched residents without alcohol use disorders (N=216) on functioning, admission characteristics, and health services use.

RESULTS

Residents with alcohol use disorders functioned somewhat better than did residents in the demographically-matched sample group, as indicated by performance of basic activities of daily living. However, they were significantly more likely to have lived alone before admission and to have obtained mental health and social services. There was a significant group x gender interaction on length of stay: men with alcohol use disorders had shorter lengths of stay than did men without alcohol use disorders; women with alcohol use disorders had longer lengths of stay than did women without such disorders.

CONCLUSIONS

Having fewer social resources may contribute to elevated admission risk and need for mental health and social services among older nursing home residents who have alcohol use disorders. Duration and severity of alcohol problems may help explain gender differences in length of stay among these residents.

Older adults' health and changes in late-life drinking patterns

This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

High-risk alcohol consumption and late-life alcohol use problems

OBJECTIVES

We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.

METHODS

A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.

RESULTS

Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.

CONCLUSION

Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.

A ten-year follow-up of older former problem drinkers: risk of relapse and implications of successfully sustained remission

OBJECTIVE

This study examines the risk, predictors of relapse and the effects of successfully sustained remission on the drinking behavior, functioning, life context, coping and help seeking of older adults who were problem drinkers earlier in life.

METHOD

Older former problem drinkers (n = 447) were prospectively followed for 10 years and compared to lifetime nonproblem drinkers.

RESULTS

Of former problem drinkers, 31% (n = 141) died over the 10-year interval, a rate 1.6 times higher than that of lifetime nonproblem drinkers. Among surviving former problem drinkers, although relapse was relatively uncommon (11%), a less severe drinking history, heavier baseline alcohol consumption, and lower baseline income were associated with relapse. The majority (63%) of former problem drinkers who successfully achieved sustained remission continued to drink alcohol, though at levels below those consumed by older lifetime nonproblem drinkers (n = 339). Stably remitted problem drinkers who were abstinent (SRAs) generally reported more severe drinking histories, greater functioning and life context deficits and more help seeking than did stably remitted problem drinkers who were nonabstinent (SRNs). Although SRAs and SRNs both experienced improvements in functioning over the 10-year interval, they continued to experience financial, health-related and life context deficits relative to older lifetime nonproblem drinkers.

CONCLUSIONS

Results suggest there are long-term costs associated with earlier drinking problems, even when remission is maintained. Both current drinking behavior and drinking history are worth considering when making recommendations regarding older adults' alcohol consumption.

Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patents were initially functioning a well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses.

Long-term use of VA mental health services by older patients with substance use disorders

OBJECTIVE

The authors studied long-term patterns and predictors of use of mental health services by older surviving patients with substance use disorders in the Veterans Affairs (VA) health care system.

METHODS

In this prospective longitudinal study, patient treatment records were used to determine long-term (ten-year) patterns and predictors of use of VA mental health services in a nationwide cohort of 10,678 surviving patients with a substance use disorder who were 55 years of age or older. The patients were categorized into three groups based on diagnosis during the index episode: patients with alcohol or drug abuse or dependence, patients with alcohol or drug psychosis, and patients with both a substance use and a psychiatric disorder. Most of the patients had alcohol use disorders.

RESULTS

Over the ten-year period, successively fewer patients obtained outpatient and inpatient mental health care. Among patients who did obtain such care, the intensity of service use increased. Medical care did not substitute for mental health treatment. Younger age, being unmarried, and having a more severe disorder were associated with a greater likelihood of mental health service use over the ten-year period. Patients with a dual diagnosis were significantly more likely to obtain outpatient mental health care. Treatment on a residential care unit and longer initial hospital stay were associated with a lower rate of mental health readmissions.

CONCLUSIONS

Of the substantial number of patients with substance use disorders who survive into old age, those with more long-standing substance use problems and with dual diagnoses have the greatest need for long-term mental health treatment.

Successful remission of late-life drinking problems: a 10-year follow-up

OBJECTIVE

This study sought to determine (1) the rate and predictors of long-term remission among a sample of untreated late-life problem drinkers and (2) whether successfully remitted older problem drinkers attain levels of functioning and life contexts comparable to those of lifetime nonproblem drinkers at a 10-year follow-up.

