Alcohol misuse, gender and depressive symptoms in community-dwelling seniors

Impacts of alcohol consumption on farmers' mental health: Insights from rural China

The global mental health crisis presents a significant challenge to sustainable development, and this crisis is more pronounced in China's rural areas versus urban areas. Alcohol consumption has increased in rural areas with China's economic growth, but the number of studies on the relationship between farmers' alcohol consumption and their mental health is limited. Based on data from the China Labor Force Dynamics Survey (CLDS), this study uses the endogenous switching regression model (ESR) to analyze the influence of alcohol consumption on farmers' mental health. On this basis, the study further conducts a counterfactual analysis to estimate the average treatment effect of alcohol consumption on farmers' mental health. The results show that: (1) There is a significant positive relationship between alcohol consumption and farmers' mental health. Specifically, the mental health index of drinking farmers increases by 19.7 % compared to non-drinking farmers. (2) Heterogeneity analysis shows that alcohol consumption is more beneficial for improving the mental health of male farmers, elderly farmers, and employed farmers. Furthermore, drinking alcohol almost every day, consuming Baijiu, and each drinking consumption ranging from 0 to 100 mL per occasion are more conducive to improving farmers' mental health. These findings have implications for relieving depressive symptomology and improving farmers' mental health in developing countries. The results of this study also provide guidance for addressing the global mental health crisis.

Gender differences in the association between lifestyle behaviors and mental health among psychiatrists in China

INTRODUCTION

Mental health symptoms are common among health professionals and the influence of lifestyle behaviors on psychiatrists' mental health is insufficiently understood. Based on a nationwide sample, we aimed to survey the lifestyle behaviors and mental health status among psychiatrists, and to identify the co-occurrence and gender differences in lifestyle behaviors.

METHODS

Data were collected through an anonymous questionnaire among psychiatrists in China. Depression, Anxiety and Stress Scale - 21 (DASS-21) was used to evaluate mental health symptoms. Latent class analysis (LCA) was used to explore the co-occurrence of lifestyle behaviors. The multivariate logistic regression model was used to examine the effects of demographic and lifestyle factors.

RESULTS

4520 psychiatrists were included in the analysis with 11.5 % of them reporting smoking, 10 % reporting alcohol misuse, 35.2 % reporting physical inactivity, and 23.1 % reporting insomnia. The prevalence of depression, anxiety and stress symptoms were 29.2 %, 34.5 %, and 12.2 %, respectively. Significant gender differences were found in smoking (P < 0.001), alcohol misuse (P < 0.001), and physical inactivity (P < 0.001), but not in insomnia. Based on these four high-risk health behaviors above, three lifestyle behavior clusters with huge gender differences were identified through the LCA. Accordingly, the unhealthy lifestyle classes, though defined differently for males and females, were significantly associated with depression, anxiety, and stress.

CONCLUSIONS

The co-occurrence and significant gender differences in multiple lifestyle behaviors exist in this group, highlighting the need for gender-specific comprehensive interventions against mental health symptoms and the urgency of promoting their well-being.

Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases

BACKGROUND

The association between lifetime alcohol abuse and a higher risk to develop dementia is well known. However, it is unknown whether older adults who begin abusing alcohol late in life have an underlying neurodegenerative disease.

OBJECTIVE

Identify the frequency of lifelong alcohol abuse (L-AA), late-onset alcohol abuse (LO-AA), and alcohol abuse as a first symptom of dementia (AA-FS) in patients with neurodegenerative diseases.

METHODS

Cross-sectional retrospective study of patients evaluated at an academic referral center with a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer-type dementia (AD), and semantic variant primary progressive aphasia (svPPA) (n = 1,518). The presence of alcohol abuse was screened with the National Alzheimer's Coordinating Center questionnaire. L-AA was defined as onset < 40 years, LO-AA as onset ≥40 years, and AA-FS was defined when the abuse started within the first three years from symptom onset.

