Moderate alcohol consumption and adverse drug reactions among older adults

Drug safety in older patients with alcohol use disorder: a retrospective cohort study

Background

Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function.

Objectives

In this study, we investigated the frequency and characteristics of potentially serious alcohol-medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug-drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period.

Design

Retrospective monocentric cohort study.

Methods

Prescribed medications were screened for potentially serious alcohol-medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiDKlinik®.

Results

We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol-medication interaction. Potentially serious alcohol-medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population.

Conclusion

Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol-medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs.

Determinants of adverse reactions to first-line antitubercular medicines: a prospective cohort study

BACKGROUND

The success of tuberculosis treatment relies on patients adhering to their medication regimen consistently. However, adherence levels tend to decrease among patients who experience adverse drug reactions to antitubercular medications, leading to suboptimal treatment outcomes. Hence, this study aimed to examine the types, incidence rates, and severity of adverse reactions caused by first-line antitubercular drugs. Additionally, it aimed to identify factors associated with the development of these reactions. By doing so, the study aimed to facilitate the provision of personalized and effective treatment to patients, ultimately improving treatment outcomes.

METHODS

Newly diagnosed patients with active tuberculosis were monitored from the start of their treatment until the completion of therapy. Any adverse reactions to anti-TB drugs that they encountered were carefully recorded. The collected data were analyzed using appropriate statistical methods such as analysis of variance, Chi-squared test, Fisher's exact test, and independent t-tests. Logistic regression was employed to assess the association between adverse drug reactions and various socio-demographic and clinical factors of the patients, using odds ratios as a measure of association.

RESULTS

Among the 378 patients included in the study, 181 individuals (47.9%) reported experiencing at least one adverse drug reaction, with an incidence rate of 1.75 events per 100-person months. The majority of these reactions occurred during the intensive phase of treatment. The gastrointestinal tract was the most commonly affected system, followed by the nervous system and skin. Patients aged over 45 years (OR = 1.55, 95% CI 1.01-2.39, p = 0.046) and those with extrapulmonary tuberculosis (OR = 2.41, 95% CI 1.03-5.64) were more likely to develop gastrointestinal reactions. Female gender was a significant predictor of both skin (OR = 1.78, 95% CI 1.05-3.02, p = 0.032) and nervous system (OR = 1.65, 95% CI 1.07-2.55, p = 0.024) reactions. Additionally, alcohol use and HIV infection were identified as independent predictors of adverse drug reactions affecting all three systems.

CONCLUSION

Significant risk factors for developing antitubercular drug adverse reactions include alcohol consumption, cigarette smoking, being HIV positive, female gender and extrapulmonary tuberculosis.

Hazardous alcohol consumption among older adults: A comprehensive and multi-national analysis of predictive factors in 13,351 individuals

Background

Older adults exhibit heightened vulnerability for alcohol-related health impairments. Increases in the proportion of older adults within the European Union’s total population and prevalence rates of alcohol use disorders in this age group are being observed. This large scale international study was conducted to identify those older adults with an increased risk to engage in hazardous drinking behaviour.

Methods

Socio-demographic, socio-economic, personality characteristics (Big Five Inventory, BFI-10), and alcohol consumption patterns of 13,351 individuals from 12 different European countries, collected by the Survey of Health, Aging, and Retirement in Europe, were analyzed using regression models.

Results

Age, nationality, years of education, as well as personality traits, were significantly associated with alcohol intake. For males, extraversion predicted increased alcohol intake (RR = 1.11, CI = 1.07–1.16), whereas conscientiousness (RR = 0.93, CI = 0.89–0.97), and agreeableness (RR = 0.94, CI = 0.90–0.99), were associated with a reduction. For females, openness to new experiences (RR = 1.11, CI = 1.04–1.18) predicted increased alcohol intake. Concerning excessive drinking, personality traits, nationality, and age-predicted consumption patterns for both sexes: Extraversion was identified as a risk factor for excessive drinking (OR = 1.15; CI = 1.09–1.21), whereas conscientiousness was identified as a protective factor (OR = 0.87; CI = 0.823–0.93).

Conclusion

Hazardous alcohol consumption in the elderly was associated with specific personality characteristics. Preventative measures, crucial in reducing deleterious health consequences, should focus on translating the knowledge of the association of certain personality traits and alcohol consumption into improved prevention and treatment.

Reducing Medication Risks in Older Adult Drinkers

Objectives: Prevalent concomitant alcohol and medication use among older adults is placing this group at risk for adverse health events. Given limited existing interventions to address concomitant alcohol and medication risk (AMR), a brief educational intervention was demonstrated. The purpose of the current study was to examine change in AMR behaviors 3 months post-education among older adult drinkers. Methods: A convenience sample of 58 older adult drinkers (mean age = 72) was recruited and followed (n = 40; 70% at follow-up), from four pharmacies in rural Virginia. Results: Findings indicated decreased alcohol consumption in high-risk drinkers. Conclusion: Future research should explore methods to sustain reduced AMR.

Epidemiology of at-risk alcohol use and associated comorbidities of interest among community-dwelling older adults: a protocol for a systematic review

INTRODUCTION

There is little epidemiological evidence and knowledge about at-risk alcohol use among community-dwelling older adults and their chronic and acute alcohol-related comorbidities of interest. This systematic review will summarise and examine relevant studies about the epidemiology of at-risk alcohol use and associated comorbidities of interest in this population.

METHODS

We will search the following databases, without language or date restrictions, from inception to 31 August 2019: Embase.com, Medline Ovid SP, Pubmed (NOT medline[sb]), CINAHL EBSCO, PsycINFO Ovid SP, Central-Cochrane Library Wiley and Web of Science (Core Collection). Search strategies will be developed in collaboration with a librarian. We will use predefined search terms for alcoholism, epidemiology, the elderly, living place and comorbidities of interest, as well as terms related to the identification of "measurements", "tools" or "instruments" for measuring harm from alcohol use. At-risk status will be determined by the amount of alcohol consumed and any comorbidities of interest associated with at-risk alcohol use, with the latter being documented separately or using an assessment tool for at-risk drinking. We will also examine the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in all languages.

ETHICS AND DISSEMINATION

No ethical approval is necessary. Results will be presented in national and international conferences on addiction and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018099965.

Self-reported adverse drug effects and associated factors among H. pylori infected patients on standard triple therapy: Prospective follow up study

Background

One of the most common reasons for poor medication adherence and associated treatment failure of triple therapy is adverse drug effect (ADEs) of medications.

