Alcohol-drinking history and fatal injury in older adults

Medical and social implications of alcohol use among adult women in a rural area of Ranchi, Jharkhand: A cross-sectional study

Introduction

The harmful use of alcohol is increasing at a huge pace leading to the occurrence of multiple diseases and has become a leading risk factor for global burden of diseases.

Aims and Objectives

The aim of this study is to assess the health profile of adult women and to find out the medical and social effects of alcohol consumption.

Methodology

A cross-sectional study was conducted in the rural field practice area, Ormanjhi of RIMS, Ranchi, for a duration of 27 months (September 2016 to November 2018) among 336 women by multistage random sampling. A pretested semi-structured questionnaire was used for data collection. Templates were generated in MS Excel sheet and analysis of data was done using SPSS software (20.0).

Results

The mean BMI of the study subjects was 21.62 ± 3.33 kg/m2. Anaemia was present in 42.6% of the women, 10.4% women were hypertensive and 9.2% were suffering from diabetes. The association between alcohol consumption and occurrence of co-morbidities was found insignificant. The social effects of alcoholism varied ranging from going into debts seen in 35.42% of the women; 62.5% of the women were criticised about their drinking habit by relatives or children. About 9.5% of the women were found to consume alcohol during their last pregnancy, and among women who were on regular intake of alcohol even during pregnancy, majority (65.62%) of them delivered by normal vaginal delivery.

Conclusion

Alcohol consumption among females caused several adverse social consequences without any significant effect on health.

Clusters of older adults with and without experience of alcohol-related harms based on affective motivations for drinking

Aim: This cross-sectional study explores profiles of community-residing Norwegian older adults (aged 62-95 years) in relation to their personally expressed motives for alcohol use. It specifically investigates drinking motives as they uniquely characterise alcohol consumers reporting problem and non-problem drinking assessed using the Drinking Problem Index (DPI). Methods: Two-step cluster analysis was used to delineate subgroups of alcohol consumers on seven drinking motivation variables, together with DPI score. The clusters were evaluated by gender, physical health and psychological health status. Results: Four clusters of alcohol consumers were identified in relation to drinking motives: Low motivated drinkers, Ambivalent drinkers, Enhancement drinkers, and Coping drinkers. For one subgroup, a strong reliance on alcohol to cope with negative feelings was most relevant to both non-problem and problem drinkers. For another subgroup, enjoying the effects of alcohol, but non-reliance on alcohol to cope with negative mood were associated with reporting drinking problems. Ambivalent drinkers reported overall low satisfaction with mental health. Very poor physical and mental health were more prevalent in men than in women characterised as Coping drinkers. Predominantly mental health status supported distinctiveness of delineated clusters. Conclusion: This study demonstrates that the classification approach to profiling of characteristics of alcohol consumers based on their motivations to drink may have a potential utility in human care settings to identify individuals who incur or may be at risk of developing alcohol-related problems in later life, and those who are not.

Cognitive impairment and treatment outcomes amongst people attending an alcohol intervention service for those aged 50+

Purpose

No studies have evaluated the relationship between cognitive impairment and alcohol treatment outcomes amongst older drinkers. This study aims to explore the extent of cognitive impairment amongst older adults seeking alcohol treatment and examine the relationship between cognitive impairment, treatment retention and alcohol use following treatment.

Design/methodology/approach

The study used data from the Drink Wise Age Well programme; an alcohol intervention service for older adults (aged 50+). The Montreal Cognitive Assessment was used to screen for cognitive impairment; alcohol use was assessed using the alcohol use disorders identification test.

Findings

In total, 531 participants completed the assessment at treatment entry. Over half the sample were male (57%), with a mean age of 60 years (Standard deviation: 7.09). Almost half (48.4%) had cognitive impairment at the entry to treatment: 51.6% had a normal cognitive function, 41.4% had mild cognitive impairment, 5.8% had moderate cognitive impairment and 1.1% had severe cognitive impairment. Cognitive impairment was not associated with increased treatment drop-out and was not predictive of alcohol use following treatment. Alcohol treatment was associated with a significant improvement in cognitive functioning.

Originality/value

This study suggests there may be a significant amount of unidentified cognitive impairment amongst older adults attending alcohol treatment. Assessment and routine screening for cognitive impairment in drug and alcohol services may help in care planning and setting treatment goals; in the absence of routine screening opportunities for treatment planning and intervention may be missed.

Predictors and burden of injury mortality in the Thai cohort study 2005-2015

BACKGROUND

Thailand is a high injury burden setting. In 2015 it had the world's second highest rate of road traffic fatalities. In order to develop strategies to reduce this burden an accurate understanding of the development of injury risk over the life course is essential.

METHODS

A national cohort of adult Thais was recruited in 2005 (n = 87,151). Participants completed a health questionnaire covering geodemographic, behavioural, health and injury data. Citizen ID numbers were matched with death registration records, identifying deaths from any injury. Adjusted logistic regression models were used to measure associations between baseline exposures and injury deaths between 2005 and 2015.

RESULTS

Injury mortality comprised 363 individuals, the majority (36%) from traffic injuries. Predictors of all-injury mortality were being male (AOR 3.55, 95% CI 2.57-4.89), Southern Thai (AOR 1.52, 95% CI 1.07-2.16), smoking (AOR 1.55, 95% CI 1.16-2.17), depression (AOR 1.78, 95% CI 1.07-2.96), previous injury (AOR 1.37, 95% CI 1.03-1.81) and drink driving history (AOR 1.37, 95%CI 1.02-1.85). Age and region of residence were stronger predictors for men, while anxiety/depression was a stronger predictor for women. Among males in the far south, assault caused the largest proportion of injury mortality, elsewhere traffic injury was most common.

CONCLUSIONS

This study identifies that a history of drink driving, but not regular alcohol consumption, increased injury risk. The associations between smoking and depression, and injury mortality also need further consideration.

Use of Alcohol in Long Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice and the Law

Alcohol is one of the most widely available psychoactive substances globally. Many accept the risks associated with alcohol consumption for reasons such as social engagement and feelings of pleasure. Alcohol consumption in a nursing home (NH) setting highlights the moral and logistical challenges of balancing the need for a safe living and working environment with the dignity of risk (DoR) and personal autonomy of residents. This analysis explores public health, human rights, and legal frameworks in their approach to a NH resident's choice to drink alcohol. Key issues under the public health framework include the medical risks associated with alcohol consumption, whether residents with impaired cognitive functioning have the capacity to make a decision about alcohol consumption, and the practical and ethical implications of supplying alcohol to residents. Under a legal framework, NHs must consider the legal imperative to respect residents' rights, the possibility of liability in negligence, duties owed to employees, the existence of substitute decision-makers, and liquor licensing laws. Fundamental considerations under the human rights framework include the damaging psychological effects of risk-avoidance and the importance of inclusive risk assessment processes. Alcohol policies should incorporate elements from all 3 frameworks. There is limited data publicly available about alcohol policies in NHs. Further research is needed to establish current practice and to evaluate the merits and disadvantages of different policies. Establishing inclusive and thorough decision-making processes is key to achieving better consumer-directed care.

