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Allen RS, Lin SSH, Ly TK, Jacobs ML, McKinney RE, Cox BS, Albright AE, Dragan DM, Carroll D, Halli-Tierney A. Substance Use Screening in Geriatric Primary Care: Cultural Issues and Alcohol Consumption in the Deep South. Clin Gerontol 2024:1-9. [PMID: 38469621 DOI: 10.1080/07317115.2024.2326523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To investigate indicators of potentially hazardous alcohol use among older adults living in a region with high substance use stigma. METHODS Patients at a university-affiliated geriatrics clinic in the Deep South of theUS completed behavioral health screenings including self-reported alcohol use, symptoms of depression or anxiety, and cognitive functioning between 2018 and 2022. RESULTS Participants (N = 278) averaged 76.04 years of age (SD = 9.25), were predominantly female (70.9%), and non-Hispanic white (84.5%), with an averageof 6.08 comorbid diagnoses (SD = 2.86). Race/ethnicity, age, and symptoms of anxiety were associated with alcohol use and hazardous alcohol use, with non-Hispanic whites, younger individuals, and those with more anxiety symptoms reporting more alcohol use. Notably, alcohol use and hazardous alcohol use were associated with cognitive functioning in the dementia range. CONCLUSION Self-reported alcohol use is low in geriatric primary care in the Deep South, US, differs by race/ethnicity, and is predictive of cognitive impairment when alcohol use is hazardous. Issues of trust and stigma may play a role in self-report ofstigmatized behaviors. CLINICAL IMPLICATIONS Self-reported alcohol intake must be considered within the cultural context of regional stigma. Recommendations to address this are provided.
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Affiliation(s)
- Rebecca S Allen
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Shayne S H Lin
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Timothy K Ly
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - M Lindsey Jacobs
- Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Robert E McKinney
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Psychiatry and Behavioral Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Brian S Cox
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Amy E Albright
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Deanna M Dragan
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Salem Veterans Affairs Medical Center, Salem, Virginia, USA
| | - Dana Carroll
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Family, Internal, and Rural Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
- Harrison School of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Anne Halli-Tierney
- Alabama Research Institute on Aging, Alabama Life Research Institute, The University of Alabama, Tuscaloosa, Alabama, USA
- Family, Internal, and Rural Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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Margraf AM, Davoodi NM, Chen K, Shield RR, McAuliffe LM, Collins CM, Zullo AR. Provider beliefs about the ideal design of an opioid deprescribing and substitution intervention for older adults. Am J Health Syst Pharm 2023; 80:53-60. [PMID: 36205419 DOI: 10.1093/ajhp/zxac282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Opportunities exist to meaningfully reduce suboptimal prescription opioid use among older adults. Deprescribing is one possible approach to reducing suboptimal use. Appropriate interventions should outline how to carefully taper opioids, closely monitor adverse events, substitute viable alternative and affordable nonopioid pain treatments, and initiate medications for opioid use disorder to properly manage use disorders, as needed. We sought to document and understand provider perceptions to begin developing effective and safe opioid deprescribing interventions. METHODS We conducted 3 semistructured focus groups that covered topics such as participant perspectives on opioid deprescribing in older adults, how to design an ideal intervention, and how to identify potential barriers or facilitators in implementing an intervention. Focus group transcripts were double coded and qualitatively analyzed to identify overarching themes. RESULTS Healthcare providers (n = 17), including physicians, pharmacists, nurses, social workers, and administrative staff, participated in 3 focus groups. We identified 4 key themes: (1) involve pharmacists in deprescribing and empower them as leaders of an opioid deprescribing service; (2) ensure tight integration and close collaboration throughout the deprescribing process from the inpatient to outpatient settings; (3) more expansive inclusion criteria than age alone; and (4) provision of access to alternative pharmacological and nonpharmacological pain management modalities to patients. CONCLUSION Our findings, which highlight various healthcare provider beliefs about opioid deprescribing interventions, are expected to serve as a framework for other organizations to develop and implement interventions. Future studies should incorporate patients' and family caregivers' perspectives.
