The relationship between alcohol problems and health functioning of older adults in primary care settings

Health Literacy, Socio-Economic Determinants, and Healthy Behaviours: Results from a Large Representative Sample of Tuscany Region, Italy

Background: Health Literacy (HL) is one of the main determinants of health and is crucial for the prevention of noncommunicable diseases, by influencing key health-related behaviours. The aim of the present study was to assess the role of HL and sociodemographic factors in predicting the adoption of two healthy behaviours—physical activity and fruits and vegetables consumption. Methods: This study was conducted on the Tuscan population subsample of the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results: About 40% of the 7157 interviewees reported an inadequate or problematic HL level. Female sex, poor financial status, foreign nationality, and low education were associated with a problematic HL level, while an inadequate HL level was associated with being 50–69 years old, low education level, foreign nationality, poor financial status and unemployment or inactive status. Inadequate HL level was a strong predictor of both eating less than three portions of fruits/vegetables per day and not engaging in sufficient PA during leisure times. Conclusions: Our findings showed that an inadequate level of HL could negatively affect physical activity and diet, independently from the other sociodemographic conditions, confirming the role of HL as a relevant social determinant of health.

Polysubstance use classes and health outcomes among women attending specialist substance use treatment services

INTRODUCTION

Substance use is increasingly prevalent among women. Little research examines subgroups of women with substance use issues to identify their characteristics and thus enable treatment recommendations. The present study used latent class analysis to identify subgroups of substance use among women in substance-use treatment based on use in the 30 days prior to intake and examined changes in mental health and treatment outcomes following 60 days of treatment.

METHODS

Participants were women (N = 493) attending specialist non-government substance use treatment services in New South Wales, Australia.

RESULTS

Four distinct classes of substance users were identified: (i) Amphetamine Type Stimulants (ATS) Polysubstance (40.6%, n = 200); (ii) Alcohol Only (33.1%, n = 163); (iii) Cannabis and Alcohol (17.0%, n = 84) and (iv) Other Polysubstance (9.3%, n = 46). Women in the ATS Polysubstance class were the youngest and those in the Alcohol Only class were the oldest.

DISCUSSION AND CONCLUSIONS

Findings show that classes with high polysubstance use (ATS Polysubstance) differed from the single-substance use class (Alcohol Only). The ATS Polysubstance class had significantly greater improvements in health outcomes after 60 days compared to the Alcohol Only class. These findings suggest that although women with polysubstance use can benefit from substance use treatment, younger women (ATS Polysubstance) may benefit even more than older women (Alcohol Only). Future research should utilise a longitudinal design and examine additional psychosocial characteristics to extend on current findings.

Factors influencing the perceived health status of older adults living alone based on the Korean National Health and Nutrition Examination Survey (2016-2018)

PURPOSE

Older adults living alone have a lower level of health due to functional degradation and social isolation, and hence, it is important to assess their health condition and health-related factors. In this study we intended to evaluate the factors influencing the perceived health status of older adults living alone in Korea.

MATERIALS AND METHODS

Data from the 7th (2016-2018) Korean National Health and Nutrition Examination Survey (KNHANES) were used. Perceived health status and health-related and demographic characteristics of 1,074 older adults (age≥65 years) living alone were included in this study. A complex sample design analysis method was used to consider the characteristics of the raw data of the KNHANES, and a complex sample ordinal logistic regression analysis was performed to identify factors that affect perceived health status.

RESULTS

Female sex, low economic status, not consuming alcohol, perceived stress, high number of chronic diseases, underweight, and limitation of activity were risk factors of low perceived health status of older adults living alone.

CONCLUSIONS

Interventions to improve the identified health-related factors, such as stress, underweight, and activity limitation of older adults need to be devised. In addition, differences in risk factors according to sex should be considered when providing interventions. Furthermore, policies supporting the promotion of health status among older adults with low-income and living alone are warranted to improve health equity in Korea.

Health Behaviors and Health-Related Quality of Life Among U.S. Adults Aged 18-64 Years

INTRODUCTION

This study aims to (1) describe the prevalence and clustering of 3 health behaviors, (2) examine the association between individual health behaviors and health-related quality of life, and (3) explore the association between the clustering of the health behaviors and health-related quality of life.

METHODS

Investigators analyzed a sample of U.S. adults aged 18-64 years using data from the 2016-2018 Behavioral Risk Factor Surveillance System survey in March 2020. Logistic regression models examined the associations among 3 healthy behaviors (currently not smoking, physical activity, and nonheavy alcohol consumption) and 4 indicators of health-related quality of life (general health, physical health, mental health, and activity limitation). Alpha was set at 0.01.

RESULTS

A total of 450,870 individuals were included in the analysis (weighted n=100,102,329). Of these, 82.0% were current nonsmokers, 92.8% were nonheavy drinkers, and 77.6% reported physical activity. The prevalence of having none, 1, 2, and 3 of the health behaviors was 0.7%, 7.7%, 30.1%, and 61.5%, respectively. Smoking status and physical activity status were significantly associated with all the 4 health-related quality of life indicators. Alcohol status was significantly associated with mental health and activity limitation. The associations demonstrated a higher health-related quality of life among individuals who reported healthy behaviors than among those who did not engage in healthy behaviors. Compared with respondents who reported none of the health behaviors, people with all 3 health behaviors were more likely to report higher health-related quality of life.

CONCLUSIONS

Health behaviors were significantly associated with health-related quality of life among U.S. adults. Healthy behaviors should be encouraged because adopting these behaviors may contribute to a higher health-related quality of life.

How different health literacy dimensions influences health and well-being among men and women: The mediating role of health behaviours

Background

Health literacy, the ability to access, understand, evaluate and apply health information, was found to contribute to positive health outcomes, possibly via promoting healthy behaviours. However, the specific pathways linking different health literacy skills to health and well‐being have remained unclear.

