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Gareri P, Gallelli L, Gareri I, Rania V, Palleria C, De Sarro G. Deprescribing in Older Poly-Treated Patients Affected with Dementia. Geriatrics (Basel) 2024; 9:28. [PMID: 38525745 PMCID: PMC10961769 DOI: 10.3390/geriatrics9020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug-drug and drug-disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called "duplicate" drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.
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Affiliation(s)
- Pietro Gareri
- Department of Frailty, Center for Cognitive Disorders and Dementia (CDCD) Catanzaro Lido—ASP Catanzaro, Magna Graecia University, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Ilaria Gareri
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
| | - Vincenzo Rania
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
| | - Caterina Palleria
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giovambattista De Sarro
- Unit of Clinical Pharmacology and Pharmacovigilance, “Renato Dulbecco” University Hospital, 88100 Catanzaro, Italy; (L.G.); (V.R.); (G.D.S.)
- Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy; (I.G.); (C.P.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
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Schröder S, Westhoff MS, Pfister T, Seifert J, Bleich S, Koop F, Proskynitopoulos PJ, Glahn A, Heck J. Drug safety in older patients with alcohol use disorder: a retrospective cohort study. Ther Adv Psychopharmacol 2024; 14:20451253241232563. [PMID: 38384595 PMCID: PMC10880528 DOI: 10.1177/20451253241232563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/07/2024] [Indexed: 02/23/2024] Open
Abstract
Background Older patients with alcohol use disorder are at particular risk of developing adverse drug reactions due to multimorbidity, polypharmacy, and altered organ function. Objectives In this study, we investigated the frequency and characteristics of potentially serious alcohol-medication interactions, potentially inappropriate medications (PIMs) for older adults, and potential drug-drug interactions (pDDIs) in a population of older patients with alcohol use disorder over a 10-year period. Design Retrospective monocentric cohort study. Methods Prescribed medications were screened for potentially serious alcohol-medication interactions, PIMs, and pDDIs using the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria, the PRISCUS 2.0 list, the FORTA (Fit fOR The Aged) classification, and the drug interaction program AiDKlinik®. Results We enrolled 114 patients aged ⩾65 years with alcohol use disorder, who were treated in an addiction unit of a university hospital in Germany. About 80.7% of the study population had at least one potentially serious alcohol-medication interaction. Potentially serious alcohol-medication interactions most commonly affected the cardiovascular (57.7%) and the central nervous system (32.3%). A total of 71.1% of the study population received at least one prescription of a FORTA C or D drug, compared with 42.1% who received at least one PIM prescription according to the PRISCUS 2.0 list. A total of 113 moderate and 72 severe pDDIs were identified in the study population. Conclusion Older patients with alcohol use disorders are frequently exposed to potentially serious alcohol-medication interactions, PIMs, and pDDIs. Improvements in the quality of prescribing should primarily target the use of cardiovascular and psychotropic drugs.
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Affiliation(s)
- Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tabea Pfister
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johanna Seifert
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Felix Koop
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Alexander Glahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
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Helle AC, Wycoff AM, Griffin SA, Fleming M, Freeman LK, Vebares TJ, Rodriguez EM, Zapata MF, Trull TJ. Co-use of medication and alcohol: The influence on subjective effects of intoxication and affect. Personal Disord 2022; 13:75-83. [PMID: 33464103 PMCID: PMC8362240 DOI: 10.1037/per0000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Co-use of alcohol and medication can have serious negative health effects (e.g., overdose risk, liver damage). Research has primarily focused on older adults or the pharmacokinetics of specific medication-alcohol combinations. Little work has focused on the subjective experience of persons who take alcohol-interactive (AI) medications and also drink alcohol, particularly in psychiatric samples at high risk for problematic alcohol use and high rates of prescription medication use, such as individuals with borderline personality disorder (BPD). Data from a larger ecological momentary assessment study of alcohol use in 52 persons diagnosed with BPD (83% women; Mage = 26 years) were used to examine the influence of alcohol intoxication (i.e., estimated blood alcohol concentration [eBAC]) and medication co-use on momentary subjective experience while drinking. Participants reported AI medication use at baseline and completed multiple ecological momentary assessment reports per day over 21 days, which included reports of alcohol use, subjective effects of alcohol (e.g., pleasure, feeling worse), and negative and positive affect. AI medications significantly moderated the association between eBAC and pleasurable effects of alcohol, such that at higher levels of eBAC, those taking AI medications experienced blunted subjective pleasure compared with those not taking AI medications. AI medications did not moderate the associations between eBAC and subjective relief, feeling worse, positive affect, or negative affect. Attenuated pleasure during drinking could lead to increased drinking in an attempt to achieve a desirable state among individuals who co-use psychiatric medications and alcohol, and therefore may represent a useful target for prevention and intervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Ashley C. Helle
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Andrea M. Wycoff
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Sarah A. Griffin
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Megan Fleming
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Lindsey K. Freeman
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Tayler J. Vebares
- University of Missouri, Department of Psychological Sciences, Columbia, MO
| | - Elsa M. Rodriguez
- University of Missouri, Department of Psychological Sciences, Columbia, MO
- Middlebury College
| | - Maria F. Zapata
- University of Missouri, Department of Psychological Sciences, Columbia, MO
- Florida International University
| | - Timothy J. Trull
- University of Missouri, Department of Psychological Sciences, Columbia, MO
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Shields MC, Horgan CM, Ritter GA, Busch AB. Use of Electronic Health Information Technology in a National Sample of Hospitals That Provide Specialty Substance Use Care. Psychiatr Serv 2021; 72:1370-1376. [PMID: 33853380 PMCID: PMC8517030 DOI: 10.1176/appi.ps.202000816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals. METHODS Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse. RESULTS Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79). CONCLUSIONS Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.
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Affiliation(s)
- Morgan C Shields
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Constance M Horgan
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Grant A Ritter
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Alisa B Busch
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
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van Gils Y, Franck E, Dierckx E, van Alphen SPJ, Saunders JB, Dom G. Validation of the AUDIT and AUDIT-C for Hazardous Drinking in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9266. [PMID: 34501856 PMCID: PMC8431181 DOI: 10.3390/ijerph18179266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. METHOD A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. RESULTS Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. CONCLUSION The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender.
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Affiliation(s)
- Yannic van Gils
- Faculty of Medicine and Social Science, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (E.F.); (G.D.)
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium; (E.D.); (S.P.J.v.A.)
| | - Erik Franck
- Faculty of Medicine and Social Science, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (E.F.); (G.D.)
| | - Eva Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium; (E.D.); (S.P.J.v.A.)
- Alexianen Zorggroep Tienen, Psychiatric Hospital, Liefdestraat 10, 3300 Tienen, Belgium
| | - Sebastiaan P. J. van Alphen
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium; (E.D.); (S.P.J.v.A.)
- Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, J.F. Kennedylaan, 301, 6419 XZ Heerlen-Maastricht, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands
| | - John B. Saunders
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Geert Dom
- Faculty of Medicine and Social Science, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; (E.F.); (G.D.)