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Affiliation(s)
- Alissa M Margraf
- Department of Pharmacy, Rhode Island Hospital and Lifespan Corporation, Providence, RI, USA
| | | | - Kevin Chen
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Renee R Shield
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Laura M McAuliffe
- Department of Pharmacy, Rhode Island Hospital and Lifespan Corporation, Providence, RI, USA
| | - Christine M Collins
- Department of Pharmacy, Rhode Island Hospital and Lifespan Corporation, Providence, RI, USA
| | - Andrew R Zullo
- Department of Pharmacy, Rhode Island Hospital, Providence, RI.,Departments of Epidemiology, Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
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Wainblat E, Weleff J, Anand A. Management of Phenibut Use Disorder and Withdrawal in a Geriatric Patient. Am J Geriatr Psychiatry 2023; 31:67-74. [PMID: 36266201 DOI: 10.1016/j.jagp.2022.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 01/25/2023]
Abstract
Phenibut is a misused substance which has shown an increase in use over the past decade. Marketed as a "dietary supplement," it is not approved in the United States for use and is not regulated by the Food and Drug Administration. The substance, however, is readily available for purchase through online markets. It has a similar drug profile as alcohol, gabapentin and benzodiazepines. Clinical effects of this drug include physiologic dependence, euphoria, anxiolysis, antispasticity, sedation, and possible nootropic properties. While there are emerging new cases of managing phenibut withdrawal, no cases currently feature phenibut addiction and withdrawal management in the geriatric population. Here we discuss such a case of phenibut addiction and withdrawal in a 68-year-old male who initially began misusing phenibut to alleviate anxiety and insomnia precipitated by worsening affective disorder, sedative, hypnotic, or anxiolytic use disorder, and alcohol use disorder.
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Affiliation(s)
| | - Jeremy Weleff
- Department of Psychiatry (JW), Yale University School of Medicine, New Haven, CT; Department of Psychiatry and Psychology (JW, AA), Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Akhil Anand
- Department of Psychiatry and Psychology (JW, AA), Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine at Case Western Reserve University (AA), EC-=10 Cleveland Clinic, Cleveland, OH.
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Abstract
Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.
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Haber PS, Riordan BC, Winter DT, Barrett L, Saunders J, Hides L, Gullo M, Manning V, Day CA, Bonomo Y, Burns L, Assan R, Curry K, Mooney-Somers J, Demirkol A, Monds L, McDonough M, Baillie AJ, Clark P, Ritter A, Quinn C, Cunningham J, Lintzeris N, Rombouts S, Savic M, Norman A, Reid S, Hutchinson D, Zheng C, Iese Y, Black N, Draper B, Ridley N, Gowing L, Stapinski L, Taye B, Lancaster K, Stjepanović D, Kay-Lambkin F, Jamshidi N, Lubman D, Pastor A, White N, Wilson S, Jaworski AL, Memedovic S, Logge W, Mills K, Seear K, Freeburn B, Lea T, Withall A, Marel C, Boffa J, Roxburgh A, Purcell-Khodr G, Doyle M, Conigrave K, Teesson M, Butler K, Connor J, Morley KC. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Med J Aust 2021; 215 Suppl 7:S3-S32. [PMID: 34601742 DOI: 10.5694/mja2.51254] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022]
Abstract
OF RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 2: Screening and assessment for unhealthy alcohol use Screening Screening for unhealthy alcohol use and appropriate interventions should be implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C). Quantity-frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B). The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT-C is a suitable alternative (Level A). Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B). Assessment Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C). Assessment for alcohol-related physical problems, mental health problems and social support should be undertaken routinely (GPP). Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C). Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient's needs (Level D). Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C). Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow-up Brief interventions Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A). Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A). Psychosocial interventions Cognitive behaviour therapy should be a first-line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A). Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A). Residential rehabilitation may be of benefit to patients who have moderate-to-severe alcohol dependence and require a structured residential treatment setting (Level D). Alcohol withdrawal management Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B). Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP). Pharmacotherapies for alcohol dependence Acamprosate is recommended to help maintain abstinence from alcohol (Level A). Naltrexone is recommended for prevention of relapse to heavy drinking (Level A). Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A). Some evidence for off-label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first-line medication (Level B). Peer support programs Peer-led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A). Relapse prevention, aftercare and long-term follow-up Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP). A harm-minimisation approach should be considered for patients who are unable to reduce their drinking (GPP). Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations Gender-specific issues Screen women and men for domestic abuse (Level C). Consider child protection assessments for caregivers with alcohol use disorder (GPP). Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B). Pregnant and breastfeeding women Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B). Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP). Young people Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B). Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B). Aboriginal and Torres Strait Islander peoples Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP). Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander-specific approaches to care (Level B). Culturally and linguistically diverse groups Use an appropriate method, such as the "teach-back" technique, to assess the need for language and health literacy support (Level C). Engage with culture-specific agencies as this can improve treatment access and success (Level C). Sexually diverse and gender diverse populations Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C). Seek to incorporate LGBTQ-specific treatment and agencies (Level C). Older people All new patients aged over 50 years should be screened for harmful alcohol use (Level D). Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D). Consider shorter acting benzodiazepines for withdrawal management (Level D). Cognitive impairment Cognitive impairment may impair engagement with treatment (Level A). Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A). SUMMARY OF KEY RECOMMENDATIONS AND LEVELS OF EVIDENCE Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co-occurring mental disorders, and physical comorbidities Polydrug use and dependence Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP). Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP). Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C). Co-occurring mental disorders More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP). The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A). People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C). Physical comorbidities Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk-free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A). In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A). Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
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Helvik AS, Engedal K, Johannessen A. Elevated alcohol consumption among geriatric psychiatric in-patients. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:400-410. [PMID: 35310925 PMCID: PMC8899249 DOI: 10.1177/1455072520936813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/02/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment. Aim: To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption. Method: This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs. Results: In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively). Conclusion: A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim; and Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim, Norway
| | - Knut Engedal
- Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim, Norway
| | - Aud Johannessen
- Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim; and University of South-Eastern Norway, Norway
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Roche AM, Harrison NJ, Chapman J, Kostadinov V, Woodman RJ. Ageing and Alcohol: Drinking Typologies among Older Adults. J Aging Health 2020; 32:1486-1497. [PMID: 32583701 DOI: 10.1177/0898264320936953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: Alcohol consumption and harms among older people are increasing. We examined different demographic characteristics and drinking patterns among an older population. Methods: Secondary analyses of nationally representative Australian data; subjects aged 50+ years (N = 10,856). Two-step cluster analysis was performed to identify demographic groups and alcohol consumption behaviours. Results: Three groups were identified: Group 1 (older, unmarried, and lived alone): >65 years, moderate drinkers, poorest health, psychological distress, social disadvantage, smokers, illicit drug users, and more frequent previous alcohol treatment. Group 3 (older married): >65 years, good health, low psychological distress, less likely to drink at risky levels, and one in five drank daily. Group 2 (younger married): 50-64 years, mostly employed, highest proportion of risky drinkers and of 5+ standard drinks per session, and liberal drinking attitudes with most concern from others about their drinking. Discussion: These demographic typologies can inform targeted prevention efforts for an estimated 1.3 million adults older than 50 years drinking at risky levels.