Methods

A cross‐sectional survey with structural questionnaires was administered among 2236 adults in Hong Kong (mean age = 46.10 ± 19.05). Health literacy was measured by HLS‐Asian‐47. Participants' physical conditions and subjective well‐being were predicted by health literacy and health behaviours with structural modelling path analysis.

Results

Health literacy in finding and understanding information showed a direct effect on enhancing physical health, while applying information capacity had an indirect positive effect via promoting health behaviours, which was moderated by sex. Only among women, this indirect effect predicting fewer physical symptoms and better well‐being was significant.

Conclusions

Different health literacy dimensions showed distinct direct and indirect pathways in influencing health for men and women. Based on the findings, skill trainings should be developed to enhance both gender's abilities of finding and understanding health information, while the ability of applying health information should also be improved for modifying lifestyle and promoting health, particularly for women.

Patient or Public Contribution

Two thousand and two hundred thirty‐six adults from different districts of Hong Kong participated in the study, and responded to questions on health literacy, behaviours and health status.

Liver transplantation and aging

An increase in the average life expectancy, paralleled by a demographic shift in the population with end-stage liver disease lies behind the rising demand for liver transplantation (LT) among the elderly. Some of the most common indications for LT including hepatocellular carcinoma, alcohol-related liver disease, chronic hepatitis C and non-alcoholic fatty liver disease tend to affect older patients. Transplant professionals are faced with an increasing demand for LT among elderly patients in an age of organ shortage and it is important that risk and benefits are carefully weighed in order to achieve the optimum use of precious liver grafts.

Prevalence and correlates of comorbid PTSD with depression among older people exposed to the Jeju April 3 incident

BACKGROUND

The psychological consequences of the Jeju April 3 incident, which occurred almost 70 years ago, may be long-lasting. Thus, the present study investigated the prevalence and impact of comorbid post-traumatic stress disorder (PTSD) and depression among older people exposed to this incident.

METHODS

A total of 110 survivors and 1,011 immediate family members of the victims of the Jeju April 3 incident completed a questionnaire that collected demographic information, the Center for Epidemiologic Studies Depression Scale (CES-D), and the PTSD Checklist-Civilian Version (PCL-C). Comorbidity was defined as a combination of CES-D positivity and PCL-C positivity. To identify trends among clinical characteristics according to the severity of the comorbid PTSD and depression condition, linear-by-linear association tests were conducted.

RESULTS

Of the 1,121 older people included in the present study, 10.8% met the criteria for comorbid PTSD and depression, 3.0% had PTSD only, and 24.3% had depression only. Additionally, as the severity of the comorbid condition increased, there were trends for lower levels of socioeconomic status and perceived family support and higher suicidality. Compared to either disorder alone, individuals with the comorbid condition were 2.04 times more likely to have a higher suicidal risk.

LIMITATIONS

Standardized diagnostic tools for assessing the case findings were not employed in the present study.

CONCLUSION

Comorbid PTSD and depression was prevalent among older people exposed to the Jeju April 3 incident. Additionally, this comorbid condition was related to a serious clinical phenomenology, including a higher suicidal risk.

Epidemiology of at-risk alcohol use and associated comorbidities of interest among community-dwelling older adults: a protocol for a systematic review

INTRODUCTION

There is little epidemiological evidence and knowledge about at-risk alcohol use among community-dwelling older adults and their chronic and acute alcohol-related comorbidities of interest. This systematic review will summarise and examine relevant studies about the epidemiology of at-risk alcohol use and associated comorbidities of interest in this population.

METHODS

We will search the following databases, without language or date restrictions, from inception to 31 August 2019: Embase.com, Medline Ovid SP, Pubmed (NOT medline[sb]), CINAHL EBSCO, PsycINFO Ovid SP, Central-Cochrane Library Wiley and Web of Science (Core Collection). Search strategies will be developed in collaboration with a librarian. We will use predefined search terms for alcoholism, epidemiology, the elderly, living place and comorbidities of interest, as well as terms related to the identification of "measurements", "tools" or "instruments" for measuring harm from alcohol use. At-risk status will be determined by the amount of alcohol consumed and any comorbidities of interest associated with at-risk alcohol use, with the latter being documented separately or using an assessment tool for at-risk drinking. We will also examine the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in all languages.

ETHICS AND DISSEMINATION

No ethical approval is necessary. Results will be presented in national and international conferences on addiction and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018099965.

Gender difference in the association between alcohol consumption and depressive symptoms among the elderly in rural areas

To determine gender difference in the nature of the association between alcohol consumption and depressive symptoms in the elderly aged 60 and above in a rural community sample. A cross-sectional face-to-face survey conducted for community residents 60 years of age and older (n = 1,819). Alcohol consumption problems were measured by self-report of the Korean version of Alcohol Use Disorders Identification Test (AUDIT-K) scale. Depressive symptom was measured using the Korean Beck Depression Inventory (K-BDI) scale. Potential explanatory variables included MCS, PCS, and health-related behavior, socio-economics status, and democratic variables. Two gender-specific multivariate regression models were applied for the analysis. A U-shaped relationship between alcohol consumption and depressive symptoms was found, and the relationship did not differ by gender. Non-problem drinkers and hazardous and harmful drinkers were related to an increased risk of depressive symptoms for both men and women. Several correlates for the association were found. No gender difference was found in a U-shaped curvilinear relationship between alcohol consumption and depression found among the elderly aged 60 and above in rural communities in South Korea. The findings of this study suggest the need for further investigation of subgroup differences in the association by using samples of various age groups in rural and urban areas, and samples drawn from different cultural contexts than the studies conducted in Western countries.

Assessment Protocol for Older Adults With Substance Use

This quality improvement project focuses on geriatric syndromes in patients 55 years and older admitted to a Minnesota substance abuse treatment center. Age-specific assessments identify abnormal conditions or geriatric syndromes, which prompt earlier nursing and medical interventions. Nursing staff attended a training program that focused on older adults and the use of the Fulmer SPICES tool for patients over the age of 55 years. Pretest and posttest scores showed a positive change in nursing knowledge with an increase in mean test scores of 10.32 (SD = 1.763) to 12.81 (SD = 1.545), p = .000. A 2-month preimplementation and postimplementation chart audit identified changes in assessment findings using the SPICES tool with an increase in adverse outcomes (1.03%) including sleep problems in 75.4% (n = 43) of the target population.

Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality

Objectives

Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method

Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results

Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion

The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

Comparing daily drivers of problem drinking among older and younger adults: An electronic daily diary study using smartphones

BACKGROUND

By 2030, numbers and proportions of older adults with substance-use problems are expected to increase. While risk factors for problem drinking in late life have been identified, it remains unknown whether these factors drive daily drinking among older problem drinkers. This study examined the daily drivers of drinking among problem drinkers, moderated by age, utilizing ecological momentary assessment (EMA).

METHOD

Participants (N = 139), ages 20-73, received daily EMA online surveys completed via a smartphone prior to initiation of treatment. Multilevel modeling tested the moderating impact of age on within- and between-person relationships between drinking and focal predictors (mood, loneliness, boredom, stress, poor sleep, social factors, alcohol salience, commitment and confidence not to drink heavily).

RESULTS

Older adults reported greater alcohol consumption when daily boredom levels were higher. Heavier drinking among younger adults was associated with poorer sleep quality. Greater daily confidence, daily commitment and daily alcohol salience did not impact drinking to the same extent for older adults as for younger adults. Greater person-level commitment predicted reduced drinking equivalently across age, but low person-level commitment predicted greater drinking among older adults compared to their younger counterparts.

CONCLUSION

Older adults may have unique daily drivers of drinking that are not fully realized in current research and intervention efforts. Addressing the growing substance-use treatment needs among this population will require identifying the unique drivers of drinking among older adults, such as boredom, when compared to younger adults.

A pilot study of online feedback for adult drinkers 50 and older: Feasibility, efficacy, and preferences for intervention

Normative (NF) and personalized feedback (PF) are moderately effective brief interventions for at-risk drinking middle-aged and older adults. This study tested the feasibility of online feedback for drinkers 50 and older. This study's aims were to identify whether there is differential effectiveness of PF over NF in prompting drinkers 50years old and older to plan for change and to determine potential preferences for intervention among adult drinkers 50 and older with practical knowledge about computers.

METHOD

Using Amazon's Mechanical Turk, 138 male and female drinkers aged 50 to 75+ were recruited to complete an online survey that asked about their: perceptions of their drinking, quantity and frequency of drinking, and any comorbid health and/or mental health disorders/medications. They were then provided either NF or PF. NF provided information about how participants' drinking compared to their same age and gendered peers. PF provided information about level of risk to health and provided recommendations for safe levels of drinking. After feedback, participants were evaluated for their reactions (e.g., "How much does this worry you?") and their plan to change their drinking. Participants were asked about preferences for interventions.

RESULTS

80% of participants rated themselves a no or low-risk drinker, yet 52.2% were found to be at-risk drinkers. Overall, participants reported feedback was helpful, and 43.9% made some kind of plan to change. Participants in NF were significantly more likely to make a plan for change than those in PF. Participants reported that they most preferred an online (40.9%) or a brief in-person (31.8%) intervention.

CONCLUSION

Findings revealed that brief online feedback was feasible, though limited to those who are computer knowledgeable. Unexpectedly, NF outperformed PF, suggesting that peer comparisons may be more motivating for adults 50 and older than previously thought. Finally, an online intervention appears to be a preferred intervention for alcohol use among this particular group of drinkers.

Health Care Utilization by Older Alcohol-Using Veterans: Effects of a Brief Intervention to Reduce At-Risk Drinking

The objective of the study was to estimate the effect of a brief alcohol-reduction intervention on health care use. Male veterans aged 55 years and older drinking more than guideline limits participated in an effective primary care-based randomized clinical trial to reduce drinking. Repeated measures ANCOVA assessed short-term and long-term changes in both inpatient and outpatient utilization. Stage of change (SOC) was assessed in a subsample to test for interaction between SOC and the intervention. Veterans exposed to the intervention used more outpatient medical services in the short term. Long-term effects on inpatient/outpatient use were not observed. SOC did not moderate the effect of the intervention but was associated with differential use of health care services. A cost-effective brief intervention to reduce drinking may spur increased efforts to seek health care. Early detection and management of alcohol-related or other illnesses might be expected to accrue savings in later years.

Health Literacy Is Associated With Health Behaviors and Social Factors Among Older Adults: Results from the LifeLines Cohort Study

This study assesses the associations between health literacy and various health behaviors and social factors among older adults, and whether social factors moderate the other associations. Data from 3,241 participants in the LifeLines Cohort Study were analyzed (mean baseline age = 68.9 years). Data on health literacy, health behaviors (physical activity, fruit and vegetable consumption, smoking, breakfast consumption, alcohol consumption, and body mass index (BMI), and social factors (loneliness, social support, social activities, social contacts, and living situation) were collected in three waves. Logistic regression analyses were used, adjusted for age and gender. Low health literacy was associated with insufficient physical activity, insufficient fruit and vegetable consumption, lack of regular breakfast consumption, obesity (odds ratios (ORs) > 1.31, p-values < .005) and low alcohol use (OR = 0.81, p = .013), but not with smoking. Low health literacy was also associated with greater loneliness, engaging in fewer social activities, and having fewer social contacts (ORs > 1.48, p-values < .005), but not with social support or living situation. Only the association between health literacy and smoking was moderated by social contacts, but this finding needs confirmation in future studies. In conclusion, low health literacy is negatively associated with health behaviors and social factors in older adults, but social factors seldom moderate the associations between health literacy and health behaviors.

Correlates of alcohol abstinence and at-risk alcohol consumption in older adults with depression: the NESDO study

OBJECTIVES

To compare alcohol use between depressed and nondepressed older adults, and to investigate correlates of alcohol abstinence and at-risk alcohol consumption in depressed older adults.

DESIGN

Cross-sectional study.

SETTING

Netherlands Study of Depression in Older Persons (NESDO).

PARTICIPANTS

A total of 373 participants (mean [standard deviation] age: 70.6 [7.3] years; 66% women) diagnosed with a depressive disorder, and 128 nondepressed participants.

MEASUREMENTS

Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT). Participants were categorized into abstainers (AUDIT score: 0), moderate drinkers (AUDIT score: 1-4), and at-risk drinkers (AUDIT score: ≥5). Multinomial logistic regression analysis was performed with AUDIT categories as outcome, and demographic, social, somatic, and psychological variables as determinants.

RESULTS

The depressed group consisted of 40.2% abstainers, 40.8% moderate drinkers, and 19.0% at-risk drinkers. The depressed participants were more often abstinent and less often moderate drinkers than the nondepressed participants; they did not differ in at-risk drinking. Depressed abstainers more often used benzodiazepines but less often used antidepressants, and they had a poorer cognitive function than depressed moderate drinkers. Depressed at-risk drinkers were more often smokers and had fewer functional limitations but more severe depressive symptoms than depressed moderate drinkers.

CONCLUSIONS

Although alcohol abstinence was more common in depressed than in nondepressed older adults, 19% of depressed persons were at-risk drinkers. Because at-risk drinking is associated with more severe depression and may have a negative impact on health and treatment outcome, it is important that physicians consider alcohol use in depressed older adults.

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

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

Age-based differences in treatment outcome among alcohol-dependent women

The literature suggests that women are at higher risk for negative consequences from alcohol use than men and that these risks are compounded by age. The current study investigated how alcohol-dependent women from different age groups might differ in terms of baseline functioning and treatment response. The sample consisted of 181 participants drawn from two randomized clinical trials of cognitive-behavioral treatments for alcohol-dependent women. Demographic and psychopathology data were obtained at baseline using the SCID (Structured Clinical Interview for DSM disorders) I for Axis I disorders and the SCID II or Personality Disorders Questionnaire for Axis II disorders. Social networks data were collected using the Important People and Activities Interview. Drinking data were collected at baseline and follow-up using the Timeline Follow Back Interview. ANOVAs revealed that older women had better psychosocial functioning in terms of being better educated and reporting fewer Axis I disorders. Also, older women had more supportive social networks in terms of more people, a smaller percentage of heavy drinkers, and a nondrinking spouse. Older women reported a less severe lifetime substance use history with a later age of first drink, later onset of alcohol use disorders, fewer lifetime abuse/dependence items, and less drug use. However, they reported drinking more frequently and more heavily over the 90 days prior to treatment. Finally, older women were more compliant with treatment and responded better by reducing drinking frequency and percentage of heavy drinking days. Suggestions to enhance treatment efficacy for younger women are made as well as suggestions for future research.

Alcohol use and health-related quality of life among hospital outpatients in South Africa

AIMS

This study examined the association of alcohol use and health-related quality of life (HRQOL) in a clinic population in South Africa.

METHODS

A probability sample of 1532 (56.4% men and women 43.6%) patients from different hospital outpatient departments completed the Alcohol Use Disorder Identification Test and the social functioning (SF)-12 Health Survey. Physical and Mental Health Component Summaries and primary scales of the SF-12 were used as measures of HRQOL.

RESULTS

The study did not find a significant association between alcohol-use disorders and HRQoL [Physical Component Summary (PCS) and Mental health Component Summary (MCS)] in this clinic population. However, probable alcohol dependence was associated with poorer quality of life in three areas of functioning measured by the SF-12 (physical functioning, general health and mental health) compared with patients not meeting the criteria of alcohol dependence. The magnitude of the decrement in the PCS and MCS for daily or almost daily tobacco use, severe psychological distress and the number of other chronic conditions was significantly greater than for alcohol abuse or dependence.

CONCLUSION

It appears that hospital outpatients in this study did not experience a diminished quality of life related to their alcohol use compared with other attenders at these clinics. Also, intervention studies with hazardous drinkers may not be able to identify treatment-related changes in global HRQoL.

The influence of posttraumatic stress disorder numbing and hyperarousal symptom clusters in the prediction of physical health status in veterans with chronic tobacco dependence and posttraumatic stress disorder

Smoking and PTSD are predictors of poor physical health status. This study examined the unique contribution of PTSD symptoms in the prediction of the SF-36 physical health status subscales accounting for cigarette smoking, chronic medical conditions, alcohol and drug use disorders, and depression. This study examined baseline interview and self-report data from a national tobacco cessation randomized, controlled trial (Veterans Affairs Cooperative Study 519) that enrolled tobacco-dependent veterans with chronic PTSD (N = 943). A series of blockwise multiple regression analyses indicated that PTSD numbing and hyperarousal symptom clusters explained a significant proportion of the variance across all physical health domains except for the Physical Functioning subscale, which measures impairments in specific physical activities. Our findings further explain the impact of PTSD on health status by exploring the way PTSD symptom clusters predict self-perceptions of health, role limitations, pain, and vitality.

Heavy/binge drinking and depressive symptoms in older adults: gender differences

OBJECTIVES

The purpose of this study was to examine gender similarity/difference in the association between depressive symptoms (11-item Center for Epidemiologic Scale for Depression (CES-D) scores), on the one hand, and frequency and amount of alcohol use, on the other, among older adults.

METHODS

Data came from the National Social Life, Health, and Aging Project (NSHAP), Wave 1, which included a nationally representative probability sample (n = 2924) of community-dwelling individuals aged 57-85. Heavy/binge drinking was defined as the consumption of 4+ drinks for men and 3+ drinks for women per drinking day. The relationship between CES-D scores and the frequency and amount of alcohol consumption was tested using gender-separate, 2-step ordinary least squares (OLS) regression analyses.

RESULTS

A significant proportion of both men (67.7%) and women (52.2%) had consumed alcohol in the preceding 3 months, and 12.3% of male and 8.4% of female drinkers were heavy/binge drinkers. Substantial differences between male and female heavy drinkers were found in sociodemographics, health status, and social support and social engagement. Regression results show that both frequency of drinking and heavy/binge drinking, as opposed to abstinence, were significantly positively associated with men's CES-D scores, but not with women's.

CONCLUSION

Heavy/binge-drinking older men may use alcohol to cope with depressive mood, and heavy drinking might also contribute to their social isolation and depressive symptoms. Depression screening and treatment for older men should be accompanied by alcohol screening and treatment and vice versa.

Drinking, smoking, and psychological distress in middle and late life

A limited number of studies have examined the co-occurrence of alcohol use and smoking and their mental health effects in middle and late life. In this study, using the 2008 National Survey of Drug Use and Health, the characteristics of individuals aged 50 and older who abstained from both substances, who used both substances, and who used one or the other substance were examined. Then, the main and interaction effects of drinking and smoking on psychological distress were analyzed. Findings show that smoker-nondrinkers are the most disadvantaged group in terms of sociodemographic and health characteristics, while drinker-nonsmokers are the most advantaged group. When sociodemographic, health, and other factors were controlled, no direct effects of drinking or interaction effect of drinking and smoking were detected for either gender. However, heavy smoking (6+ cigarettes on a typical smoking day) was significantly associated with an elevated level of psychological distress among women. The findings highlight the vulnerability of heavy smoking middle-aged and older women. These women are the most psychologically distressed and may need interventions designed to help them quit smoking, reduce or quit drinking, and alleviate psychological distress.

Painful medical conditions and alcohol use: a prospective study among older adults

OBJECTIVE

To determine associations between older adults' baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations.

METHODS

At baseline, then, 1, 4, and 10 years later, late-middle-aged community residents (M = 61 years; N = 1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships.

RESULTS

At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems.

CONCLUSIONS

Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men.

Treatment Outcomes for Older Adults Who Abuse Substances

A Center for Substance Abuse Treatment Knowledge Application Program based on cognitive-behavioral and self-management treatment approaches and targeted to older adults with substance abuse was provided through a community behavioral health center. A sample of 199 adults aged 50 and above participated in the 18-session program. Observations were made at intake and 6 months after intake. Program completers versus noncompleters differed significantly over time, favoring completers with regard to decreased use of nonmedical prescription drugs, improved cognitive functioning, improved mental health, increased vitality, and lack of bodily pain. Significant time effects were noted in participants’ decreased use of alcohol and binge drinking, reduced stress, fewer emotional problems, a decrease in having to reduce important activities, and increased prescription of medication for psychological problems. Participants also reported significant improvement in their social functioning, and their physical health and emotional problems had less impact on what they were able to do.

Physical health and drinking among medical inpatients with unhealthy alcohol use: a prospective study

OBJECTIVE

Unhealthy alcohol use is common in medical inpatients, and hospitalization has been hypothesized to serve as a "teachable moment" that could motivate patients to decrease drinking, but studies of hospital-based brief interventions have often not found decreases. Evaluating associations between physical health and subsequent drinking among medical inpatients with unhealthy alcohol use could inform refinement of hospital-based brief interventions by identifying an important foundation on which to build them. We tested associations between poor physical health and drinking after hospitalization and whether associations varied by alcohol dependence status and readiness to change.

METHODS

Participants were medical inpatients who screened positive for unhealthy alcohol use and consented to participate in a randomized trial of brief intervention (n = 341). Five measures of physical health were independent variables. Outcomes were abstinence and the number of heavy drinking days (HDDs) reported in the 30 days prior to interviews 3 months after hospitalization. Separate regression models were fit to evaluate each independent variable controlling for age, gender, randomization group, and baseline alcohol use. Interactions between each independent variable and alcohol dependence and readiness to change were tested. Stratified models were fit when significant interactions were identified.

RESULTS

Among all participants, measures of physical health were not significantly associated with either abstinence or number of HDDs at 3 months. Having an alcohol-attributable principal admitting diagnosis was significantly associated with fewer HDDs in patients who were nondependent [adjusted incidence rate ratio (aIRR) 0.10, 95% CI 0.03-0.32] or who had low alcohol problem perception (aIRR 0.36, 95% CI 0.13-0.99) at hospital admission. No significant association between alcohol-attributable principal admitting diagnosis and number of HDDs was identified for participants with alcohol dependence or high problem perception.

CONCLUSIONS

Among medical inpatients with nondependent unhealthy alcohol use and those who do not view their drinking as problematic, alcohol-attributable illness may catalyze decreased drinking. Brief interventions that highlight alcohol-related illness might be more successful.