National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment study

BACKGROUND

Alcohol use has increased globally, with varying trends in different parts of the world. This study investigates gender, age, and geographical differences in the alcohol-attributable burden of disease from 2000 to 2016.

METHODS

This comparative risk assessment study estimated the alcohol-attributable burden of disease. Population-attributable fractions (PAFs) were estimated by combining alcohol exposure data obtained from production and taxation statistics and from national surveys with corresponding relative risks obtained from meta-analyses and cohort studies. Mortality and morbidity data were obtained from the WHO Global Health Estimates, population data were obtained from the UN Population Division, and human development index (HDI) data were obtained from the UN Development Programme. Uncertainty intervals (UIs) were estimated using a Monte Carlo-like approach.

FINDINGS

Globally, we estimated that there were 3·0 million (95% UI 2·6-3·6) alcohol-attributable deaths and 131·4 million (119·4-154·4) disability-adjusted life-years (DALYs) in 2016, corresponding to 5·3% (4·6-6·3) of all deaths and 5·0% (4·6-5·9) of all DALYs. Alcohol use was a major risk factor for communicable, maternal, perinatal, and nutritional diseases (PAF of 3·3% [1·9-5·6]), non-communicable diseases (4·3% [3·6-5·1]), and injury (17·7% [14·3-23·0]) deaths. The alcohol-attributable burden of disease was higher among men than among women, and the alcohol-attributable age-standardised burden of disease was highest in the eastern Europe and western, southern, and central sub-Saharan Africa regions, and in countries with low HDIs. 52·4% of all alcohol-attributable deaths occurred in people younger than 60 years.

INTERPRETATION

As a leading risk factor for the burden of disease, alcohol use disproportionately affects people in low HDI countries and young people. Given the variations in the alcohol-attributable burden of disease, cost-effective local and national policy measures that can reduce alcohol use and the resulting burden of disease are needed, especially in low-income and middle-income countries.

FUNDING

None.

Examining the Association Between Alcohol Consumption and Health Conditions in Community Dwelling Older Adults

The Canadian low-risk drinking guidelines were developed for adults, however, the applicability to older adults was not considered in the development of the guidelines. The objectives of this study were to: (1) to examine alcohol use in community dwelling older males and females using the current Canadian guidelines; (2) to test lower limits of alcohol use on various health factors; and (3) to determine health factors associated with high-risk drinking in older males and females. Data on community dwelling older adults (aged 65 +) was used from the Canadian Injury Prevention Survey (n = 2274). Descriptive statistics and comparative analysis were used to compare alcohol consumption categories. Logistic regressions were performed to examine the relationships between health factors and alcohol consumption categories. 70% of the sample reported having at least one drink per week; 4.5% of males and 6.8% of females were high-risk drinkers according to the current guidelines. There were no significant associations between the current alcohol categories with demographics, behavioral risk factors or health conditions. Using the new guidelines, 21% of males and females were classified as high-risk drinkers, respectively. Diabetes and having an illness or disability before retirement was protective of high-risk drinking in males while having diabetes and poorer physical health was protective of high-risk drinking in females. The prevalence of high-risk drinkers is dependent on what alcohol classifications are used. Further studies are needed to determine the causal relationships between health-related factors and alcohol using standardized definitions of alcohol consumption.

Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age

INTRODUCTION

The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship.

METHOD

From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied.

RESULTS

A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40-2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age.

CONCLUSIONS

The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.

Positive alcohol expectancies and injunctive drinking norms in drinking to cope motives and alcohol use among older adults

BACKGROUND

Studies indicate older adults have increased risk for alcohol-related harms (e.g., risk for falls) that can manifest at lower levels of consumption than younger adults. Specifically, age-related changes in alcohol metabolism, physiology, increased morbidity, and potential interactions with medications to manage chronic conditions increases risk for related harms among older adults.

PURPOSE

The present study used cross-sectional data to examine the associations between drinking to cope motives and positive alcohol expectancies, and injunctive drinking norms in older adults. We also explored the interaction between drinking to cope, positive expectancies and injunctive drinking norms on alcohol use.

METHODS

Adults aged 65 and older (N = 98) completed a series of measures assessing drinking to cope motives, positive alcohol expectancies, injunctive drinking norms, and past-month alcohol use.

RESULTS

Positive alcohol expectancies were positively associated with drinking to cope motives. Drinking norms were not associated with coping motives. Moderating effects of expectancies varied on the link between coping motives and alcohol use. Greater endorsement of coping motives was associated with more alcohol consumption but only for those with low expectancies.

CONCLUSIONS

Better understanding of the complex interplay between drinking to cope motives, positive expectancies, and injunctive drinking norms of proximal as well as distal referents could foster improvement of clinical assessments to screen for risk factors of alcohol abuse and promote development of more age-salient measures of alcohol expectancies, norms, and motives.

Comparison of injury pattern and clinical outcomes between young adults and elderly patients with alcohol-related injury in South Korea 2011-2016

Background

Alcohol is an important factor that contributes to emergency department (ED) visits due to injury. However, the role of alcohol in elderly patients visiting ED due to injury has not been clearly defined. This study aims to examine age and alcohol as risk factors of injury severity and clinical outcomes.

Methods

This study included patients who visited EDs between January 2011 and December 2016. Data was obtained from the Emergency Department-Based Injury In-depth Surveillance of the Korea Centers for Disease Control and Prevention, South Korea. Injury patients aged ≥18 years were included, but those who visited the ED more than 48 hours after injury, with unknown clinical outcomes (admission, mortality, and excess mortality ratio-adjusted injury severity score [EMR-ISS]) were excluded.

Results

We analyzed 887,712 patients, of whom 131,708 (17.7%) non-elderly and 9,906 (7.0%) elderly had alcohol-related injury. Falls and slips are the most common injury mechanism (37.9%) in patients consuming alcohol (36.3% non-elderly/58.40% elderly). The injury occurred on roads (40.6%), houses (33.8%), and commercial facilities (11.9%) in elderly patients consuming alcohol. Suicide rate was 12.0% in elderly and 9.7% in non-elderly patients. According to the time of day of injury, evening (60.8%) was the most common in elderly and night (62.6%) in non-elderly patients. Admission rate (odds ratio [OR] 2.512 confidence interval [CI] 2.407–2.621), intensive care unit (ICU) care rate (OR 5.507 [CI] 5.178–5.858), mortality rate (OR 4.593 [CI] 4.086–5.162), and EMR-ISS >25 (OR 5.498 [CI] 5.262–5.745) were compared between patients with alcohol-related injury and non-elderly with non-alcohol-related injury patients. Alcohol consumption in elderly patients results in significant impairment and increases EMR-ISS, ICU care rate, and mortality rate. To reduce injury in elderly patients, alcohol screening, appropriate counseling, and intervention are needed.