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Affiliation(s)
- Ann M Roche
- 1065Flinders University, Adelaide, Australia
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Rieb LM, Samaan Z, Furlan AD, Rabheru K, Feldman S, Hung L, Budd G, Coleman D. Canadian Guidelines on Opioid Use Disorder Among Older Adults. Can Geriatr J 2020; 23:123-134. [PMID: 32226571 PMCID: PMC7067148 DOI: 10.5770/cgj.23.420] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors' Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults. METHODS A systematic review of English language literature from 2008-2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method. RESULTS Thirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care. CONCLUSION These guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.
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Affiliation(s)
- Launette M Rieb
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Zainab Samaan
- Department of Psychiatry, McMaster University, Hamilton, ON
| | | | - Kiran Rabheru
- Department of Psychiatry, University of Ottawa, Ottawa, ON
| | - Sid Feldman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Lillian Hung
- Canadian Gerontological Nurses Association, Toronto, ON
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Rao R. Risky drinking and dual diagnosis in older people under a UK community old age psychiatry service. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-05-2019-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The assessment of patterns in risky drinking and its association with dual diagnosis in community services for older people remains under-explored. The paper aims to discuss this issue.
Design/methodology/approach
Drinking risk using the Alcohol Use Disorders Identification Test (AUDIT) and the presence of co-existing mental disorders was examined in 190 people aged 65 and over.
Findings
In total, 24 per cent of drinkers drank above lower risk levels and 22 per cent reported binge drinking over the past 12 months. Those scoring 1 or more on the AUDIT were more likely to be male and to have greater cognitive impairment than non-drinkers and those reporting no past problems with alcohol.
Research limitations/implications
Given the limitations of the Mini Mental State Examination in the detection of alcohol related cognitive impairment (ARCI), the use of other cognitive screening instruments in larger study populations is also warranted.
Practical implications
Greater attention needs to be paid to the assessment of risky drinking in older male drinkers and those with cognitive impairment.
Originality/value
There is considerable scope for the routine detection of cognitive impairment and dementia in older people with alcohol use within mainstream mental health services, particularly in those with binge drinking. As ARCI is associated with loss of function and independence, early detection and intervention can improve health and social outcomes.
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Cusack L, Kelly J, Groenkjaer M, Wilkinson C, Harland J. Acceptability and suitability of alcohol, smoking and substance involvement screening test for older people in the community. Contemp Nurse 2019; 55:486-494. [PMID: 31469048 DOI: 10.1080/10376178.2019.1661785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Alcohol use is a common phenomenon within Australian culture. While there has been significant focus on alcohol use among young Australians, there has been little on health promotion or early interventions focussing on older Australians.Methods: This paper presents the findings of an explorative study that used four interactive focus group workshops to ask the question: Is an existing World Health Organisation alcohol and drug screening tool called the Alcohol, Smoking and Substance Involvement Screening Test (originally developed for young people) acceptable and suitable for older people? The data were analysed based on the question using thematic coding.Results: Participants generally considered that they would be more comfortable talking with their health providers about their alcohol and drug use rather than filling out the Alcohol, Smoking and Substance Involvement Screening Test themselves. This suggests that the tool should be modified to accommodate the differences in health status that reflect life events of the different older age groups.Conclusion: Due to potential complex medical and diverse range of pharmacotherapies common among this age group, it is recommended that, if the tool is used, it be administered by health practitioners such as nurses.
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Affiliation(s)
- Lynette Cusack
- School of Nursing, The University of Adelaide, Adelaide, Australia
| | - Janet Kelly
- School of Nursing, The University of Adelaide, Adelaide, Australia
| | - Mette Groenkjaer
- Aalborg University Hospital and Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Celia Wilkinson
- National Drug Research Institute, Curtin University, Shenton Park, Australia
| | - Jennifer Harland
- Discipline of Pharmacology, The University of Adelaide, Adelaide, Australia
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Sehgal M, Hidlebaugh E, Checketts MG, Reyes B. Geriatrics Screening and Assessment. Prim Care 2018; 46:85-96. [PMID: 30704662 DOI: 10.1016/j.pop.2018.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Geriatric screening and assessment allows clinicians to care for older patients in an efficient, patient-centered manner. This framework includes standard screening questions that may trigger the use of standard geriatric assessment tools and/or other interventions. Additionally, it serves to complement the history and physical examination, and is critical for maximizing the health, function, safety, and quality of life of older patients.