Objective

Assessment of ADEs and associated factors during H. pylori eradication therapy.

Method

Consented H. pylori positive adult outpatients on standard triple therapy (proton pump inhibitor, amoxicillin and clarithromycin) were involved in this facility based follow up study from May 2016 to April 2018 at Bahir Dar city in Ethiopia. Pre-developed questionnaire and formats were used to collect sociodemographic, medical information, and patient practice data before, during, and after therapy. Bivariate and backward stepwise multivariate logistic regression was used to analyze data. P-value < 0.05 at 95%CI was considered as significant.

Result

A total of 421 patients were involved in the study. Almost 80% of the patients were urban residents. Mean (±SD) age and body weight of patients were 30.63 (± 10.74) years and 56.79 (± 10.17) kg, respectively. ADE was reported from 26.1% of the patients and of all the reported ADEs, more than 85% was manifested with gastrointestinal symptoms which include gastrointestinal discomfort(39.1%), nausea (13.6%), constipation(12.7%), diarrhea(12.9%) and anorexia(10%). Determinants of self-reported ADEs among patients in the present study were body mass index above 25 (AOR: 2.55; 95%CI (1.21–5.38), p = 0.014), duration of acid-pepsin disorder more than 3weeks (AOR: 3.57; 95%CI (1.63–7.81), p = 0.001), pain feeling during long interval between meals (AOR: 2.14; 95%CI (1.19–3.84), p = 0.011), and residence in urban area (AOR: 1.95; 95% CI (1.04–3.67), p = 0.038).

Conclusion

Significant proportion of patients reported ADEs which commonly manifested with gastrointestinal symptoms. Consideration of patients’ body mass index, duration of the disorder, period of the day when patients feel pain, and patients’ area of residence could help to reduce ADEs experienced during H. pylori eradication therapy.

The use of medication and alcohol in recreational downhill skiers: Results of a survey including 816 subjects in Tyrol

OBJECTIVE

The aim of this study was to collect data on the medication and alcohol use in recreational downhill skiers.

DESIGN

Cross-sectional study.

METHODS

The study was conducted during the 2014 winter season in different ski resorts in Tyrol, Austria. Participants were asked to complete a brief survey including questions about basic anthropometric data (age, stature, weight) the use of medication (yes/no) and alcohol intake on the skiing day or the day before (yes/no).

RESULTS

In total, 816 persons with an age between 6-87 years were surveyed. In general, 22% of the male and 20% of the female recreational downhill skiers reported the use of medication. In the age group >40 years, half of the respondents were taking medication on a regular basis. 30% of males and 16% of females reported to consume alcohol on the skiing day whereas more than 50% drank alcohol on the evening before skiing the next day. 63% of those under medication concomitantly consumed alcohol.

CONCLUSIONS

The findings confirm a high prevalence of medication use and alcohol consumption in recreational downhill skiers. Even more importantly, 63% of skiers under medication concomitantly consumed alcohol. Considering the fact that only a small amount of alcohol can already affect motor and cognitive skills, it may be strongly assumed that the risk for skiing injuries is increased with alcohol consumption. Side effects of simultaneous intake of drugs and alcohol may include hypotension, vertigo and collapse which are thought to be associated with increased risks of skiing falls and injuries.

Drink wise, age well; reducing alcohol related harm among people over 50: a study protocol

Background

Evidence suggests that the use of alcohol among older adults (defined as those aged 50+) has increased in recent years, with people aged 55–64 now more likely to exceed the recommended weekly guidelines than any other age group.

Methods/ design

This is a quasi-experimental study with a before-after design. A postal questionnaire will be sent to 76,000 people aged 50 and over registered with a general practice in five different ‘demonstration’ (intervention) and control areas in the UK. Multiple interventions will then be delivered in demonstration areas across the UK. At the end of the programme, a postal questionnaire will be sent to the same individuals who completed it pre-programme to establish if there has been a reduction in alcohol use, at-risk drinking and alcohol related problems. Qualitative interviews with clients and staff will explore how the interventions were experienced; how they may work to bring about change and to identify areas for practice improvements.

Discussion

This study protocol describes a multi-level, multi-intervention prevention-to-treatment programme which aims to reduce alcohol-related harm in people aged 50 and over.

'I take my tablets with the whiskey': A qualitative study of alcohol and medication use in mid to later life

Background

Concurrent alcohol and medication use can result in significant problems especially in mid to later life. Alcohol is often used instead of medication for a number of health-related conditions. This novel qualitative study explored concurrent alcohol and medication use, as well as the use of alcohol for medicinal purposes, in a sample of individuals in mid to later life.

Methods

Twenty-four interviews (12 men/12 women, ages 51–90 years) and three focus groups (n = 27, 6 men/21 women, ages 50–95 years) from three branches of Age UK and two services for alcohol problems in North East England.

Results

Older people in this study often combined alcohol and medication, frequently without discussing this with their family doctor. However, being prescribed medication could act as a motivating factor to stop or reduce alcohol consumption. Participants also used alcohol to self-medicate, to numb pain, aid sleep or cope with stress and anxiety. Some participants used alcohol to deal with depression although alcohol was also reported as a cause of depression. Women in this study reported using alcohol to cope with mental health problems while men were more likely to describe reducing their alcohol consumption as a consequence of being prescribed medication.

Conclusions

As older people often combine alcohol and medication, health professionals such as family doctors, community nurses, and pharmacists should consider older patients’ alcohol consumption prior to prescribing or dispensing medication and should monitor subsequent drinking. In particular, older people should be informed of the dangers of concurrent alcohol and medication use.

Acceptability of intervention materials to decrease risk for alcohol and medication interactions among older adults

BACKGROUND

The majority of older adults take prescription or over-the-counter medications and about half consume alcohol regularly. Despite high risk for alcohol medication interactions (AMI), few community-level interventions exist to prevent AMI. The current study assessed the acceptability of educational materials created for use in a brief intervention to prevent AMI among older adults.

METHODS

Older adults from two senior centers reviewed intervention materials (poster, patient and pharmacist brochures, and public service announcement) and participated in a pre and post-test to provide feedback and to assess changes in AMI-related awareness and intentions.

RESULTS

Post-test data showed positive feedback and an increase in participant understanding of AMI prevention, with statistically significant changes in perceived importance of messaging surrounding risky alcohol use and potential consequences of AMI.

DISCUSSION

The intervention materials were positively received, and participant feedback indicated that the collective presentation of all the materials was the most preferred tool for educating the community. With positive trends in awareness and knowledge, intervention effectiveness needs to be further evaluated in future large-scale studies.