Nursing diagnosis for Risk of Suicide in elderly: integrative review

OBJECTIVE

To analyze the specialized literature regarding the risk factors in nursing diagnosis for suicide risks in elderly.

METHOD

This is an integrative literature review carried out during June 2015 in the following databases with no time limit: MEDLINE, PsycINFO and CINAHL.

RESULTS

A total of 80 full papers were analyzed. It was suggested the inclusion of 23 risk factors in NANDA-I taxonomy: apathy; unrest; low self esteem; carelessness with medication; Inability to ask for help; Inability to express feelings; suicidal plan; rigidity; functional disability; visual problems; sadness; hostility; anxiety; failure; frustration; unhappiness; dishonor; frequent visits to a physician with unclear symptoms; social deprivation; social devaluation; psychological violence; Interfamilial violence; and financial violence.

CONCLUSION

The risks for suicide presented in NANDA-I taxonomy need to be refined and adapted to the elderly reality. Furthermore, a review is also recommended for the risk factors not included in this classification.

Prevalence and correlates of binge drinking among older adults with multimorbidity

BACKGROUND

Binge drinking among older adults has increased in the past decade. Binge drinking is associated with unintentional injuries, medical conditions, and lower health-related quality of life. No studies have characterized multimorbidity among older binge drinkers.

METHODS

We examined past 30-day binge alcohol use and lifetime medical conditions among adults age ≥50 from the National Survey on Drug Use and Health from 2005 to 2014. Self-reported lifetime prevalence of 13 medical conditions and medical multimorbidity (≥2 diseases) among binge drinkers were compared to non-binge drinkers. Multivariable logistic regression models were used to examine correlates of binge alcohol use among older adults with medical multimorbidity.

RESULTS

Among adults aged ≥50, 14.4% reported past-month binge drinking. Estimated prevalence of medical multimorbidity was lower (21.4%) among binge drinkers than non-binge drinkers (28.3%; p < 0.01). Binge drinkers were more likely to use tobacco and illegal drugs than non-binge drinkers (ps < 0.001). In the adjusted model, among older adults with multimorbidity, higher income (AOR = 1.44, p < 0.05), past-month tobacco use (AOR = 2.55, p < 0.001) and substance use disorder for illegal drugs (AOR = 1.80, p < 0.05) was associated with increased odds of binge alcohol use.

CONCLUSION

The prevalence of multimorbidity was lower among current binge drinkers compared to non-binge drinkers, possibly because older adults in good health are apt to drink more than adults in poorer health. Current use of tobacco and substance use disorder were associated with an increased risk for binge drinking among older adults with multimorbidity. Binge drinking by older adults with multimorbidity may pose significant health risks especially with the concurrent use of other substances.

Manner of Death of Older People with Regard to Blood Alcohol Concentration

OBJECTIVE

Alcohol abuse is related to a wide variety of negative health outcomes including mortality in older people. Alcohol abuse in older people is characterised by certain specific features uncommon in general adult population. The main objective of this study was to analyse the autopsy protocols of deceased older people in relation to blood alcohol concentration (BAC), sex, age, and manner of death. As a positive BAC, >0.20 g/kg was accepted.

METHODS

The sample consists of 1,012 deceased older people (i.e. aged 65 years and over) selected out of 2,377 autopsied subjects in the period from 2003–2013. Subjects included into the sample were chosen via the proportional sampling method. Data (BAC, sex, age, and manner of death) was recorded in a single structured protocol. Data was evaluated statistically (Kolmogorov-Smirnov two-sample test, Wilcoxon two-sample test, risk ratio).

RESULTS

Among older people, there has been a statistically significant correlation of natural death with sex (men died earlier) and with increased BAC (people with positive BAC died earlier). In case of violent death there is a difference in the types of accidents in older people with positive BAC (>0.2 g/kg) and with negative BAC (≤0.2 g/kg). Drowning is more common in older people with positive BAC.

CONCLUSIONS

Health campaigns in Europe and the Czech Republic aimed at reducing alcohol consumption mainly deal with young people. Alcohol abuse has an impact on premature mortality even in older people. As shown by this study, older people with positive BAC die significantly earlier.

Fall-related mortality in southern Sweden: a multiple cause of death analysis, 1998-2014

OBJECTIVES

To investigate temporal trend in fall mortality among adults (aged ≥20 years) in southern Sweden using multiple cause of death data.

METHODS

We examined all death certificates (DCs, n=2 01 488) in adults recorded in the Skåne region during 1998-2014. We identified all fall deaths using International Statistical Classification of Diseases (ICD)-10 codes (W00-W19) and calculated the mortality rates by age and sex. Temporal trends were evaluated using joinpoint regression and associated causes were identified by age-adjusted and sex-adjusted observed/expected ratios.

RESULTS

Falls were mentioned on 1.0% and selected as underlying cause in 0.7% of all DCs, with the highest frequency among those aged ≥70 years. The majority (75.6%) of fall deaths were coded as unspecified fall (ICD-10 code: W19) followed by falling on or from stairs/steps (7.7%, ICD-10 code: W10) and other falls on the same level (6.3%, ICD-10 code: W18). The mean age at fall deaths increased from 77.5 years in 1998-2002 to 82.9 years in 2010-2014 while for other deaths it increased from 78.5 to 79.8 years over the same period. The overall mean age-standardised rate of fall mortality was 8.3 and 4.0 per 1 00 000 person-years in men and women, respectively, and increased by 1.7% per year in men and 0.8% per year in women during 1998-2014. Head injury and diseases of the circulatory system were recorded as contributing cause on 48.7% of fall deaths.

CONCLUSIONS

There is an increasing trend of deaths due to falls in southern Sweden. Further investigations are required to explain this observation particularly among elderly men.

Relating factors to severe injury from outdoor falls in older people

AIM

The aim of the present study was to evaluate the clinical characteristics, including floor characteristics and factors, related to severe injury from outdoor falls in older adults.

METHODS

Patients were divided into two groups based on injury severity: the severe group and non-severe group. The clinical and general characteristics were compared between the two groups, and factors associated with severe injury were investigated.

RESULTS

Approximately 5% (364/7635) of older people involved in outdoor falls were classified into severe injury. The proportion of men and the rate of alcohol ingestion were higher in the severe group compared with that in the non-severe group. Falling from stairs was a more frequent mechanism of fall in the severe group compared with that in the non-severe group. Non-slippery floor condition had a higher proportion in the severe group than that in the non-severe group. Head and neck were the predominantly injured regions in both groups. Discharge was the most common result of emergency department treatment in the non-severe group, whereas admission to intensive care unit was the main result in the severe group. Multivariate logistic analysis showed that male sex and falls from stairs rather than slipping down on the same level were associated with severe injury.

