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Sadek J, Diaz-Piedra B, Saleh L, MacDonald L. A narrative review: suicide and suicidal behaviour in older adults. Front Psychiatry 2024; 15:1395462. [PMID: 38800059 PMCID: PMC11117711 DOI: 10.3389/fpsyt.2024.1395462] [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] [Received: 03/04/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.
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Affiliation(s)
- Joseph Sadek
- Professor, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Leah Saleh
- Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Luke MacDonald
- MD Candidate, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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2
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Patel D, Andersen S, Smith K, Ritter A. Completed Suicide by Firearm in an Individual With the Agrammatic Variant of Primary Progressive Aphasia: Case Report. Front Neurol 2022; 13:828155. [PMID: 35370921 PMCID: PMC8965452 DOI: 10.3389/fneur.2022.828155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
The agrammatic or nonfluent variant of Primary Progressive Aphasia (nfvPPA) is a form of Frontotemporal Dementia (FTD) that is characterized by progressive language dysfunction, poor sentence construction, and low verbal fluency. Individuals with nfvPPA have intact insight into their decline, which may manifest as frustration and hopelessness, and show signs of impulsivity and disinhibition. Little is known about suicide risk in this patient population. Here we describe a case of an 84 year-old male with nfvPPA who, over the course of his care, experienced a decline in language and motoric functioning which coincided with increasing irritability and impulsivity. Despite this significant decline, he denied depressive symptoms or showed any suicidal tendencies, and he seemed to be looking forward to future events. His suicide, committed with a handgun during what appeared to be a rather innocuous trip to the garage, came as a significant shock to his spouse, family, and his clinical care team. To our knowledge, this is the first reported case of completed suicide in a patient with the nfvPPA subtype of FTD. Though this patient demonstrated demographic risk factors for suicide (advanced age, retired military veteran with easy access to firearms) there is a lack of data regarding how FTD may have contributed. Retained insight especially seems to be a risk factor for suicide across all forms of dementia. Impulsivity may be key when considering suicidality amongst FTD patients. Additionally, this case demonstrates the importance of addressing gun safety as there are few guidelines around gun ownership in this patient population.
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Affiliation(s)
- Deepal Patel
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Shaun Andersen
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Kyler Smith
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
| | - Aaron Ritter
- Kirk Kerkorian School of Medicine, Las Vegas, NV, United States.,University of Nevada, Reno, NV, United States.,Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, United States
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Ko TM, Kalesnikava VA, Jurgens D, Mezuk B. A Data Science Approach to Estimating the Frequency of Driving Cessation Associated Suicide in the US: Evidence From the National Violent Death Reporting System. Front Public Health 2021; 9:689967. [PMID: 34485220 PMCID: PMC8415628 DOI: 10.3389/fpubh.2021.689967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
Driving cessation is a common transition experienced by aging adults that confers both a symbolic and literal loss of independence due to the central role of automobiles for mobility in the US. Prior research has shown that driving cessation has negative implications for mental health, social participation, and access to healthcare. Given these sequelae of driving cessation and prior work showing that late-life transitions related to independence (e.g., transitioning into residential care) are associated with suicide, we sought to estimate the frequency of driving cessation associated suicide. Data include suicide (n = 59,080) and undetermined (n = 6,862) deaths aged ≥55 from the National Violent Death Reporting System (NVDRS, 2003-2017). Each case in the NVDRS has both quantitative data (e.g., demographic characteristics) and qualitative text narratives, derived from coroner/medical examiner reports, which describe the most salient circumstances and features of each death. To identify cases associated with driving cessation, we employed a supervised random forest algorithm to develop a Natural Language Processing (NLP) classifier. Identified driving cessation associated cases were then categorized and characterized using descriptive statistics and qualitative content analysis. From 2003 to 2017, there were an estimated 305 cases of suicide/undetermined deaths associated with driving cessation in the NVDRS, representing 0.04% of all cases. Cases associated with driving cessation were older, more likely to be male, more likely to have a physical health problem, more likely to have experienced a recent crisis, and more likely to have lived in a rural county than other decedents. Qualitative analysis identified functional impairment, alcohol-related driving limitations, loss of employment, and recent car accidents as common themes among cases associated with driving cessation. This analysis illustrates the utility of NLP in identifying novel correlates of suicide in later life. Although driving cessation associated suicide is a rare outcome, further research is warranted on understanding the conditions under which driving cessation is associated with suicidal behavior, and how to support the well-being of aging adults during these types of major life transitions.
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Affiliation(s)
- Tomohiro M. Ko
- Rutgers—Robert Wood Johnson Medical School, Piscataway, NJ, United States
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - David Jurgens
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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Sleep disturbances are associated with cortical and subcortical atrophy in alcohol use disorder. Transl Psychiatry 2021; 11:428. [PMID: 34400604 PMCID: PMC8368207 DOI: 10.1038/s41398-021-01534-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 11/08/2022] Open
Abstract
Sleep disturbances are prominent in patients with alcohol use disorder (AUD) and predict relapse. So far, the mechanisms underlying sleep disruptions in AUD are poorly understood. Because sleep-related regions vastly overlap with regions, where patients with AUD showed pronounced grey matter (GM) reduction; we hypothesized that GM structure could contribute to sleep disturbances associated with chronic alcohol use. We combined sleep EEG recording and high-resolution structural brain imaging to examine the GM-sleep associations in 36 AUD vs. 26 healthy controls (HC). The patterns of GM-sleep associations differed for N3 vs. REM sleep and for AUD vs. HC. For cortical thickness (CT), CT-sleep associations were significant in AUD but not in HC and were lateralized such that lower CT in right hemisphere was associated with shorter N3, whereas in left hemisphere was associated with shorter REM sleep. For the GM density (GMD), we observed a more extensive positive GMD-N3 association in AUD (right orbitofrontal cortex, cerebellum, dorsal cingulate and occipital cortex) than in HC (right orbitofrontal cortex), and the GMD-REM association was positive in AUD (midline, motor and paralimbic regions) whereas negative in HC (the left supramarginal gyrus). GM structure mediated the effect of chronic alcohol use on the duration of N3 and the age by alcohol effect on REM sleep. Our findings provide evidence that sleep disturbances in AUD were associated with GM reductions. Targeting sleep-related regions might improve sleep in AUD and enhance sleep-induced benefits in cognition and emotional regulation for recovery.
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Martinotti G, Schiavone S, Negri A, Vannini C, Trabace L, De Berardis D, Pettorruso M, Sensi SL, Di Giannantonio M. Suicidal Behavior and Club Drugs in Young Adults. Brain Sci 2021; 11:brainsci11040490. [PMID: 33921484 PMCID: PMC8069608 DOI: 10.3390/brainsci11040490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 12/17/2022] Open
Abstract
Psychoactive drugs play a significant role in suicidality when used for intentional overdose or, more frequently, when the intoxication leads to disinhibition and alterations in judgment, thereby making suicide more likely. In this study, we investigated suicidality prevalence among drug users and evaluated the differences in suicide ideation, taking into account the substance categories and the association of suicide ideation intensity with other psychiatric symptoms. Subjects admitted to the Can Misses Hospital's psychiatry ward in Ibiza were recruited during summer openings of local nightclubs for four consecutive years starting in 2015. The main inclusion criterium was an intake of psychoactive substances during the previous 24 h. The Columbia Suicide Severity Rating Scale (C-SSRS) was used to assess the suicide risk. Suicidality was present in 39% of the study cohort. Suicide Ideation Intensity overall and in the previous month was higher in users of opioids and in general of psychodepressors compared to psychostimulants or psychodysleptics. Suicidality was not correlated with alterations in any of the major psychopathological scales employed to assess the psychiatric background of the study subjects. The presence of high levels of suicidality did not specifically correlate with any major symptom indicative of previous or ongoing psychopathological alterations. These findings suggest that impulsivity and loss of self-control may be determinants of the increased suicidality irrespectively of any major ongoing psychiatric background.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti-Pescara, Italy; (G.M.); (C.V.); (M.P.); (S.L.S.); (M.D.G.)