RESULTS

The frequency of LO-AA was 2.2% (n = 33/1,518). LO-AA was significantly more frequent in patients with bvFTD than AD (7.5%, n = 13/173 versus 1.3%, n = 16/1,254, CI:1.0;11.4%), but not svPPA (4.4%, n = 4/91, CI: -4.4;10.7%). Similarly, AA-FS was more frequent in bvFTD patients than AD (5.7%, n = 10/173 versus 0.7%, n = 9/1,254, CI:0.5%;9.5%), but not svPPA (2.2%, n = 2/91, CI:-2.4;9.1%).

CONCLUSION

LO-AA can be a presenting symptom of dementia, especially bvFTD. Alcohol abuse onset later in life should prompt a clinical investigation into the possibility of an underlying neurodegenerative process because delay in diagnosis and treatment may increase patient and caregiver burden. The results need to be interpreted with caution due to the limitations of the study.

Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling

PURPOSE

To: (1) explore how multi-level factors impact the longitudinal prevalence of depression and alcohol misuse among urban older adults (≥ 65 years), and (2) simulate the impact of alcohol taxation policies and targeted interventions that increase social connectedness among excessive drinkers, socially isolated and depressed older adults; both alone and in combination.

METHODS

An agent-based model was developed to explore the temporal co-evolution of depression and alcohol misuse prevalence among older adults nested in a spatial network. The model was based on Los Angeles and calibrated longitudinally using data from the Multi-Ethnic Study of Atherosclerosis.

RESULTS

Interventions with a social component targeting depressed and socially isolated older adults appeared more effective in curbing depression prevalence than those focused on excessive drinkers. Targeting had similar impacts on alcohol misuse, though the effects were marginal compared to those on depression. Alcohol taxation alone had little impact on either depression or alcohol misuse trajectories.

CONCLUSIONS

Interventions that improve social connectedness may reduce the prevalence of depression among older adults. Targeting considerations could play an important role in determining the success of such efforts.

Depression Screening Rates and Symptom Severity by Alcohol Use Among Primary Care Adult Patients

BACKGROUND

Hazardous alcohol use with depression may exacerbate health conditions and complicate medical care. We examined the rate of depression screening by alcohol use severity among primary care patients screened for hazardous alcohol use and, among those screened, examined patterns of significant depressive symptoms.

METHODS

Using cross-sectional data from primary care patients (n = 2,894,906), we examined past-90-day alcohol use (number of typical drinking days/week and typical number of drinks consumed daily); depression screening rates (using the Patient Health Questionnaire 9 [PHQ-9]); and symptom severity, demographics, and prevalence of selected psychiatric diagnoses.

RESULTS

Within 30 days of routine, in-clinic alcohol use screening by medical assistants, 2.4% (n = 68,686) of patients also completed a PHQ-9; these patients were more likely to be female, younger, white, Medicaid insured, and to have a nondepressive psychiatric diagnosis and a lower Charlson comorbidity score. Abstainers and moderate drinkers (1 to 7 drinks/week or 1 to 4 drinks/week for women and individuals >65 years or for men ≤65 years, respectively) were less likely than hazardous drinkers (exceeding weekly limits) to complete the PHQ-9 or to have significant depressive symptoms (PHQ-9 score ≥10). Nonwhite patients with higher Charlson comorbidity scores were more likely to endorse significant depressive symptoms.

CONCLUSIONS

Only a small fraction of patients in this cohort were screened for depression. Nonwhite patients and those with higher comorbidity burden were more likely to report depression but less likely to be screened. These discrepancies between depression-screening rates and significant depressive symptoms suggest that screening for depression should be enhanced in these at-risk groups.

How does Older People's Drinking Appear in the Daily Work of Home Care Professionals?

Aims

In this article the authors ask how the alcohol use of elderly home care clients affects the daily work of home care professionals and how the professionals act to support the drinking client.

Methods

Semi-structured interviews with 10 home care professionals were conducted from December 2014 to February 2015 in the Helsinki metropolitan area of Finland. Everyday situations during home visits related to the clients' alcohol use were analysed according to modalities of agency of the home care professionals.

