Diagnosis and treatment of alcohol dependence in older alcoholics

Pharmacotherapeutic challenges for treating the baby boomer cohort

As the baby boomer cohort ages, they have an ever-increasing number of comorbidities and associated poly-pharmaceutical treatment needs. The challenge for healthcare providers is to stay current of advancements in providing for this aging population. Baby boomers can expect a longer life expectancy than any previous generation. Yet, longevity has not correlated with better health. This cohort is noted for being goal driven and more self-assured than younger generations. They are resourceful and will often attempt to fix things themselves, including their healthcare. They believe hard work deserves justifiable rewards and relaxation. These beliefs have resulted in baby boomers utilizing more alcohol and illicit drugs. Altogether this means today's healthcare providers must be aware of potential interactions from the polypharmacy of prescribed medication, and they must include and understand additional complications associated with supplemental medications and illegal drugs.

Sex differences in an old adult sample with substance use disorder: A 6 months follow-up study

Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.

Major life events and risk of alcohol use disorders: a prospective cohort study

AIMS

To estimate associations of individual major life events as well as accumulated major life events in childhood, adult private life and adult work life with risk of alcohol use disorders (AUD).

DESIGN

Prospective cohort study with baseline examination in 1991-93 and linkage to national registers to identify AUD at follow-up.

SETTING

Copenhagen, Denmark.

PARTICIPANTS

Individuals (aged 21-93 years) who participated in the Copenhagen City Heart Study in 1991-93 (n = 8758).

MEASUREMENTS

The primary outcome was first registration with AUD during follow-up (n = 249). AUD was identified in the Danish National Patient Register, in the Danish Psychiatric Central Register and in an outpatient treatment register. Major life events were assessed by a questionnaire in the Copenhagen City Heart study. Data were analysed by Cox proportional hazards models adjusted for age, sex, educational level, household income, cohabitation status and psychiatric comorbidity.

FINDINGS

Serious family conflicts in childhood [hazard ratio (HR) = 1.35; 95% confidence interval (CI) = 1.00, 1.83] and serious economic problems in adult life (HR = 2.22; 95% CI = 1.64, 3.01) were associated significantly with increased risk of AUD. Prospective analyses did not show consistent effects of accumulation of major life events in childhood or adult life, but an additional analysis based on all AUD registrations suggested an association between accumulated childhood events and risk of AUD.

CONCLUSIONS

Serious economic problems in adult life are associated strongly with risk of alcohol use disorders, and there may be an influence of accumulated childhood events on risk of alcohol use disorders.

Psychiatric correlates of alcohol and tobacco use disorders in U.S. adults aged 65 years and older: results from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions

OBJECTIVE

To examine associations of alcohol and tobacco use disorders and psychiatric conditions among older U.S. adults.

METHODS

Sample was individuals aged at least 65 years (N = 8,205) who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Measurements included lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol use disorders (AUDs), tobacco use disorders (TUDs), and psychiatric conditions.

RESULTS

Among older adults, prevalence of lifetime and past 12-month AUDs were 16.1% and 1.5% and lifetime and past 12-month TUDs were 8.7% and 4.0%, respectively. Lifetime TUD was associated with increased odds of both lifetime (odds ratio [OR]: 4.17; 95% confidence interval [CI]: 3.30-5.26) and past 12-month (OR: 2.52; 95% CI: 1.50-4.24) AUDs, and lifetime AUD was associated with increased odds of both lifetime (OR: 4.13; 95% CI: 3.28-5.210 and past 12-month (OR: 3.51; 95% CI: 2.47-4.96) TUDs. Any lifetime mood, anxiety, or personality disorder among older adults was associated with increased odds of lifetime AUD and TUD, any lifetime mood disorder was associated with increased odds of past 12-month AUD and TUD, and any personality disorder was associated with past 12-month TUD.

CONCLUSION

There is a strong association between AUD and TUD among older U.S. adults as well as associations between AUD and TUD with mood, anxiety, and personality disorders. Understanding the psychiatric conditions associated with AUDs and TUDs, especially past 12-month use disorders involving alcohol or tobacco, will enable healthcare providers to target screening and be more aware of symptoms and signs of potential AUDs and TUDs among those at higher risk.

Alcohol, tobacco, and nonmedical drug use disorders in U.S. Adults aged 65 years and older: data from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions

OBJECTIVES

To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older.

DESIGN

The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample.

SETTING

The United States.

PARTICIPANTS

Eight thousand two hundred five adults aged 65 years and older.

MEASUREMENTS

Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders.

RESULTS

Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder.

CONCLUSIONS

More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use.