| | - Stefania Schiavone
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (S.S.); (L.T.)
| | - Attilio Negri
- S.C Area Ser.D Mantova—U.O. Ser.T Alto Mantovano, 46100 Mantova, Italy;
- Department of Clinical and Pharmaceutical Sciences, School of Life and Medical Science, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Chiara Vannini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti-Pescara, Italy; (G.M.); (C.V.); (M.P.); (S.L.S.); (M.D.G.)
| | - Luigia Trabace
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (S.S.); (L.T.)
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini”, 64100 Teramo, Italy
- Correspondence: ; Tel.: +39-0861429708
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti-Pescara, Italy; (G.M.); (C.V.); (M.P.); (S.L.S.); (M.D.G.)
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti-Pescara, Italy; (G.M.); (C.V.); (M.P.); (S.L.S.); (M.D.G.)
- Center for Advanced Studies and Technology (CAST) University G. d’Annunzio of Chieti-Pescara, 66100 Chieti-Pescara, Italy
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti-Pescara, Italy; (G.M.); (C.V.); (M.P.); (S.L.S.); (M.D.G.)
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6
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Batsis JA, Daniel K, Eckstrom E, Goldlist K, Kusz H, Lane D, Loewenthal J, Coll PP, Friedman SM. Promoting Healthy Aging During COVID-19. J Am Geriatr Soc 2021; 69:572-580. [PMID: 33470421 PMCID: PMC8013507 DOI: 10.1111/jgs.17035] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 12/22/2022]
Abstract
Older adults have been markedly impacted by the coronavirus disease 19 (COVID‐19) pandemic. The American Geriatrics Society previously published a White Paper on Healthy Aging in 2018 that focused on a number of domains that are core to healthy aging in older adults: health promotion, injury prevention, and managing chronic conditions; cognitive health; physical health; mental health; and social health. The potentially devastating consequences of COVID‐19 on health promotion are recognized. The purpose of this article is multifold. First, members of the Healthy Aging Special Interest Group will present the significant difficulties and obstacles faced by older adults during this unprecedented time. Second, we provide guidance to practicing geriatrics healthcare professionals overseeing the care of older adults. We provide a framework for clinical evaluation and screening related to the five aforementioned domains that uniquely impact older adults. Last, we provide strategies that could enhance healthy aging in the era of COVID‐19.
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Affiliation(s)
- John A Batsis
- Division of Geriatric Medicine, School of Medicine, and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathryn Daniel
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Kady Goldlist
- Division of Aging, Harvard Medical School, Boston, Massachusetts, USA.,The Quimby Center for Geriatric Care, Mount Auburn Hospital, Cambridge, Massachusetts, USA
| | - Halina Kusz
- Department of Medicine, College of Human Medicine, Michigan State University, McLaren Flint Campus, Flint, Michigan, USA
| | - Douglas Lane
- VA Puget Sound HCS, University of Washington Department of Psychiatry, Pacific Lutheran University School of Nursing, Tacoma, Washington, USA
| | - Julia Loewenthal
- Division of Aging, Harvard Medical School, Boston, Massachusetts, USA.,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick P Coll
- Center on Aging, University of Connecticut Health, Farmington, Connecticut, USA.,Department of Family Medicine, University of Connecticut Health, Farmington, CT, USA
| | - Susan M Friedman
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Satre DD, Hirschtritt ME, Silverberg MJ, Sterling SA. Addressing Problems With Alcohol and Other Substances Among Older Adults During the COVID-19 Pandemic. Am J Geriatr Psychiatry 2020; 28:780-783. [PMID: 32359882 PMCID: PMC7174977 DOI: 10.1016/j.jagp.2020.04.012] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Derek D. Satre
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA,Division of Research, Kaiser Permanente Northern California Region, Oakland, CA,Send correspondence and reprint requests to Derek D. Satre, Ph.D., Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143.