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Social Science, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Oshi DC, Mitchell G, Harrison J, Campbell-Williams K, Oshi SN, Albarus N, Chukwu NE, Abel WD. Alcohol consumption among elderly persons in Jamaica: prevalence and associated factors. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1821806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Daniel C. Oshi
- Department of Community Health, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Jamaica
| | - Gabrielle Mitchell
- Department of Community Health, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Jamaica
| | - Joy Harrison
- Department of Community Health, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Jamaica
| | - Kayan Campbell-Williams
- Department of Community Health, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Jamaica
| | - Sarah N. Oshi
- Department of Social & Behavioural Sciences, University of the Commonwealth Caribbean, Jamaica
| | - Neena Albarus
- Department of Sociology, Psychology and Social Work, Faculty of Social Sciences, The University of the West Indies, Mona Campus, Jamaica
| | - Ngozi E. Chukwu
- Department of Social Work, Faculty of Social Sciences, University of Nigeria, Nsukka, Nigeria
| | - Wendel D. Abel
- Department of Community Health, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Jamaica
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Weisz D, Gusmano MK. Alcohol Consumption by Older New York City Residents: The Need for New Policies to Address Misuse. Alcohol Alcohol 2020; 55:448-454. [DOI: 10.1093/alcalc/agaa022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
The aim of this study is to assess risk factors for alcohol misuse among older New York City residents and examine the effect of local public health efforts to address alcohol misuse.
Methods
The Community Health Survey, a cross-sectional telephone survey of 8500 randomly selected adult New Yorkers, records the frequency of alcohol use. We examine these results among 65 and older subjects by sociodemographic status using logistic regression modeling and compare trends in smoking and alcohol consumption between 2002 and 2016.
Results
Those with unhealthy drinking habits, combining binge drinking and excessive consumption, constituted 5.7% of 65 plus population and were more likely to be White, US born, healthy, better educated and wealthier. The percentage of older smokers in New York City has decreased while unhealthy drinking is nearly flat since 2002.
Conclusions
Our findings reinforce the importance of screening geriatric populations for alcohol use disorders and support the development of new public health efforts to address alcohol misuse if the city is to achieve results similar to those obtained in decreasing tobacco consumption.
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Affiliation(s)
- Daniel Weisz
- World Cities Project, International Longevity Center, The Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10068, USA
| | - Michael Kelley Gusmano
- Health System and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Room 311, Piscataway, NJ 08854, USA
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Bareham BK, Kaner E, Spencer L, Hanratty B. Health and social care providers' perspectives of older people's drinking: A systematic review and thematic synthesis of qualitative studies. Age Ageing 2020; 49:afaa005. [PMID: 32080741 PMCID: PMC7187873 DOI: 10.1093/ageing/afaa005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/01/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND alcohol may increase risks to late-life health, due to its impact on conditions or medication. Older adults must weigh up the potential risks of drinking against perceived benefits associated with positive roles of alcohol in their social lives. Health and social care workers are in a key position to support older people's decisions about their alcohol use. OBJECTIVE to systematically review and synthesise qualitative studies exploring health and social care providers' views and experiences of older people's drinking and its management in care services. METHOD a pre-specified search strategy was applied to five electronic databases from inception to June 2018. Grey literature, relevant journals, references and citations of included articles were searched. Two independent reviewers sifted and quality-appraised articles. Included study findings were analysed through thematic synthesis. RESULTS 18 unique studies were included. Four themes explained findings: uncertainty about drinking as a legitimate concern in care provision for older people; the impact of preconceptions on work with older adults; sensitivity surrounding alcohol use in later life; and negotiating responsibility for older adults' alcohol use. Discipline- and country-specific patterns are highlighted. CONCLUSIONS reservations about addressing alcohol could mean that service providers do not intervene with older adults. Judgements of whether older care recipients' drinking warrants intervention are complex. Providers will need support and training to recognise and provide appropriate intervention for drinking amongst older care recipients.
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Affiliation(s)
- Bethany Kate Bareham
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Foster J, Patel S. Prevalence of simultaneous use of alcohol and prescription medication in older adults: findings from a cross-sectional survey (Health Survey for England 2013). BMJ Open 2019; 9:e023730. [PMID: 31256017 PMCID: PMC6609060 DOI: 10.1136/bmjopen-2018-023730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To investigate the concurrent use of 'at-risk' (AR) drinking (>10 units of alcohol per week) and prescription medications, while controlling for sociodemographic, and health-related factors, among older adults (aged 65-89 years). DESIGN Cross-sectional survey. SETTING Data from Health Survey of England, 2013. INTERVENTIONS None. PARTICIPANTS General population survey of 2169 adults aged 65-89 years. PRIMARY OUTCOME MEASURES AR drinking (>10 units per week). Secondary outcome was AR drinking defined as >14 units of alcohol per week limit (the cut-off used by the Department of Health for AT drinking). RESULTS Twenty-seven per cent (n=568) of the sample were AR drinkers. Factors associated with alcohol consumption were gender, age, social class, marital status, rurality of dwelling, deprivation index, self-reported general health, cigarette smoking, body mass index, exercise level, health and well-being scores' and number of prescription drugs. Logistic regression analysis showed that males were more likely to be AR drinkers (OR 3.44, 95% CI 2.59 to 4.57, p<0.0001) than females. Each year increase in age, lowered the probability of AR drinking by a factor of 0.95 (95% CI 0.93 to 0.98, p<0.0001). Using prescription drugs reduced AR drinking by a factor of 0.92 (95% CI 0.85 to 0.93, p=0.033), after controlling for age, sex and rurality of dwelling. No other predictors were significant. Similar results were obtained for AR drinking of >14units per week. CONCLUSION AR drinking is more likely in older men than women. The odds of AR drinking lessens, as individuals age, and using prescription drugs also reduces AR drinking.
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Affiliation(s)
- John Foster
- Psychology, Social Work and Counselling, University of Greenwich, London, UK
| | - Swatee Patel
- Psychology, Social Work and Counselling, University of Greenwich, London, UK
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10
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Bareham BK, Kaner E, Spencer LP, Hanratty B. Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people's perceptions and experiences. Age Ageing 2019; 48:134-146. [PMID: 29733341 PMCID: PMC6322501 DOI: 10.1093/ageing/afy069] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 04/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background alcohol presents risks to the health of older adults at levels that may have been ‘safer’ earlier in life. Moderate drinking is associated with some health benefits, and can play a positive role in older people’s social lives. To support healthy ageing, we must understand older people’s views with regards to their drinking. This study aims to synthesise qualitative evidence exploring the perceptions and experiences of alcohol use by adults aged 50 years and over. Methods a pre-specified search strategy was applied to Medline, PsychINFO, Scopus, Applied Social Sciences Index and Abstracts and Cumulative Index to Nursing and Allied Health Literature databases from starting dates. Grey literature, relevant journals, references and citations of included articles were searched. Two independent reviewers sifted articles and assessed study quality. Principles of thematic analysis were applied to synthesise the findings from included studies. Results of 2,056 unique articles identified, 25 articles met inclusion criteria. Four themes explained study findings: routines and rituals of older people’s drinking; self-image as a responsible drinker; perceptions of alcohol and the ageing body; and older people’s access to alcohol. Differences between gender, countries and social patterns are highlighted. Conclusions older people perceive themselves as controlled and responsible drinkers. They may not recognise risks associated with alcohol, but appreciate its role in sustaining social and leisure activities important to health and well-being in later life. These are important considerations for intervention development. Drinking is routinised across the life course and may be difficult to change in retirement.