Alcohol use disorders in geriatrics

Alcohol use disorders cause significant morbidity and mortality in the geriatric population. This review article begins with a hypothetical case for illustration, asking what the primary care physician could do for a geriatric patient with alcohol abuse over a course of four office visits. Various aspects of alcohol use disorders in the geriatric population are reviewed, such as range of alcohol use, epidemiology, medical/psychiatric impact, detection, comprehensive treatment planning, modalities of psychotherapy, medication management, and resources for clinicians/patients.

Factor structure of pain medication questionnaire in community-dwelling older adults with chronic pain

OBJECTIVES

This study was to develop a version of the Pain Medication Questionnaire (PMQ) specific to the elderly chronic pain population and to identify relevant subscales and items for that population. Exploratory factor analysis (EFA) was conducted to assess the factor structure of the PMQ, to eliminate items that are not appropriate for this population, and to improve ease of administration in the elderly population.

METHODS

Data were obtained through a survey administered to older adults with chronic pain who consumed opioid medications in a cross-sectional study at outpatient clinics affiliated with the Baltimore Veterans Affairs Medical Center and the University of Maryland Medical System. EFA was conducted on the PMQ in the geriatric chronic pain population, which was compared with the PMQ studies from the general chronic pain population.

RESULTS

A two-factor solution yielded Factor 1 with four items and Factor 2 with three items; 18 items did not load significantly on either factor, and only seven items loaded significantly on either factor. All of the chosen factor loadings ranged from 0.41 to 0.88.

CONCLUSION

  The findings suggest that, although a small number of the items were identified from the overall scale, they adequately explain two relatively unique factors pertaining to pain management among older adults. This preliminary study suggests that the seven-item PMQ may be useful in assessing opioid medication misuse in community-dwelling older adults with chronic pain. Future studies are needed to confirm the reliability, validity, and factor structure of this modified PMQ in the geriatric population.

Substance use disorder among older adults in the United States in 2020

AIMS

This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020.

DESIGN

Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002-06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020.

SETTING

Non-institutionalized US residences.

PARTICIPANTS

Representative sample of the US civilian, non-institutionalized population.

MEASUREMENTS

Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

FINDINGS

Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002-06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups.

CONCLUSIONS

Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.

The health behaviors of the older US worker

BACKGROUND

As the US workforce ages, lifestyle factors will increasingly affect their health, yet little information is available on their prevalence in older working populations.

METHODS

Using the nationally representative 1997-2003 National Health Interview Survey (NHIS), reported current smoking, risky drinking and leisure-time physical activity behaviors of older workers (> or =65 years) were compared with older non-workers. These behaviors were evaluated by age, gender, race, ethnicity, and occupation, as well as prototype "healthy" and "risky" persons.

RESULTS

The study population of 4,946 older US workers and 38,313 older non-workers represented an estimated 3.9 million older workers and 28.9 million older non-workers annually. Relative to older non-workers, older workers reported more current smoking and risky drinking, but higher levels of leisure-time physical activity with variations by subpopulations.

CONCLUSIONS

Less than 4% of the older US worker population reported overall healthy behaviors. Certain occupations and other subpopulations can be targeted for age-appropriate behavioral interventions.

Myths and Realities of Aging

As the aging population expands, it will become increasingly important for health care providers to become aware of and sensitive to the needs and concerns of older adults.Ageismis a term that describes negative stereotyping of older adults and discrimination because of older age. Health concerns and symptoms in the elderly may be overlooked or dismissed as part of the normal aging process. Consequently, several conditions in olders adults are significantly underdiagnosed and undertreated. Misconceptions about aging frequently encountered in medicine and in society at large include issues involving sexuality, sleep disturbance, depression, cognitive impairment, and substance abuse. We can learn to recognize ageist notions that influence medical practice. Perhaps by becoming more aware of myths and realities of aging, we can improve the health and quality of life of our elderly patients.

Geriatric alcoholism

BACKGROUND

The authors reviewed the clinical features, epidemiology, diagnosis, medical treatment, orofacial findings and dental treatment of geriatric patients with alcoholism.

TYPES OF STUDIES REVIEWED

The authors conducted MEDLINE searches for the period 1995 through 2004 using the terms "alcoholism," "geriatric," "pathophysiology," "treatment" and "dentistry." They selected reports published in English in peer-reviewed journals for further review.

RESULTS

Physiological changes associated with aging permit the harmful effects of drinking alcohol to arise at lower levels of consumption than in younger people. Excessive use of alcohol exacerbates the medical and emotional problems associated with aging and predisposes the person to adverse drug reactions with medications controlling these illnesses.

CLINICAL IMPLICATIONS

The incidence of dental disease in this population is extensive because of diminished salivary flow and a disinterest in performing appropriate oral hygiene techniques. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of patients who abuse alcohol, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Clinicians must take precautions when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol.