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Zurovac J, Shin E, Earlywine J, Ghosh A, Brown J. Association between Comprehensive Primary Care Plus and opioid prescribing and prescription fills among Medicare beneficiaries. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209621. [PMID: 39736399 DOI: 10.1016/j.josat.2024.209621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 11/22/2024] [Accepted: 12/26/2024] [Indexed: 01/01/2025]
Abstract
INTRODUCTION To examine if Medicare beneficiaries attributed to Comprehensive Primary Care Plus (CPC+) practices had a greater decrease in the potential overuse of prescription opioids relative to beneficiaries attributed to other primary care practices. Primary care practices that participated in CPC+ received enhanced Medicare payment to support five functions: access and continuity of care, care management, comprehensiveness and coordination, patient and caregiver engagement, and planned care and population health. CPC+ practices participated within two tracks starting in 2017; Track 2 practices received larger payments to support more enhanced care delivery than Track 1 practices. METHODS Using difference-in-differences, we used Medicare claims and Part D data to examine changes in potential opioid overuse between 2016 (baseline) and 2021 (the fifth program year). Our measure of potential opioid overuse measure relies on specifications for an existing quality measure of the same name that is defined as filling opioid prescriptions at a daily dosage of 90 morphine milligram equivalents or more among beneficiaries who use opioids for at least 90 days of supply per year. A total of 40,219 Medicare fee-for-service beneficiaries used opioids long term and were attributed to 2888 CPC+ practices; 129,178 beneficiaries used opioids long term and were attributed to 6921 comparison practices. RESULTS Across the combined treatment and comparison groups, potential opioid overuse decreased from 19 % in 2016 to 12 % in 2021. Relative to the comparison group, beneficiaries attributed to Track 1 CPC+ practices experienced an 0.8 percentage point greater decrease in potential opioid overuse (95 % CI = -1.4, -0.2) in the third program year compared to baseline. These findings persisted in the fourth and fifth years and were similar in magnitude to those in the third year. Track 2 results were similar to Track 1 results. The findings were likely driven by changes in CPC+ clinicians' prescribing behaviors: clinicians in CPC+ practices reduced the average dosage and the number of days' supply of prescription opioids more than clinicians in comparison practices. CONCLUSIONS A large-scale primary care delivery transformation initiative was associated with reduced potential opioid overuse among Medicare beneficiaries.
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Affiliation(s)
- Jelena Zurovac
- Mathematica, Inc., 1100 1st Street, NE, 12th Floor, Washington, DC 20002, United States of America.
| | - Eunhae Shin
- University of Georgia, Department of Health Policy and Management, 100 Foster Rd, Athens, GA 30622, United States of America.
| | - Joel Earlywine
- Mathematica, Inc., P.O. Box 2393, Princeton, NJ 08543-2393, United States of America.
| | - Arkadipta Ghosh
- Mathematica, Inc., P.O. Box 2393, Princeton, NJ 08543-2393, United States of America.
| | - Jonathan Brown
- Mathematica, Inc., 1100 1st Street, NE, 12th Floor, Washington, DC 20002, United States of America.
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Prusaczyk B, Tilmon S, Landman J, Seibert D, Colston DC, Westergaard R, Cooper H, Feinberg J, Friedmann PD, Go VF, Khoury D, Korthius T, Mixson S, Moellner A, Nolte K, Smith G, Young A, Pho MT, Jenkins W. Barriers to Healthcare and Social Service Utilization Among Rural Older Adults Who Use Drugs. J Appl Gerontol 2024; 43:1977-1984. [PMID: 38839560 PMCID: PMC11560726 DOI: 10.1177/07334648241258018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
The objective of this study was to understand barriers to healthcare and social service utilization among older adults residing in rural areas who use drugs. A cross-sectional survey of persons who use opioids or inject drugs in rural counties with high overdose rates across ten states was conducted. For this analysis, participants were restricted to only the 375 individuals aged 50 and older. They were asked about barriers to utilizing healthcare and social services. Multivariate analyses were conducted. The most common barriers were a lack of transportation and a fear of stigma. The average number of barriers was 2.53. Those who were either uninsured or homeless endorsed 37% more barriers. For every five-year increase in age, the number of barriers reduced by 15%. Efforts to reduce these barriers may include expanding eligibility for transportation and housing services and leveraging trusted community members to broker linkages to providers to overcome stigma.
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Affiliation(s)
- Beth Prusaczyk
- Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Institute for Informatics, Data Science, and Biostatistics, Center for Population Health Informatics, Washington University School of Medicine in St. Louis, St. Louis, MO USA
| | - Sandra Tilmon
- Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Joshua Landman
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Drake Seibert
- Medical School, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David C. Colston
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ryan Westergaard
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hannah Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Judith Feinberg
- Department of Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Peter D. Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Dalia Khoury
- RTI International, Research Triangle Park, North Carolina, USA
| | - Todd Korthius
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
| | - Sarah Mixson
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alexandria Moellner
- Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kerry Nolte
- College of Health and Human Services, University of New Hampshire, Durham, NH, USA
| | - Gordon Smith
- School of Public Health, West Virginia University, Morgantown, WV, USA
| | - April Young
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Mai T. Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, IL, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
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Schachman KA, Macomber CA, Mitchell ML, Brown JM, Scott JL, Darr RL, Fabbro MA, Morrone WR, Peckham KA, Charbonneau-Ivey TK. Gaining Recovery in Addiction for Community Elders (GRACE) Project: The Impact of Age-Specific Care on Clinical Outcomes and Health Care Resource Utilization in Older Adults With Substance Use Disorder in an Interprofessional Addiction Clinic. J Am Psychiatr Nurses Assoc 2024:10783903241261694. [PMID: 39049443 DOI: 10.1177/10783903241261694] [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: 07/27/2024]
Abstract
BACKGROUND The prevalence of substance use disorders (SUDs) in older adults has been increasing, necessitating tailored and effective addiction care for this aging demographic. AIMS The purpose of this study was to assess the impact of age-specific, interprofessional addiction care on clinical outcomes and health care resource utilization in older adults with SUD. METHODS This quasi-experimental study directly compares patients enrolled in the Gaining Recovery in Addiction for Community Elders (GRACE) Project, an interprofessional age-specific addictions treatment program, with age-matched older adults who received conventional "treatment as usual" (TAU). Through retrospective comparative analysis, substance use outcomes, mental and physical health improvements, and inappropriate use of emergency services were examined among 78 older adults with SUD. RESULTS Clinical outcomes and health care resource utilization were superior for older adults who received age-specific addictions care through the GRACE Project, as compared to mixed-age conventional "TAU." GRACE patients had improved treatment adherence, fewer relapses, and longer treatment engagement. While both groups exhibited significant reductions in depression and anxiety scores, GRACE patients showed greater improvements. This group demonstrated superior control of both hypertension and diabetes. Importantly, they had fewer inappropriate emergency department visits and avoidable hospitalizations than conventional "TAU." CONCLUSIONS Addiction treatment delivered by an interprofessional team to meet the unique strengths and needs of older adults has the potential to improve treatment adherence and more favorable long-term outcomes in substance use, mental health, and chronic medical conditions. Nurses are poised to lead interprofessional teams to meet the growing demand for specialized addiction treatment and integrated care for older adults.