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Affiliation(s)
- Bethany Kate Bareham
- Institute of Health and Society, Newcastle University The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Liam Patrick Spencer
- Institute of Health and Society, Newcastle University The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute of Health and Society, Newcastle University The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
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11
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Zanjani F, Allen H, Smith RV, Antimisiaris D, Schoenberg N, Martin C, Clayton R. Pharmacy Staff Perspectives on Alcohol and Medication Interaction Prevention Among Older Rural Adults. Gerontol Geriatr Med 2018; 4:2333721418812274. [PMID: 30515450 PMCID: PMC6262491 DOI: 10.1177/2333721418812274] [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: 07/26/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 11/15/2022] Open
Abstract
Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. The main categories identified for AMI prevention messaging were Informational, Health Significance, and Recommendations. Within barriers to participation, the main categories identified were Health Illiteracy, Personal Attitudes, and Feasibility. The main categories identified for program facilitators were Understanding, Beneficial Consequences, and Practicality. Multimethod dissemination strategies were commonly suggested. This study found positive pharmacy staff perspectives for the planning and implementation of AMI prevention programming, and future development and feasibility testing of such programming in the pharmacy setting is warranted.
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Haighton C, Kidd J, O’Donnell A, Wilson G, McCabe K, Ling J. 'I take my tablets with the whiskey': A qualitative study of alcohol and medication use in mid to later life. PLoS One 2018; 13:e0205956. [PMID: 30335835 PMCID: PMC6193697 DOI: 10.1371/journal.pone.0205956] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 10/04/2018] [Indexed: 01/11/2023] Open
Abstract
Background Concurrent alcohol and medication use can result in significant problems especially in mid to later life. Alcohol is often used instead of medication for a number of health-related conditions. This novel qualitative study explored concurrent alcohol and medication use, as well as the use of alcohol for medicinal purposes, in a sample of individuals in mid to later life. Methods Twenty-four interviews (12 men/12 women, ages 51–90 years) and three focus groups (n = 27, 6 men/21 women, ages 50–95 years) from three branches of Age UK and two services for alcohol problems in North East England. Results Older people in this study often combined alcohol and medication, frequently without discussing this with their family doctor. However, being prescribed medication could act as a motivating factor to stop or reduce alcohol consumption. Participants also used alcohol to self-medicate, to numb pain, aid sleep or cope with stress and anxiety. Some participants used alcohol to deal with depression although alcohol was also reported as a cause of depression. Women in this study reported using alcohol to cope with mental health problems while men were more likely to describe reducing their alcohol consumption as a consequence of being prescribed medication. Conclusions As older people often combine alcohol and medication, health professionals such as family doctors, community nurses, and pharmacists should consider older patients’ alcohol consumption prior to prescribing or dispensing medication and should monitor subsequent drinking. In particular, older people should be informed of the dangers of concurrent alcohol and medication use.
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Affiliation(s)
- Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| | - Jess Kidd
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amy O’Donnell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Graeme Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- Reid School of Music, University of Edinburgh, Edinburgh, United Kingdom
| | - Karen McCabe
- School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom
| | - Jonathan Ling
- School of Nursing and Health Sciences, University of Sunderland, Sunderland, United Kingdom
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Tripathi D, Welch E, Cheekatla SS, Radhakrishnan RK, Venkatasubramanian S, Paidipally P, Van A, Samten B, Devalraju KP, Neela VSK, Valluri VL, Mason C, Nelson S, Vankayalapati R. Alcohol enhances type 1 interferon-α production and mortality in young mice infected with Mycobacterium tuberculosis. PLoS Pathog 2018; 14:e1007174. [PMID: 30071107 PMCID: PMC6072099 DOI: 10.1371/journal.ppat.1007174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/24/2018] [Indexed: 12/31/2022] Open
Abstract
In the current study, we used a mouse model and human blood samples to determine the effects of chronic alcohol consumption on immune responses during Mycobacterium tuberculosis (Mtb) infection. Alcohol increased the mortality of young mice but not old mice with Mtb infection. CD11b+Ly6G+ cells are the major source of IFN-α in the lungs of Mtb-infected alcohol-fed young mice, and IFN-α enhances macrophage necroptosis in the lungs. Treatment with an anti-IFNAR-1 antibody enhanced the survival of Mtb-infected alcohol-fed young mice. In response to Mtb, peripheral blood mononuclear cells (PBMCs) from alcoholic young healthy individuals with latent tuberculosis infection (LTBI) produced significantly higher amounts of IFN-α than those from non-alcoholic young healthy LTBI+ individuals and alcoholic and non-alcoholic old healthy LTBI+ individuals. Our study demonstrates that alcohol enhances IFN-α production by CD11b+Ly6G+ cells in the lungs of young Mtb-infected mice, which leads to macrophage necroptosis and increased mortality. Our findings also suggest that young alcoholic LTBI+ individuals have a higher risk of developing active TB infection. Chronic alcohol consumption modulates the host immune defense mechanism(s) and makes the host susceptible to various fungal, viral and bacterial infections, including Mycobacterium tuberculosis (Mtb). However, limited information is available about the mechanisms involved in alcohol-mediated host susceptibility to Mtb and other intracellular bacterial infections. In the current study, we fed control and alcohol diets to young and old mice and determined the mortality rates and the immune mechanisms involved in host susceptibility to Mtb infection. We found that alcohol increases the mortality of young mice but not old mice infected with Mtb. The increased mortality in alcohol-fed Mtb-infected young mice was due to IFN-α production by CD11b+Ly6G+ cells. We also found that PBMCs from young alcoholic individuals with latent tuberculosis infection (LTBI) produced significantly higher amounts of IFN-α than those from young non-alcoholic, old alcoholic and old non-alcoholic LTBI+ individuals. Our findings suggest that young alcoholic LTBI+ individuals have a higher risk of developing active TB infection. Our studies provide the first evidence that chronic alcohol consumption induces IFN-α production in young Mtb-infected mice and increases their mortality rates. Further characterization of CD11b+Ly6G+ cells and delineation of the mechanisms through which alcohol enhances IFN-α production in Ly6G+ cells during Mtb infection will facilitate the development of therapies for alcoholic individuals with latent and active Mtb.
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Affiliation(s)
- Deepak Tripathi
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Elwyn Welch
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Satyanarayana Swamy Cheekatla
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Rajesh Kumar Radhakrishnan
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Sambasivan Venkatasubramanian
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Padmaja Paidipally
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Abhinav Van
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | - Buka Samten
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
| | | | | | | | - Carol Mason
- Department of Medicine, Section of Pulmonary/Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Steve Nelson
- Department of Medicine, Section of Pulmonary/Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Ramakrishna Vankayalapati
- Department of Pulmonary Immunology, Center for Biomedical Research, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America
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Deplanque D, Machuron F, Waucquier N, Jozefowicz E, Duhem S, Somers S, Colin O, Duhamel A, Bordet R. Etifoxine impairs neither alertness nor cognitive functions of the elderly: A randomized, double-blind, placebo-controlled crossover study. Eur Neuropsychopharmacol 2018; 28:925-932. [PMID: 30135030 DOI: 10.1016/j.euroneuro.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/04/2018] [Accepted: 05/17/2018] [Indexed: 01/29/2023]
Abstract
Etifoxine hydrochloride (Stresam®), a treatment indicated for psychosomatic manifestations of anxiety, could be an alternative to benzodiazepines. While no impact on alertness and cognitive functions has been proven among youth, data on elderly are lacking. The primary objective of this study was to measure the impact of etifoxine, lorazepam or placebo on alertness in the elderly. The secondary objectives were to evaluate cognitive performances and adverse effects. In this randomized, placebo-controlled, double-blind, 3-way crossover design, 30 healthy volunteers aged 65 to 75 years underwent three one-day sessions. After treatment intake, standardized cognitive tests were conducted using the Cambridge Neuropsychological Test Automated Batteries and other psychological tests (Stroop, Rey Auditory Verbal Learning Test, Digit Span). The reaction time (RTI) as primary endpoint was analysed using a 3 × 3 latin square variance analysis. A 100-mg dose of etifoxine has no deleterious impact on alertness and causes no cognitive disorders as compared to placebo (RTI: 744 ± 146 ms versus 770 ± 153 ms; p = 1.00). As expected, a 2-mg dose of lorazepam impairs alertness (RTI: 957 ± 251 ms versus placebo; p < 0.0001) and cognitive functions. A similar frequency of adverse events was observed with etifoxine and placebo while their incidence was 3-fold higher with lorazepam, drowsiness being the most frequent adverse event. No serious adverse events were observed. This study demonstrates in the elderly that a single dose of etifoxine does neither impair alertness nor any of the cognitive parameters evaluated. Etifoxine may be a good option when anxiolytic treatment is required, especially in elderly people.
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Affiliation(s)
- D Deplanque
- Univ. Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular cognitive disorders, F-59000 Lille, France; Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'Investigation Clinique, F-59000 Lille, France.
| | - F Machuron
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - N Waucquier
- Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'Investigation Clinique, F-59000 Lille, France
| | - E Jozefowicz
- Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'Investigation Clinique, F-59000 Lille, France
| | - S Duhem
- Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'Investigation Clinique, F-59000 Lille, France
| | - S Somers
- Univ. Lille, Inserm, CHU Lille, CIC 1403 - Centre d'Investigation Clinique, F-59000 Lille, France
| | - O Colin
- Univ. Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular cognitive disorders, F-59000 Lille, France
| | - A Duhamel
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - R Bordet
- Univ. Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular cognitive disorders, F-59000 Lille, France
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Karriker-Jaffe KJ, Greenfield TK, Mulia N, Zemore SE. Ten-Year Trend in Women's Reasons for Abstaining or Limiting Drinking: The 2000 and 2010 United States National Alcohol Surveys. J Womens Health (Larchmt) 2018; 27:665-675. [PMID: 29634451 PMCID: PMC5962333 DOI: 10.1089/jwh.2017.6613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Data on individual and cultural factors contributing to drinking can inform screening and brief intervention in clinical practice. Our aims were to examine 10-year trends in women's reasons for abstaining/limiting drinking and to document changes in associations with drinking status for population subgroups defined by race/ethnicity and age. MATERIALS AND METHODS Using repeated cross-sectional data from White, Black and Hispanic women in the 2000 and 2010 United States National Alcohol Surveys (combined N = 5501), population-weighted multiple linear and multinomial logistic regression models assessed changes in three reasons for abstaining or limiting drinking (health concerns, religious prohibition, and upsetting family or friends) and drinking status (past-year abstainer, low-risk drinker, or at-risk drinker), and their associations over time. RESULTS Adjusting for key demographics, reasons for limiting alcohol consumption declined in importance over time, with reductions in both health concerns and religious prohibition particularly noteworthy for older women of all three racial/ethnic backgrounds. Despite these reductions in importance, both health concerns and religious prohibition were most consistently associated with increased abstinence relative to low-risk drinking; these reasons were not strongly associated with at-risk drinking, however. CONCLUSIONS It is essential for healthcare providers and others to disseminate accurate information about the risks of drinking to counter cultural shifts that suggest greater acceptance of moderate-to-heavy drinking by women aged 40 and older.
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Affiliation(s)
| | | | - Nina Mulia
- Alcohol Research Group, Public Health Institute , Emeryville, California
| | - Sarah E Zemore
- Alcohol Research Group, Public Health Institute , Emeryville, California
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16
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Hattingh HL, Tait RJ. Pharmacy-based alcohol-misuse services: current perspectives. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2018; 7:21-31. [PMID: 29732288 PMCID: PMC5927143 DOI: 10.2147/iprp.s140431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context Globally, the use of alcohol is a leading cause of mortality and morbidity. Opportunistic screening and brief interventions (SBIs) have been shown to be effective in reducing alcohol consumption in certain primary care settings and provide a means of reaching some of those who do not seek treatment for alcohol-related problems. Further, community pharmacies have the potential to reach consumers at an early stage of their alcohol use and incorporate intervention and advice into their role in providing medications. Aim The purpose of this review was to inform pharmacists and stakeholders of the evidence base for SBI in community pharmacy settings. To date, there has been limited research on the effectiveness of alcohol SBI in community pharmacies, with a systemic review only identifying two randomized trials. Methods This narrative review reports on the period 2007–2017, covering feasibility studies, pilot programs, and surveys of consumers and pharmacy staff attitudes relating to alcohol SBI in this setting. Studies were identified via MEDLINE, CINAHL, Google Scholar, and reference lists of relevant publications. Findings The findings indicated that the provision of community pharmacy alcohol SBI requires training in communication and intervention skills and in some cases increasing confidence and alcohol-related knowledge. Consumers were generally receptive to the SBI approach but requested private areas for delivery of such. Conclusion The high prevalence of “at risk” alcohol use in many countries and the low level of treatment seeking by this group means that novel approaches to engage opportunistically with these people is imperative in reducing alcohol-related harms. However, before committing routine health funding, these novel approaches need rigorous evaluation.
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Affiliation(s)
- Hendrika L Hattingh
- School of Pharmacy and Pharmacology, Griffith Health, Griffith University, Gold Coast, QLD
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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17
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Zanjani F, Allen H, Schoenberg N, Martin C, Clayton R. Acceptability of intervention materials to decrease risk for alcohol and medication interactions among older adults. EVALUATION AND PROGRAM PLANNING 2018; 67:160-166. [PMID: 29334631 PMCID: PMC5835203 DOI: 10.1016/j.evalprogplan.2017.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 12/13/2017] [Accepted: 12/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The majority of older adults take prescription or over-the-counter medications and about half consume alcohol regularly. Despite high risk for alcohol medication interactions (AMI), few community-level interventions exist to prevent AMI. The current study assessed the acceptability of educational materials created for use in a brief intervention to prevent AMI among older adults. METHODS Older adults from two senior centers reviewed intervention materials (poster, patient and pharmacist brochures, and public service announcement) and participated in a pre and post-test to provide feedback and to assess changes in AMI-related awareness and intentions. RESULTS Post-test data showed positive feedback and an increase in participant understanding of AMI prevention, with statistically significant changes in perceived importance of messaging surrounding risky alcohol use and potential consequences of AMI. DISCUSSION The intervention materials were positively received, and participant feedback indicated that the collective presentation of all the materials was the most preferred tool for educating the community. With positive trends in awareness and knowledge, intervention effectiveness needs to be further evaluated in future large-scale studies. LESSONS LEARNED This study provides health education specialists with tools to prevent alcohol and medication interactions among older adults.
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Affiliation(s)
- Faika Zanjani
- Virginia Commonwealth University, School of Allied Health Professions, 730 East Broad Street, Richmond, VA, 23298, USA.
| | - Hannah Allen
- University of Maryland School of Public Health, 4200 Valley Drive, College Park, MD, 20742, USA.
| | - Nancy Schoenberg
- University of Kentucky College of Public Health, 111 Washington Ave., Lexington, KY, 40536, USA.
| | - Catherine Martin
- University of Kentucky College of Medicine, UK Medical Center MN 150, Lexington, KY, 40536, USA.
| | - Richard Clayton
- University of Kentucky College of Public Health, 111 Washington Ave., Lexington, KY, 40536, USA.