LESSONS LEARNED

This study provides health education specialists with tools to prevent alcohol and medication interactions among older adults.

Sustained Intervention Effects on Older Adults' Attitudes Towards Alcohol and Medication Interactions

Background

Older adults are at risk for experiencing alcohol and medication interactions (AMI) given concomitant alcohol and medication use. However, there have been limited efforts to develop and evaluate AMI prevention interventions.

Purpose

The current study examined sustained intervention effects on older adults' attitudes, awareness, and intentions regarding AMI.

Methods

A sample of N = 134 older adults completed assessments before and after exposure to AMI risk educational materials (Times 1 and 2). N = 97 participants (72%) were reached for a three-month follow-up phone call (Time 3).

Results

There was a positive linear trend over time in the number of identified AMI side effects. While knowledge of intervention messages remained high and stable over time, quadratic trends for perceived importance of AMI messages indicated positive short-term effects that did not sustain over time. Few differences by drinking status were found.

Discussion

This intervention had positive short-term effects on AMI awareness, intentions, and perceived messaging importance, but these short-term effects were only maintained over time for awareness.

Translation to Health Education Practice

This study provides Certified Health Education Specialists with a model for planning and evaluating a brief intervention to prevent AMI among older adults.

Consensus validation of the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria

OBJECTIVES

Older adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and there is a lack of consensus regarding what constitutes an alcohol-interactive medicine. The objective of this study was to develop an explicit list of potentially serious alcohol-medication interactions for use in older adults.

DESIGN

Following a systematic review, review of drug compendia and clinical guidance documents, a two-round Delphi consensus method was conducted.

SETTING

Ireland and the United Kingdom (UK), primary care and hospital setting.

PARTICIPANTS

The Project Steering Group developed a list of potentially serious alcohol-medication interactions. The Delphi panel consisted of 19 healthcare professionals (general practitioners, geriatricians, hospital and community pharmacists, clinical pharmacologists and pharmacists, and physicians specialising in substance misuse).

RESULTS

An inventory of 52 potentially serious alcohol-medication interactions was developed by the Project Steering Group. British National Formulary black dot warnings (n=8) were included in the final criteria as they represent 'potentially serious' interactions. The remaining 44 criteria underwent a two-round Delphi process. In the first round, 13 criteria were accepted into the POtentially Serious Alcohol-Medication INteractions in Older adults (POSAMINO) criteria. Consensus was not reached on the remaining 31 criteria; 9 were removed and 8 additional criteria were included following a review of panellist comments. The remaining 30 criteria went to round 2, with 17 criteria reaching consensus, providing a final list of 38 potentially serious alcohol-medication interactions: central nervous system (n=15), cardiovascular system (n=9), endocrine system (n=5), musculoskeletal system (n=3), infections (n=3), malignant disease and immunosuppression (n=2), and respiratory system (n=1).

CONCLUSIONS

POSAMINO is the first set of explicit potentially serious alcohol-medication interactions for use in older adults. Following future validation studies, these criteria may allow for the risk stratification of older adults at the point of prescribing.

Concurrent use of alcohol interactive medications and alcohol in older adults: a systematic review of prevalence and associated adverse outcomes

BACKGROUND

Older adults are susceptible to adverse effects from the concurrent use of medications and alcohol. The aim of this study was to systematically review the prevalence of concurrent use of alcohol and alcohol-interactive (AI) medicines in older adults and associated adverse outcomes.

METHODS

A systematic search was performed using MEDLINE (PubMed), Embase, Scopus and Web of Science (January 1990 to June 2016), and hand searching references of retrieved articles. Observational studies reporting on the concurrent use of alcohol and AI medicines in the same or overlapping recall periods in older adults were included. Two independent reviewers verified that studies met the inclusion criteria, critically appraised included studies and extracted relevant data. A narrative synthesis is provided.

RESULTS

Twenty studies, all cross-sectional, were included. Nine studies classified a wide range of medicines as AI using different medication compendia, thus resulting in heterogeneity across studies. Three studies investigated any medication use and eight focused on psychotropic medications. Based on the quality assessment of included studies, the most reliable estimate of concurrent use in older adults ranges between 21 and 35%. The most reliable estimate of concurrent use of psychotropic medications and alcohol ranges between 7.4 and 7.75%. No study examined longitudinal associations with adverse outcomes. Three cross-sectional studies reported on falls with mixed findings, while one study reported on the association between moderate alcohol consumption and adverse drug reactions at hospital admission.

CONCLUSIONS

While there appears to be a high propensity for alcohol-medication interactions in older adults, there is a lack of consensus regarding what constitutes an AI medication. An explicit list of AI medications needs to be derived and validated prospectively to quantify the magnitude of risk posed by the concurrent use of alcohol for adverse outcomes in older adults. This will allow for risk stratification of older adults at the point of prescribing, and prioritise alcohol screening and brief alcohol interventions in high-risk groups.

Impact of comorbidity on adverse drug reaction profile in a cohort of patients treated with Artemisinin combination therapies for uncomplicated malaria in Nigeria

Artemisinin‐based combination antimalarial therapy (ACTs), is still highly effective in uncomplicated falciparum malaria, however, there remain some concerns in relation to its safety and tolerability. Comorbid disease conditions may influence susceptibility to adverse drug reactions (ADRs) as the presence of multiple disease conditions may predisposes patients to ADRs due to the use of many medicines. There is therefore need to assess the impact of comorbidities on the ADR profile of malaria patients treated with ACTs. The study was carried out in health care facilities spread across Nigeria. From the database of over 10,000 patients recruited into an initial cohort, data for 1000 patients with comorbidities was extracted and matched with a control group of 1000 randomly selected patients with no comorbidity. There were 1105 adverse drug reactions in all, of which 66.2% were recorded in patients with comorbidity, and 34% are patients without comorbidity. The mean age of patients with comorbidities was 38.3 ± 17.5 years and 23.8 ± 17.2 for those without comorbidity. Out of the 979 patients with comorbidity, 36% were hypertensive, 2.2% hypertensive‐diabetes, 16.4% peptic ulcer disease, 10.4% HIV/AIDS, 4.4% diabetes and 4.3% were asthmatic. Patients with comorbidity were three times more likely to have adverse drug reaction than those without comorbidity (Odds ration = 2.96; 95% CI = 2.23–3.93). HIV/AIDS and osteoarthritis were significantly associated with development of adverse drug reactions. Probability was <0.0001. Age, weight, and height of patients were also found to be risk factor for development of adverse drug reactions.