METHOD

We compared 140 older baseline problem drinkers who were successful in achieving long-term remission to 184 baseline problem drinkers whose drinking problems did not remit over the course of 10 years and to 339 lifetime nonproblem drinkers, on functioning and life contexts at baseline and at 4- and 10-year follow-ups.

RESULTS

Being female, having more recent onset of drinking problems, fewer and less severe drinking problems, friends who approved less of drinking, and drinking less and drinking less frequently at baseline predicted long-term remission. In many regards, long-term remitted problem drinkers attained levels of functioning and life context similar to those of lifetime nonproblem drinkers. However, remitted problem drinkers continued to report more incipient drinking problems, depressive symptoms, health and financial stressors, psychoactive medication use, reliance on avoidance coping strategies and less social support from friends than did lifetime nonproblem drinkers at the 10-year follow-up.

CONCLUSIONS

About a third (30%) of an untreated sample of late-life problem drinkers succeeded in attaining stable, long-term remission. The functioning and life contexts of untreated remitted problem drinkers improved significantly over time; however, some deficits persisted at follow-up.

Predictors and outcomes of outpatient mental health care: a 4-year prospective study of elderly Medicare patients with substance use disorders

BACKGROUND

Many elderly inpatients have substance use disorders; recent treatment guidelines suggest that they should receive regular outpatient mental health care after discharge from hospital.

OBJECTIVE

The prevalence, predictors, and outcomes of outpatient mental health care obtained by elderly Medicare patients with substance use disorders were examined.

RESEARCH DESIGN

A longitudinal prospective follow-up was performed.

SUBJECTS

Data from Medicare Provider Analysis and Review Record and Part B Medicare Annual Data were used to identify elderly inpatients with substance use disorders (n = 4,961) and determine their outpatient mental health care 4 years following hospital discharge.

RESULTS

Only 12% to 17% of surviving elderly substance abuse patients received outpatient mental health care in each of 4 years after discharge. Cumulatively over 4 years, approximately 18% of surviving patients obtained diagnostic/evaluative mental health services, 22% obtained psychotherapy, and 9% received medication management. Of patients who obtained outpatient mental health care, 57% made 10 or fewer outpatient mental health visits over the entire 4 years. Younger, non-black, and female patients were more likely to obtain mental health outpatient care, as were patients with prior substance-related hospitalizations, dual diagnoses, and fewer medical conditions. Prompt outpatient mental health care was predictively associated with higher likelihood of mental health readmissions and, among patients with drug disorders, lower mortality.

CONCLUSION

Very few elderly Medicare substance abuse patients obtain outpatient mental health care, perhaps because of health or economic barriers.

Elderly Medicare inpatients with substance use disorders: characteristics and predictors of hospital readmissions over a four-year interval

OBJECTIVE

(1) To describe the characteristics and 4-year readmissions of elderly Medicare inpatients with substance use disorders; (2) to determine whether their readmissions are elevated relative to case controls'; and (3) to examine gender differences in characteristics and predictors of readmissions among elderly inpatients with substance use disorders.

METHOD

Health Care Financing Administration Medicare Provider Analysis and Review data were used to identify elderly patients with substance use disorders and their case controls, and to determine patient characteristics and readmissions over a 4-year interval following hospital discharge.

RESULTS

Of elderly inpatients with substance use disorders (N = 22,768), 37% were women, 11% were black, 22% had previous, substance-related hospitalizations, 14% had concomitant psychiatric disorders and 9% had accident-related diagnoses. Among surviving patients with substance use disorders (N = 12,417), 73% were rehospitalized, a higher rate than among case controls (69%). Women with substance use disorders were more likely to have a psychiatric or accident diagnosis at the index episode than were men with substance use disorders.

CONCLUSIONS

Many women and a disproportionate number of blacks constitute elderly Medicare inpatients with substance use disorders. These patients often have prior substance-related hospitalizations, psychiatric comorbidities, and accidents involving poisoning, adverse drug reactions and falls. They make costly, relatively heavy use of inpatient health services. Elderly women with substance use disorders may benefit from treatment that focuses on their psychiatric disorders and accident risk. Diagnostic information available at discharge can be used to identify patients at higher risk for subsequent rehospitalization and to plan treatment accordingly.