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18
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Badrakalimuthu VR, Rumball D, Wagle A. Drug misuse in older people: old problems and new challenges. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.108.006221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryVery little attention has been paid to the invisible epidemic of substance misuse among older people in the UK. This article looks at the prevalence of substance misuse in the people over the age of 60. The reasons for difficulty in diagnosing substance misuse are explored and ways to improve diagnostic ability are discussed. Substance misuse leads to severe physical and psychiatric morbidity that is being managed by meagre resources. The article provides recommendations on specific issues related to interventions, biological and psychosocial, and training of psychiatrists.
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Holton AE, Gallagher PJ, Ryan C, Fahey T, Cousins G. Consensus validation of the POSAMINO (POtentially Serious Alcohol-Medication INteractions in Older adults) criteria. BMJ Open 2017; 7:e017453. [PMID: 29122794 PMCID: PMC5695415 DOI: 10.1136/bmjopen-2017-017453] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Older adults are particularly vulnerable to adverse effects from concurrent alcohol and medication use. However, there is limited evidence regarding the prevalence of these adverse outcomes among older adults, and there is a lack of consensus regarding what constitutes an alcohol-interactive medicine. The objective of this study was to develop an explicit list of potentially serious alcohol-medication interactions for use in older adults. DESIGN Following a systematic review, review of drug compendia and clinical guidance documents, a two-round Delphi consensus method was conducted. SETTING Ireland and the United Kingdom (UK), primary care and hospital setting. PARTICIPANTS The Project Steering Group developed a list of potentially serious alcohol-medication interactions. The Delphi panel consisted of 19 healthcare professionals (general practitioners, geriatricians, hospital and community pharmacists, clinical pharmacologists and pharmacists, and physicians specialising in substance misuse). RESULTS An inventory of 52 potentially serious alcohol-medication interactions was developed by the Project Steering Group. British National Formulary black dot warnings (n=8) were included in the final criteria as they represent 'potentially serious' interactions. The remaining 44 criteria underwent a two-round Delphi process. In the first round, 13 criteria were accepted into the POtentially Serious Alcohol-Medication INteractions in Older adults (POSAMINO) criteria. Consensus was not reached on the remaining 31 criteria; 9 were removed and 8 additional criteria were included following a review of panellist comments. The remaining 30 criteria went to round 2, with 17 criteria reaching consensus, providing a final list of 38 potentially serious alcohol-medication interactions: central nervous system (n=15), cardiovascular system (n=9), endocrine system (n=5), musculoskeletal system (n=3), infections (n=3), malignant disease and immunosuppression (n=2), and respiratory system (n=1). CONCLUSIONS POSAMINO is the first set of explicit potentially serious alcohol-medication interactions for use in older adults. Following future validation studies, these criteria may allow for the risk stratification of older adults at the point of prescribing.
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Affiliation(s)
- Alice E Holton
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Paul J Gallagher
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Cristín Ryan
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Tom Fahey
- Division of Population Health Science, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
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Tevik K, Selbæk G, Engedal K, Seim A, Krokstad S, Helvik AS. Use of alcohol and drugs with addiction potential among older women and men in a population-based study. The Nord-Trøndelag Health Study 2006-2008 (HUNT3). PLoS One 2017; 12:e0184428. [PMID: 28886172 PMCID: PMC5590962 DOI: 10.1371/journal.pone.0184428] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/23/2017] [Indexed: 02/06/2023] Open
Abstract
Background Little is known about the consumption habits of older adults in Norway with respect to alcohol and the use of drugs with addiction potential, such as benzodiazepines, z-hypnotics and opioids, among regular drinkers. We studied the prevalence of self-reported consumption of alcohol on a regular basis in community-living older men and women (≥ 65 years). Furthermore, we investigated the prevalence of dispensed prescribed drugs with addiction potential in older men and women who were regular drinkers. Methods We used data from the Nord-Trøndelag Health Study 2006–2008 (HUNT3). Of 12,361 older adults in the HUNT3 study, 11,545 had answered the alcohol consumption item and were included in our study. Regular drinkers were defined as consuming alcohol one or more days a week. Data on dispensed drugs with addiction potential were drawn from the Norwegian Prescription Database. Addiction potential was defined as at least one prescription for benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years. Results In total 28.2% of older Norwegian adults were regular drinkers. Men in the study were more likely to be regular drinkers than women. Drugs with addiction potential were used by 32.4% of participants, and were more commonly used by women. Nearly 12% of participants used benzodiazepines, 19% z-hypnotics and 12.4% opioids. Among regular drinkers, 29% used drugs with addiction potential, which was also more common among women. Adjusted for age, gender and living situation, use of z-hypnotics was associated with regular alcohol intake, while use of opioids was associated with no regular alcohol intake. Conclusion The prevalence of the use of drugs with addiction potential was high in a Norwegian population of older adults who reported regular consumption of alcohol. Strategies should be developed to reduce or prevent alcohol consumption among older adults who use drugs with addiction potential.
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Affiliation(s)
- Kjerstin Tevik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Arnfinn Seim
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway
- Psychiatric Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Anne-S. Helvik
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- St. Olavs University Hospital, Trondheim, Norway
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Bosque-Prous M, Brugal MT, Lima KC, Villalbí JR, Bartroli M, Espelt A. Hazardous drinking in people aged 50 years or older: a cross-sectional picture of Europe, 2011-2013. Int J Geriatr Psychiatry 2017; 32:817-828. [PMID: 27388047 DOI: 10.1002/gps.4528] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/12/2016] [Accepted: 05/27/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess gender and age differences in hazardous drinking and to analyse and compare the factors associated with it in men versus women, and in 50 to 64-year-old versus ≥65-year-old people in Europe. METHODS Cross-sectional study with data from 65,955 people aged ≥50 years from 18 countries (SHARE project, 2011-2013). The outcome variable, hazardous drinking, was calculated using an adaptation of the AUDIT-C test. Several individual (sociodemographic, life-style and health factors) and contextual variables (country socioeconomic indicators and alcohol policies) were analysed. The prevalence of hazardous drinking was estimated by each exposure variable. To estimate associations, multilevel Poisson regression models with robust variance were fit, yielding prevalence ratios and their 95% confidence intervals (95%CI). RESULTS Overall, the prevalence of hazardous drinking was 21.5% (95%CI = 21.1-22.0), with substantial differences between countries. The proportion of hazardous drinking was higher in men than in women [26.3%(95%CI = 25.6-27.1); 17.5%(95%CI = 17.0-18.0), respectively], as well as in middle-aged people than in older people [23.6%(95%CI = 23.0-24.3); 19.2%(95%CI = 18.6-19.8), respectively]. At the individual level, associations were found for migrant background, marital status, educational level, tobacco smoking, depression and self-perceived health. At the contextual level, hazardous drinking was associated with gender inequalities in society (only in women) and alcohol advertising regulations (both genders). CONCLUSIONS One in five people aged ≥50 years in the countries studied is a hazardous drinker, with large differences by countries, gender and age group. Interventions and policies aimed at preventing or reducing alcohol use in this population should account for country, gender and age differences, as well as individual characteristics. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marina Bosque-Prous
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - M Teresa Brugal
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Kenio C Lima
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil
| | - Joan R Villalbí
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Albert Espelt
- Agència de Salut Pública de Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Psicobiologia i Metodologia en Ciències de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Bosque-Prous M, Kunst AE, Brugal MT, Espelt A. Changes in alcohol consumption in the 50- to 64-year-old European economically active population during an economic crisis. Eur J Public Health 2017; 27:711-716. [PMID: 28472296 PMCID: PMC5881701 DOI: 10.1093/eurpub/ckx044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The aim was to compare alcohol drinking patterns in economically active people aged 50-64 years before the last economic crisis (2006) and during the crisis (2013). Methods Cross-sectional study with data from 25 479 economically active people aged 50-64 years resident in 11 European countries who participated in wave 2 or wave 5 of the SHARE project (2006 and 2013). The outcome variables were hazardous drinking, abstention in previous 3 months and the weekly average number of drinks per drinker. The prevalence ratios of hazardous drinking and abstention, comparing the prevalence in 2013 vs. 2006, were estimated with Poisson regression models with robust variance, and the changes in the number of drinks per week with Poisson regression models. Results The prevalence of hazardous drinking decreased among both men (PR = 0.75; 95%CI = 0.63-0.92) and women (PR = 0.91; 95%CI = 0.72-1.15), although the latter decrease was smaller and not statistically significant. The proportion of abstainers increased among both men (PR = 1.11; 95%CI = 0.99-1.29) and women (PR = 1.18; 95%CI = 1.07-1.30), although the former increase was smaller and not statistically significant. The weekly average number of drinks per drinker decreased in men and women. The decreases in consumption were larger in Italy and Spain. Conclusion From 2006 to 2013, the amount of alcohol consumed by late working age drinkers decreased in Europe, with more pronounced declines in the countries hardest hit by the economic crisis.