Results

The results focus on three themes raised in the interviews: supporting life management of the client, the lack of qualifications in tackling clients' drinking and the need for multi-professional collaboration. Intoxicated clients complicated the home care nurses' work and obstructed the implementation of recommendations set out to guide the professionals' operations. Care work with alcohol-using clients was particularly demanding, and the professionals were concerned about not having enough training in how to encounter elderly clients' drinking. Multi-professional collaboration with substance abuse services and emergency department personnel was called for to remedy this problem.

Conclusions

More extensive and detailed research is needed for a better picture of how clients' drinking influences home care nurses' working conditions and what kind of skills nurses need in different alcohol-related situations. Such research would have the potential to benefit clients and improve the well-being of the employees.

Understanding older problem drinkers: The role of drinking to cope

INTRODUCTION AND AIMS

Despite a common perception that older adults drink less than younger adults, drinking frequency increases with age. The aim of this study was to examine the types of coping motives associated with problem drinkers in addition to the types of specific drinking problems most commonly endorsed by older drinkers. The study also sought to investigate the role of individual drinking to cope motives in problem drinking.

METHOD

Participants were 288 community dwelling older adults aged who consumed alcohol, and were drawn from a larger study of health and aging in rural areas of Australia. Participants completed a postal questionnaire comprising the Drinking Problems Index, Drinking Motives Questionnaire, The AUDIT-C, and the Centre for Epidemiological Studies Depression Scale.

RESULTS

Overall, 22.2% of the sample were problem drinkers, with a higher prevalence for men (30.4%) than women (15.6%). Problem drinkers were significantly more likely to consume alcohol according to several indices of risky drinking. The most common drinking problems experienced were becoming intoxicated, spending too much money on drinking, feeling confused after drinking, and skipping meals. Drinking to cope motives to relax, to manage physical symptoms and to feel more self-confident increased the odds of problem drinking.

CONCLUSIONS

Problem drinking is highly prevalent in older adults. Given the potential adverse consequences of problem drinking on the health of older adults it is imperative that health professionals pay attention to drinking behaviours as part of routine practice.

Shades of Grey: The Need for a Multi-disciplinary Approach to Research Investigating Alcohol and Ageing

This paper calls for an increase in multi-disciplinary research on the issue of alcohol and ageing, to ensure public health interventions reflect the complex and diverse needs of older drinkers. Older people (65+ years) represent a unique segment of the population; compared to adolescents and younger people, they are more likely to have a range of co-morbid conditions and be taking prescribed medication, and are more physiologically vulnerable to the effects of alcohol. This suggests that from a public health perspective, alcohol use by older people is problematic. However, as with younger people, alcohol use is closely associated with socialisation and social engagement. While social engagement is important at all stages of life, it is particularly critical as people age, when many of the formal social roles which provide a catalyst for social integration shift or are lost. Currently, however, there is little evidence of an integrated public health response to the complex issue of alcohol and ageing. That is, what is needed is a concurrent acknowledgement of the health problems that may be associated with contraindicated alcohol use, versus the potential health benefits that can accrue from social drinking. This will require a holistic rather than reductionist approach that integrates biomedical and social science insights to develop a more comprehensive and nuanced understanding of the implications of alcohol use amongst diverse populations of older people. Significance for public healthWith the rapid ageing of the global population and concerns about recent increases in the consumption of alcohol amongst older people, the issue of alcohol and ageing is becoming an important public health issue. However, there remains little research that adopts a holistic multi-disciplinary perspective. Such research is important and may offer the best way forward in terms of unravelling the complexity of competing risks and benefits associated with low to moderate drinking amongst older people.

Alcohol Consumption among the Oldest Old and How It Changes during Two Years

This longitudinal study aimed to examine the pattern of alcohol consumption (using the AUDIT-C) among the oldest old (80+) and how it changed two years later. Five hundred seventy-six persons from the Gothenburg metropolitan area were interviewed between 2008 and 2011. Men represented a higher proportion of at-risk consumers (21.8%) than women (14.5%), but there was no sex difference in binge drinking (13.8% versus 12%). Men decreased their weekly consumption and also the proportion of binge drinking, and women decreased only in binge drinking. Further studies of the causality between alcohol consumption and health are suggested.