| | - Matthew E. Hirschtritt
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA,Division of Research, Kaiser Permanente Northern California Region, Oakland, CA
| | | | - Stacy A. Sterling
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA,Division of Research, Kaiser Permanente Northern California Region, Oakland, CA
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8
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Choi NG, Marti CNN, DiNitto DM, Choi BY. Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis. West J Emerg Med 2015; 16:1146-58. [PMID: 26759670 PMCID: PMC4703192 DOI: 10.5811/westjem.2015.9.27704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Late middle-aged and older adults' share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. METHODS Data came from the 2013 National Health Interview Survey's Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators. RESULTS LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. CONCLUSION Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | | | - Diana M. DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Bryan Y. Choi
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
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Sacco P, Unick GJ, Kuerbis A, Koru AG, Moore AA. Alcohol-Related Diagnoses in Hospital Admissions for All Causes Among Middle-Aged and Older Adults: Trends and Cohort Differences From 1993 to 2010. J Aging Health 2015; 27:1358-74. [PMID: 25903980 PMCID: PMC4755348 DOI: 10.1177/0898264315583052] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This aim of this study was to characterize trends in alcohol-related hospital admissions among middle-aged and older adults from 1993 to 2010 in relation to age, gender, race, and cohort membership. METHOD This study utilized repeated cross-sectional data from the Nationwide Inpatient Sample. Using alcohol-related classified admissions, yearly rates and longitudinal trends of alcohol-related inpatient hospitalizations based on age, period, birth cohort, gender, and race were estimated. RESULTS Among those aged 45 and older, admissions rose from an estimated 610,634 to more than 1,134,876, and rates of any alcohol-related diagnosis also increased from 1993 to 2010. Rates for men were consistently higher than women, and rates for Blacks were higher than Whites. Age was associated with decreasing rates, but post-World War II cohorts displayed higher rates over time. DISCUSSION Rates of alcohol-related admissions are increasing among adults above age 45, which may be a function of cohort effects. Training the health care workforce is crucial to respond to this trend.
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Affiliation(s)
- Paul Sacco
- University of Maryland-Baltimore, Baltimore, MD, USA
| | | | | | - A Güneş Koru
- University of Maryland-Baltimore County, Baltimore, MD, USA
| | - Alison A Moore
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Sacco P, Unick GJ, Zanjani F, Camlin EAS. Hospital outcomes in major depression among older adults: differences by alcohol comorbidity. J Dual Diagn 2015; 11:83-92. [PMID: 25671685 PMCID: PMC4718396 DOI: 10.1080/15504263.2014.993295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression. METHODS We analyzed a subsample (N = 8,480) of older adults (65+) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups. RESULTS Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p <.001) and younger (70.9 versus 75.9 years, p <.001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p <.001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p <.001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p <.02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p <.001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital. CONCLUSIONS In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits.