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Affiliation(s)
- Kathleen A Schachman
- Kathleen A. Schachman, PhD, FNP-BC, PMHNP-BC, FIAAN, FAANP, Saginaw Valley State University, University Center, MI, USA
| | - Catherine A Macomber
- Catherine A. Macomber, PhD, LMSW, Saginaw Valley State University, University Center, MI, USA
| | - Matthew L Mitchell
- Matthew L. Mitchell, DHA, LMSW, MBA, CAADC, CCS, Saginaw Valley State University, University Center, MI, USA
| | - Jill M Brown
- Jill M. Brown, PhD, MOST, OTRL, Saginaw Valley State University, University Center, MI, USA
| | - Jennifer L Scott
- Jennifer L. Scott, DNP, FNP-BC, PMHNP-BC, Saginaw Valley State University, University Center, MI, USA
| | - Rachel L Darr
- Rachel L. Darr, PhD, RD, CSSD, Saginaw Valley State University, University Center, MI, USA
| | - Mindy A Fabbro
- Mindy A. Fabbro, DNP, FNP-BC, PMHNP-BC, Saginaw Valley State University, University Center, MI, USA
| | - William R Morrone
- William R. Morrone, DO, MPH, MS, FACOFP, Recovery Pathways, LLC, Bay City, MI, USA
| | - Kari A Peckham
- Kari A. Peckham, EMT-B, CADC, Saginaw Valley State University, University Center, MI, USA
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Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024; 17:589-614. [PMID: 38753455 PMCID: PMC11233252 DOI: 10.1080/17512433.2024.2350968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
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Affiliation(s)
| | - Nancy N. Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H. Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
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Ransome Y, Martinez-Brockman JL, Galusha D, Thompson TA, Adams OP, Nazario CM, Nunez M, Nunez-Smith M, Maharaj RG. Prevalence and correlates of alcohol use among the elderly in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort study. Addict Behav 2024; 153:108001. [PMID: 38447411 DOI: 10.1016/j.addbeh.2024.108001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Alcohol use is pervasive in the Caribbean; however, the prevalence and correlates of alcohol use and drinking problems in the elderly have not been extensively studied. METHODS Data were obtained from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study, a cohort study of Caribbean people from Puerto Rico, Barbados, Trinidad, and Tobago, and the U.S. Virgin Islands, collected between 2013 and 2018 (baseline study sample, ages 60+, n = 811). Descriptive statistics were used to compare the differences in drinking status (current vs. former vs. never), alcohol problems (Cut-down, Annoyed, Guilty, and Eye-opener (CAGE) scale score ≥2 vs. <2), and binge drinking days (0 days vs. 1-2 days vs. ≥3 days) across sample characteristics. Logistic regression analyses estimated the association of these alcohol measures with sociodemographic (e.g., sex), psychological (depression), and cultural (e.g., religion) correlates. RESULTS Thirty-six percent were 70 + years of age, 64 % were female, and 41 % had less than a high school education. Alcohol problems (≥2 CAGE score) was 21 %. Binge drinking ≥3 days was 30.6 %. Never attending religious services (vs. attending once a week or more) was associated with almost three times higher odds of alcohol problems (adjusted Odds Ratio: OR = 2.88, 95 % CI = 1.02, 8.15) four times higher odds of increasing binge drinking days (aOR = 4.04, 95 % CI = 1.11, 14.96). College education was protective against both the outcomes. CONCLUSION We provide current estimates of alcohol problems among elderly Eastern Caribbean people. Among the sociodemographic, psychological, and cultural correlates examined, religious attendance was significant. Replicate longitudinal studies using DSM-5 alcohol dependence are recommended.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA.
| | - Josefa L Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Deron Galusha
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | | | - Oswald P Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill BB11000, Barbados.
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan 00936, PR, USA.
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, VI 00802, USA.
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT 06510, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
| | - Rohan G Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago.
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Kapinos KA, DeYoreo M, Gracner T, Stein BD, Cantor J. Trends in Geographic Proximity to Substance Use Disorder Treatment. Am J Prev Med 2023; 65:618-626. [PMID: 37037326 PMCID: PMC10524906 DOI: 10.1016/j.amepre.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION This study aims to assess the trends in the number and characteristics of substance use disorder (SUD) treatment facilities within the county of residence of adults aged 50+ years over time. METHODS Using retrospective longitudinal data from the 1992-2018 Health and Retirement Study merged with the county-level data on all licensed treatment facilities in the country, linear mixed models were estimated to calculate geographic accessibility to SUD treatment, adjusted for person-level demographics, state-level controls, and calendar year-fixed effects. Analysis was conducted in 2022. RESULTS Overall, older adults experienced a decline in the average number of SUD treatment facilities within their counties of residence from 4.80 per 100,000 residents (95% CI=4.69, 4.92) in 1992 to 4.50 (95% CI=4.35, 4.64) in 2018. However, the number accepting Medicare increased from 0.26 (95% CI=0.21, 0.30) in 1992 to 1.88 (95% CI=1.80, 1.96) facilities per 100,000 (42% of facilities); Medicaid increased from 0.20 (95% CI=0.13, 0.26) in 1992 to 3.50 (95% CI=3.39, 3.62) facilities per 100,000 (78% of facilities) in 2018. Older adults living in more rural areas experienced the most growth in SUD treatment facilities per capita in their counties but with less significant growth in facilities offering medication for opioid use disorder than those living in more urban areas. CONCLUSIONS Despite increases in the number of SUD treatment facilities in rural areas, there has been less growth in nearby facilities offering evidence-based medication treatment for opioid use disorder.
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Affiliation(s)
- Kandice A Kapinos
- RAND Corporation, Arlington, Virginia; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas.
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Arcadepani FB, Fidalgo TM. Substance use among older adults: a review of the literature. J Addict Dis 2023; 41:289-299. [PMID: 36377720 DOI: 10.1080/10550887.2022.2109923] [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: 11/16/2022]
Abstract
OBJECTIVES To explore studies that have examined the effectiveness of possible interventions to reduce the substance use among older adults. METHODS From the search, 295 abstracts were identified and 200 were excluded. Ninety-five remaining articles were reviewed, and 90 were excluded after full text review. Nine articles were included after reviewing bibliographic references on the topic. A total of 14 articles, which all met the inclusion criteria, were considered in the review. RESULTS All 14 studies found that pharmacological and non-pharmacological interventions can reduce substance use (alcohol, cocaine, nicotine and benzodiazepines) among older adults (mean age 45 years or older). CONCLUSIONS There are promising possibly pharmacological and non-pharmacological interventions that can be used to reduce substance use among older adults. In addition, other studies are needed to expand the therapeutic arsenal in this population.
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Affiliation(s)
- Felipe B Arcadepani
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
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Oldfield BJ, Chen K, Joudrey PJ, Biegacki ET, Fiellin DA. Availability of Specific Programs and Medications for Addiction Treatment to Vulnerable Populations: Results from the Addiction Treatment Locator, Assessment, and Standards (ATLAS) Survey. J Addict Med 2023; 17:477-480. [PMID: 37579115 DOI: 10.1097/adm.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVES This study aimed to describe addiction treatment facilities by their offerings of medications for alcohol use disorder (MAUD) and/or for opioid use disorder (MOUD), and by their offering services to groups with barriers to care: uninsured and publicly insured, youth, seniors, individuals preferring to receive care in Spanish, and sexual minority individuals. METHODS We examined addiction treatment facility survey data in 6 US states. We performed bivariate analyses comparing facilities that offered MAUD, MOUD, and both (main outcomes). We then constructed a multivariable model to identify predictors of offering MAUD, MOUD, or both, including exposures that demonstrate programming for special populations. RESULTS Among 2474 facilities, 1228 (50%) responded between October 2019 and January 2020. Programs were offered for youth (30%), elderly (40%), Spanish-speaking (37%), and sexual minority populations (39%), with 58% providing MAUD, 67% providing MOUD, and 56% providing both. Among those providing MAUD, MOUD, or both, a majority (>60% for all exposures) offered programming to vulnerable populations. With Delaware as reference, Louisiana (adjusted odds ratio [aOR], 0.28; 95% confidence interval [CI], 0.12-0.67) and North Carolina (aOR, 0.33; 95% CI, 0.15-0.72) facilities had lesser odds of offering both MAUD and MOUD. All exposures identifying facilities offering treatment to vulnerable groups were associated with offerings of MAUD and/or MOUD except for offerings to youth; these facilities had less odds of offering MOUD (aOR, 0.31; 95% CI, 0.31-0.62). CONCLUSIONS There are facility-level disparities in providing MAUD and MOUD by state, and facilities with youth programming have lesser odds of offering MOUD than other facilities.
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Affiliation(s)
- Benjamin J Oldfield
- From the Fair Haven Community Health Care, New Haven, CT (BJO); Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (BJO, ETB, DAF); Office of Ambulatory Care and Population Health, New York City Health and Hospitals Corporation, New York, NY (KC); Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY (KC); Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (PJJ); Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (DAF); and Yale School of Public Health, New Haven, CT (DAF)
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Avieli H. The role of substance use in the lives of incarcerated older adults: A qualitative study. Front Psychiatry 2023; 14:1116654. [PMID: 36993924 PMCID: PMC10040766 DOI: 10.3389/fpsyt.2023.1116654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BackgroundThe prevalence of drug abuse among older adults has grown over the last decade. Despite the expanding development of a body of research dedicated to studying this phenomenon, drug abuse by incarcerated older adults has been marginalized. Thus, the aim of the present study was to explore drug abuse patterns in the lives of incarcerated older adults.MethodSemi-structured interviews were conducted with 28 incarcerated older adults, and an interpretive analysis was used to analyze the participants’ narratives.FindingsFour themes emerged: (1) Growing up around drugs; (2) Prison onset; (3) Professionals, and (4) Lifelong substance abuse.ConclusionThe study findings reveal a unique typology of drug-related themes in the lives of incarcerated older adults. This typology sheds light on the interplay between aging, drug use, and incarceration and the way these three socially marginalized positions may intersect.