The morning after: alcohol misuse and employment problems

Using a rich, recent, and nationally representative longitudinal survey specifically designed to examine alcohol use and associated problems, we investigate the effects of alcohol misuse on a series of understudied and perhaps less common employment problems. Such problems include being fired or laid off from a job, sustained unemployment, and conflicts with a supervisor and/or co-worker. After controlling for time-invariant omitted variables via fixed effects estimation, we find evidence that three measures of alcohol misuse are significantly related to employment problems. The results offer new information on the potential adverse labor market effects of alcohol misuse and shed light on potential mechanisms through which alcohol misuse may impact intensive labor supply and/or wages.

Older adults' own reasoning for their alcohol consumption

OBJECTIVE

The aim of the study was to investigate what the older adults themselves consider to be the reasons for their alcohol consumption.

METHODS

The data were collected with a postal questionnaire from a random sample of 2100 elderly people (≥65 years) living in the medium-sized city of Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. Altogether 868 persons responded that they use alcohol. Of them, 831 gave reasons for their drinking. We defined "at-risk users" as consuming >7 drinks per week, or ≥5 drinks on a typical drinking day, or using ≥3 drinks several times per week.

RESULTS

Main reasons given for alcohol consumption were "having fun or celebration" (58.7%), "for social reasons" (54.2%), "using alcohol for medicinal purposes" (20.1%), and "with meals" (13.8%). Younger age groups reported more often than the older age groups that they use alcohol for "having fun or celebration" and "for social reasons." The older age groups used more often "alcohol for medicinal purposes". Men used alcohol more often than women "as pastime" or "as sauna drink". Those defined as "at-risk users" reported using alcohol because of "meaningless life," for "relieving depression," "relieving anxiety," and "relieving loneliness."

CONCLUSIONS

Older adults have diverse alcohol consumption habits like people in other age groups. The oldest olds reported that they use alcohol for medicinal purposes. The "at-risk users" admit they use alcohol because of meaningless life, and relieving depression, anxiety, and loneliness.

Heavy/binge drinking and depressive symptoms in older adults: gender differences

OBJECTIVES

The purpose of this study was to examine gender similarity/difference in the association between depressive symptoms (11-item Center for Epidemiologic Scale for Depression (CES-D) scores), on the one hand, and frequency and amount of alcohol use, on the other, among older adults.

METHODS

Data came from the National Social Life, Health, and Aging Project (NSHAP), Wave 1, which included a nationally representative probability sample (n = 2924) of community-dwelling individuals aged 57-85. Heavy/binge drinking was defined as the consumption of 4+ drinks for men and 3+ drinks for women per drinking day. The relationship between CES-D scores and the frequency and amount of alcohol consumption was tested using gender-separate, 2-step ordinary least squares (OLS) regression analyses.

RESULTS

A significant proportion of both men (67.7%) and women (52.2%) had consumed alcohol in the preceding 3 months, and 12.3% of male and 8.4% of female drinkers were heavy/binge drinkers. Substantial differences between male and female heavy drinkers were found in sociodemographics, health status, and social support and social engagement. Regression results show that both frequency of drinking and heavy/binge drinking, as opposed to abstinence, were significantly positively associated with men's CES-D scores, but not with women's.

CONCLUSION

Heavy/binge-drinking older men may use alcohol to cope with depressive mood, and heavy drinking might also contribute to their social isolation and depressive symptoms. Depression screening and treatment for older men should be accompanied by alcohol screening and treatment and vice versa.

Drinking, smoking, and psychological distress in middle and late life

A limited number of studies have examined the co-occurrence of alcohol use and smoking and their mental health effects in middle and late life. In this study, using the 2008 National Survey of Drug Use and Health, the characteristics of individuals aged 50 and older who abstained from both substances, who used both substances, and who used one or the other substance were examined. Then, the main and interaction effects of drinking and smoking on psychological distress were analyzed. Findings show that smoker-nondrinkers are the most disadvantaged group in terms of sociodemographic and health characteristics, while drinker-nonsmokers are the most advantaged group. When sociodemographic, health, and other factors were controlled, no direct effects of drinking or interaction effect of drinking and smoking were detected for either gender. However, heavy smoking (6+ cigarettes on a typical smoking day) was significantly associated with an elevated level of psychological distress among women. The findings highlight the vulnerability of heavy smoking middle-aged and older women. These women are the most psychologically distressed and may need interventions designed to help them quit smoking, reduce or quit drinking, and alleviate psychological distress.