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Affiliation(s)
- Mandi Sehgal
- Department of Integrated Medical Science, Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, BC 71, Boca Raton, FL 33431, USA.
| | - Elizabeth Hidlebaugh
- Department of Integrated Medical Science, Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, BC 71, Boca Raton, FL 33431, USA
| | - Matthew G Checketts
- Department of Integrated Medical Science, Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, BC 71, Boca Raton, FL 33431, USA
| | - Bernardo Reyes
- Department of Integrated Medical Science, Florida Atlantic University, Charles E. Schmidt College of Medicine, 777 Glades Road, BC 71, Boca Raton, FL 33431, USA
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Gary FA, Yarandi H, Evans E, Still C, Mickels P, Hassan M, Campbell D, Conic R. Beck Depression Inventory-II: Factor Analyses with Three Groups of Midlife Women of African Descent in the Midwest, the South, and the U.S. Virgin Islands. Issues Ment Health Nurs 2018; 39:233-243. [PMID: 29193995 PMCID: PMC5889520 DOI: 10.1080/01612840.2017.1373175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This research encompasses a factor analysis of the Beck Depression Inventory-II (BDI-II), which involves three groups of midlife women of African descent who reside in the Midwest, the South, and the U.S. Virgin Islands. The purpose of the study was to determine the factor structure of the BDI-II when administered to a sample of women aged 40-65 of African descent who reside in the three distinct geographical regions of the United States. A correlational, descriptive design was used, and 536 women of African descent were invited to participate in face-to-face interviews that transpired in community settings. Results of the factor analysis revealed a two-factor explanation. Factor one included symptoms such as punishment feelings and pessimism (cognitive), and the second factor included symptoms such as tiredness and loss of energy (somatic-affective). The application of the Beck Depression Inventory-II among the three groups of women generated specific information about each group and common findings across the groups. Knowledge gained from the research could help to guide specific intervention programs for the three groups of women, and explicate the common approaches that could be used for the three groups.
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Affiliation(s)
- Faye A Gary
- a Frances Payne Bolton School of Nursing, Case Western Reserve University , Cleveland , USA
| | - Hossein Yarandi
- b Center for Health Research, Wayne State University , Detroit , USA
| | - Edris Evans
- c Nursing, University of the Virgin Islands School of Nursing , Saint Thomas , Virgin Islands , USA
| | - Carolyn Still
- d University Hospital of Cleveland , Cleveland , USA
| | - Prince Mickels
- e University of Florida Health Center , Gainesville , USA
| | - Mona Hassan
- f Case Western Reserve University, Nursing , Cleveland , USA
| | - Doris Campbell
- c Nursing, University of the Virgin Islands School of Nursing , Saint Thomas , Virgin Islands , USA
| | - Ruzica Conic
- g Medicine, Case Western Reserve University, University Heights , USA
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Vafeas C, Graham R, de Jong G, Sharp J, Ngune I, Maes S. Alcohol consumption patterns of older adults: a study in a regional town in Western Australia. Contemp Nurse 2017; 53:647-657. [PMID: 29279033 DOI: 10.1080/10376178.2017.1421051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM This study aimed to demonstrate that opportunistic health screening at health expos can provide an overall impression of alcohol consumption patterns. DESIGN A repeated cross-sectional survey design, completed over a four-year period (2011-2014), was used to assess the risk of harmful alcohol consumption, within a community setting of older adults, in the South West region of Western Australia. METHODS An alcohol screening survey (AUDIT) was used to collect data on alcohol consumption patterns on those aged 65 years and over. A total of 411 surveys were completed. RESULTS There was a statistically significant difference in mean risk scores across the four years (p < .001). 6.3-22.2% of survey completers presented as 'risky', and a further 3.8-12.3% as 'high risk' in terms of alcohol consumption. CONCLUSIONS Opportunistic screening for alcohol consumption during health expos can aid the identification of at-risk individuals who may require further education or treatment.