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Affiliation(s)
- Paul Sacco
- a School of Social Work , University of Maryland , Baltimore , Maryland , USA
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11
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Waern M, Marlow T, Morin J, Ostling S, Skoog I. Secular changes in at-risk drinking in Sweden: birth cohort comparisons in 75-year-old men and women 1976-2006. Age Ageing 2014; 43:228-34. [PMID: 24067499 PMCID: PMC3927771 DOI: 10.1093/ageing/aft136] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: little is known about the prevalence of at-risk drinking in older adults. Objective: to compare rates of at-risk drinking in 75-year-olds examined in 1976–77 and in 2005–06. Design: cross-sectional survey. Setting: two samples representative of the general population in Gothenburg, Sweden. Participants: 75-year-olds born in 1901–02 (n = 303) and in 1930 (n = 753). Methods: participants took part in a multidisciplinary study on health and ageing. Protocols regarding alcohol consumption were identical for both cohorts. Total weekly alcohol intake was estimated and at-risk drinking was defined as ≥100 g alcohol/week. Results: the proportion abstaining differed significantly between birth cohorts (18% in 1976–77 versus 9% in 2005, P < 0.001). Frequencies of drinking beer and liquor were similar in the two cohorts for men, but were lower for women in the later-born cohort. Proportions drinking wine were higher in the later-born cohort for both sexes. Total weekly alcohol intake was higher for both men and women. At-risk drinking was observed in 19.3% of the men in the earlier-born cohort, and in 27.4% in the later-born cohort (P = 0.117). Corresponding figures for women were 0.6 and 10.4% (P < 0.001). At-risk drinking was significantly associated with birth cohort in women (OR: 13.77, CI: 1.82–104.0, P = 0.011) and the occupational group in men (OR: 1.60, CI: 1.13–2.26, P = 0.008). Conclusions: alcohol consumption in 75-year-olds has changed markedly, especially in women. Studies need to be carried out in varied settings in order to evaluate the clinical and public health implications of changing trends in alcohol consumption.
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Affiliation(s)
- Margda Waern
- Neuropsychiatric Epidemiology Unit, University of Gothenburg, Gothenburg, Sweden
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12
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Schulte MT, Hser YI. Substance Use and Associated Health Conditions throughout the Lifespan. Public Health Rev 2014; 35:https://web-beta.archive.org/web/20150206061220/http://www.publichealthreviews.eu/upload/pdf_files/14/00_Schulte_Hser.pdf. [PMID: 28366975 PMCID: PMC5373082 DOI: 10.1007/bf03391702] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood. FINDINGS 1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder). CONCLUSION Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.
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Affiliation(s)
- Marya T. Schulte
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
| | - Yih-Ing Hser
- UCLA Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
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Demographic and clinical characteristics of middle-aged versus younger adults enrolled in a clinical trial of a web-delivered psychosocial treatment for substance use disorders. J Addict Med 2013; 7:66-72. [PMID: 23340711 DOI: 10.1097/adm.0b013e31827e2d04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Evidence suggests that substance abuse is becoming more prevalent in middle-aged adults. The objective of this secondary analysis was to add to the growing empirical literature on the unique features of middle-aged substance abuse populations. METHODS We descriptively compared baseline demographic and clinical characteristics of middle-aged (age 45-62 years, n = 111) and younger (age 18-44 years, n = 395) substance abusers entering a Web-based psychosocial treatment study as part of the National Institute on Drug Abuse Clinical Trials Network. RESULTS A significantly greater percentage of middle-aged adults were nonwhite and had a marital status other than single/never married. There was a significant association between frequency of Internet use and the age group. Forty-six percent of middle-aged adults versus 21% of younger adults reported no Internet use in the prior 90 days. A significantly greater percentage of middle-aged adults used cocaine, and a significantly greater percentage of younger adults used marijuana and opioids. Clinically significant cognitive impairment (z < -1.0) was found for the average participant in both groups on logical association of familiar concepts. CONCLUSIONS This secondary analysis of a National Institute on Drug Abuse Clinical Trials Network study provides additional information on the unique features of middle-aged substance abusers. Increasing knowledge of similarities and differences between younger and middle-aged substance abusers can help with potential age-specific substance abuse treatment planning.