CONCLUSIONS

Floor characteristics did not influence injury severity; however, the risk of severe injury from outdoor falls in older adults was high in men and those who fell from stairs. Geriatr Gerontol Int 2018; 18: 80-87.

Prevalence and Factors Associated with Hazardous Alcohol Use Among Persons Living with HIV Across the US in the Current Era of Antiretroviral Treatment

Hazardous alcohol use is associated with detrimental health outcomes among persons living with HIV (PLWH). We examined the prevalence and factors associated with hazardous alcohol use in the current era using several hazardous drinking definitions and binge drinking defined as ≥5 drinks for men versus ≥4 for women. We included 8567 PLWH from 7 U.S. sites from 2013 to 2015. Current hazardous alcohol use was reported by 27% and 34% reported binge drinking. In adjusted analyses, current and past cocaine/crack (odd ratio [OR] 4.1:3.3-5.1, p < 0.001 and OR 1.3:1.1-1.5, p < 0.001 respectively), marijuana (OR 2.5:2.2-2.9, p < 0.001 and OR 1.4:1.2-1.6, p < 0.001), and cigarette use (OR 1.4:1.2-1.6, p < 0.001 and OR 1.3:1.2-1.5, p < 0.001) were associated with increased hazardous alcohol use. The prevalence of hazardous alcohol use remains high in the current era, particularly among younger men. Routine screening and targeted interventions for hazardous alcohol use, potentially bundled with interventions for other drugs, remain a key aspect of HIV care.

Individual housing-based socioeconomic status predicts risk of accidental falls among adults

PURPOSE

Accidental falls are a major public health concern among people of all ages. Little is known about whether an individual-level housing-based socioeconomic status measure is associated with the risk of accidental falls.

METHODS

Among 12,286 Mayo Clinic Biobank participants residing in Olmsted County, Minnesota, subjects who experienced accidental falls between the biobank enrollment and September 2014 were identified using ICD-9 codes evaluated at emergency departments. HOUSES (HOUsing-based Index of SocioEconomic Status), a socioeconomic status measure based on individual housing features, was also calculated. Cox regression models were utilized to assess the association of the HOUSES (in quartiles) with accidental fall risk.

RESULTS

Seven hundred eleven (5.8%) participants had at least one emergency room visit due to an accidental fall during the study period. Subjects with higher HOUSES were less likely to experience falls in a dose-response manner (hazard ratio: 0.58; 95% confidence interval: 0.44-0.76 for comparing the highest to the lowest quartile). In addition, the HOUSES was positively associated with better health behaviors, social support, and functional status.

CONCLUSIONS

The HOUSES is inversely associated with accidental fall risk requiring emergency care in a dose-response manner. The HOUSES may capture falls-related risk factors through housing features and socioeconomic status-related psychosocial factors.

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.

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.

Problem Drinking and Depression in Older Adults with Multiple Chronic Health Conditions

OBJECTIVES

To examine the intersection of depression and alcohol use among older adults with multiple chronic health conditions (MCCs).

DESIGN

Wave 1 data from the National Social Life, Health and Aging Project (2005-06).

SETTING

Community-based sampling throughout the United States.

PARTICIPANTS

Individuals aged 57 to 85 who identified as active alcohol consumers (N = 1,643).

MEASUREMENTS

Participants reported whether they currently had MCCs, problem drinking (defined as affirming two or more of the four CAGE screening questions), symptoms associated with depression, and other social and health measures.

RESULTS

Although older adults with MCCs were no more likely to be problem drinkers than those with no MCCs, those with MCCs and depression were nearly five times as likely to experience problem drinking as older adults with MCCs and no depression.

CONCLUSION

Older adults with MCCs have differences that have implications for health, including mental health problems. Implementing screening and assessment in medical care settings for problem drinking and improving self-management interventions to include consequences of alcohol use components are critical avenues for reducing healthcare expenditures and improving quality of life of individuals with MCC.

Suicide: scientific overview and relevance for trauma care providers

The World Health Organization estimates that in the year 2000, approximately one million people died from suicide worldwide. Over the last 45 years, suicide rates have increased by 60%, with a particularly precipitous rise among young people. The underlying psychology of suicide is complex and individual. However, certain themes emerge from studying individuals who have attempted or completed suicides. This paper will provide an overview of suicide and suicidal behaviour as it relates to trauma practitioners, detailing risk factors, biologic and genetic interactions, and opportunities for prevention and treatment.

Alcohol Consumption at Any Level Increases Risk of Injury Caused by Others: Data from the Study on Global AGEing and Adult Health

BACKGROUND

Alcohol use is a well-known risk factor for injury. However, information is needed about alcohol drinking patterns and the risk of injury among older adults in low- and middle-income countries as this population grows. We aimed to examine the influence of drinking patterns on the burden of injury and investigate factors associated with different types of injury in older populations in six emerging economies.

METHODS

Data from more than 37,000 adults aged 50 years and older were included from the Study on Global AGEing and Adult Health (SAGE) Wave 1 conducted in six emerging economies, namely, China, Ghana, India, Mexico, Russia, and South Africa. We investigated past-year reported injuries from falls, traffic accidents, and being hit or stabbed. Alcohol drinking patterns were measured as lifetime abstinence, ever but not past- week use, and gender-specific past-week low-risk and high-risk use. We stratified by gender and used logistic regression models to observe the association between alcohol drinking pattern and risk of injury by controlling for other factors.

RESULTS

During the year prior to interview, 627 (2.2%) subjects reported bodily injury resulting from a car accident, 1,156 (4.2%) from a fall, and 339 (0.9%) from being hit or stabbed during the past year. For women, only being a high-risk drinker increased the risk of being hit or stabbed, whereas for men, all levels of drinking were associated with an increased risk of being hit or stabbed. We observed a higher risk of being hit or stabbed from past-week high-risk drinking among women (odds ratio [OR] = 6.09, P < 0.01) than among men (OR = 3.57, P < 0.01). We observed no association between alcohol drinking pattern and injury due to car accidents for either women or men.

CONCLUSIONS

The risk of experiencing injury due to violence increased with level of alcohol exposure of the victim. The increase in alcohol use in emerging economies calls for further study into the consequences of alcohol use and for public health initiatives to reduce the risk of violence in older adult populations, with special attention to the experience of older adult women.

Alcohol Intake and Reduced Mortality in Patients with Traumatic Brain Injury

BACKGROUND

The purpose of our study was to determine whether alcohol intake influences short-term mortality in patients with traumatic brain injury (TBI), using a comprehensive trauma database.