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Affiliation(s)
- Caroline Vafeas
- a School of Nursing & Midwifery , Edith Cowan University , Joondalup , Australia
| | - Renee Graham
- a School of Nursing & Midwifery , Edith Cowan University , Joondalup , Australia
| | - Gideon de Jong
- a School of Nursing & Midwifery , Edith Cowan University , Joondalup , Australia
| | - Jennie Sharp
- b School of Nursing & Midwifery , Edith Cowan University , Bunbury , Australia
| | - Irene Ngune
- c School of Nursing, Midwifery & Paramedicine , Curtin University , Bentley , Australia
| | - Saskia Maes
- d Edith Cowan College, Edith Cowan University , Joondalup , Australia
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Rudzinski K, McDonough P, Gartner R, Strike C. Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience. Subst Abuse Treat Prev Policy 2017; 12:41. [PMID: 28915841 PMCID: PMC5603070 DOI: 10.1186/s13011-017-0125-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/28/2017] [Indexed: 12/15/2022] Open
Abstract
Research in the area of illicit substance use remains preoccupied with describing and analyzing the risks of people who use drugs (PWUD), however more recently there has been a drive to use a strengths-based or resilience approach as an alternative to investigating drug use. This leads us to ask: what can be known about PWUD from the point of view of resilience? The objective of this scoping review is to analyze how the concept of resilience is defined, operationalized, and applied in substance use research. Popular health, social science, psychology, and inter-disciplinary databases namely: SCOPUS, PUBMED, PsycINFO, and Sociological Abstracts were searched. Studies were selected if they used the concept of resilience and if substance use was a key variable under investigation. A total of 77 studies were identified which provided a definition of resilience, or attempted to operationalize (e.g., via scales) the concept of resilience in some manner. Data were charted and sorted using key terms and fundamental aspects of resilience. The majority of studies focus on youth and their resistance to, or engagement in, substance use. There is also a small but growing area of research that examines recovery from substance addiction as a form of resilience. Very few studies were found that thoroughly investigated resilience among PWUD. Consistently throughout the literature drug use is presented as a 'risk factor' jeopardizing one's ability to be resilient, or drug use is seen as a 'maladaptive coping strategy', purporting one's lack of resilience. Currently, substance use research provides a substantial amount of information about the internal strengths that can assist in resisting future drug use; however there is less information about the external resources that play a role, especially for adults. Though popular, outcome-based conceptualizations of resilience are often static, concealing the potential for developing resilience over time or as conditions change. Studies of resilience among PWUD predominantly concentrate on health-related behaviours, recovery-related factors or predefined harm reduction strategies. Indeed, overall, current conceptualizations of resilience are too narrow to recognize all the potential manifestations of resilience practices in the daily lives of individuals who actively use drugs.