Alcohol and depression

AIMS

To examine the literature on the associations between alcohol use disorders (AUD) and major depression (MD), and to evaluate the evidence for the existence of a causal relationship between the disorders.

METHODS

PsycInfo; PubMed; Embase; Scopus; ISI Web of Science database searches for studies pertaining to AUD and MD from the 1980 to the present. Random-effects models were used to derive estimates of the pooled adjusted odds ratios (AOR) for the links between AUD and MD among studies reporting an AOR.

RESULTS

The analysis revealed that the presence of either disorder doubled the risks of the second disorder, with pooled AORs ranging from 2.00 to 2.09. Epidemiological data suggest that the linkages between the disorders cannot be accounted for fully by common factors that influence both AUD and MD, and that the disorders appear to be linked in a causal manner. Further evidence suggests that the most plausible causal association between AUD and MD is one in which AUD increases the risk of MD, rather than vice versa. Potential mechanisms underlying these causal linkages include neurophysiological and metabolic changes resulting from exposure to alcohol. The need for further research examining mechanisms of linkage, gender differences in associations between AUD and MD and classification issues was identified.

CONCLUSIONS

The current state of the literature suggests a causal linkage between alcohol use disorders and major depression, such that increasing involvement with alcohol increases risk of depression. Further research is needed in order to clarify the nature of this causal link, in order to develop effective intervention and treatment approaches.

Creating and using the CDC HRQOL healthy days index with fixed option survey responses

PURPOSE

"Healthy days" are calculated by adding the number of poor physical and mental health days and subtracting the total from 30 days using the US Centers for Disease Control and Prevention Health-Related Quality of Life (HRQOL) scale. This study sought to compute the index with forced responses and hypothesized significant HRQOL differences with demographic and risk behavior variables would be observed.

METHODS

Using the 1997 South Carolina YRBS and a 2007 university data set, variables were created based on the averages within each response option from the index items (e.g., 1-2 days would assigned as 1.5 days, etc.). Then the greater of the two values in each respective cell (poor physical or mental health days) was chosen for the analysis.

RESULTS

Although some differences existed between the two samples, the same general pattern of responses was established. Significant HRQOL differences were observed among selected demographic, substance use, weight perception, and self-rated health variables (P < .05).

CONCLUSIONS

Preliminary evidence suggests the "healthy days" calculation is a valid approach with fixed option responses.

Alcohol use among older adults

Alcohol use is common in older adults and is associated with numerous health and social problems. Recent evidence suggests that in addition to level of alcohol consumption, drinking pattern may also be important. Moderate alcohol intake may confer some cardiac benefits, while heavy episodic drinking seems particularly problematic. Detecting alcohol misuse in older adults is difficult since clinical acumen is often poor, screening questionnaires have serious limitations and laboratory tests are not diagnostic. Brief alcohol interventions to reduce alcohol consumption appear useful in younger populations, but are less studied in older adults. While there is increasing research into the issue of alcohol use among older adults, clinicians and policy-makers must rely on limited evidence when making clinical decisions.

Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients

Nutrition is an important determinant of health in persons over the age of 65. Malnutrition in the elderly is often underdiagnosed. Careful nutritional assessment is necessary for both the successful diagnosis and development of comprehensive treatment plans for malnutrition in this population. The purpose of this article is to provide clinicians with an educational overview of this essential but often underecognized aspect of geriatric assessment. This article will review some common issues in nutrition for the elderly in both hospital and community settings. The complexity and impact of multiple comorbidities on the successful nutritional assessment of elderly patients is highlighted by using case scenarios to discuss nutritional issues common to elderly patients and nutritional assessment tools. Three case studies provide some context for an overview of these issues, which include the physiology of aging, weight loss, protein undernutrition, impaired cognition, malnutrition during hospitalization, screening procedures, and general dietary recommendations for patients 65 years of age and older.