Quality of Life and Related Factors in the Older Rural and Urban Chinese Populations in Zhejiang Province

The aim of this study was to evaluate the quality of life (QoL) in the older rural and urban Chinese populations in Zhejiang province. An analysis of the association between potential factors and QoL for these two groups was conducted. A cross-sectional study was conducted from October to December 2007. The total sample consisted of 2,441 rural and 2,554 urban participants. A Chinese version of the 36-item Short Form Health Survey (SF-36) was used to quantify the QoL of participants. A comparison between the QoL of rural and urban participants was made. The association between potential factors and QoL was performed using a multiple linear regression model. The study revealed all scale scores of SF-36 in the rural population were significantly lower than those in the urban population except general health (GH; p < .001). The common factors associated with high QoL in both older rural and urban populations were gender (male), tea consumption, income, and consumption of alcohol. Age and the number of chronic diseases an individual suffered from were negatively associated with QoL. In addition, the study revealed the perception that giving up smoking cigarettes and drinking alcohol were negatively associated with QoL for participants living in rural areas, whereas educational level and regular exercise were positively associated with QoL for participants living in urban areas. Intervention programs for decreasing chronic diseases, establishing security mechanisms of the pension, and spreading the knowledge of healthy lifestyles may improve QoL for the older populations in Zhejiang province, especially in rural areas.

Alcohol use among older adults in the National Epidemiologic Survey on Alcohol and Related Conditions: a latent class analysis

OBJECTIVE

We examined latent classes of alcohol use among current drinkers ages 60 and older and explored risk factors associated with class.

METHOD

We used a subsample of older current drinkers (> or =60 years; n = 4,646) from the National Epidemiologic Survey on Alcohol and Related Conditions. Employing alcohol consumption and diagnostic indicators, latent class analysis was used to identify classes. We analyzed the associations between class membership and sociodemographic, psychiatric, health, and mental health variables using multinomial and linear regression.

RESULTS

Latent class analysis identified three latent classes. Individuals in the low-risk drinker class (89.17%) displayed low endorsement of heavy episodic use, at-risk consumption, and alcohol abuse/dependence criteria. Individuals in the moderate-risk drinker class (9.65%) were more likely to exceed consumption guidelines, and those in the high-risk drinker class (1.17%) displayed high probabilities of both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and risky alcohol consumption items. Female gender, older age, and African-American race were associated with decreased risk of being a moderate-risk drinker. Being the adult child of an alcoholic, being a previous smoker, and being a current smoker were associated with increased risk. Female gender, older age, and college education were associated with decreased odds of being a high-risk drinker. having major depression, being the child of an alcoholic, and being a current smoker were associated with increased odds of being a high-risk drinker. Individuals classified in the high-risk drinker class had significantly lower self-rated mental and physical health than low-risk drinkers.

CONCLUSIONS

A subpopulation of older drinkers may exceed consumption guidelines without DSM-defined alcohol-related problems. However, for some older drinkers, risky alcohol use is part of a larger pattern of health risks including current smoking, major depression, and alcohol abuse/dependence history.

Determinants of improvement in quality of life of alcohol-dependent patients during an inpatient withdrawal programme

BACKGROUND

To investigate the improvement in quality of life (QoL) of alcohol-dependent patients during a 3-week inpatient withdrawal programme, and to identify the sociodemographic, clinical and alcohol-related variables associated with baseline QoL on admission and with improvement of QoL during residential treatment.

METHODS

This prospective, observational study included 414 alcohol-dependent patients, hospitalised for a period of 3 weeks. QoL was measured on admission and at discharge using the French version of the Medical Outcome Study SF-36. The mean scores for each dimension and for the Physical and Mental Component Summary scores were calculated.

RESULTS

The mean scores per dimension and the mean Physical and Mental Component Summary scores were significantly lower on admission than at discharge; the lowest scores being observed for social functioning and role limitations due to emotional problems. At discharge, the mean scores per dimension were similar to those observed in the French general population. Female gender, age > 45 years, living alone, working as a labourer or employee, somatic comorbidity, and the existence of at least five criteria for alcohol dependence according to the DSM-IV classification were associated with a low Physical Component Summary score on admission; psychiatric comorbidity, the presence of at least five DSM-IV dependence criteria, smoking and suicidality were associated with a low Mental Component Summary score on admission. The increase in Physical and Mental Component Summary scores during hospitalisation was more marked when the initial scores were low. Apart from the initial score, the greatest improvement in Physical Component Summary score was seen in patients with a high alcohol intake and in those without a somatic comorbidity; the increase in Mental Component Summary score was greatest in patients without psychotic symptoms and in those who abused or were dependent on illegal drugs.

CONCLUSION

QoL improvement after a residential treatment was related to low QoL scores at admission. Improvement in physical component of QoL was related to baseline alcohol intake and good somatic status. Improvement in mental component of QoL was related to other drugs abuse/dependence.

Alcohol consumption and health among elders

PURPOSE

This article estimates the effects of alcohol consumption on self-reported overall health status, injuries, heart problems, emergency room use, and hospitalizations among persons older than the age of 65.

DESIGN AND METHODS

We analyzed data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative study. We used multivariate regression and instrumental variables methods to study the associations between alcohol consumption (current drinking, binge drinking, and average number of drinks consumed) and several indicators of health status and health care utilization.

RESULTS

Alcohol consumption by women was associated with better self-perceived health status, improved cardiovascular health, and lower rates of hospitalizations. We detected no significant negative or positive associations for older men.

IMPLICATIONS

These findings suggest that light to moderate alcohol use by older women may have beneficial health effects. Experimental trials, however, are needed to more rigorously assess the potential benefits of alcohol use by elders due to the inherent biases of observational studies.