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Older Adult Substance Use Treatment First-Time Admissions Between 2008 and 2018. Am J Geriatr Psychiatry 2022; 30:1055-1063. [PMID: 35418347 DOI: 10.1016/j.jagp.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/23/2021] [Accepted: 03/14/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To see whether the percentage of older adults entering substance use treatment for their first time continued to increase and whether there were changes in the use patterns leading to the treatment episode, particularly an increase in illicit drugs. DESIGN Public administrative health record study. SETTING The Treatment Episode Data Sets publicly available from the Substance Abuse Mental Health Services Administration from 2008 to 2018. PARTICIPANTS Young adults age 30-54 years (N = 3,327,903) and older adults age 55 years and older (N = 453,598) with a first-time admission for a publicly funded substance use treatment. MEASUREMENTS Demographic and substance use history variables at admission. RESULTS The proportion of older adults going for substance use treatment for the first time continued to increase between 2008 and 2018 relative to younger adults, continuing the trend of increasing first-time admission between 1998 and 2008. For the first time, the primary substance at admission for older adults was an illicit substance only, surpassing alcohol only and the combination of alcohol and illicit drug use. In this period, use of opioids, particularly heroin, and methamphetamine increased among older adults entering treatment. CONCLUSIONS As our population ages and substance use trends change, healthcare providers that take care of older adults must have skills to prevent, screen for, diagnose, and treat substance use disorders. Given recent trends in substance use and treatment among older adults, substance use treatment programs must adapt to meet the needs of an older population.
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Chen F, Xu Y, Shi K, Zhang Z, Xie Z, Wu H, Ma Y, Zhou Y, Chen C, Yang J, Wang Y, Robbins TW, Wang K, Yu J. Multi-omics study reveals associations among neurotransmitter, extracellular vesicle-derived microRNA and psychiatric comorbidities during heroin and methamphetamine withdrawal. Biomed Pharmacother 2022; 155:113685. [PMID: 36137407 DOI: 10.1016/j.biopha.2022.113685] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022] Open
Abstract
Despite decades of research in the field of substance withdrawal, molecular biomarkers and related mechanistic study have generally been lacking. In addition to known neurotransmitters, circulating miRNAs are found in small vesicles known as exosomes within blood that have diagnostic potential and are known to contribute to psychiatric disorders. The aim of this work was to characterize the changes in neurotransmitter and exosomal miRNA profiles during heroin and methamphetamine withdrawal using a cross-sectional study design, and to determine their associations to psychiatric comorbidities in a large group of patients with substance use disorders (SUDs). Using weighted gene co-expression network analysis, a series of known, conserved, and novel exosomal miRNAs were identified as being associated with the severity of anxiety and depression, as well as the concentrations of neurotransmitters GABA, choline, and serotonin. Bioinformatics analyses established that the differences in the miRNA profile target signaling pathways are significantly associated with developmental and intellectual abnormalities. Notably, a set of dysregulated miRNA signatures including hsa-mia-451a and hsa-mir-21a resulted in an AUC of 0.966 and 0.861, respectively, for predicting the patients with SUDs. Furthermore, hsa-miR-744a-5p was positively correlated with serotonin, and its important role in maintaining neuronal development and function was revealed using an in vitro human induced pluripotent stem cells derived neuronal model. Our results suggest that the miRNA content of circulating exosomes represent a biomolecular "fingerprint" of the progression of substance withdrawal and may uncover the putative mechanism of how these exosomal miRNAs contribute to psychiatric symptoms.
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Affiliation(s)
- Fengrong Chen
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; School of Medicine, Kunming University of Science and Technology
| | - Yu Xu
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Kai Shi
- College of Science, Guilin University of Technology, Guilin 541004, China
| | - Zunyue Zhang
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; School of Medicine, Yunnan University, Yunnan, China
| | - Zhenrong Xie
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Hongjin Wu
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yuru Ma
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yong Zhou
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Cheng Chen
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jiqing Yang
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yuan Wang
- Department of R&D, Echo Biotech Co., Ltd, Beijing, China
| | - Trevor W Robbins
- Department of Psychology and the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom; Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Kunhua Wang
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; School of Medicine, Yunnan University, Yunnan, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Juehua Yu
- NHC Key Laboratory of Drug Addiction Medicine (Kunming Medical University), First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China; Centre for Experimental Studies and Research, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
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12
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Bishop L, Barclay K. Birth order and health events attributable to alcohol and narcotics in midlife: A 25-year follow-up of a national Swedish birth cohort and their siblings. SSM Popul Health 2022; 19:101219. [PMID: 36091296 PMCID: PMC9450127 DOI: 10.1016/j.ssmph.2022.101219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
Higher birth order is associated with increased risks of adverse health outcomes attributable to alcohol or narcotics in adolescence, but it remains unclear whether these observed birth order effects are also present in midlife. Drawing on a national Swedish cohort born in 1953 and their siblings, we estimate associations between birth order and alcohol- or narcotics-attributable hospitalization or death with a 25-year follow-up to assess whether birth order differences are observed during this life course period. Health events attributable to alcohol or narcotics use were identified using the Swedish National Patient and Cause of Death registers, respectively. We apply Cox proportional hazards models to estimate average birth order differences in hazards for alcohol- or narcotics-attributable hospitalization or death between ages 30 and 55. We estimate birth order differences between families, and use two fixed-effects approaches to estimate birth order differences within families and within families of the same type. Bivariate results indicate increased hazards for both outcomes with higher birth order; however, these results are no longer observed after adjustment for familial background characteristics in all models. Our results thereby show limited evidence for birth order differences in midlife. This study highlights that shared factors within the family of origin may be stronger predictors of adverse health outcomes attributable to substance use among siblings during this life course period. Future research should disentangle the contributions of the social environment within the family of origin for adverse health outcomes attributable to alcohol or narcotics among siblings. We estimate birth order differences for alcohol or narcotics use outcomes between ages 30-55. Birth order differences are not observed for alcohol- or narcotics-attributable events in midlife. Family background characteristics may be stronger predictors of these outcomes.
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13
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Hussain J, Ling L, Alonzo RT, Rodrigues R, Nicholson K, Stranges S, Anderson KK. Associations between sleep patterns, smoking, and alcohol use among older adults in Canada: Insights from the Canadian Longitudinal Study on Aging (CLSA). Addict Behav 2022; 132:107345. [PMID: 35526407 DOI: 10.1016/j.addbeh.2022.107345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/12/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
Poor sleep is associated with chronic health conditions among older adults. As substance use rates increase in this population, age-related physiological and cognitive declines may exacerbate its detrimental consequences, including sleep problems. We analyzed cross-sectional associations between sleep patterns, smoking, and alcohol use using baseline data from 30,097 community-dwelling Canadian adults aged 45-85 years from the Canadian Longitudinal Study on Aging. Insomnia symptoms (difficulties falling/staying asleep), sleep duration (short:<6h; long:>8h), and sleep satisfaction(dissatisfied/neutral/satisfied) were measured. Smoking and alcohol-use frequency (past 12 months), average daily amount (past 30 days), and binge drinking (past 12 months) were self-reported, and associations were examined using modified Poisson regression. Approximately 23% of participants had insomnia symptoms, and 26% reported sleep dissatisfaction. 91% of participants were current non-smokers, whereas 7% reported smoking daily. Over 50% drank ≤ 2 drinks daily, and 3% reported binge drinking. There was a higher adjusted prevalence of insomnia among daily smokers (PR = 1.10, 95% CI = 1.00-1.21) and binge drinkers (PR = 1.21, 95% CI = 1.02-1.43). Odds of short sleep duration were lower among regular drinkers (COR = 0.71, 95% CI = 0.56-0.90) and higher among daily smokers (COR = 1.19, 95% CI = 1.01-1.40). Heavy and frequent smoking and alcohol use are associated with both insomnia symptoms and sleep dissatisfaction, but not consistently with sleep duration. Further longitudinal investigation of this relationship in aging populations is needed in clinical and public health settings to infer the extent of causality and design effective public health interventions in this vulnerable population.
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Affiliation(s)
- Junayd Hussain
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Linda Ling
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rea T Alonzo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, Western University, London, Ontario, Canada.
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14
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Briggs M, Peacock A. Screening Older Adults for Alcohol Use. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Parish WJ, Mark TL, Weber EM, Steinberg DG. Substance Use Disorders Among Medicare Beneficiaries: Prevalence, Mental and Physical Comorbidities, and Treatment Barriers. Am J Prev Med 2022; 63:225-232. [PMID: 35331570 DOI: 10.1016/j.amepre.2022.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to determine the prevalence of treated and untreated substance use disorders among Medicare beneficiaries, the characteristics of Medicare beneficiaries with substance use disorders, and reasons for their unmet needs. METHODS This study used data from the National Survey of Drug Use and Health, 2015-2019. Substance use disorder was defined based on DSM-IV dependence or abuse criteria. Descriptive analyses were conducted in 2021, including testing for differences in unadjusted means. RESULTS Approximately 1.7 million Medicare beneficiaries were estimated to have past-year substance use disorder (8% of Medicare beneficiaries aged <65 years and 2% aged ≥65 years). Overall, 77% had an alcohol use condition, 16% had a prescription drug use condition, and 10% had a marijuana use condition. Of those who had past-year substance use disorder, 11% received treatment for their condition. Common reasons for not receiving treatment were lack of motivation (41%), financial barriers (33%), concern about what others might think (24%), logistical barriers such as lack of transportation (21%), and uncertainty about treatment efficacy (13%). Medicare beneficiaries with substance use disorders were more than twice as likely to have past-year serious psychological distress as those without substance use disorders (44% vs 21%, p<0.001 for those aged <65 years; 14% vs 4%, p<0.001 for those aged ≥65 years). Percentages of past-year suicidal ideation were also much higher among Medicare beneficiaries with substance use disorders than without (24% vs 6%, p<0.001 for those aged <65 years; 7% vs 2%, p=0.006 for those aged ≥65 years). CONCLUSIONS Few Medicare beneficiaries who need substance use disorder treatment receive it. Reducing Medicare coverage gaps and stigma may help meet this need.