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Affiliation(s)
- Katherine Rudzinski
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Peggy McDonough
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Rosemary Gartner
- Centre for Criminology & Sociolegal Studies, University of Toronto, 14 Queen’s Park Crescent West, Toronto, ON M5S 3K9 Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
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Johannessen A, Engedal K, Helvik AS. Assessment of alcohol and psychotropic drug use among old-age psychiatric patients in Norway: Experiences of health professionals. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:243-254. [PMID: 32934488 PMCID: PMC7450868 DOI: 10.1177/1455072517696323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/08/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Increased awareness among health professionals regarding older people's alcohol and prescribed psychotropic drug use may be beneficial for reducing their unhealthy consumption among elderly. AIM This study explores how health professionals experienced their participation in a study in which they collected data on alcohol and psychotropic drug use among patients treated in old-age psychiatry departments and, subsequently, how they experienced their work day after the study ended. METHOD Focus-group and individual interviews with 15 professionals in specialist psychiatric hospitals were performed in 2016. The data were analysed using content analysis. RESULTS Two themes emerged from the data: the informants' "experiences with participation" and "consequences of participation". These themes described how the informants had experienced their participation in the study and whether these experiences subsequently affected their work routines. The first theme included two subthemes: "approaching the topic" covered the challenges and "applying assessment scales" described the participants' opinions about the scales. Two subthemes were included in the second theme: "increasing knowledge", which covered their reflections on new knowledge; and "influencing work routines", which described their new approach to the topic. CONCLUSION Study participation positively affected the informants' work routines regarding alcohol and psychotropic drug use. The results of this study may contribute to a better understanding, development, and organization of services for people with increased substance use and thus may more holistically promote the health of older people.
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Affiliation(s)
- Aud Johannessen
- Vestfold Hospital Trust, Ageing and Health, National Advisory Unit, Tønsberg, Norway
| | - Knut Engedal
- Vestfold Hospital Trust, Ageing and Health, National Advisory Unit, Tønsberg, Norway
| | - Anne-Sofie Helvik
- Vestfold Hospital Trust, Ageing and Health, National Advisory Unit, Tønsberg, Norway; Norwegian University of Science and Technology (NTNU), Trondheim, Norway; St Olav’s University Hospital, Trondheim, Norway
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16
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Johannesen A, Engedal K, Larsen M, Lillehovde E, Stelander LT, Helvik AS. Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:57-71. [PMID: 32934467 PMCID: PMC7450840 DOI: 10.1177/1455072516682642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/24/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although alcohol and prescribed psychotropic drug use has increased among older people, the usefulness of information provided about these substances in patients' referrals to departments of old-age psychiatry (OAPsy) is unknown. AIMS To examine whether patients' self-reported elevated use of alcohol and prescribed psychotropic drugs corresponds with information provided in the referrals to OAPsy departments and to explore the factors associated with elevated self-reported use of these substances. METHODS We recorded the information provided in referrals about the elevated use of alcohol and psychotropic drugs in a sample of 206 patients (69 men) from 12 OAPsy departments. The Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) helped to assess self-reported use. We also collected demographic data, as well as information about cognitive functioning and symptoms of anxiety and depression. RESULTS Seventy-three patients (35%) scored above the cut-off for alcohol use for women/men (AUDIT ≥ 3/4) or psychotropic drugs (DUDIT ≥ 6/8), if not both. Twenty patients (10%) reported an elevated use of both alcohol and psychotropic drugs, and the referrals for eight (40%) and ten (50%) of them, respectively, included information about this use. There was a significant association between self-reported use of alcohol above the cut-off and information about elevated use in the referrals. However, no such association was found between information in the referrals and self-reported use of prescribed psychotropic drugs. Elevated alcohol use was associated with more years of education, while elevated use of psychotropic drugs was associated with younger age and severe symptoms of anxiety and depression. CONCLUSION The information reported in referrals about the elevated use of alcohol and psychotropic drugs demonstrated a trend in associations with self-reported use. However, the risk factors for elevated use of alcohol and psychotropic drugs in the elderly need to be examined further.