Community pharmacists require additional support to develop capacity in delivering alcohol-related health information to older adults

OBJECTIVES

This qualitative study explored the barriers and enablers influencing Western Australian (WA) community pharmacists' knowledge, confidence, willingness and practice in engaging older clients (>60 years) in alcohol-related health discussions.

METHODS

Two focus groups were conducted with a total of 14 community pharmacists who had previously completed a formative quantitative survey (n = 63), and indicated willingness to participate in a follow-up focus group. Focus group questions, informed by the survey results, explored participants' perceptions about barriers and enablers to delivering health information and advice about alcohol to older clients (60+ years). Shaw and colleagues' theoretical framework was used to understand barriers and enablers in relation to role legitimacy, role adequacy and role support.

KEY FINDINGS

Participants acknowledged that providing health information about alcohol to older clients is a legitimate part of a community pharmacist's role, and most were confident performing this role in situations perceived as core to their professional practice, such as while dispensing medicines. However, many participants identified limited knowledge, skills and confidence in assisting older clients who may have alcohol issues, beyond advising them on medication and alcohol use. Structural barriers such as time and financial barriers were also identified.

CONCLUSION

Routine professional practice including dispensing medicine and home medicine reviews may provide valuable opportunities to engage older clients in alcohol-related discussions. However, limited knowledge concerning appropriate strategies to assist older clients reduce their alcohol consumption, coupled with limited skills and confidence among community pharmacists in raising sensitive alcohol-related issues with clients, suggest the need for specific alcohol-related training and support.

Community pharmacy staff perceptions on preventing alcohol and medication interactions in older adults

OBJECTIVES

To examine rural and urban pharmacy staff perceptions on messaging, barriers, and motivators for preventing alcohol and medication interactions (AMI) in older adults (≥65 years of age).

METHODS

A survey was distributed through the local pharmacist association and statewide pharmacy registry in Kentucky. A total of 255 responses were received from pharmacists, pharmacy technicians, and pharmacy students.

RESULTS

Across rural and urban regions alike, among the AMI prevention messages provided, participants identified the most important messages to be: AMI can be potentially dangerous and life threatening; emergency rooms should be used when experiencing an AMI; and doctors and pharmacists should be consulted about AMI. The most common AMI prevention barriers indicated were stigma, costs, and low perceived risks. The most common AMI prevention motivators indicated were physical health improvement, promoting a healthy lifestyle, convenient setting, and financial incentives.

CONCLUSION

Regardless of geography, participants similarly rated the presented AMI prevention messages, barriers, and motivators. With the use of these findings, the development of an AMI prevention program is suggested to use messaging about AMI threat, behavioral management, and behavioral prevention.

Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents

BACKGROUND

Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions.

OBJECTIVE

Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions.

METHODS

Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined.

RESULTS

There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%).

CONCLUSIONS

Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.

Patterns of alcohol consumption in the older population of Spain, 2008-2010

BACKGROUND

Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe.

OBJECTIVE

The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010.

MAIN OUTCOME MEASURE

Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2.

STATISTICAL ANALYSIS PERFORMED

The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design.

RESULTS

The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake.

CONCLUSIONS

Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

Development of an adverse drug reaction risk assessment score among hospitalized patients with chronic kidney disease

Background

Adverse drug reactions (ADRs) represent a major burden on the healthcare system. Chronic kidney disease (CKD) patients are particularly vulnerable to ADRs because they are usually on multiple drug regimens, have multiple comorbidities, and because of alteration in their pharmacokinetics and pharmacodynamic parameters. Therefore, one step towards reducing this burden is to identify patients who are at increased risk of an ADR.

Objective

To develop a method of identifying CKD patients who are at increased risk for experiencing ADRs during hospitalisation.

Materials and Methods

Factors associated with ADRs were identified by using demographic, clinical and laboratory variables of patients with CKD stages 3 to 5 (estimated glomerular filtration rate, 10–59 ml/min/1.73 m²) who were admitted between January 1, 2012, and December 31, 2012, to the renal unit of Dubai Hospital. An ADR risk score was developed by constructing a series of logistic regression models. The overall model performance for sequential models was evaluated using Akaike Information Criterion for goodness of fit. Odd ratios of the variables retained in the best model were used to compute the risk scores.

Results

Of 512 patients (mean [SD] age, 60 [16] years), 62 (12.1%) experienced an ADR during their hospitalisation. An ADR risk score included age 65 years or more, female sex, conservatively managed end-stage renal disease, vascular disease, serum level of C-reactive protein more than 10 mg/L, serum level of albumin less than 3.5 g/dL, and the use of 8 medications or more during hospitalization. The C statistic, which assesses the ability of the risk score to predict ADRs, was 0.838; 95% CI, 0.784–0.892).

Conclusion

A score using routinely available patient data can be used to identify CKD patients who are at increased risk of ADRs.

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.

Prospective associations between unforgiveness and physical health and positive mediating mechanisms in a nationally representative sample of older adults

OBJECTIVE

This study examined the prospective association between unforgiveness and self-reported physical health and potential positive psychological mediators of this association.

DESIGN

Participants were a national sample of 1024 USA's adults of ages 66 years and older. Data were collected at two time points separated by three years.

MAIN OUTCOME MEASURES

Measures of trait unforgiveness, self-rated physical health, socio-demographics, health behaviours and positive psychological traits (e.g. life satisfaction, self-esteem) were included in a comprehensive survey known as the 'Religion, Aging, and Health Survey.'

RESULTS

The results indicated that unforgiveness was prospectively associated with declines in self-reported physical health three years later, and poor initial self-reported health status did not predict increases in unforgiveness across time. Furthermore, the prospective association of unforgiveness with self-reported health was mediated by a latent positive psychological traits variable.

CONCLUSION

These results confirm cross-sectional findings suggesting that unforgiveness is related to health. The present study also suggests that unforgiveness has a prospective, but not reciprocal, association with self-reported physical health. Unforgiveness may have its association with self-reported physical health through its interruption of other positive traits that typically confer health benefits.

The prevalence of potential alcohol-drug interactions in older adults

OBJECTIVES

The aim of this study was to assess the possibility of clinically significant drug-alcohol interactions among home-dwelling older adults aged ≥ 65 years.