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Affiliation(s)
- William J Parish
- Community Health Research Division, RTI International, Research Triangle Park, North Carolina.
| | - Tami L Mark
- Community Health Research Division, RTI International, Rockville, Maryland
| | - Ellen M Weber
- Legal Action Center, Washington, District of Columbia
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16
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Huhn AS, Ellis JD. Commentary on Zolopa et al.: Trauma as an impediment to successful aging and a precipitant of opioid and stimulant use among older adults. Addiction 2022; 117:2189-2190. [PMID: 35352411 PMCID: PMC9542171 DOI: 10.1111/add.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew S. Huhn
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Jennifer D. Ellis
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
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17
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Hereford TE, Porter A, Stambough JB, Cherney SM, Mears SC. Prevalence of Chronic Opioid Use in the Elderly After Hip Fracture Surgery. J Arthroplasty 2022; 37:S530-S535. [PMID: 35219575 DOI: 10.1016/j.arth.2022.01.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND While interest has focused on opioid use after total hip arthroplasty, little research has investigated opioid use in elderly patients after hip fracture. We hypothesize that a substantial number of opioid-naïve elderly patients go on to chronic opioid use after hip fracture surgery. METHODS We reviewed a consecutive series of 219 patients 65 years and older who underwent surgical fixation between January 1, 2016 and February 28, 2019 for a native hip fracture. Patients were excluded for polytrauma, periprosthetic or pathologic fractures, recent major surgery, or death within 90 days of their hip surgery. The state prescription monitoring database was used to determine opioid use. RESULTS Overall, 58 patients (26%) were postoperative chronic opioid users. Of the initial 188 opioid-naïve patients, 43 (23%) became chronic users. Of the 31 preoperative opioid users, 15 (48%) continued as chronic users. Chronic postoperative users were more likely to be White (76% vs 91%, P = .04), younger (78 vs 82 years, P = .003), and preoperative opioid users (odds ratio 3.3, P = .007). Arthroplasty vs fixation did not affect the rate of chronic opioid use (P = .22). CONCLUSION Chronic opioid use is surprisingly common after hip fracture repair in the elderly. Twenty-three percent of opioid-naïve hip fracture patients became chronic users after surgery. Continued vigilance is needed by orthopedic surgeons to limit the amount and duration of postoperative narcotic prescriptions and to monitor for continued use.
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Affiliation(s)
- Timothy E Hereford
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Austin Porter
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Department of Health, Little Rock, AR
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Steven M Cherney
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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18
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Ahmadi S, Mohaqeqi Kamal SH, Basakha M, Soleimanvandiazar N, Ghaedamini Harouni G. Substance use among Iranian older adults: opium, a substance for all seasons. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sina Ahmadi
- Social Determinants of Health Research Center, Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Hossein Mohaqeqi Kamal
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Basakha
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Neda Soleimanvandiazar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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19
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Jemberie WB, Padyab M, McCarty D, Lundgren LM. Hospital Admission Rate, Cumulative Hospitalized Days, and Time to Admission Among Older Persons With Substance Use and Psychiatric Conditions. Front Psychiatry 2022; 13:882542. [PMID: 35530023 PMCID: PMC9075517 DOI: 10.3389/fpsyt.2022.882542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Substance use among older persons occurs with medical and psychiatric comorbidities. This study examined the associations of substance use disorder (SUD), psychiatric, and dual diagnoses with 12-month cumulative hospitalized days, hospital admission rate and number of days to first hospitalization. Methods The cohort of 3,624 individuals (28.2% women) aged 50 years or older was assessed for substance use severity in 65 Swedish municipalities during March 2003-May 2017. Addiction Severity Index data were linked to hospital discharge records and crime statistics. The outcomes were (a) 12-month cumulative hospitalized days; (b) Hospital admission rate, and (c) days to first hospitalization. Generalized linear regression techniques investigated associations between outcomes and SUD, psychiatric and dual diagnoses at admission. Results During 2003-2017, 73.5% of the participants were hospitalized. Twelve-month hospitalized days were positively associated with SUD (Incidence rate ratio (IRR) = 1.41, 95%CI: 1.26-1.58), dual diagnosis (IRR = 2.03, 95%CI: 1.74-2.36), and psychiatric diagnoses (IRR = 2.51, 95%CI: 2.09-3.01). Hospital admission rate was positively associated with SUD (IRR = 4.67, 95%CI: 4.28-5.08), dual diagnosis (IRR = 1.83, 95%CI: 1.64-2.04), and psychiatric diagnoses (IRR = 1.73, 95%CI: 1.55-1.92). Days to first hospitalization were negatively associated with SUD (IRR = 0.52, 95%CI: 0.47-0.58), dual diagnosis (IRR = 0.57, 95%CI: 0.50-0.65), and psychiatric diagnoses (IRR = 0.83, 95%CI: 0.73-0.93). The marginal effects of SUD and/or mental disorders increased with age for all outcomes, except for days to first hospitalization. Conclusion Three of four older persons assessed for substance use severity were later hospitalized. Substance use disorders, dual diagnoses and other mental disorders were the primary reasons for hospitalization and were associated with longer stays, earlier hospitalization, and repeated admissions. Sensitizing service providers to old age substance use and sharing data across the care continuum could provide multiple points of contact to reduce the risk of hospitalizations among older persons with problematic substance use.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
- The Swedish National Graduate School on Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden
| | - Mojgan Padyab
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| | - Dennis McCarty
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States
| | - Lena M. Lundgren
- Department of Social Work, Umeå University, Umeå, Sweden
- Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States
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20
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Zhukovsky P, Savulich G, Morgan S, Dalley JW, Williams GB, Ersche KD. Morphometric similarity deviations in stimulant use disorder point towards abnormal brain ageing. Brain Commun 2022; 4:fcac079. [PMID: 35694145 PMCID: PMC9178962 DOI: 10.1093/braincomms/fcac079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/17/2021] [Accepted: 03/27/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Chronic drug use negatively impacts ageing, resulting in diminished health and quality of life. However, little is known about biomarkers of abnormal ageing in stimulant drug users. Using morphometric similarity network mapping, a novel approach to structural connectomics, we first mapped cross-sectional morphometric similarity trajectories of ageing in the publicly available Rockland Sample (20-80 years of age, n = 665). We then compared morphometric similarity and neuropsychological function between non-treatment-seeking, actively using patients with stimulant use disorder (n = 183, mean age 35.6 years) and healthy control participants (n = 148, mean age 36.0 years). Significantly altered mean regional morphometric similarity was found in 43 cortical regions including the inferior and orbital frontal gyri, pre/postcentral gyri and anterior temporal, superior parietal and occipital areas. Deviations from normative morphometric similarity trajectories in patients with stimulant use disorder suggested abnormal brain ageing. Furthermore, deficits in paired associates learning were consistent with neuropathology associated with both ageing and stimulant use disorder. Morphometric similarity mapping provides a promising biomarker for ageing in health and disease and may complement existing neuropsychological markers of age-related cognitive decline. Neuropathological ageing mechanisms in stimulant use disorder warrant further investigation to develop more age-appropriate treatments for older people addicted to stimulant drugs.