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Affiliation(s)
- Marina Bosque-Prous
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton E. Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M. Teresa Brugal
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Albert Espelt
- Agencia de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Centros de Investigación Biomédica en Red. Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Psicobiologia i Metodologia en Ciències de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Holton AE, Gallagher P, Fahey T, Cousins G. Concurrent use of alcohol interactive medications and alcohol in older adults: a systematic review of prevalence and associated adverse outcomes. BMC Geriatr 2017; 17:148. [PMID: 28716004 PMCID: PMC5512950 DOI: 10.1186/s12877-017-0532-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults are susceptible to adverse effects from the concurrent use of medications and alcohol. The aim of this study was to systematically review the prevalence of concurrent use of alcohol and alcohol-interactive (AI) medicines in older adults and associated adverse outcomes. METHODS A systematic search was performed using MEDLINE (PubMed), Embase, Scopus and Web of Science (January 1990 to June 2016), and hand searching references of retrieved articles. Observational studies reporting on the concurrent use of alcohol and AI medicines in the same or overlapping recall periods in older adults were included. Two independent reviewers verified that studies met the inclusion criteria, critically appraised included studies and extracted relevant data. A narrative synthesis is provided. RESULTS Twenty studies, all cross-sectional, were included. Nine studies classified a wide range of medicines as AI using different medication compendia, thus resulting in heterogeneity across studies. Three studies investigated any medication use and eight focused on psychotropic medications. Based on the quality assessment of included studies, the most reliable estimate of concurrent use in older adults ranges between 21 and 35%. The most reliable estimate of concurrent use of psychotropic medications and alcohol ranges between 7.4 and 7.75%. No study examined longitudinal associations with adverse outcomes. Three cross-sectional studies reported on falls with mixed findings, while one study reported on the association between moderate alcohol consumption and adverse drug reactions at hospital admission. CONCLUSIONS While there appears to be a high propensity for alcohol-medication interactions in older adults, there is a lack of consensus regarding what constitutes an AI medication. An explicit list of AI medications needs to be derived and validated prospectively to quantify the magnitude of risk posed by the concurrent use of alcohol for adverse outcomes in older adults. This will allow for risk stratification of older adults at the point of prescribing, and prioritise alcohol screening and brief alcohol interventions in high-risk groups.
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Affiliation(s)
- Alice E. Holton
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Paul Gallagher
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
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Abstract
T. Sulander: Increasing numbers of older people use alcohol The number of older people using alcohol has increased and abstinence has decreased over the past few decades in Finland. However, the average amount of consumed alcohol per week has remained the same. The rapid lowering of alcohol taxes in 2004 led to a slight increase in alcohol use among people aged 65–84. The number of older people in need of care for their alcohol problems has increased parallel to the increasing trend of moderate drinking. It is, however, difficult to reach heavy drinkers by using different research methods. Therefore, their number in the population could only be estimated. Alcohol use in Finland has been increasing steadily already before the alcohol tax was considerably lowered in 2004. To reverse this negative trend, alcohol taxes should be considerably increased and health promotion activities should be initiated.
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Affiliation(s)
- Tommi Sulander
- pol. dr, docent, forskare Äldreinstitutet Kalevagatan 12 A, 00100 Helsingfors, Finland
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25
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Wolf IK, Du Y, Knopf H. Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11. BMC Psychiatry 2017; 17:90. [PMID: 28279159 PMCID: PMC5345233 DOI: 10.1186/s12888-017-1254-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/04/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychotropic drug use and alcohol consumption among older adults need to be monitored over time as their use or combined use bears risks of harms. Representative data on changes in prevalence, patterns and co-relates of substance use are lacking in Germany. METHODS Participants were older adults (60-79 years) from two German National Health Surveys: 1997-99 (GNHIES98, N = 1,606) and 2008-11 (DEGS1, N = 2,501). Included were drugs acting on the nervous system used during the last 7 days. Alcohol consumption was measured by frequency (daily drinking) and quantity (risky drinking: ≥20/10 g/day alcohol for men/women). Changes in prevalence adjusted for potential socio-economic and health-related confounders were calculated by logistic regression models approximated by the SAS LSMEANS statement. RESULTS The prevalence of overall psychotropic drug use (20.5% vs. 21.4%) remained constant between the two surveys. Significant changes were observed in the use of some psychotropics (all GNHIES98 vs. DEGS1): Synthetic antidepressants (3.9% vs. 6.9%), St. John's wort (2.9% vs. 1.1%), benzodiazepines (3.7% vs. 2.5%), benzodiazepine related drugs (0.2% vs. 0.8%), narcotic analgesics (3.0% vs. 4.1%), anti-dementia drugs (2.2% vs. 4.2%) and anti-epileptics (1.0% vs. 2.3%). Significant changes were also observed in long-term use of synthetic anti-depressants (3.2% vs. 5.9%), St. John's wort (2.0% vs. 0.6%) and opioid analgesics (1.0% vs. 2.2%). Further, we found significant changes in benzodiazepines use (3.3% vs. 1.4%) among men, opioids use (2.9% vs. 7.3%) among people with a lower social status, and overall psychotropics (26.8% vs. 32.5%) as well as opioids use (4.4% vs. 8.1%) among those with a worse health status. Moderate alcohol consumption increased significantly (58.0% vs. 66.9%). Risky drinking remained unchanged (16.6% vs. 17.0%). In spite of significant increases in daily alcohol drinking (13.2% vs. 18.4%) psychotropic drug use combined with daily drinking remained unchanged (1.8% vs. 2.7%). CONCLUSIONS Although prevalence of overall psychotropic drug use remained stable, changes in the use of some psychotropic drug groups and alcohol consumption patterns have been observed. Further studies are required to investigate resulting health consequences and public health relevance of those outcomes.