DESIGN

This study was a cross-sectional assessment of a stratified random sample of 2100 elderly people (≥ 65 years) in Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. The drugs were coded according to their Anatomical Therapeutic Chemical (ATC) classification index (ATC DDD 2012). Significant alcohol interactive (AI) drugs were examined according to the Swedish, Finnish, INteraction X-referencing (SFINX) interaction database, as well as concomitant use of central nervous system drugs, hypoglycaemics, and warfarin with alcohol. "At-risk alcohol users" were defined consuming > 7 drinks/week, or ≥ 5 drinks on a typical drinking day, or using ≥ 3 drinks several times/week, "moderate users" as consuming at least one drink/month, but less than 7 drinks/week, and "minimal/non-users" less than one drink/month.

RESULTS

Of the total sample (n = 1395), 1142 respondents responded as using at least one drug. Of the drug users, 715 (62.6%) persons used alcohol. The mean number of medications was 4.2 (SD 2.5) among "at-risk users", 4.0 (SD 2.6) among "moderate users", and 5.4 (SD 3.4) among "minimal/non-users" (p < 0.001). The concomitant use of AI drugs was widespread. Among the "at-risk users", "moderate users", and "minimal/nonusers" 42.2%, 34.9%, and 52.7%, respectively, were on AI drugs (p < 0.001). One in 10 of "at-risk users" used warfarin, hypnotics/sedatives, or metformin.

CONCLUSIONS

Use of AI drugs is common among older adults, and this increases the potential risks related to the use of alcohol.

Adverse drug reactions in older people: detection and prevention

Adverse drug reactions (ADRs) in older adults are an important healthcare problem since they are frequently a cause of hospitalization, occur commonly during admission, and are an important cause of morbidity and mortality. Older adults are particularly susceptible to ADRs because they are usually on multiple drug regimens and because age is associated with changes in pharmacokinetics and pharmacodynamics. The presentation of an ADR in older adults is often atypical, which further complicates its recognition. One potential strategy for improving recognition of ADRs is to identify those patients who are at risk of an ADR. The recently developed GerontoNet ADR Risk Score is a practical tool for identification of older patients who are at increased risk for an ADR and who may represent a target for interventions aimed at reducing ADRs. Provision of adequate education in the domain of clinical geriatric pharmacology can improve recognition of ADRs. Besides formal surveillance systems, built-in computer programs with electronic prescribing databases and clinical pharmacist involvement in patient care within multidisciplinary geriatric teams might help to minimize the occurrence of ADRs. In addition, a number of actions can be taken in hospitals to stimulate appropriate prescribing and to assure adequate communication between primary and hospital care. In older adults with complex medical problems and needs, a global evaluation obtained through a comprehensive geriatric assessment may be helpful in simplifying drug prescription and prioritizing pharmacological and healthcare needs, resulting in an improvement in quality of prescribing.

Alcohol effects on cognitive change in middle-aged and older adults

OBJECTIVES

This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups.

METHODS

Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities).

RESULTS

Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status.

DISCUSSION

In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.

Adverse Drug Reactions in Elderly Hospitalized Patients: A 12-Year Population-Based Retrospective Cohort Study

BACKGROUND:

Although research has identified some risk factors for first-time adverse drug reactions (ADRs), little is known about the risks associated with the number of ADRs. Modeling ADR counts is relatively complex because of the rarity of the events, requiring careful consideration of appropriate models that best present the observed data.

OBJECTIVE:

To determine the incidence of ADRs among elderly hospitalized patients, assess patient-related risk factors for the number of ADRs, and review drug classes commonly responsible for ADRs.

METHODS:

This retrospective cohort study used a population-based large administrative database on hospital separations from all acute care hospitals in the Canadian province of Newfoundland and Labrador. Patients aged 65 years or older with at least 1 hospital admission from April 1, 1995, to March 31, 2007, were included. Comorbidities, Charlson Comorbidity Index (CCI), and sociodemographic factors were assessed as predictors of ADR counts. A zero-inflated negative binomial regression model was used for analysis.

RESULTS:

The study cohort contained 64,446 patients. The incidence of ADRs was 15.2 per 1000 person-years (95% CI 14.8 to 15.7). Of those having an ADR, 15.4% had recurrent ADRs. The most common drug category implicated in ADRs was cardiovascular agents (17.7%). A dose-response relationship was found between CCI and ADR counts (rate ratio [RR] 1.67, 95% CI 1.41 to 1.98 for CCI 2-3; RR 2.38, 95% CI 1.98 to 2.87 for CCI 4-5; and RR 3.83, 95% CI 3.21-4.57 for CCI ≥6). Comorbid conditions including congestive heart failure (RR 1.58, 95% CI 1.33 to 1.89), diabetes (RR 2.42, 95% CI 1.64 to 3.56), and cancer (RR 3.12, 95% CI 2.58 to 3.76) were strong predictors. Rural areas (RR 1.22, 95% CI 1.01 to 1.46) were associated with increased risk for ADRs, whereas age and sex had no effect.

CONCLUSIONS:

Comorbidity from chronic diseases and severity of illness, rather than individual characteristics (advancing age and sex), increased the likelihood of ADRs. Changes in the delivery of care focusing on the monitoring of prescribed drugs in elderly patients with comorbidities could mitigate ADRs.

Forgiveness of others and health: do race and neighborhood matter?

OBJECTIVES

This study examines the relationship between interpersonal forgiveness and health for older Blacks and Whites. We outline a series of arguments concerning the following: (a) how forgiveness can affect health, (b) how forgiveness may be more protective for Blacks, and (c) how the relationship between forgiveness and health may vary by neighborhood deterioration.

METHOD

Two waves (2001 and 2004) of the Religion, Aging, and Health Survey provided data from a nationally representative elderly sample of 436 Blacks and 500 Whites. Measures included sociodemographics, forgiveness, and three dimensions of health: self-reported health, alcohol use, and chronic conditions. We employ both longitudinal and cross-sectional analyses.

RESULTS

Results suggest that forgiveness of others was protective of health for Blacks but not Whites. Moreover, among Blacks, we found the following: (a) forgiveness was positively associated with self-reported health over time, (b) forgiveness was negatively associated with alcohol use and number of chronic conditions, and (c) forgiveness interacted with neighborhood deterioration such that the beneficial effects of forgiveness for self-reported health did not extend to those living in run-down neighborhoods.

DISCUSSION

Race and neighborhood were shown to be important for understanding the forgiveness-health connection. Forgiveness was associated with better health for Blacks but not Whites, consistent with McCullough's evolutionary framework (McCullough, M. E. (2008). Beyond revenge: The evolution of the forgiveness instinct. San Francisco, CA: Jossey-Bass), forgiveness was beneficial in some settings but had a deleterious impact in more noxious environments. This study suggests that researchers should give more consideration to race and social context in attempting to more fully understand the relationship between forgiveness and health.