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Affiliation(s)
- Peter Zhukovsky
- Department of Psychology, University of Cambridge, UK
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, UK
| | - George Savulich
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, UK
| | - Sarah Morgan
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, UK
- Department of Computer Science and Technology, University of Cambridge, UK
- The Alan Turing Institute, London, UK
| | | | - Guy B. Williams
- Department of Clinical Neurosciences, University of Cambridge, UK
- Wolfson Brain Imaging Centre, Cambridge Biomedical Campus, Cambridge UK
| | - Karen D. Ersche
- Department of Psychiatry, University of Cambridge, School of Clinical Medicine, UK
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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21
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Chen C, Winterstein AG, Lo-Ciganic WH, Tighe PJ, Wei YJJ. Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: A population-based cohort study. PLoS Med 2022; 19:e1003921. [PMID: 35231025 PMCID: PMC8887769 DOI: 10.1371/journal.pmed.1003921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gabapentinoids are increasingly prescribed to manage chronic noncancer pain (CNCP) in older adults. When used concurrently with opioids, gabapentinoids may potentiate central nervous system (CNS) depression and increase the risks for fall. We aimed to investigate whether concurrent use of gabapentinoids with opioids compared with use of opioids alone is associated with an increased risk of fall-related injury among older adults with CNCP. METHODS AND FINDINGS We conducted a population-based cohort study using a 5% national sample of Medicare beneficiaries in the United States between 2011 and 2018. Study sample consisted of fee-for-service (FFS) beneficiaries aged ≥65 years with CNCP diagnosis who initiated opioids. We identified concurrent users with gabapentinoids and opioids days' supply overlapping for ≥1 day and designated first day of concurrency as the index date. We created 2 cohorts based on whether concurrent users initiated gabapentinoids on the day of opioid initiation (Cohort 1) or after opioid initiation (Cohort 2). Each concurrent user was matched to up to 4 opioid-only users on opioid initiation date and index date using risk set sampling. We followed patients from index date to first fall-related injury event ascertained using a validated claims-based algorithm, treatment discontinuation or switching, death, Medicare disenrollment, hospitalization or nursing home admission, or end of study, whichever occurred first. In each cohort, we used propensity score (PS) weighted Cox models to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of fall-related injury, adjusting for year of the index date, sociodemographics, types of chronic pain, comorbidities, frailty, polypharmacy, healthcare utilization, use of nonopioid medications, and opioid use on and before the index date. We identified 6,733 concurrent users and 27,092 matched opioid-only users in Cohort 1 and 5,709 concurrent users and 22,388 matched opioid-only users in Cohort 2. The incidence rate of fall-related injury was 24.5 per 100 person-years during follow-up (median, 9 days; interquartile range [IQR], 5 to 18 days) in Cohort 1 and was 18.0 per 100 person-years during follow-up (median, 9 days; IQR, 4 to 22 days) in Cohort 2. Concurrent users had similar risk of fall-related injury as opioid-only users in Cohort 1(aHR = 0.97, 95% CI 0.71 to 1.34, p = 0.874), but had higher risk for fall-related injury than opioid-only users in Cohort 2 (aHR = 1.69, 95% CI 1.17 to 2.44, p = 0.005). Limitations of this study included confounding due to unmeasured factors, unavailable information on gabapentinoids' indication, potential misclassification, and limited generalizability beyond older adults insured by Medicare FFS program. CONCLUSIONS In this sample of older Medicare beneficiaries with CNCP, initiating gabapentinoids and opioids simultaneously compared with initiating opioids only was not significantly associated with risk for fall-related injury. However, addition of gabapentinoids to an existing opioid regimen was associated with increased risks for fall. Mechanisms for the observed excess risk, whether pharmacological or because of channeling of combination therapy to high-risk patients, require further investigation. Clinicians should consider the risk-benefit of combination therapy when prescribing gabapentinoids concurrently with opioids.
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Affiliation(s)
- Cheng Chen
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, United States of America
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, United States of America
- Department of Epidemiology, University of Florida Colleges of Medicine and Public Health & Health Professions, Florida, United States of America
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, United States of America
| | - Patrick J. Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Florida, United States of America
| | - Yu-Jung Jenny Wei
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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22
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El Hayek S, Geagea L, El Bourji H, Kadi T, Talih F. Prevention Strategies of Alcohol and Substance Use Disorders in Older Adults. Clin Geriatr Med 2021; 38:169-179. [PMID: 34794700 DOI: 10.1016/j.cger.2021.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Older adults are increasingly engaging in unhealthy substance use. Owing to aging and comorbid medical conditions, older adults are at increased risk of adverse effects from alcohol, tobacco, and illicit drug use. Preventative measures, regular screening, and appropriate intervention can protect older adults from the negative outcomes of substance use and potentially improve their quality of life. This article reviews the latest trends of substance use in older adults, impact on health, and the best practice approaches for the clinical assessment of substance use disorders in this age group.
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Affiliation(s)
- Samer El Hayek
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon. https://twitter.com/samerelhayek
| | - Luna Geagea
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon
| | | | - Tamara Kadi
- American University of Beirut, Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon.
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23
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Choi NG, DiNitto DM, Marti CN, Choi BY. Cannabis and binge alcohol use among older individuals with major depressive episode. Subst Abus 2021; 43:657-665. [PMID: 34666638 DOI: 10.1080/08897077.2021.1986879] [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: 10/20/2022]
Abstract
BACKGROUND Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial logistic regression models to examine associations of a major depressive episode (MDE) with cannabis and binge alcohol use and co-use and associations of binge alcohol use with nonmedical and medical cannabis use. Results: Of individuals age 50+, 89.6% had no history of MDE, 5.7% had prior-to-past-year MDE, and 4.7% had past-year MDE. The rates of past-month cannabis use were 4.3%, 7.7%, and 11.6% and binge alcohol use were 17.3%, 18.7%, and 19.9% among those with no MDE history, prior-to-past-year MDE, and past-year MDE, respectively. Compared to no MDE history, prior-to-past-year MDE (RRR = 1.70, 95% CI = 1.30-2.23) and past-year MDE (RRR = 1.80, 95% CI = 1.27-2.55) were significantly associated with past-month cannabis use (with or without binge alcohol use). However, MDE status was not associated with past-month binge alcohol use. Among cannabis users, binge alcohol use was significantly associated with nonmedical cannabis use only (RRR = 2.50, 95% CI = 1.95-3.21). Users of cannabis and/or binge alcohol also had a higher likelihood of using tobacco products and illicit drugs. Conclusions: Healthcare professionals treating individuals age 50+ with depression should screen for substance use, provide education on the potential adverse effects of polysubstance use, and help them access treatment for co-occurring depression and substance use problems.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.,Bayhealth Medical Center, Dover, Delaware, USA
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Abstract
Purpose of Review The prevalence of alcohol use disorder (AUD) among older adults in the United States is rising, but remains underdiagnosed, underreported, and inadequately managed. This review highlights the medical, social, and cultural factors of AUD in older adults and provides guidelines for its screening, evaluation, and management. Recent Findings The COVID-19 pandemic has created additional challenges and barriers to care, as older adults may have disproportionate worsening of anxiety, depression, and substance use resulting from increased isolation related to physical distancing and shelter-in-place guidelines. Summary All older adults should be routinely screened for AUD with standardized screening tools. If a patient’s screening results are positive, a clinician should conduct a brief assessment, which may be supplemented by laboratory tests. Most older adults at risk for alcohol misuse do not need specialized SUD treatment, but most can benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) to prevent substance misuse before it occurs. Medications for the treatment of AUD in older adults include naltrexone, acamprosate, disulfiram, gabapentin and topiramate. Psychosocial treatments, including mutual help groups, are equally important.
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Grooms J, Ortega A. Substance use disorders among older populations: What role do race and ethnicity play in treatment and completion? J Subst Abuse Treat 2021; 132:108443. [PMID: 34102462 DOI: 10.1016/j.jsat.2021.108443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022]
Abstract
Research that explores the role of substance use treatment among older individuals is scarce. This paper offers a historical investigation of admissions and discharges for treatment episodes over the past two decades across race, ethnicity, gender, and age. Our results suggest that although older individuals are not typically associated with risky behavior, they are increasingly seeking treatment for substance use disorders. We find that substance use treatment admissions for people aged 50 and older have persistently increased over our sample period. Our findings also indicate that, on average, Black (relative to white) admissions across all ages are less likely to complete treatment and more likely to have their treatment terminated by a treatment facility. We also find some evidence that Hispanic admissions are relatively less likely to complete treatment across all age groups. Hispanics over 50 years old are also more likely to terminate treatment. Interestingly, among younger individuals in the most recent years of our sample, the disparity between minority completion rates has improved. Lastly, we find that males (relative to females) are more likely to complete a substance use treatment program but no more likely to have their treatment terminated by a substance use treatment facility.
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Mannelli P. Heroin Use in Older Adults: A Treatment Challenge. Am J Geriatr Psychiatry 2021; 29:426-428. [PMID: 33640267 DOI: 10.1016/j.jagp.2021.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Paolo Mannelli
- Department of Psychiatry and Behavioral Sciences (PM), Duke University Medical Center, Durham, NC.