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Abstract
OBJECTIVE Alcohol and drug use and related problems may compromise depression treatment, and older adults may be especially at risk for poor outcomes. However, alcohol and drug use among older adults have not been studied in settings in which depression treatment is provided. This study examined the prevalence and clinical and demographic correlates of alcohol and drug use and misuse of prescription drugs among adults with depression seeking outpatient psychiatric care (excluding chemical dependency treatment). METHODS The sample included 154 older adults (age 60 years and older who scored ≥10 on the Beck Depression Inventory-II [BDI-II] at intake). Participants also completed alcohol and drug use questions and the Short Michigan Alcohol Screening Test. RESULTS Recent alcohol and drug use, heavy episodic drinking, and history of alcohol-related problems were common. Alcohol use in the prior 30 days was reported by 53% of men and 50% of women. Cannabis use in the prior 30 days was reported by 12% of men and 4% of women; and misuse of sedatives in the prior 30 days was reported by 16% of men and 9% of women. In exact logistic regression, higher BDI-II score was associated with cannabis use (odds ratio = 15.8, 95% confidence interval = 2.0-734.0, exactp = 0.003). CONCLUSIONS Older adults with depression are likely to present for treatment with a range of concurrent alcohol and drug use patterns, including cannabis use and misuse of prescription medication. Clinicians should evaluate depressed patients for substance use and related problems and consider appropriate interventions.
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Merrick ESL, Hodgkin D, Garnick DW, Horgan CM, Panas L, Ryan M, Blow FC, Saitz R. Older adults' inpatient and emergency department utilization for ambulatory-care-sensitive conditions: relationship with alcohol consumption. J Aging Health 2010; 23:86-111. [PMID: 20935248 DOI: 10.1177/0898264310383156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study examined the relationship between drinking that exceeds guideline-recommended limits and acute-care utilization for ambulatory-care-sensitive conditions (ACSCs) by older Medicare beneficiaries. METHOD This secondary data analysis used the 2001-2006 Medicare Current Beneficiary Survey (unweighted n = 5,570 community dwelling, past-year drinkers, 65 years and older). Self-reported alcohol consumption (categorized as within guidelines, exceeding monthly but not daily limits, or heavy episodic) and covariates were used to predict ACSC hospitalization, emergency department visit not resulting in admission, and emergency department visit that did result in admission. RESULTS Heavy episodic drinking was significantly associated with higher likelihood of an ACSC emergency department visit not resulting in admission (adjusted odds ratio = 1.91, 95% CI: 1.11-3.30; p < .05). Drinking pattern was not significant for other ACSC measures. DISCUSSION Results partially support the hypothesis that excessive drinking may be related to ACSC acute-care utilization among older adults, suggesting increased risk of lower quality outpatient care.
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McDougall GJ, Becker H, Delville CL, Vaughan PW, Acee TW. Alcohol use and older adults: A little goes a long way. INTERNATIONAL JOURNAL ON DISABILITY AND HUMAN DEVELOPMENT : IJDHD 2007; 6:431. [PMID: 20098631 PMCID: PMC2809392 DOI: 10.1901/jaba.2007.6-431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We examined the relationships between alcohol use, cognitive and affective variables, and the potential differential benefits of training for older adults drinkers and non-drinkers who participated in a randomized trial implemented between 2001-2006. Participants, who were living independently in the community, were randomly assigned to either twelve hours of memory training or health promotion classes. Outcomes included depression, health, cognition, verbal, visual, memory, and performance-based IADLs. The sample was 79% female, 17% Hispanic and 12% African-American. The typical participant had an average age of 75 years with 13 years of education. In the memory intervention group, there were 135 individuals (63 drinkers, 72 non-drinkers). In the health promotion condition, there were 129 individuals (58 drinkers and 71 non-drinkers). At baseline, drinkers scored higher on cognition, verbal memory, and lower on depression than non-drinkers. Alcohol use was positively related to physical health at baseline as measured by the Physical Component Summary Score of the Medical Outcomes Health Scale (SF-36). We found significant effects for the time*drinking*treatment group interaction in the repeated measures ANCOVA for the Mini Mental Status Examination, the Hopkins Verbal Learning Test, and the SF-36 Mental Health sub-scale. The time*drinking*group interactions were not statistically significant for any of the other outcomes; This study demonstrated that older adults benefited from targeted psychosocial interventions on affective, cognitive and functional outcomes. In addition, the SeniorWISE study provides empirical support to the research evidence emphasizing the health benefits of moderate alcohol consumption in older adults.
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