Sex and gender in adverse drug events, addiction, and placebo

Sex-gender-based differences in response to pharmaceutical treatments are still under evaluation but evidence already exists regarding the impact of sex-gender-related differences on drug safety profile, drug abuse/addiction, and placebo effects. For a number of drugs it is well recognized that a sex-gender dimorphic profile in terms of drug adverse effects exists and appears to be more frequent and severe in women than in men. However, it is not well known whether this is due to pharmacodynamic or pharmacokinetic differences. Indeed the optimization of therapy requires that attention is paid to single sex-gender. Numerous pharmacokinetic, pharmacodynamic, and sociocultural differences between women and men in drug abuse have been described. Here we focus on sex-gender differences in alcoholism and nicotine addiction. The relevance of sex and gender differences in addiction appear to be relevant. Specific programs aimed to address addicted women's specific needs (child care, pregnancy, housing, and violence and others) are recommended. Finally, this article discusses the possible effect of sex-gender on placebo response in the light of the more significant recent literature evidencing that studies are urgently required in order to better understand the role of sex-gender on placebo mechanism and its impact on randomized clinical trials outcomes.

Alcohol and the older adult: a comprehensive review

Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.

Heart failure and adverse drug reactions among hospitalized older adults

The aim of this study was to assess whether heart failure (HF) could be a risk factor for adverse drug reactions (ADRs) among hospitalized older adults. This study included 19,496 patients admitted to community- and university-based hospitals in Italy (mean age 70 +/- 14 years; 49.7% female). ADRs were identified in 207 of the 2,413 (8.6%) patients with HF and in 855 (5.0%) of the 17,083 patients without HF (P < 0.001). After adjusting for potential confounders, HF was shown to be associated with an increased likelihood of experiencing an ADR (odds ratio (OR) 1.29; 95% confidence interval (CI) 1.06-1.56). After stratifying the sample by gender, the association continued to be seen in the women (OR 1.58; 95% CI 1.22-2.05) but not in the men (OR 0.99; 95% CI 0.74-1.34). In conclusion, HF appears to be associated with a higher rate of ADRs among hospitalized patients. Gender may influence the effect of HF on the risk of ADRs.

Alcohol consumption and health among elders

PURPOSE

This article estimates the effects of alcohol consumption on self-reported overall health status, injuries, heart problems, emergency room use, and hospitalizations among persons older than the age of 65.

DESIGN AND METHODS

We analyzed data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative study. We used multivariate regression and instrumental variables methods to study the associations between alcohol consumption (current drinking, binge drinking, and average number of drinks consumed) and several indicators of health status and health care utilization.

RESULTS

Alcohol consumption by women was associated with better self-perceived health status, improved cardiovascular health, and lower rates of hospitalizations. We detected no significant negative or positive associations for older men.

IMPLICATIONS

These findings suggest that light to moderate alcohol use by older women may have beneficial health effects. Experimental trials, however, are needed to more rigorously assess the potential benefits of alcohol use by elders due to the inherent biases of observational studies.

Comorbidity and repeat admission to hospital for adverse drug reactions in older adults: retrospective cohort study

OBJECTIVES

To identify factors that predict repeat admission to hospital for adverse drug reactions (ADRs) in older adults.

DESIGN

Population based retrospective cohort study.

SETTING

All public and private hospitals in Western Australia.

PARTICIPANTS

28 548 patients aged >or=60 years with an admission for an ADR during 1980-2000 followed for three years using the Western Australian data linkage system.

RESULTS

5056 (17.7%) patients had a repeat admission for an ADR. Repeat ADRs were associated with sex (hazard ratio 1.08, 95% confidence interval 1.02 to 1.15, for men), first admission in 1995-9 (2.34, 2.00 to 2.73), length of hospital stay (1.11, 1.05 to 1.18, for stays >or=14 days), and Charlson comorbidity index (1.71, 1.46 to 1.99, for score >or=7); 60% of comorbidities were recorded and taken into account in analysis. In contrast, advancing age had no effect on repeat ADRs. Comorbid congestive cardiac failure (1.56, 1.43 to 1.71), peripheral vascular disease (1.27, 1.09 to 1.48), chronic pulmonary disease (1.61, 1.45 to 1.79), rheumatological disease (1.65, 1.41 to 1.92), mild liver disease (1.48, 1.05 to 2.07), moderate to severe liver disease (1.85, 1.18 to 2.92), moderate diabetes (1.18, 1.07 to 1.30), diabetes with chronic complications (1.91, 1.65 to 2.22), renal disease (1.93, 1.71 to 2.17), any malignancy including lymphoma and leukaemia (1.87, 1.68 to 2.09), and metastatic solid tumours (2.25, 1.92 to 2.64) were strong predictive factors. Comorbidities requiring continuing care predicted a reduced likelihood of repeat hospital admissions for ADRs (cerebrovascular disease 0.85, 0.73 to 0.98; dementia 0.62, 0.49 to 0.78; paraplegia 0.73, 0.59 to 0.89).

CONCLUSIONS

Comorbidity, but not advancing age, predicts repeat admission for ADRs in older adults, especially those with comorbidities often managed in the community. Awareness of these predictors can help clinicians to identify which older adults are at greater risk of admission for ADRs and, therefore, who might benefit from closer monitoring.

Drinking alcohol for medicinal purposes by people aged over 75: a community-based interview study

BACKGROUND

Physicians often encounter patients using alcohol as self-medication, but studies on community level are scarce. Because of alcohol-medicine interactions, it is important to know also all self-medication used.

OBJECTIVE

To describe alcohol use as self-medication by people aged over 75 years.

METHODS

The home-dwelling elderly (n = 699) among a random sample of 1000 subjects from the total population of individuals aged 75 years or more in the city of Kuopio, Finland, were interviewed about their alcohol consumption and use as self-medication and also about their lifestyle habits, medicaments and diseases. A geriatrician checked their medical records for medical conditions.

RESULTS

Half of the subjects consumed alcohol, and 40% of them used alcohol for medicinal purposes. This was equally common in females and males. The quantity used was half a unit or less in 68% of cases. Brandy and other spirits were the most commonly used beverages, and heart and vascular disorders (38%), sleep disorders (26%) and mental problems (23%) were the commonest reasons for use. The study found altogether 84 persons who responded negatively to the question about alcohol consumption but later reported using alcohol as self-medication.