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Affiliation(s)
- Aud Johannesen
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
| | | | | | | | - Anne-Sofie Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway
- Faculty of Medicine, Department for Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Norway
- St. Olav’s University Hospital, Norway
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Gilson KM, Bryant C, Judd F. Understanding older problem drinkers: The role of drinking to cope. Addict Behav 2017; 64:101-106. [PMID: 27597130 DOI: 10.1016/j.addbeh.2016.08.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Despite a common perception that older adults drink less than younger adults, drinking frequency increases with age. The aim of this study was to examine the types of coping motives associated with problem drinkers in addition to the types of specific drinking problems most commonly endorsed by older drinkers. The study also sought to investigate the role of individual drinking to cope motives in problem drinking. METHOD Participants were 288 community dwelling older adults aged who consumed alcohol, and were drawn from a larger study of health and aging in rural areas of Australia. Participants completed a postal questionnaire comprising the Drinking Problems Index, Drinking Motives Questionnaire, The AUDIT-C, and the Centre for Epidemiological Studies Depression Scale. RESULTS Overall, 22.2% of the sample were problem drinkers, with a higher prevalence for men (30.4%) than women (15.6%). Problem drinkers were significantly more likely to consume alcohol according to several indices of risky drinking. The most common drinking problems experienced were becoming intoxicated, spending too much money on drinking, feeling confused after drinking, and skipping meals. Drinking to cope motives to relax, to manage physical symptoms and to feel more self-confident increased the odds of problem drinking. CONCLUSIONS Problem drinking is highly prevalent in older adults. Given the potential adverse consequences of problem drinking on the health of older adults it is imperative that health professionals pay attention to drinking behaviours as part of routine practice.
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Affiliation(s)
- Kim-Michelle Gilson
- Centre for Health Equity, Melbourne, School of Population and Global Health, Victoria, 3010, Australia
| | - Christina Bryant
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Fiona Judd
- Department of Psychiatry, University of Melbourne, Victoria, Australia
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Kalapatapu RK, Ventura MI, Barnes DE. Lifetime alcohol use and cognitive performance in older adults. J Addict Dis 2016; 36:38-47. [PMID: 27719514 DOI: 10.1080/10550887.2016.1245029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Substance use is an important clinical issue in the older adult population. As older adults are susceptible to cognitive disorders, the intersection of the fields of substance use and cognitive neuroscience is an active area of research. Prior studies of alcohol use and cognitive performance are mixed, and inconsistencies may be due to under- or over-adjustment for confounders. This article adds to this literature by conducting a secondary analysis of self-reported lifetime history of alcohol use and cognitive performance in older adults (n = 133). It was hypothesized that current alcohol users would have poorer cognitive performance compared to never/minimal and former alcohol users. Older adult participants were classified into never/minimal alcohol users, former alcohol users, and current alcohol users. A neurocognitive battery included a global cognitive measure and individual measures of attention, memory, fluency, and executive function. A directed acyclic graph-based approach was used to select variables to be included in the multiple linear regression models. Though unadjusted analyses showed some significant associations between alcohol use and cognitive performance, all associations between alcohol use and cognitive performance were eliminated after adjusting for age, education, sex, race, and smoking pack years. Alcohol drink years were not significantly associated with cognitive performance among current and former alcohol users. These results suggest that lifetime alcohol use is not significantly associated with cognitive performance in older adults after adjustment for key confounders. Inconsistencies in prior studies may be due to uncontrolled confounding and/or unnecessary adjustment of mediators and/or colliders.
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Affiliation(s)
- Raj K Kalapatapu
- a Department of Psychiatry , University of California , San Francisco , California , USA.,b Department of Epidemiology and Biostatistics , University of California , San Francisco , California , USA.,c San Francisco Veterans Affairs Medical Center , San Francisco , California , USA
| | - Maria I Ventura
- b Department of Epidemiology and Biostatistics , University of California , San Francisco , California , USA
| | - Deborah E Barnes
- a Department of Psychiatry , University of California , San Francisco , California , USA.,b Department of Epidemiology and Biostatistics , University of California , San Francisco , California , USA.,c San Francisco Veterans Affairs Medical Center , San Francisco , California , USA
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Affiliation(s)
- Celia Wilkinson
- School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia. .,National Drug Research Institute, Curtin University, Perth, Australia.
| | - Steve Allsop
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Julie Dare
- School of Exercise and Health Sciences, Edith Cowan University, Perth, Australia
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