METHODS

We collected data from 7 emergency departments (EDs) between June 1, 2008 and May 31, 2010, using the same data form. Cases were included if they met the following criteria: (i) older than 15 and (ii) injuries including TBI. Demographics and outcomes were compared between patients with and without alcohol intake. We present the risk of mortality using hazard ratios and 95% confidence intervals.

RESULTS

A total of 76,596 trauma patients visited the EDs during the study period; 12,980 patients were older than 15 and had TBI. There were 4,009 (30.9%) patients in the alcohol-intake group, of whom 3,306 (82.5%) patients were male, 1,450 (36.2%) patients were moved by ambulance, and 1,218 (30.4%) patients' injuries were intentional. The most frequent injury mechanism was falling down with alcohol intake and blunt injury without alcohol intake. Mortality rate was 1.0% with alcohol intake and 2.0% without alcohol intake. After adjusting for all factors related to mortality, the hazard ratio of mortality was 0.72 in the alcohol-intake group.

CONCLUSIONS

Mortality rate due to TBI in the alcohol-intake group appears to be lower compared to that in the no-alcohol-intake group after adjusting for main confounding variables.

Alcohol-Related Diagnoses in Hospital Admissions for All Causes Among Middle-Aged and Older Adults: Trends and Cohort Differences From 1993 to 2010

OBJECTIVE

This aim of this study was to characterize trends in alcohol-related hospital admissions among middle-aged and older adults from 1993 to 2010 in relation to age, gender, race, and cohort membership.

METHOD

This study utilized repeated cross-sectional data from the Nationwide Inpatient Sample. Using alcohol-related classified admissions, yearly rates and longitudinal trends of alcohol-related inpatient hospitalizations based on age, period, birth cohort, gender, and race were estimated.

RESULTS

Among those aged 45 and older, admissions rose from an estimated 610,634 to more than 1,134,876, and rates of any alcohol-related diagnosis also increased from 1993 to 2010. Rates for men were consistently higher than women, and rates for Blacks were higher than Whites. Age was associated with decreasing rates, but post-World War II cohorts displayed higher rates over time.

DISCUSSION

Rates of alcohol-related admissions are increasing among adults above age 45, which may be a function of cohort effects. Training the health care workforce is crucial to respond to this trend.

Prevalence of alcohol consumption and pattern of use among the elderly in the WHO European Region

BACKGROUND/AIMS

Alcohol-related problems are relevant in the elderly, particularly in developed countries, but there is a lack of cross-country comparisons. The present work aims to examine the frequency and patterns of alcohol consumption in older adults across different European countries, and to analyze the relationship between socioeconomic status and gender with alcohol consumption.

METHODS

General population-based household surveys of randomly selected adults over 60 years of age in 14 European countries.

PARTICIPANTS

10,119 subjects [mean age: 70.4 (SD = 7.1)], 61.9% women.

RESULTS

There are marked differences in alcohol consumption across countries. Except for three countries from eastern regions, most people in all countries present moderate consumption regarding the amount of alcohol and pattern of use. However, there are marked gender differences, with a higher intake in men (effect sizes ranging from 0.57 to 1.27), although these differences are relatively proportional across countries. Finally, a higher socioeconomic status is positively related (B = 0.845, 95% CI: 0.30/1.40) with alcohol consumption after controlling for gender, age, health-functioning status and the country's development level.

CONCLUSIONS

There are marked differences in consumption of alcohol in the elderly between the different countries, and male gender, as well as a higher SES, were associated with higher alcohol consumption.

Differences between older and younger adults in residential treatment for co-occurring disorders

OBJECTIVE

The purpose of this study was to examine differences between older and younger adults who received integrated treatment for co-occurring substance use and mental disorders, including differences on demographic and baseline characteristics (e.g., substance use, readiness for change, mental health symptoms, and severity of problems associated with substance use), as well as predictors of retention in treatment.

METHODS

This study included 1400 adults who received integrated substance abuse and mental health treatment services at one of two private residential facilities offering residential and outpatient services. Initial analyses consisted of basic descriptive and bivariate analyses to examine differences between older (≥ 50 years old) and younger (< 50 years old) adults on baseline variables. Next, three ordinary least squares regression models were employed to examine the influence of baseline characteristics on length of stay.

RESULTS

Three main findings emerged. First, older adults differed from younger adults on pre-treatment characteristics. Older adults used more alcohol and experienced greater problem severity in the medical and alcohol domains, while younger adults used more illicit drugs (e.g., heroin, marijuana, and cocaine) and experienced problems in the drug, legal, and family/social domains. Second, while readiness to change did not differ between groups at baseline, older adults remained enrolled in treatment for a shorter period of time (nearly four days on average) than younger adults. Third, the pattern of variables that influenced length of stay in treatment for older adults differed from that of younger adults. Treatment retention for older adults was most influenced by internal factors, like psychological symptoms and problems, while younger adults seemed influenced primarily by external factors, like drug use, employment difficulties, and readiness for change.

CONCLUSIONS

The results of this study add to the limited knowledge base regarding older adults receiving integrated treatment for co-occurring substance use and mental health disorders by documenting that age-based differences exist in general and in the factors that are associated with the length of stay in residential treatment.

Observational cohort study on correlates of mortality in older community-dwelling outpatients: The value of functional assessment

AIM

To analyze correlates of mortality with admission features/factors in older community-dwelling outpatients.

METHOD

This is an observational cohort study including 608 patients aged >60 years admitted to the geriatrics outpatient clinics of a university hospital. On admission, demographic characteristics, history of smoking-alcohol consumption, individual comorbidities, individual drugs, number of comorbidities, number of drugs and the components of comprehensive geriatric assessment (functional status, nutritional status, depression and cognition screening) of the patients were recorded. Survival status was assessed through the related official website. The relationship between mortality and recorded parameters were analyzed individually by univariate analyses. Consequently, stepwise forward Cox regression analysis was carried out to detect independent correlates for mortality (for those variables statistically significantly related to mortality.)

RESULTS

The mean age was 73.8 ± 6.9 years. 66.6% of participants were female. The mean follow-up time was 40.4 ± 25.3 months. The mortality rate was 17.8%. Correlates of mortality were calculated using univariate analysis. They were age, sex, nutritional status, activities of daily living (ADL), instrumental ADL, diabetes mellitus (P < 0.001 for all), suspected dementia (P = 0.002), hyperlipidemia (P = 0.048) and total number of diseases (P = 0.025). Independent correlates of mortality were advanced age (HR 1.10, 95% CI 1.06-1.13; P < 0.001, low ADL score (HR 1.22, 95% CI 1.12-1.32; P < 0.001), the presence of diabetes (HR 2.64, 95% CI 1.78-3.91, P < 0.001), male sex (HR 1.68, 95% CI 1.13-2.49; P = 0.01) and suspected dementia (HR 1.51, 95% CI 1.02-2.22; P < 0.05).