Predictors of violence following Emergency Department visit for cocaine-related chest pain

This study examined 1-year violence outcomes among non-injured patients treated in the Emergency Department (ED) for cocaine-related chest pain. An urban Level I ED required patients with chest pain (age 60 and younger) provide a urine sample for cocaine testing. Cocaine-positive consenting patients (n=219) were interviewed in the ED; 80% completed follow-up interviews over 12-months (n=174; 59% male, 79% African-American, mean age=38.8, standard deviation 9.06; range=19-60). Baseline rates of past year violent victimization and perpetration history were: 38% and 30%, respectively. During the 12-month follow-up, rates of victimization and perpetration outcomes were 35% and 30%, respectively. Predictors of violence outcomes (either victimization or perpetration) in the year post-ED visit based on characteristics were measured at baseline or during the follow-up period (i.e., gender, age, psychological distress, binge drinking days, cocaine use days, marijuana use days, substance abuse/dependence diagnosis, victimization/perpetration history). Victimization during the follow-up was related to younger age, more frequent binge drinking and marijuana use at baseline, and victimization history, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Specifically, participants who reported victimization at baseline were approximately 3 times more likely to report victimization at 12-month follow-up. Perpetration during the follow-up was related to younger age and more frequent binge drinking at baseline, and to substance abuse/dependence, more frequent binge drinking, and psychiatric distress at follow-up. Overall, no significant gender differences were observed in violence; however, women were more likely than men to report injury during the most severe partner violence incident. Violence is a common problem among patients presenting to an inner-city ED for cocaine-related chest pain, with younger age and frequency of binge drinking being a consistent marker of continued violence involvement. Intervention approaches to link these not-in-treatment cocaine users to services and reduce cocaine use must take into account concomitant alcohol misuse and violence.

Alcohol use and older adults: A little goes a long way

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.

Alcohol consumption and suicide mortality among Japanese men: the Ohsaki Study

The risk of suicide is well known to be increased among heavy alcohol drinkers. However, whether the risk is increased or decreased among light drinkers is still under debate. We investigated this association in a population-based sample of men in Japan. The Ohsaki Study was a population-based, prospective cohort study among Japanese adults aged from 40 to 79 years. Between October and December, 1994, 22,804 men in Miyagi Prefecture, Japan, completed a questionnaire on various health-related lifestyles, including alcohol drinking. During the subsequent 7 years follow-up, 73 participants committed suicide. We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) for suicide mortality according to the quantity of alcohol consumed daily, with adjustment for potential confounders. There was a statistically significant positive and linear association between the amount of alcohol consumed and the risk of suicide: the multivariate HRs in reference to nondrinkers (95% confidence interval) were 1.2 (0.5-2.7), 1.5 (0.7-3.4), and 2.4 (1.2-4.6) in current drinkers who consumed </=22.7g, 22.8g-45.5g, and >/=45.6g of alcohol per day, respectively (P-trend=.016). Even after the early death cases were excluded, a significant linear association was observed between alcohol consumption and the risk of suicide, with the risk of suicide also being nonsignificantly higher among the light drinkers than among nondrinkers (multivariate HR=1.7). This prospective cohort study indicated a positive linear association between alcohol consumption and the risk of suicide, and the suicide risk among the light drinkers was not decreased as compared with that in nondrinkers.

Women, aging, and alcohol use disorders

The increase in prevalence rates of alcohol use disorders in younger versus older cohorts of female drinkers is many times higher than the corresponding increase in prevalence rates for male drinkers. Thus, the number and impact of older female drinkers is expected to increase over the next 20 years as the disparity between men's and women's drinking rates decrease. Due to differences in metabolism of alcohol, women of all ages compared to men are at higher risk for negative physical, medical, social, and psychological consequences associated with at-risk and higher levels of alcohol consumption. Aging women face new sets of antecedents related to challenges in the middle and older adult phases of life, such as menopause, retirement, "empty nest," limited mobility, and illness. As women age, they are subject to an even greater physiological susceptibility to alcohol's effect, as well as to a risk of synergistic effects of alcohol in combination with prescription drugs. On the other hand, there is mixed research indicating that older women may benefit from the buffering effect of low levels of alcohol on hormonal declines associated with menopause, perhaps serving as a protective factor against Coronary Heart Disease and osteoporosis. However, with heavier drinking, these benefits are either reversed or eclipsed. In addition, any alcohol consumption increases the risk for breast cancer in older women. The possible beneficial effects of alcohol must be weighed with the fact that the research does not typically establish causality, that low-risk drinking equates to one standard drink per day, that there is a risk of progression towards alcohol dependence, and that there are alternate methods to gain the same benefits without the associated risks. Older women also experience unique barriers to detection of and treatment for alcohol problems. Current treatment options specifically for older women are limited, though researchers are beginning to address differential treatment response of older women, as well as development of elder women-specific treatment approaches. Treatment options include self-help/mutual peer support, which provides ancillary advantages, brief interventions in primary care settings, which have been demonstrated to be effective in reducing drinking levels, and cognitive behavioral techniques, which have been demonstrated to be useful; but more studies and larger samples are needed. Elder-specific treatments need to be appropriate in terms of content, to address the challenges associated with life stage, such as the loss of the parental role and widowhood, and in terms of process, such as delivery in a respectful therapeutic style and at a slower pace. Future directions in research should address the lack of assessment instruments, the risks of simultaneous use of alcohol and prescription medications, and the under-representation of older women in randomized trials of alcohol treatments.

Alcohol consumption, medical conditions, and health behavior in older adults

OBJECTIVES

To examine associations between drinking patterns, medical conditions, and behavioral health risks among older adults.

METHODS

Analyses compared survey participants (health plan members ages 65 to 90, N = 6662) who drank moderately to those who drank over recommended limits or did not drink.

RESULTS

Overlimit drinking was associated with smoking; not trying to eat low-fat foods (in men), and lower BMI (in women). Predictors of not drinking during the prior 12 months included ethnicity, lower education, worse self-reported health, diabetes and heart problems.

CONCLUSIONS

Significant relationships exist between health and alcohol consumption patterns, which vary by gender.

Alcohol consumption among older adults in primary care

BACKGROUND

Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients.

OBJECTIVES

To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients.

DESIGN

Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers.

PARTICIPANTS

Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients.

MEASUREMENTS

Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety.

RESULTS

Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1-7 drinks/week), 4.1% were at-risk drinkers (8-14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables.