CONCLUSIONS

Drinking alcohol for medicinal purposes is common among the aged in Finland. Some people, especially older women, may find it easier to discuss their alcohol consumption in the context of medicinal use. Physicians have to consider the possible risks of alcohol associated with concomitant medical conditions and interactions of alcohol with medicines.

Longitudinal course of substance treatment benefits in older male veteran at-risk drinkers

BACKGROUND

This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared.

METHODS

This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version.

RESULTS

Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weekly consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study.

CONCLUSIONS

Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC.

Risks of combined alcohol/medication use in older adults

BACKGROUND

Many older adults (ie, those aged >65 years) drink alcohol and use medications that may be harmful when consumed together.

OBJECTIVE

This article reviews the literature on alcohol and medication interactions, with a focus on older adults.

METHODS

Relevant articles were identified through a search of MEDLINE and International Pharmaceutical Abstracts (1966-August 2006) for English-language articles. The following medical subject headings and key words were used: alcohol medication interactions, diseases worsened by alcohol use, and alcohol metabolism, absorption, and distribution. Additional articles were identified by a manual search of the reference lists of the identified articles, review articles, textbooks, and personal reference sources.

RESULTS

Many older adults drink alcohol and take medications that may interact negatively with alcohol. Some of these interactions are due to age-related changes in the absorption, distribution, and metabolism of alcohol an medications. Others are due to disulfiram-like reactions observed with some medications, exacerbation of therapeutic effects and adverse effects of medications when combined with alcohol, and alcohol's interference with the effectiveness of some medications.

CONCLUSIONS

Older adults who drink alcohol and who take medications are at risk for a variety of adverse consequences depending on the amount of alcohol and the type of medications consumed. It is important for clinicians to know how much alcohol their older patients are drinking to be able to effectively assess their risks and to counsel them about the safe use of alcohol and medications. Similarly, it is important for older adults to understand the potential risks of their combined alcohol and medication use to avoid the myriad of problems possible with unsafe use of these substances..

Adverse drug events in cognitively impaired elderly patients

BACKGROUND/AIMS

Adverse drug events (ADEs) are a frequent problem encountered in the elderly. The aim of this study was to elucidate the factors that influence ADEs in an elderly population with cognitive impairment.

METHODS

242 patients were recruited from dementia clinics and assessed after 6 months for ADEs. The use of natural health products (NHPs) was also documented.

RESULTS

Backward logistic regression found that higher age (OR = 1.06; 95% CI 1.01-1.12), and greater cognitive impairment (OR = 0.94; 95% CI 0.90-0.98) were associated with an increased risk of developing an ADE while the use of NHPs (OR = 0.32; 95% CI 0.13-0.79) was associated with a decreased risk (chi(2) = 27.6, p < 0.001).

CONCLUSION

Risk of ADEs increased with greater age and cognitive impairment but decreased with the use of NHPs.

Alcohol use among older adults

Alcohol use problems among older adults have been called the "invisible epidemic." As the population of older adults continues to grow, there is an increased need to reexamine alcohol use in this population. The authors provide an overview on alcohol use in the over-60 age group. The main areas of focus included research on the prevalence of drinking in that population, as well as comments on the best practices in assessment and psychological treatment. Several screening assessments have been recommended for use with older adults, such as the CAGE questionnaire, Michigan Alcohol Screening Test-Geriatric version, Alcohol-Related Problems Survey, and the Alcohol Use Disorders Identification Test. The authors note age-appropriate psychological treatment interventions that include brief interventions, family interventions, motivational counseling, and cognitive behavioral therapies. Barriers to assessment and treatment are also discussed.

Prevalence of smoking and drinking among older adults in seven urban cities in Latin America and the Caribbean

In 2000, a representative sample of the elderly population (60 years or older) was selected from seven urban cities in Latin America and the Caribbean: Buenos Aires (Argentina), Mexico City (Mexico), Santiago (Chile), Havana (Cuba), Montevideo (Uruguay), Bridgetown (Barbados), and Sao Paulo (Brazil). A face-to-face interview was uniformly administered in the respective official languages. A total of 10,577 older adults were included in this study. The elderly in Havana had the highest prevalence of smoking (46.5% of men and 21.5% women). The highest prevalence of daily drinking was in Buenos Aires (19%). In contrast, only 1.5% of respondents in Mexico City and 2.3% of respondents in Havana consumed alcohol daily. Smoking and daily drinking were highly prevalent among older adults. As the older adult population grows steeply, the health behavior of this population starts carrying important implications for health care systems.

Predictors of adherence within an intervention research study of the at-risk older drinker: PRISM-E

The aim of this study was to determine predictors of research adherence and treatment initiation in at-risk older drinkers. This investigation was conducted at primary care clinics in the Philadelphia Veteran Affairs Medical Center and the University of Pennsylvania, participating sites in a larger multisite study trial (PRISM-E). Persons aged 65 and older with appointments at participating clinics were eligible for recruitment (n = 8367). Approximately half (n = 4000) consented to the study, of which 145 were identified as at-risk drinkers and 125 agreed to treatment. Slightly more than half of the patients who agreed to treatment attended a mental health visit. The results suggest that predictors of research adherence and treatment initiation vary across research stage. Principal predictors include age, mental health status, and at-risk drinking attributes. Moreover, there was evidence that an integrated care treatment model may be capable of improving treatment initiation in at-risk older drinkers who have no history of substance management behaviors. Future researchers can use the current findings to create mechanisms to improve research participation and treatment initiation and target participants with classifications of poor adherence.

Community prevalence of alcohol use and concomitant use of medication--a source of possible risk in the elderly aged 75 and older?

AIMS

To explore alcohol use and concomitant use of prescription and over the counter (OTC) medicines in people aged 75 years or over.

DESIGN

Community-based randomized survey of home-dwelling elderly persons, Setting: the City of Kuopio, Finland.

PARTICIPANTS

Population-based random sample of 700 persons aged 75 years or over, of whom 601 participated (86%). Only home-dwellers (n = 523) were included in this study.

MEASUREMENTS

Alcohol use based on responses to questions concerning quantity and frequency, and CAGE questions. Use of prescription and non-prescription medicines. Mean corpuscular volume.

RESULTS

Of the participants, 44% used alcohol. Most alcohol drinkers used medications on a regular basis (86.9%) or as needed (87.8%), among them medicines known to have some potential interactions with alcohol. Elevated mean corpuscular volume was more widespread among alcohol drinkers than non drinkers.