CONCLUSION

In the present study--taking many factors into consideration--the variables associated with mortality were advanced age, low ADL score, presence of diabetes, male sex and suspected dementia. Functional status emerged as the second most significant factor associated with higher mortality--after advanced age. The present study highlights the importance of functional assessment in geriatric outpatient clinics.

Drinking behaviour and alcohol-related harm amongst older adults: analysis of existing UK datasets

BACKGROUND

Older adults experience age-related physiological changes that increase sensitivity and decrease tolerance to alcohol and there are a number of age-related harms such as falls, social isolation and elder abuse, which are compounded by alcohol misuse. Despite this unique vulnerability and the fact that the number of older adults is increasing, the literature on drinking behaviour and alcohol-related harm in older adults is sparse. This article describes a secondary analysis of UK data to address this knowledge gap.

METHOD

Secondary analysis of national statistics on alcohol-related hospital admissions and alcohol-related deaths, and data on drinking behaviour from the General Lifestyle Survey. Trends were identified by calculating percentage changes between time periods. The association between drinking behaviour and selected age groups was investigated using one way analysis of variance or chi-square tests.

RESULTS

Older adults (aged 65 and over) drink less and are less likely to exceed the recommended drink limits than younger adults. However, they are more likely to be admitted to hospital for an alcohol-related condition than younger adults and the most significant increases in alcohol-related hospital admission rates in recent years have occurred in older age groups. Alcohol-related death rates are highest amongst those aged 55-74 years old. Alcohol consumption and the prevalence of exceeding the recommended drink limits has fluctuated but not significantly increased in older adults in recent decades.

CONCLUSION

Older adults experience high and increasing levels of alcohol-related harm and as the population ages, this is likely to put increasing pressure on health and social services. Careful monitoring and age-appropriate strategies to detect and treat older adults at risk of alcohol-related harm are required.

Social engagement, setting and alcohol use among a sample of older Australians

The harms associated with risky alcohol consumption have long been researched and recognised in the health field. However, little available research has focused on older people or extended analysis of alcohol use by this segment of the population beyond a biomedical perspective. With the rapid ageing of the global population, research that investigates alcohol use among older people from a social perspective is important. This article reports on research with a group of older women and men, to identify and explain factors that influence alcohol consumption. In-depth interviews were conducted in Perth, Western Australia with 20 men and 22 women aged 65-74 years who were living in either private residences or retirement villages. The study findings indicated that alcohol use was linked with social engagement in activities across both settings, and that moderate alcohol use appeared to serve an important function as a 'social lubricant'. The major facilitating factors for alcohol use included the frequency of opportunities for social engagement and access to a ready-made social group in retirement villages. The major constraining factor across both settings was driving. Interestingly, health was not viewed as a major facilitating or constraining factor for alcohol consumption. Conclusions from the research were that alcohol serves an important role in enhancing social engagement, and there appear to be important associations between residential setting and alcohol use.

Understanding older adults' attitudes and beliefs about drinking: perspectives of residents in congregate living

Drinking motives may change as adults age, yet few studies in the United States of America have examined older adults' perspectives about their own drinking habits. The current study explored beliefs and attitudes of alcohol use of retired adults residing in a congregate care setting in the Baltimore/Washington DC metro area. Individual interviews were conducted with a sub-sample of 11 individuals who participated in a daily diary study on alcohol use among older adults. All participants in the study were identified as regular drinkers, meaning they had an alcoholic beverage on at least six of the eight days prior to screening. The participants' mean age was 81.5 years with a majority being women (54.5%). Older adults reported alcohol use as a long-term habit or routine. Participants also recognised that their alcohol use was influenced by peer drinking and by the availability of alcohol at the congregate care setting. Participants normalised their drinking as a form of routine socialisation carried from earlier life stages. Participants did not report reactive drinking, suggesting that older drinkers do not see their alcohol use as driven by specific reactions to life stresses or losses associated with ageing. The study also indicates that drinking may provide older adults in congregate care with a sense of continuity from before retirement and preserve their identity and autonomy.

Alcohol consumption and mortality: the Khon Kaen Cohort Study, Thailand

BACKGROUND

The prevalence of alcohol consumption among Thais is high, around 30%. We quantified the relationship between alcohol drinking and mortality in a rural population in the most populous region of Thailand.

METHODS

The data were from the Khon Kaen Cohort Study. About 24 000 Thai adults were enrolled between 1990 and 2001, and follow-up for vital status continued until March 16, 2012. Mortality data were obtained from the Bureau of Policy and Strategy, Ministry of the Interior, Thailand. A Cox proportional hazards model was used to analyze the association between alcohol drinking and death, controlling for age, education level, and smoking, and floating absolute risk was used to estimate the 95% confidence intervals of hazard ratios.

RESULTS

In total, 18 457 participants (5829 men and 12 628 women) were recruited, of whom 3155 died (1375 men and 1780 women) during a median follow-up period of 13.6 years. Although alcohol drinking was common (64% of men and 25% of women), the amounts consumed were very low (average, 4.3 g/day in men and 0.8 g/day in women). As compared with never drinkers, mortality risk was lower among current drinkers and higher among ex-drinkers. Current drinking was not associated with mortality from cancer or diseases of the circulatory system, although ex-drinkers appeared to have a higher risk of death from the latter.

CONCLUSIONS

The leading causes of mortality were not associated with current alcohol drinking at the low consumption levels observed in this population.

Feasibility and Utility of Experience Sampling to Assess Alcohol Consumption Among Older Adults

In the literature on alcohol use and aging, drinking has often been conceptualized as a means of coping with negative feelings, such as stress, yet much of the literature on older adults and drinking has utilized cross-sectional or other data ill-suited for exploring dynamic processes. Experience sampling methods have the ability to measure and analyze dynamic processes in real time, such as relations between alcohol use and mood states. Nonetheless, these approaches are intensive and may burden respondents. Therefore, this study evaluated the feasibility, acceptability, and validity of a modified daily diary to measure alcohol use and explored alternate methods of collecting diary data. Findings suggest that a modified diary was acceptable and not burdensome. Respondents were reluctant to consider technology (e.g., cellphone)-based means of data collection. Measures of alcohol use showed little within-person variation suggesting that for those who drink at all, drinking is a daily habit.

Drinking patterns of older adults with chronic medical conditions

BACKGROUND

Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population.

OBJECTIVES

To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions.

DESIGN/METHODS

This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n = 7,422). Based on self-reported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines).

RESULTS

Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking.

CONCLUSIONS

Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.