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27
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Marupuru S, Axon DR. Association of Multimorbidity on Healthcare Expenditures Among Older United States Adults With Pain. J Aging Health 2021; 33:741-750. [PMID: 33881371 DOI: 10.1177/08982643211011841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This cross-sectional study compared the healthcare expenditures associated with multimorbidity (having ≥2 chronic conditions) versus no multimorbidity among older United States (US) adults (aged ≥ 50 years) with self-reported pain in the past 4 weeks. Methods: This research used data from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression models evaluated group differences in various annual healthcare expenditures. Results: Descriptive statistics indicated multimorbidity was associated with all personal characteristics (p < 0.05) except gender and smoking status (p > 0.05). Multimorbidity had 75.8% greater annual total health expenditures (p = 0.0083), 40.6% greater office-based expenditures (p = 0.0224), 100.6% greater prescription medication costs, (p = 0.0268), yet 47.3% lower inpatient expenditures (p = 0.0158), and 56.6% lower home healthcare expenditures (p < 0.0001) than no multimorbidity. Discussion: This study found greater healthcare expenditures among older US adults with pain and multimorbidity, which captures the financial burden of comorbidity in this population.
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Affiliation(s)
- Srujitha Marupuru
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, USA
| | - David R Axon
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, USA
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Rosen D. Increasing Participation in a Substance Misuse Programs: Lessons Learned for Implementing Telehealth Solutions During the COVID-19 Pandemic. Am J Geriatr Psychiatry 2021; 29:24-26. [PMID: 33153870 PMCID: PMC7553906 DOI: 10.1016/j.jagp.2020.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Daniel Rosen
- University of Pittsburgh (DR), School of Social Work, Pittsburg, PA.
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29
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Bejda G, Kułak-Bejda A, Waszkiewicz N, Krajewska-Kułak E. Type D Personality, Stress Level, Life Satisfaction, and Alcohol Dependence in Older Men. Front Psychiatry 2021; 12:712508. [PMID: 34707518 PMCID: PMC8542794 DOI: 10.3389/fpsyt.2021.712508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Alcohol consumption among older adults is becoming an increasing public health problem due to the rapidly growing elderly population. There is a theory that Type D personality is positively correlated with alcohol dependence. The study aimed to assess the style of coping with stress, emotions and anxiety in elder men addicted to alcohol and the relationship between the above. The study included 170 men aged 60 years and older (mean age - 63 ± 3.1 years) addicted to alcohol staying in the Department of Alcohol Addiction Therapy for Men. They were tested with the questionnaire sheet and the following scales: Perceived Family Wealth (PFW), Family Affluence Scale (FAS), Cantril's Ladder of Life Scale, Satisfaction with Life Scale, Type D Personality Scale-14 (DS14), and the 10-item Perceived Stress Scale (PSS-10). The respondents' wealth on a scale of 1-5 points was assessed on avg. 3.1 ± 0.2. The above was confirmed by the results of the FAS scale study, where the respondents obtained an average of 3.9 ± 1.9 (min. 1, max. 8), which proves their average level of affluence. The evaluation of the satisfaction with life using Cantril's Ladder showed that the respondents were also satisfied with life on average (on average 5.5 ± 1.9). The assessment of life satisfaction using the Satisfaction with Life Scale (SWLS) scale allowed for the conclusion that the respondents were very dissatisfied with their lives (mean 17.2 ± 4.9). The evaluation of the measurement of perceived stress (PSS-10 scale) showed that the respondents obtained an average of 23.5 ± 3.7, and on the sten scale, a mean of 7.7 ± 0.98, which proves a high level of perceived stress. The study using the DS14 scale showed that the respondents were in the negative emotionality (NE) subscale - 17.4 ± 4.5 points, and in the HS scale - 16.2 ± 3.2, which proves that they can be classified as a Type D personality. The participants were very dissatisfied with their lives, with a high perceived stress and Type D personality.
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Affiliation(s)
- Grzegorz Bejda
- The School of Medical Science in Białystok, Białystok, Poland
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30
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Wiener RC. Unhealthy Opioid Use and COVID-19 Mortality Incidence in Older Adults: A Multicenter Research Network Study. Subst Use Misuse 2021; 56:2044-2048. [PMID: 34429022 DOI: 10.1080/10826084.2021.1967988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Opioid use has the potential to influence infectious respiratory diseases. The purpose of this research is to examine if there is an association of deaths from the respiratory infection, COVID-19, and unhealthy opioid use in older adults. Data about patients, ages ≥65 years, who had a COVID-19 infection between 1/20/2020 to 12/23/2020 (n = 533,153) were extracted using the TriNetX system. Mortality incidence between initial diagnosis and ninety days after contracting COVID-19 were determined. Comparisons were made between people with and without unhealthy opioid use. There were 7,547 COVID-19 patients with unhealthy opioid use (mean age, 71.8 years; standard deviation 6.3 years) and 525,606 COVID-19 patients (mean age, 74.1 years; standard deviation 7.3 years) without unhealthy opioid use. Of the total, 15,852 (3.0%) died within 3 months of COVID-19 diagnosis. The unadjusted risk ratio of the cohort with unhealthy opioid use compared with the cohort that did not have unhealthy opioid uses was 1.18 (95% CI: 1.05,1.33); p = 0.0069. The relationship failed to remain significant in analysis with propensity score matching (risk ratio = 0.96; 95% CI: 0.82, 1.14; p = 0.6606, ns). The public health implication is that although older adults are more vulnerable to COVID-19 than younger adults, a difference between older adults with or without unhealthy opioid use did not increase vulnerability to death from COVID-19 and should be not be considered if rationing of care becomes necessary.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry 104a Health Sciences Addition, West Virginia University, Morgantown, West Virginia, USA
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31
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Tucker JS, Huang W, Green HD, Pollard MS. Patterns of Substance Use and Associations with Mental, Physical, and Social Functioning: A Latent Class Analysis of a National Sample of U.S. Adults Ages 30-80. Subst Use Misuse 2021; 56:131-139. [PMID: 33167746 PMCID: PMC7984420 DOI: 10.1080/10826084.2020.1843059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Trends show increased substance use among adults, yet little research on general population samples has examined differential patterns of licit and illicit substance use that can inform prevention and treatment efforts. This study identifies distinct patterns (classes) of substance use among 30- to 80-year olds, identifies demographic subgroups with the highest probability of class memberships, and compares classes on key indicators of functioning. Method: Participants (n = 1,877) were from the RAND American Life Panel. Online survey measures included current alcohol, tobacco, cannabis, and nonmedical prescription drug use, as well as mental, physical, and social functioning. Results: Latent class analysis identified four classes: "Lighter Drinking" (46.6%), "Abstaining" (33.7%), "Heavy Drinking with Cigarette/Cannabis Use" (17.1%), and "Cigarette Smoking with Prescription Drug/Cannabis Use" (2.6%). Of these classes, "Cigarette Smoking with Prescription Drug/Cannabis Use" reported the worst mental and physical functioning, and greater loneliness than the "Lighter Drinking" class. "Heavy Drinking with Cigarette/Cannabis Use" reported worse mental and physical functioning than the "Lighter Drinking" class and less social support than the "Lighter Drinking" and "Abstaining" classes. The "Abstaining" class reported consistently worse functioning than the "Lighter Drinking" class. Both polysubstance use classes were associated with younger age, less education, and lower income, and heavy drinking polysubstance use was associated with being male and unmarried. Conclusions: Although lighter drinking was the most common pattern, 20% of adults were classified into two polysubstance use classes associated with poorer functioning. Targeted efforts may be needed to reach certain subgroups of adults who are particularly susceptible to polysubstance use.
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Affiliation(s)
| | | | - Harold D Green
- Indiana University School of Public Health, Department of Applied Health Science, Bloomington, Indiana, USA
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32
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Pitchumoni CS. Gastrointestinal Physiology and Aging. GERIATRIC GASTROENTEROLOGY 2021:155-200. [DOI: 10.1007/978-3-030-30192-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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33
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Park JE, Hong JP, Jeon HJ, Seong SJ, Sohn JH, Ha TH, Lee DW, Park JI, Cho SJ, Chang SM, Kim BS, Suk HW, Cho MJ, Hahm BJ. Age-related differences in the associations among at-risk drinking, alcohol use disorder, and psychological distress across the adult lifespan: a nationwide representative study in South Korea. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1335-1344. [PMID: 32052102 DOI: 10.1007/s00127-020-01845-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/03/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate age-related differences in the relationships among at-risk alcohol consumption, alcohol use disorder (AUD), and psychological distress with a special focus on older adults. METHODS We used a nationwide cross-sectional study of a representative sample of community-dwelling adults from the Korean Epidemiologic Catchment Area study for psychiatric disorders conducted by door-to-door interviews. The Korean version of the Composite International Diagnostic Interview was applied. Subjects were categorized into four age groups: young-to-middle-aged (20-54 years), near-old (55-64 years), early-old (65-74 years), and late-old (≥ 75 years). The associations among at-risk drinking, alcohol use disorder, and psychological distress were examined according to age groups. RESULTS Among a total of 5102 individuals, half of them drank alcohol in the previous year, of whom 20.5% were at-risk drinkers (≥ 100 g/week). Older people were less often diagnosed with AUD than young-to-middle-aged adults with a similar degree of at-risk drinking. They were less likely to meet the DSM-5 AUD criteria in terms of social and vocational role disruption or creation of a physically hazardous situation. However, at-risk drinking showed a stronger association with subjective psychological distress in older adults, particularly in the near-old group (adjusted odds ratio 1.82, 95% confidence interval 1.09-3.03; p = 0.023). CONCLUSIONS These findings indicate the importance of screening for mental health problems in older adults, especially near-old adults, who drink more than 100 g of alcohol per week even when they do not satisfy the criteria for a diagnosis of AUD.