CONCLUSION

Theoretical risks posed by alcohol use are not minimal in the older elderly, though the quantity of alcohol use is not considerable. Physicians and nurses should pay attention to chronic diseases and medications when counselling aged people about alcohol consumption. The question of clinical importance of alcohol-medication interactions needs to be studied further.

Socio-demographic factors related to the prevalence of adverse drug reaction at hospital admission in an elderly population

To identify and to measure the association between socio-demographic factors and the prevalence of adverse drug reaction at hospital admission in an elderly population, we carried out a cross-sectional study on a sample of 19,070 patients of the Gruppo Italiano di Farmacoepidemiologia nell'Anziano data base (Italy). The following socio-demographic variables were considered as independent variables: gender, age, education, living arrangement, widowhood/widowerhood, and alcohol and tobacco habit. We estimated the association of these variables with diagnosis of any adverse drug reaction at hospital admission. We used a logistic regression model to obtain estimates of this association, taking into account hepatic and renal diseases, number of diseases, number of drugs used, albumin index (indicator of nutritional condition) and cognitive function. Out of the 19,070 patients included in our study, 878 (4.3%) were diagnosed with an adverse drug reaction at admission. The multivariate analysis shows that none of the socio-demographic variables and health habits considered are associated with adverse drug reactions at admission. A worse nutritional condition of the subject (OR = 1.39; 95% CI: 1.17-1.64), the number of drugs consumed in the month previous to the admission (OR = 1.74; 95% CI: 1.47-2.08) and the presence of renal disease (OR = 1.76; 95% CI: 1.41-2.55) are associated with ADR at hospital admission. Our results suggest that special attention should be paid to avoid adverse drug reactions in elderly people with nutritional problems, renal failure or those who are using two drugs or more. Additional precautions should be taken with people with cognitive impairment, because of their reduced capacity to report their symptoms.

Inappropriate medication use among hospitalized older adults in Italy: results from the Italian Group of Pharmacoepidemiology in the Elderly

OBJECTIVE

To determine the prevalence of inappropriate medication use among hospitalized older adults and to identify predictors of this use.

METHODS

A total of 5734 patients (mean age 79 years) admitted to geriatric and internal medicine wards participating in the study in 1995 and 1997 were included in this analysis. Inappropriate medication use was defined on the basis of the criteria published by Beers in 1997. Only medications used during hospital stay were considered for the present study.

RESULTS

During hospital stay, 837 (14.6%) patients received one or more medications classified as inappropriate based on Beers criteria. Ticlopidine ( n=346; 6.0% of the study sample) was the most frequently used medication among those in Beers' list, followed by digoxin ( n=174; 3.0%) and amytriptyline ( n=113; 2.0%). The multivariate analysis showed that age [75-84 years vs 65-74 years, odds ratio (OR) 0.85, 95% confidence interval (CI) 0.71-1.00; >or=85 years vs 65-74 years, OR 0.58, 95% CI 0.46-0.73], cognitive impairment (OR 0.77, 95% CI 0.64-0.94), Charlson co-morbidity index (>or=2 vs 0-1, OR 1.20, 95% CI 1.02-1.40) and overall number of medications used during hospital stay (5-8 medications vs <5 medications, OR 2.20, 95% CI 1.72-2.82; >or=9 medications vs <5 medications, OR 3.68, 95% CI 2.86-4.73) were significantly associated with use of inappropriate medications.

CONCLUSIONS

Inappropriate medication use was common among hospitalized older adults. The most important determinant of risk of receiving an inappropriate medication was the number of drugs being taken. Older age and cognitive impairment were associated with a reduced likelihood of using an inappropriate medication.

Moderate alcohol consumption and unappreciated risk for alcohol-related harm among ethnically diverse, urban-dwelling elders

The purpose of this cross-sectional survey was to gather data describing how older adults define moderate alcohol consumption and how they have interpreted media reports of the health benefits of moderate alcohol consumption. Results showed that many older adults define moderate alcohol use at levels above Federal guidelines, and a notable number of older adults agree that moderate use is good for health. The disparity between older adults' definition of moderate drinking and Federal guidelines for low-risk drinking may contribute to the underrecognition of problem drinking by nurses and other health care providers and place older adults at an unappreciated level of risk for alcohol-related harm.

Adverse drug reactions as cause of hospital admissions: results from the Italian Group of Pharmacoepidemiology in the Elderly (GIFA)

OBJECTIVES

To determine the prevalence of adverse drug reaction (ADR)-related hospital admissions in an older population, to describe the most common clinical manifestations and drugs most frequently responsible for ADR-related hospital admissions, and to identify independent factors predictive of these ADRs.

DESIGN

Multicenter pharmacoepidemiology survey conducted between 1988 and 1997.

SETTING

Eighty-one academic hospitals throughout Italy.

PARTICIPANTS

Twenty-eight thousand four hundred eleven patients consecutively admitted to participating centers during the survey periods.

MEASUREMENTS

For each suspected ADR at admission, a physician, who coded description, severity, and potentially responsible drugs, completed a questionnaire.

RESULTS

Mean age +/- standard deviation of the patients was 70 +/- 16. One thousand seven hundred four ADRs were identified upon hospital admission. In 964 cases (3.4% of all admissions), ADRs were considered to be the cause of these hospital admissions. Of these, 187 ADRs were coded as severe. Gastrointestinal complaints (19%) represented the most common events, followed by metabolic and hemorrhagic complications (9%). The drugs most frequently responsible for these ADRs were diuretics, calcium channel blockers, nonsteroidal antiinflammatory drugs, and digoxin. Female sex (odds ratio (OR) = 1.30, 95% confidence interval (CI) = 1.10-1.54), alcohol use (OR = 1.39, 95% CI = 1.20-1.60), and number of drugs (OR = 1.24, 95% CI = 1.20-1.27 for each drug increase) were independent predictors of ADR-related hospital admissions. For severe ADRs, age (OR = 1.50, 95% CI = 1.01-2.23 for age 65-79 and OR = 1.53, 95% CI = 1.00-2.33 for age > or =80, respectively), comorbidity (OR = 1.12, 95% CI = 1.05-1.20 for each point in the Charlson Comorbidity Index), and number of drugs (OR = 1.18, 95% CI = 1.11-1.25 for each drug increase) were the only predisposing factors.

CONCLUSIONS

The most important determinant of risk for ADR-related hospital admissions in older patients is number of drugs being taken. When considering only severe ADRs, risk is also related to age and frailty.