The Relation Between Frequency of Binge Drinking and Psychological Distress Among Older Adult Drinkers

Objectives: The present study examined the relation between past year frequency of binge drinking and psychological distress among older adult drinkers. Method: Data were obtained from the 2009 California Health Interview Survey (CHIS). Adults aged 60 and older who had consumed alcohol in the past year ( n = 13,265) were analyzed. Psychological distress was assessed using the Kessler 6 (K6) scale. Multiple regression analyses were conducted. Results: A significant main effect of frequency of binge drinking was found in regression analyses, indicating that an increased frequency of binge drinking was significantly associated with increased psychological distress ( B = .10, p < .001). Results from additional analyses showed that binge drinking was related to increased psychological distress when individuals were binge drinking more than once in the past year. Discussion: The results suggest that binge drinking frequently may be related to increased experiences of psychological distress among older drinkers. Research and clinical implications are discussed.

The relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants

This study examines the relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants in the state of California. Data were obtained from the 2009 California Health Interview Survey and included Asian (n = 1264) and Hispanic (n = 571) adults aged 60 and older who were born outside of the US. Outcome variables included presence of past year alcohol consumption, past year binge drinking, and number of binge drinking days. Acculturation was measured with items pertaining to English use and proficiency. Hierarchical multiple or logistic regression analyses were conducted separately for each racial/ethnic group and each dependent variable. Alcohol consumption was found in less than half of the sample for both Asians (43.2%) and Hispanics (39.2%). Binge drinking was found in 3.1% of Asians and 8.4% of Hispanics. Acculturation was significantly related to past year alcohol consumption for Hispanics, past year binge drinking for Asians, and binge drinking days for Asians, such that higher level of acculturation predicted a greater likelihood of alcohol consumption but decreased likelihood of binge drinking and fewer binge drinking days. The results indicate that acculturation may be related to alcohol consumption patterns for older immigrants. This suggests future needs to develop an in-depth understanding of the health behaviors of these immigrant elderly groups.

Fall-induced deaths among older adults: nationwide statistics in Finland between 1971 and 2009 and prediction for the future

BACKGROUND

Fall-related injuries and deaths of elderly people are a major public health concern.

METHODS

Using the Official Cause-of-Death Statistics of Finland we determined the current trends in the number and age-adjusted incidence (per 100,000 persons) of fall-induced deaths among older Finnish men and women by taking into account all persons 50 years of age or older who died because of a fall-induced injury between 1971 and 2009.

RESULTS

Among elderly Finnish men, the number of deaths due to falls increased considerably between the years 1971 and 2009, from 162 to 627 (a 287% increase). The age-adjusted incidence also increased from 43.4 (per 100,000 persons) in 1971 to 57.9 in 2000, but stabilized thereafter (57.3 in 2009). Among elderly Finnish women, the number of fall-induced deaths increased till the beginning of the new millennium (from 279 in 1971 to 499 in 2000) but stabilized thereafter (506 in 2009), and, in sharp contrast to men, women's age-adjusted incidence of fall-induced deaths declined during the entire study period, the incidence being 77.2 in 1971 while only 35.3 in 2009.

CONCLUSIONS

Between 1971 and 2009 the number of fall-induced deaths increased among elderly Finns. The changes were sex-specific so that men surpassed women in both the number and age-adjusted incidence of these fatal falls. Welcome observations were that men's age-adjusted incidence of fall-induced deaths started to stabilize during the new millennium and that in women this incidence continuously declined between 1971 and 2009.

Alcohol, hospital admissions, and falls in older adults: a longitudinal evaluation

BACKGROUND

There are limited data on the impacts of alcohol use in older adults. We aimed to evaluate self-reported hospital admissions and falls against current Australian alcohol consumption guidelines.

METHODS

We conducted a longitudinal analysis of data from five Australian cohort studies. The study comprised 16,785 people aged 65 years or older at baseline. Alcohol consumption was categorized using Australian guidelines in standard (10 g) drinks per day as "abstinent," "low-risk" (>0 ≤2), "long-term risk" (>2 ≤4), or "short-term risk" (>4). Separate generalized estimating equations for men and women, controlling for key demographic, and health variables (depression, diabetes, circulatory and musculoskeletal conditions) were used to examine the relationship of alcohol consumption with hospitalization and falls against a reference category of low-risk consumption.

RESULTS

Most participants were in the low (10,369, 62%) or abstinent (5,488, 33%) categories. Among women, all alcohol groups had greater odds of admission than low-risk users; among men, only the abstinent group had increased odds. For both genders, depression, diabetes, circulatory and musculoskeletal conditions all increased the odds of admission. For both genders, the unadjusted model showed that abstainers had increased odds of falling, with depression, diabetes, and for women, musculoskeletal conditions also associated with falls in the adjusted model.

CONCLUSION

These outcomes suggest that older women in particular could benefit from targeted alcohol consumption messages or interventions. In relation to falls, other health conditions appear better targets for intervention than alcohol use.

The association of alcohol drinking pattern and self-inflicted intentional injury in Korea: a cross-sectional WHO collaborative emergency room study

OBJECTIVES

Self-inflicted intentional injuries are increasing at an alarming rate in the Republic of Korea, yet few reports describe their relationship with alcohol consumption. The aim of this study was to characterise the association of alcohol drinking patterns and self-inflicted intentional injury in Korean emergency departments (EDs) using WHO collaborative study protocol.

DESIGN

Cross-sectional study.

SETTING

Data were collected from four general hospital EDs in four geographically diverse regions of Korea: Seoul, Suwon, Chuncheon and Gwangju.

PARTICIPANTS

Information was collected on 1989 patients aged 18 and above. A representative probability sample was drawn from patients admitted to each ED for the first time within 6 h of injury.

PRIMARY AND SECONDARY OUTCOME MEASURES

Alcohol-related non-fatal injuries.

RESULTS

Among 467 persons with alcohol-related injuries, 33 (7.1%), were self-inflicted intentional injuries and 137 (29.3%) were intentional injuries caused by someone else. The adjusted odds of self-inflicted intentional injury verses unintentional injury were calculated for heavy (OR 1.764; 95% CI 0.783 to 3.976), binge (OR 2.125; 95% CI 0.930 to 4.858) and moderate drinking (OR 3.039; 95% CI 1.129 to 8.178) after controlling for demographic variables. Similar odds were reported for pooled intentional injury data (self-inflicted and caused by someone else) and drinking patterns.

CONCLUSIONS

These data show a strong association between all patterns of acute alcohol consumption and self-inflicted intentional injury in the Republic of Korea.

Comparing the impact of socio-demographic factors associated with traffic injury among older road users and the general population in Japan

BACKGROUND

The increasing number of older road users represents a public health issue because older individuals are more susceptible to traffic injury and mortality than the general population. This study investigated the association between socio-demographic factors and traffic injury and traffic mortality for the general population and among older road users in Japan.

METHODS

An ecological study was conducted using national data in Japan. Multivariate regression methods were applied to investigate the association of traffic injury and traffic mortality for the general population and among older road users with significant demographic, economic, road traffic, and medical/cultural factors.