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Affiliation(s)
- Ingrid-Katharina Wolf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64-66, D-12101, Berlin, Germany.
| | - Yong Du
- 0000 0001 0940 3744grid.13652.33Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64-66, D-12101 Berlin, Germany
| | - Hildtraud Knopf
- 0000 0001 0940 3744grid.13652.33Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 64-66, D-12101 Berlin, Germany
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26
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Madnani D, Li G, Frenz CM, Frenz DA. Oral Ethanol Potentiates the Loss of Outer Hair Cells in Cisplatin-Exposed Rats. Otolaryngol Head Neck Surg 2016; 137:327-31. [PMID: 17666265 DOI: 10.1016/j.otohns.2007.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 02/07/2007] [Accepted: 03/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE: The aim of this study was to examine the effect of oral ethanol on cisplatin ototoxicity. STUDY DESIGN AND SETTING: Twenty-seven-week-old, female Fisher 344 rats were divided into 4 experimental groups. The animals were administered per os (PO) saline (group 1), PO ethanol (group 2), PO saline with intraperitoneal (IP) cisplatin (group 3), or PO ethanol with IP cisplatin (group 4). After 3 days, scanning electron microscopy and counts of outer auditory hair cells were performed. RESULTS: A 2-fold increase in outer hair cell loss was obtained in the basal cochlear turn of rats receiving concomitant cisplatin and ethanol compared with animals receiving cisplatin and saline. No hair cell loss was observed in the middle cochlear turn of any experimental group. CONCLUSION: Our findings support potentiation of ototoxicity when cisplatin is combined with oral ethanol. SIGNIFICANCE: Contraindications for alcohol use in cancer patients receiving cisplatin are implicated.
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Affiliation(s)
- Dilip Madnani
- Department of Otorhinolaryngology--Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
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27
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Bright SJ, Williams CM. Development of Australia's first older adult-specific early intervention for alcohol-related harm: Feasibility and proof of concept. Australas J Ageing 2016; 36:52-55. [DOI: 10.1111/ajag.12366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stephen J Bright
- National Drug Research Institute; Curtin University; Perth Western Australia Australia
- Peninsula Health; Melbourne Victoria Australia
| | - Cylie M Williams
- Peninsula Health; Melbourne Victoria Australia
- School of Primary Health Care; Monash University; Melbourne Victoria Australia
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Gold SL, Powell KG, Eversman MH, Peterson NA, Borys S, Hallcom DK. High-Risk Obtainment of Prescription Drugs by Older Adults in New Jersey: The Role of Prescription Opioids. J Am Geriatr Soc 2016; 64:e67-e71. [PMID: 27564407 DOI: 10.1111/jgs.14430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the high-risk ways in which older adults obtain prescription opioids and to identify predictors of obtaining prescription opioids from high-risk sources, such as obtaining the same drug from multiple doctors, sharing drugs, and stealing prescription pads. DESIGN Logistic regression analyses of cross-sectional survey data from the New Jersey Older Adult Survey on Drug Use and Health, a representative random-sample survey. PARTICIPANTS Adults aged 60 and older (N = 725). MEASUREMENTS Items such as obtaining prescriptions for the same drug from more than one doctor and stealing prescription drugs were measured to determine high-risk obtainment of prescription opioids. RESULTS Almost 15% of the sample used high-risk methods of obtaining prescription opioids. Adults who previously used a prescription opioid recreationally had three times the risk of high-risk obtainment of prescription opioids. CONCLUSION These findings illustrate the importance of strengthening prescription drug monitoring programs to reduce high-risk use of prescription drugs in older adults by alerting doctors and pharmacists to potential prescription drug misuse and interactions.
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Affiliation(s)
- Sarah L Gold
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
| | - Kristen Gilmore Powell
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Michael H Eversman
- Department of Social Work, Newark College of Arts and Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - N Andrew Peterson
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Suzanne Borys
- New Jersey Division of Mental Health and Addiction Services, Trenton, New Jersey
| | - Donald K Hallcom
- New Jersey Division of Mental Health and Addiction Services, Trenton, New Jersey
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29
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Du Y, Wolf IK, Knopf H. Psychotropic drug use and alcohol consumption among older adults in Germany: results of the German Health Interview and Examination Survey for Adults 2008-2011. BMJ Open 2016; 6:e012182. [PMID: 27855095 PMCID: PMC5073532 DOI: 10.1136/bmjopen-2016-012182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The use and combined use of psychotropic drugs and alcohol among older adults is a growing public health concern and should be constantly monitored. Relevant studies are scarce in Germany. Using data of the most recent national health survey, we analyse prevalence and correlates of psychotropic drug and alcohol use among this population. METHODS Study participants were people aged 60-79 years (N=2508) of the German Health Interview and Examination Survey for Adults 2008-2011. Medicines used during the last 7 days were documented. Psychotropic drugs were defined as medicines acting on the nervous system (ATC code N00) excluding anaesthetics (N01), analgesics/antipyretics (N02B), but including opiate codeines used as antitussives (R05D). Alcohol consumption in the preceding 12 months was measured by frequency (drinking any alcohol-containing beverages at least once a week/a day) and quantity (alcohol consumed in grams/day; cut-offs: 10/20 g/day for women/men defining moderate and risky drinking). SPSS complex sample module was used for analysis. RESULTS 21.4% of study participants use psychotropic medications, 66.9% consume alcohol moderately and 17.0% riskily, 51.0% drink alcohol at least once a week and 18.4% daily, 2.8% use psychotropic drugs combined with daily alcohol drinking. Among psychotropic drug users, 62.7% consume alcohol moderately, 14.2% riskily. The most frequently used psychotropic medications are antidepressants (7.9%) and antidementia (4.2%). Factors associated with a higher rate of psychotropic drug use are female sex, worse health status, certified disability and polypharmacy. Risky alcohol consumption is positively associated with male sex, smoking, upper social class, better health status, having no disability and not living alone. CONCLUSIONS Despite the high risk of synergetic effects of psychotropic drugs and alcohol, a substantial part of older psychotropic drug users consume alcohol riskily and daily. Health professionals should talk about the additional health risks of alcohol consumption when prescribing psychotropic drugs to older adults.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- YD and I-KW contributed equally
| | - Ingrid-Katharina Wolf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- YD and I-KW contributed equally
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- YD and I-KW contributed equally
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Zanjani F, Crook L, Smith R, Antimisiaris D, Schoenberg N, Martin C, Clayton R. Community pharmacy staff perceptions on preventing alcohol and medication interactions in older adults. J Am Pharm Assoc (2003) 2016; 56:544-8. [PMID: 27594107 DOI: 10.1016/j.japh.2016.04.561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To examine rural and urban pharmacy staff perceptions on messaging, barriers, and motivators for preventing alcohol and medication interactions (AMI) in older adults (≥65 years of age). METHODS A survey was distributed through the local pharmacist association and statewide pharmacy registry in Kentucky. A total of 255 responses were received from pharmacists, pharmacy technicians, and pharmacy students. RESULTS Across rural and urban regions alike, among the AMI prevention messages provided, participants identified the most important messages to be: AMI can be potentially dangerous and life threatening; emergency rooms should be used when experiencing an AMI; and doctors and pharmacists should be consulted about AMI. The most common AMI prevention barriers indicated were stigma, costs, and low perceived risks. The most common AMI prevention motivators indicated were physical health improvement, promoting a healthy lifestyle, convenient setting, and financial incentives. CONCLUSION Regardless of geography, participants similarly rated the presented AMI prevention messages, barriers, and motivators. With the use of these findings, the development of an AMI prevention program is suggested to use messaging about AMI threat, behavioral management, and behavioral prevention.