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Affiliation(s)
- Jee Eun Park
- Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su Jeong Seong
- Department of Psychiatry, Hallym University Medical Center, Seoul, South Korea
| | - Jee Hoon Sohn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Tae Hyon Ha
- Department of Psychiatry, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Dong-Woo Lee
- Department of Psychiatry, Inje University College of Medicine, Seoul, South Korea
| | - Jong-Ik Park
- Department of Psychiatry, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon Medical School, Incheon, South Korea
| | - Sung Man Chang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Byung-Soo Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hye Won Suk
- Department of Psychology, Sogang University, Seoul, South Korea
| | - Maeng Je Cho
- Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Bong-Jin Hahm
- Department of Psychiatry, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
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34
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Calvo E, Medina JT, Ornstein KA, Staudinger UM, Fried LP, Keyes KM. Cross-country and historical variation in alcohol consumption among older men and women: Leveraging recently harmonized survey data in 21 countries. Drug Alcohol Depend 2020; 215:108219. [PMID: 32795884 PMCID: PMC7585691 DOI: 10.1016/j.drugalcdep.2020.108219] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alcohol consumption causes greater harm in older than younger adults. As the population ages, understanding cross-country and time-varying drinking patterns of older adults is of critical importance. Available evidence relies primarily on ecological data. METHODS We harmonized survey data for 179,881 adults age 50+ observed repeatedly between 1998 and 2016 in 21 countries. Next, we estimated historical variation in consumption across countries (overall and stratified by gender and age group 50-64/65+). RESULTS On average, 51.95 % of older adults consumed any alcohol over the observed period. For 13 countries, the proportion of older adults who drink increased (mean annual increase: 0.76 percent points). Heavy drinking (men drinks/day>3 or binge>5, women drinks/day>2 or binge>4) peaked at 23.54 % for England in 2010 and lifetime abstainers at 69.65 % for China in 2011. Across countries and among drinkers, consumption frequency was 2.57 days/week, the number of standard drink units when drinking was 2.57, and the average number of drinks/day over a week was 1.12. Consumption patterns varied substantially across countries and historical time. Overall probability and frequency of consumption were higher in men than women, with the largest gaps observed in 2011 for China, but gender gaps decreased (even reversed) in the young old and varied across country and time. CONCLUSIONS Wide variation in older adults' alcohol consumption across countries and time suggests that broad scale prevention and intervention efforts can be harnessed for potential population-level health benefits. Further variation by gender and age reflect physiological and social factors simultaneously shaping alcohol consumption.
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Affiliation(s)
- Esteban Calvo
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, United States; Society and Health Research Center and Laboratory on Aging and Social Epidemiology, School of Public Health and Facultad de Humanidades, Universidad Mayor, Santiago, Chile.
| | - José T Medina
- Laboratory on Aging and Social Epidemiology, Universidad Mayor, Santiago, Chile
| | - Katherine A Ornstein
- Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ursula M Staudinger
- Robert N. Butler Columbia Aging Center and Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Linda P Fried
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America. Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
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35
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Womack JA, Justice AC. The OATH Syndemic: opioids and other substances, aging, alcohol, tobacco, and HIV. Curr Opin HIV AIDS 2020; 15:218-225. [PMID: 32487817 PMCID: PMC7422477 DOI: 10.1097/coh.0000000000000635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Persons living with HIV (PLWH) are aging, continue to use alcohol and other substances, and experience age-associated adverse effects. We explore a new syndemic: OATH (opioids and other substances, aging, alcohol, tobacco, and HIV). RECENT FINDINGS Frailty and falls are important problems that affect the health status of PLWH who continue to use alcohol and other substances. HIV, alcohol and other substance use, and aging each contributes to inflammaging. Multimorbidity and polypharmacy are also important pathways as alcohol and other substances interact with prescribed medications resulting in adverse-drug interactions leading to potentially serious consequences. Social conditions including racism, poverty, sex bias, stress, and stigma contribute to the existence and persistence of this syndemic. SUMMARY Substance use, HIV, and aging are linked in a new syndemic (OATH) that drives age-related outcomes such as frailty and falls. We need to expand our understanding of the 'healthcare team' so that we include social and political advocates who can support necessary structural change. Treatment of substance use should be better incorporated into the management of HIV, including a focus on potential medication/substance interactions. Finally, we need to explore treatment of frailty rather than individual manifestations of frailty (e.g., atherosclerosis, neurodegeneration).
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Affiliation(s)
- Julie A. Womack
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Nursing, Orange, CT
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
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36
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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: 0.6] [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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37
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Pasha AK, Chowdhury A, Sadiq S, Fairbanks J, Sinha S. Substance use disorders: diagnosis and management for hospitalists. J Community Hosp Intern Med Perspect 2020; 10:117-126. [PMID: 32850046 PMCID: PMC7425622 DOI: 10.1080/20009666.2020.1742495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Substance use disorder is a significant health concern. Hospitalists manage patient with various forms of substance use disorder on a daily basis. In this review, we have tried to synthesize evidence together to give a brief, yet succinct, review of commonly encounters disorders; alcohol intoxication and withdrawal, opioid intoxication and withdrawal, cocaine intoxication and methamphetamine intoxication. We describe clinical features, diagnosis and management, which would serve as a great resource for hospitalist when managing these complicated patients.
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Affiliation(s)
- Ahmed K Pasha
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Mankato, MN, USA
| | - Arnab Chowdhury
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Mankato, MN, USA
| | - Sanah Sadiq
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Southwest Minnesota Region, Mankato, MN, USA
| | - Jeremiah Fairbanks
- Department of Family Medicine and Community Health, University of Minnesota, Mankato, MN, USA
| | - Shirshendu Sinha
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Southwest Minnesota Region and Mayo Clinic College of Medicine and Science, Mankato, MN, USA
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38
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Kashiwagi DT. Geriatric inpatient care: what should hospital clinicians know? Hosp Pract (1995) 2020; 48:1-2. [PMID: 32037911 DOI: 10.1080/21548331.2020.1723354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
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39
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Soder HE, Berumen AM, Gomez KE, Green CE, Suchting R, Wardle MC, Vincent J, Teixeira AL, Schmitz JM, Lane SD. Elevated Neutrophil to Lymphocyte Ratio in Older Adults with Cocaine Use Disorder as a Marker of Chronic Inflammation. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:32-40. [PMID: 31958903 PMCID: PMC7006975 DOI: 10.9758/cpn.2020.18.1.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/22/2019] [Accepted: 10/23/2019] [Indexed: 01/23/2023]
Abstract
Objective The neutrophil to lymphocyte ratio (NLR) is a non-specific, easy-to-obtain marker of inflammation associated with morbidity and mortality in systemic, psychiatric, and age-related inflammatory conditions. Given the growing trend of substance use disorder (SUD) in older adults, and the relationship between inflammation and SUD elevated NLR may serve as a useful inflammatory biomarker of the combined burden of aging and SUD. The present study focused on cocaine use disorder (CUD) to examine if cocaine adds further inflammatory burden among older adults, by comparing NLR values between older adults with CUD and a non-cocaine using, aged-matched, nationally representative sample. Methods The dataset included 107 (86% male) participants (aged 50-65 years) with cocaine use disorder. NLR was derived from complete blood count tests by dividing the absolute value of peripheral neutrophil concentration by lymphocyte concentration. For comparison, we extracted data from age-matched adults without CUD using the National Health and Nutrition Examination Survey. Individuals with immunocompromising conditions were excluded (e.g., rheumatoid arthritis and sexually transmitted infections such as HIV). A doubly-robust inverse probability-weighted regression adjustment (IPWRA) propensity score method was used to estimate group differences on NLR while controlling for potential confounding variables (age, gender, race, income, nicotine, marijuana and alcohol use). Results The IPWRA model revealed that the CUD sample had significantly elevated NLR in comparison to non-cocaine users, with a moderate effect size (β weight = 0.67). Conclusion Although non-specific, NLR represents a readily obtainable inflammatory marker for SUD research. CUD may add further inflammatory burden to aging cocaine users.