CONCLUSIONS

The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.

PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use

OBJECTIVE

This study was part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly study (PRISM-E) and determined the relative effectiveness of two different models of care for reducing at-risk alcohol use among primary care patients aged 65 and older.

METHODS

This multisite study was a randomized clinical trial comparing integrated care with enhanced specialty referral for older primary care patients screened and identified to have at-risk drinking.

RESULTS

Before the study, the 560 participants consumed a mean of 17.9 drinks per week and had a mean of 21.1 binge episodes in the prior three months. At six months, both treatment groups reported lower levels of average weekly drinking (p<.001) and binge drinking (p<.001), despite low levels of treatment engagement. However, the declines did not differ significantly between treatment groups.

CONCLUSIONS

These results suggest that older persons with at-risk drinking can substantially modify their drinking over time. Although no evidence suggested that the model of care was important in achieving this result, the magnitude of reduction in alcohol use was comparable with other intervention studies.

PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use

OBJECTIVE

This study was part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly study (PRISM-E) and determined the relative effectiveness of two different models of care for reducing at-risk alcohol use among primary care patients aged 65 and older.

METHODS

This multisite study was a randomized clinical trial comparing integrated care with enhanced specialty referral for older primary care patients screened and identified to have at-risk drinking.

RESULTS

Before the study, the 560 participants consumed a mean of 17.9 drinks per week and had a mean of 21.1 binge episodes in the prior three months. At six months, both treatment groups reported lower levels of average weekly drinking (p<.001) and binge drinking (p<.001), despite low levels of treatment engagement. However, the declines did not differ significantly between treatment groups.

CONCLUSIONS

These results suggest that older persons with at-risk drinking can substantially modify their drinking over time. Although no evidence suggested that the model of care was important in achieving this result, the magnitude of reduction in alcohol use was comparable with other intervention studies.

Older males, cognitive function, and alcohol consumption

We investigated the question, how do older men who drink alcohol differ from those who do not drink on measures of cognitive function, memory, affect, and health? Of the nonprobability sample of male participants (N = 60), 35 (58%) of the males reported some degree of alcohol consumption. Eleven men had one or more drinks per day, 14 had one or more drinks per week, and 9 were occasional drinkers. The drinkers reported significantly less depression, had higher self-reported general health and vitality, and had higher cognitive performance, cognitive flexibility, and verbal memory, and greater knowledge of memory processes.

Treatment outcomes for alcohol dependence among middle-aged and older adults

AIMS

The purpose of this study was to examine differences in the clinical presentation and treatment outcomes of older adults with a diagnosis of alcohol dependence compared to middle-aged adults.

DESIGN

The study is a prospective naturalistic study. Participants included 1358 patients admitted to a residential rehabilitation program for alcohol dependence.

RESULTS

Older adults entering an alcohol rehabilitation program are less impaired on a number measures of psychiatric distress and addiction severity but more impaired in somatic health. While there were no significantly different outcomes in abstinence rates at 1 month, older adults engaged in formal post-discharge aftercare less than middle-aged adults.

CONCLUSIONS

These results confirm impressions that older adults seeking alcohol treatment may have a lower severity of alcohol dependence compared to those at younger ages. However, results suggest that traditional outpatient substance abuse care is not accepted at the same rates as middle-aged adults. The low rates of engagement suggest the need for age appropriate treatment options and are potentially of concern if treatment is necessary to maintain short-term success.

Community prevalence of alcohol use and concomitant use of medication--a source of possible risk in the elderly aged 75 and older?

AIMS

To explore alcohol use and concomitant use of prescription and over the counter (OTC) medicines in people aged 75 years or over.

DESIGN

Community-based randomized survey of home-dwelling elderly persons, Setting: the City of Kuopio, Finland.

PARTICIPANTS

Population-based random sample of 700 persons aged 75 years or over, of whom 601 participated (86%). Only home-dwellers (n = 523) were included in this study.

MEASUREMENTS

Alcohol use based on responses to questions concerning quantity and frequency, and CAGE questions. Use of prescription and non-prescription medicines. Mean corpuscular volume.

RESULTS

Of the participants, 44% used alcohol. Most alcohol drinkers used medications on a regular basis (86.9%) or as needed (87.8%), among them medicines known to have some potential interactions with alcohol. Elevated mean corpuscular volume was more widespread among alcohol drinkers than non drinkers.

CONCLUSION

Theoretical risks posed by alcohol use are not minimal in the older elderly, though the quantity of alcohol use is not considerable. Physicians and nurses should pay attention to chronic diseases and medications when counselling aged people about alcohol consumption. The question of clinical importance of alcohol-medication interactions needs to be studied further.

Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers

AIMS

Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol.

DESIGN

Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury.

FINDINGS

At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later.

CONCLUSIONS

The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.

Older adults' health and changes in late-life drinking patterns

This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

Effects of gender, ethnicity, and medical illness on drinking cessation in older primary care patients

OBJECTIVE

This study examined the effects of gender, ethnicity, and medical illness on cessation of alcohol consumption in late life by analyzing characteristics that distinguish current drinkers from former drinkers.

METHOD

Participants were 211 medical patients aged 55 to 91 years, recruited from four urban public sector primary care clinics. Respondents completed the Short Michigan Alcohol Screening Test and provided health and demographic data. A subset (n = 139) reported drinking history. Of these participants, 40% reported cessation of alcohol consumption at least 1 year prior to their participation in the study.

RESULTS

Older age, hypertension, and heart problems were associated with drinking cessation among women but not among men. In a logistic regression model, drinking cessation was predicted by being unmarried, being a member of an ethnic minority group, heart problems, and diabetes.

DISCUSSION

Physical illnesses may contribute to drinking cessation, especially in older women. Results have implications for alcohol interventions with older adults.