RESULTS

Income per capita, total road length, and alcohol consumption per person were significantly associated with traffic injury and traffic mortality both for the general population and among older road users in Japan. Income per capita and alcohol consumption per person were negatively associated with traffic mortality for both groups. Meanwhile, for both groups, income per capita was positively associated with traffic injury, while total road length and alcohol consumption per person were negatively associated with traffic injury.

CONCLUSIONS

The effects of socio-demographic factors on traffic injury and traffic mortality in Japan were similar for both the general population and older road users. The study results suggest that injury preventive measures designed for the general population will be beneficial also for older road users in Japan.

Fatal falls in an ethnically diverse urban community: the link between demographic factors and the circumstances surrounding fatal falls

OBJECTIVES

Fatal falls cause more than 15,000 deaths per year in the United States. Despite this, the circumstances surrounding fatal falls in elderly adults are poorly understood. It is unknown whether these circumstances differ across ethnicities, although Hispanic American individuals are at reduced risk for fatal falls. This study sought to describe fatal falls in an urban, predominantly Hispanic, and white non-Hispanic community and to determine the association of demographics with the circumstances surrounding these falls (proximate factors).

METHODS

The death certificates and medical examiners' reports for all 328 elderly individuals experiencing a fatal fall in Miami-Dade County, FL, from 2005 to 2007 were reviewed for demographic and proximate factors such as the preceding activity and fall location.

RESULTS

Fatal falls in elderly adults were experienced mostly by individuals living in the community (80%) and affected all demographic subgroups, although 80% occurred in individuals older than 74 years. Most fatal falls occurred at home (74%), indoors (75%), and during nonvigorous activities such as walking (58%) and these tended to affect the oldest elderly. In addition, a significant number of fatal falls occurred in public locations, outdoors, and during vigorous activity, with these falls tending to affect younger individuals living without family. Hispanic ethnicity was not associated with proximate factors.

CONCLUSIONS

Fatal fall prevention is needed for elderly individuals living in the community and should target the oldest elderly adults living at home while helping to ensure that individuals who are living without family have the appropriate support. These data suggest that Hispanic individuals may benefit from prevention strategies developed in other populations.

Alcohol use patterns and trajectories of health-related quality of life in middle-aged and older adults: a 14-year population-based study

OBJECTIVE

A 14-year multiwave panel design was used to examine relationships between longitudinal alcohol-consumption patterns, especially persistent moderate use, and change in health-related quality of life among middle-aged and older adults.

METHOD

A nationally representative sample of 5,404 community-dwelling Canadians ages 50 and older at baseline (1994/1995) was obtained from the longitudinal National Population Health Survey. Alcohol-consumption patterns were developed based on the quantity and frequency of use in the 12 months before the interview. Health-related quality of life was assessed with the Health Utilities Index Mark 3 (HUI3). Latent growth curve modeling was used to estimate the change in HUI3 for each alcohol pattern after adjusting for covariates measured at baseline.

RESULTS

Most participants showed stable alcohol-consumption patterns over 6 years. Persistent non-users, persistent former users, those decreasing their consumption levels, and those with unstable patterns (i.e., U shaped and inverted U shaped) had lower HUI3 scores at baseline compared with persistent moderate drinkers. A more rapid decline in HUI3 scores than that observed for persistent moderate users was seen only in those with decreasing consumption (p < .001). In a subgroup identified as consistently healthy before follow-up, longitudinal drinking patterns were associated with initial HUI3 scores but not rates of change.

CONCLUSIONS

Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, U-shaped users, and inverted U-shaped users. However, rates of decline over time were similar for all groups except those decreasing their consumption, who had a greater decline in their level of health-related quality of life than persistent moderate users.

Racial/ethnic differences in prevalence and correlates of binge drinking among older adults

OBJECTIVES

This study examines how the prevalence and correlates of binge drinking among older adults vary by race/ethnicity.

METHODS

Drawn from the 2007 California Health Interview Survey, adults aged 60 and older (n = 18,772) were selected. Binge drinking was measured dichotomously based on whether individuals reported consuming five or more drinks in a single day (four or more for females) in the previous year. Prevalence rates for binge drinking in the past year were calculated by race/ethnicity. A hierarchical logistic regression analysis was conducted using binge drinking in the past year as the dependent variable.

RESULTS

Significant racial/ethnic differences were found in prevalence rates: the presence of binge drinking was most common among non-Hispanic Whites (11.9%), followed by Latinos (10.8%), American Indian/Alaska Natives (9.8%), Blacks (8.0%), and Asians (4.2%). Being a current smoker was found to be the strongest predictor of binge drinking and significant main effects were also found for being Black, being Asian, younger age, being male, being unemployed, having a higher poverty threshold, having better self-rated health, and having more psychological distress. Significant interactions between race/ethnicity and age, sex, employment status, educational attainment, smoking status, and self-rated health were found. These findings indicate that certain correlates of binge drinking vary significantly by race/ethnicity among older adults.

CONCLUSIONS

Apparent racial/ethnic differences existed in the prevalence and correlates of binge drinking among older adults. Identification of more racial/ethnic specific predictors may be important for the development of racial/ethnic appropriate intervention programs.

Cardiovascular disease risk factors in relation to suicide mortality in Asia: prospective cohort study of over one million Korean men and women

AIMS

A potential role for cardiovascular disease (CVD) risk factors in the aetiology of suicide has not been comprehensively examined. In addition to being small in scale and poorly characterized, existing studies very rarely sample Asian populations in whom risk factor-suicide relationships may plausibly differ to Caucasian groups. We examined the association between a series of CVD risk factors and future mortality from suicide.

METHODS AND RESULTS

The Korean Cancer Prevention Study is a prospective cohort study comprising 1 234 927 individuals (445 022 women) aged 30-95 years with extensive measurement of established CVD risk factors at baseline and subsequent mortality surveillance. Fourteen years of follow-up gave rise to 472 deaths (389 in men and 83 in women) from suicide. After adjustment for a range of covariates, in men, smoking hazard ratio; 95% CI: (current vs. never: 1.69; 1.27, 2.24), alcohol intake (1-24 g/day vs. none: 1.29; 1.00, 1.66), blood cholesterol (≥ 240 vs. <200 mg/dL: 0.54; 0.36, 0.80), body mass index (underweight vs. normal weight: 2.08; 1.26, 3.45), stature [quartile 1(lowest) vs. 4: 1.68; 1.23, 2.30], socioeconomic status [quartile 1(lowest) vs. 4: 1.65; 1.21, 2.24], and martial status (unmarried vs. other: 1.60; 0.83, 3.06) were related to suicide mortality risk. These associations were generally apparent in women, although of lower magnitude. Exercise and blood pressure were not associated with completed suicide.

CONCLUSION

In this cohort of Korean men and women, a series of CVD risk factors were associated with an elevated risk of future suicide mortality.

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.