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Affiliation(s)
- Heather E Soder
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
| | - Amber M Berumen
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
| | - Kira E Gomez
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
| | - Charles E Green
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA.,epartment of Pediatrics, University of Texas Health Science Center at Houston, Houston,TX, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
| | - Margaret C Wardle
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jessica Vincent
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
| | | | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, TX, USA
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Substance Use Disorders in Later Life: A Review and Synthesis of the Literature of an Emerging Public Health Concern. Am J Geriatr Psychiatry 2020; 28:226-236. [PMID: 31340887 DOI: 10.1016/j.jagp.2019.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/10/2019] [Accepted: 06/15/2019] [Indexed: 11/22/2022]
Abstract
Substance use disorders (SUDs) among older persons are among the fastest growing health problems in the United States. The number of older persons is projected to exceed 72.1 million persons by 2030, following a trend of general population growth in the mid-1940s to 1960s. The generation, known as "baby boomers," who refashioned drug use during their 20-30s, are increasingly continuing drug habits into later life. This review aims to assess the epidemiology, impact, and treatment of geriatric SUDs. Academic databases including PubMed, PsychInfo, Ovid, and Medline, were queried up to December 2018 for terms of "geriatric," "older," "elderly," "substance abuse," "drug," "drug use," "drug abuse," "drug dependency," "illicit drugs," and "geriatric psychiatry." Articles identified included 17 government documents, 29 studies based upon government documents, 43 studies not related to US government surveys, 19 review articles, 9 commentary pieces, 4 newspaper articles, 2 textbooks, and 1 published abstract. Evaluated studies and documents together suggest that older individuals are using illicit drugs and meeting criteria for SUDs at higher rates than previous geriatric cohorts resulting in substantial negative impacts on medical and psychiatric conditions. These findings represent a novel trend since previous cohorts of older individuals were thought to rarely use illicit substances. Current treatment models are inadequate to address the new wave of older individuals with SUDs. The fields of geriatrics, addiction, and geriatric psychiatry must work together to establish comprehensive care models and treatment modalities for addressing this emerging public health concern.
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Chapman J, Harrison N, Kostadinov V, Skinner N, Roche A. Older Australians' perceptions of alcohol-related harms and low-risk alcohol guidelines. Drug Alcohol Rev 2019; 39:44-54. [PMID: 31829473 DOI: 10.1111/dar.13022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/21/2019] [Accepted: 11/24/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND AIMS Australia has an ageing population. Given the concomitant increase in the numbers and proportion of risky drinkers among older adults, research examining contributory factors is a priority. The current study examined older adults' estimates of the NHMRC low-risk drinking guidelines, consumption patterns and associated harms and self-identification of drinking type. DESIGN AND METHODS Data from respondents aged 50+ years (N = 11 886) in the 2016 National Drug Strategy Household Survey were subjected to secondary analyses. Estimates of low-risk drinking levels, perceived level of harm from current drinking, self-identification of drinking type and awareness of standard drinks and labelling were included. Data were examined for those aged 50-59 years and 60+. RESULTS Seventeen percent of older Australians drank at both long-term and short-term risk levels. Approximately 39% of males and 11% of females overestimated the long-term low-risk levels and 54% of males and 20% of females overestimated the short-term low-risk levels. Overestimation was highest among risky drinkers. Most older risky drinkers were aware of standard drinks and labelling; however, less than half perceived their drinking as harmful, instead identifying as social drinkers. DISCUSSION AND CONCLUSIONS Although substantial gaps are evident in older respondents' estimates of low-risk drinking, additional public awareness campaigns are likely to be of limited use. Older peoples' engagement with the public health system presents 'windows of opportunity' to provide targeted, age-appropriate harm reduction strategies. Appropriate intervention and policy responses are required to direct resources to this emerging area of concern.
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Affiliation(s)
- Janine Chapman
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Nathan Harrison
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Victoria Kostadinov
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Natalie Skinner
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| | - Ann Roche
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
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Oldfield BJ, McGinnis KA, Edelman EJ, Williams EC, Gordon AJ, Akgün K, Crystal S, Fiellin LE, Gaither JR, Goulet JL, Korthuis PT, Marshall BDL, Justice AC, Bryant K, Fiellin DA, Kraemer KL. Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV. J Subst Abuse Treat 2019; 109:14-22. [PMID: 31856946 DOI: 10.1016/j.jsat.2019.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status. METHODS From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status. RESULTS Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51-0.85). Older age (for PLWH: AOR 0.78, 95% CI 0.61-0.99; for uninfected: AOR 0.70, 95% CI 0.61-0.80) and black race (for PLWH: AOR 0.63, 95% CI 0.0.49-0.1.00; for uninfected: AOR 0.63, 95% CI 0.48-0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. CONCLUSIONS For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).
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Affiliation(s)
- Benjamin J Oldfield
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America.
| | - Kathleen A McGinnis
- Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - E Jennifer Edelman
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Emily C Williams
- School of Public Health, University of Washington, Seattle, WA, United States of America; Health Services Research and Development, VA Puget Sound Healthcare Services, Seattle, WA, United States of America
| | - Adam J Gordon
- Department of Medicine, University of Utah, Salt Lake City, UT, United States of America; Department of Medicine, Salt Lake City VA Health Care System, Salt Lake City, UT, United States of America
| | - Kathleen Akgün
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Stephen Crystal
- School of Social Work, Rutgers University, New Brunswick, NJ, United States of America
| | - Lynn E Fiellin
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Julie R Gaither
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States of America
| | - Joseph L Goulet
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - P Todd Korthuis
- Department of Medicine, Oregon Health Sciences University, Portland, OR, United States of America
| | - Brandon D L Marshall
- School of Public Health, Brown University, Providence, RI, United States of America
| | - Amy C Justice
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Kendall Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States of America
| | - David A Fiellin
- Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Kevin L Kraemer
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
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Impact of Substance Use on Older Patients With Human Immunodeficiency Virus. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Keyes KM, Allel K, Staudinger UM, Ornstein KA, Calvo E. Alcohol consumption predicts incidence of depressive episodes across 10 years among older adults in 19 countries. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2019; 148:1-38. [PMID: 31733662 PMCID: PMC7362478 DOI: 10.1016/bs.irn.2019.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alcohol consumption is increasing in many countries, and excessive alcohol consumption is particularly increasing among older adults. Excessive alcohol consumption causes morbidity and mortality, especially among older adults, including an increased risk of depressive episodes. We review the mechanisms through which alcohol consumption may affect depression, and argue that the effects of alcohol consumption on depressive episodes among older adults are understudied. We harmonized data among older adults (≥50 years) on alcohol consumption, depressive episodes, and an array of risk factors across 10 years and 19 countries (N=57,276). Alcohol consumption was categorized as current or long-term abstainer, occasional, moderate and heavy drinking at an average of 2.3 follow-up time points. Depressive episodes were measured through the CES-D or EURO-D. Multi-level Cox proportional frailty models in which the random effect has a multiplicative relationship to hazard were estimated with controls for co-occurring medical conditions, health behaviors, and demographics. Long-term alcohol abstainers had a higher hazard of depressive episodes (HR=1.14, 95% C.I. 1.08-1.21), as did those reporting occasional (HR=1.16, 95% C.I. 1.10-1.21) and heavy drinking (HR=1.22, 95% C.I. 1.13-1.30), compared with moderate drinking. Hazard ratios were attenuated in frailty models; heavy drinking, however, remained robustly associated in a random-effects model with a frailty component (HR=1.16, 95% C.I. 1.11-1.21). Interactions were observed by gender and smoking status: long-term abstainers, women's, and smokers' (HR for interaction, 1.04, 95% C.I. 1.00-1.07) hazards of depressive episodes increased more than what would be expected based on their multiplicative effects, when compared to moderate drinking, non-smoking men. Excessive alcohol consumption among older adults is a concern not only for physical, but also for mental health. Physician efforts to screen older adults for excessive alcohol use is critical for mental health to remain strong in aging populations.
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Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Columbia University, New York, NY, United States; Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, United States; Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile.
| | - Kasim Allel
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile; Millennium Nucleus for the Study of the Life Course and Vulnerability (MLIV), Santiago, Chile
| | - Ursula M Staudinger
- Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, United States; Department of Sociomedical Sciences, Columbia University, New York, NY, United States
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, United States
| | - Esteban Calvo
- Department of Epidemiology, Columbia University, New York, NY, United States; Robert N. Butler Columbia Aging Center, Columbia University, New York, NY, United States; Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
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Nisar R, Griffin BL, Vest KM, Tran TH, Nikolaides JK. Opioid Misuse in Older Women. J Am Geriatr Soc 2019; 67:1753-1754. [DOI: 10.1111/jgs.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ramsha Nisar
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois
| | - Brooke L. Griffin
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois
| | - Kathleen M. Vest
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois
| | - Tran H. Tran
- Midwestern University Chicago College of Pharmacy Downers Grove Illinois
- Rush University Medical Center Chicago Illinois
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