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Zanjani F, Smith R, Slavova S, Charnigo R, Schoenberg N, Martin C, Clayton R. Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:422-30. [PMID: 27184414 DOI: 10.3109/00952990.2016.1154966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions. OBJECTIVE Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions. METHODS Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined. RESULTS There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%). CONCLUSIONS Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.
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Affiliation(s)
- Faika Zanjani
- a Behavioral and Community Health, School of Public Health , University of Maryland , College Park , MD , USA
| | - Rachel Smith
- b Epidemiology , University of Kentucky , Lexington , KY , USA
| | - Svetla Slavova
- c Biostatistics , University of Kentucky , Lexington , KY , USA
| | | | - Nancy Schoenberg
- d Behavioral Science , University of Kentucky , Lexington , KY , USA
| | | | - Richard Clayton
- f Health Behavior , University of Kentucky , Lexington , KY , USA
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Wilkinson C, Dare J, French M, McDermott ML, Lo J, Allsop S. Prescribing or dispensing medication represents the best opportunity for GPs and pharmacists to engage older people in alcohol-related clinical conversations. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 24:319-25. [PMID: 26871545 DOI: 10.1111/ijpp.12255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This research aimed to identify older Australian drinkers' knowledge about Australian Alcohol Guidelines and their beliefs about the risks and benefits of alcohol; their recall of alcohol-related issues being raised with them by their community pharmacist and General Practitioner (GP); and their receptiveness to alcohol-related information being provided by either health professional. METHODS This research was conducted in Perth, Western Australia. Flyers calling for participants were placed in local health and service centres, and advertisements were placed in local media. Participants who met eligibility requirements were posted a survey pack (n = 190) including an information letter, consent form, quantitative survey, and return addressed, postage paid envelope. 188 people aged over 60 years returned completed questionnaires. KEY FINDINGS Women were more familiar with national alcohol guidelines, and were more conservative about the potential health benefits of alcohol. While 90% of participants were receptive to their GP asking about their alcohol use, only 30% of men and 20% of women recalled their GP raising this issue with them in the prior 12 months. Of these, high-risk drinkers were six times more likely than low-risk drinkers to have been asked by their GP. Likewise, 50% of men and 65% of women were receptive to having alcohol-related health conversations with their community pharmacist, but less than 4% recalled their pharmacist raising this issue. Participants were most receptive to receiving information about alcohol-medication interactions. CONCLUSIONS This research highlights that prescribing and dispensing medication represents the ideal opportunity for health professionals to deliver alcohol-related information to older people.
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Affiliation(s)
- Celia Wilkinson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia. .,National Drug Research Institute, Curtin University of Technology, Perth, Western Australia, Australia.
| | - Julie Dare
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Michelle French
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | | | - Johnny Lo
- School of Science, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Steve Allsop
- National Drug Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
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Marmet S, Rehm J, Gmel G. The importance of age groups in estimates of alcohol-attributable mortality: impact on trends in Switzerland between 1997 and 2011. Addiction 2016; 111:255-62. [PMID: 26360121 DOI: 10.1111/add.13164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/19/2015] [Accepted: 09/07/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Monitoring trends of alcohol-attributable mortality is an integral part of the global strategy to reduce the harmful use of alcohol. However, mortality estimates based on different age ranges come to different conclusions. This study examined the impact of including different age ranges in terms of directions of trends of alcohol-attributable mortality during 14 years in Switzerland. METHOD Alcohol-attributable mortality was estimated at four time-points between 1997 and 2011 using the Global Burden of Disease 2010 methodology. Estimates were obtained for two age groups: 15-64 years and the total adult population (15 years and older). RESULTS Alcohol-attributable mortality among 15-64-year-olds decreased [1997: 1334 deaths, confidence interval (CI) = 1237-1432; 2011: 1019 deaths, CI = 964-1073; trend per year odds ratio (OR) = 0.99, P < 0.001]. In contrast, alcohol-attributable mortality among those 65 and older increased in the same time-period (1997: 581 deaths, CI = -196 to 1357; 2011: 1664 deaths, CI = 957-2372; OR = 1.07, P< 0.001), resulting in an overall increase of alcohol-attributable mortality for 15+ year-olds (1997: 1915 deaths, CI = 1133-2697; 2011: 2683, CI = 1973-3393; OR = 1.02, P < 0.001). The main shift in trends was due to changes in the mixture (e.g. hypertension, ischaemic heart disease) of cardiovascular diseases over time among those 65+ years old. CONCLUSIONS Trends in alcohol-attributable mortality may yield qualitatively different results based on the upper age limit for deaths set for these estimates. Global trends of alcohol-attributable mortality between 1997 and 2011 were influenced heavily by changes in the mixture of deaths across cardiovascular diseases. Trends for alcohol-attributable mortality and cross-country comparisons should be reported separately for 15-64 and 65+ year-olds.
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Affiliation(s)
- Simon Marmet
- Research Institute, Addiction Switzerland, Lausanne, Switzerland
| | - Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada.,Institute for Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany.,Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,PAHO/WHO Collaborating Centre for Mental Health and Addiction, Toronto, Canada
| | - Gerhard Gmel
- Research Institute, Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Alcohol Treatment Center, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Switzerland.,University of the West of England, Frenchay Campus, Bristol, UK
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Abstract
OBJECTIVES To characterize the extent and nature of drug-alcohol interactions in older U.S. adults. DESIGN Cross-sectional. SETTING Community. PARTICIPANTS Nationally representative population-based sample of community-dwelling older adults (N = 2,975). MEASUREMENTS Regular drinkers were defined as respondents who consumed alcohol at least weekly. Medication use was defined as the use of a prescription or nonprescription medication or dietary supplement at least daily or weekly. Micromedex was used to determine drug interactions with alcohol and their corresponding severity. RESULTS One thousand one hundred six (41%) of the participants consumed alcohol regularly, and 567 (20%) were at-risk for a drug-alcohol interaction because they were regular drinkers and concurrently using alcohol-interacting medications. More than 90% of these interactions were of moderate or major severity. Antidepressants and analgesics were the most commonly used alcohol-interacting medications in regular drinkers. Older adult men with multiple chronic conditions had the highest prevalence of potential drug-alcohol interactions. CONCLUSION The potential for drug-alcohol interactions in the older U.S. adult population may have important clinical implications. Efforts to better understand and prevent the use of alcohol-interacting medications by regular drinkers, particularly heavy drinkers, are warranted in this population.
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Affiliation(s)
- Dima Mazen Qato
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois, Chicago, Illinois.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago, Illinois
| | - Beenish S Manzoor
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois, Chicago, Illinois
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois, Chicago, Illinois.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago, Illinois
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Britton A, Bell S. Reasons why people change their alcohol consumption in later life: findings from the Whitehall II Cohort Study. PLoS One 2015; 10:e0119421. [PMID: 25756213 PMCID: PMC4355077 DOI: 10.1371/journal.pone.0119421] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/13/2015] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Harmful alcohol consumption among the ageing population is an important public health issue. Very few studies ask drinkers why they change their consumption in later life. The aim of this paper was to determine whether a group of people aged over 60 years increased or decreased their alcohol consumption over the past decade and to determine the reasons for their change. We also examined whether the responses varied by age, sex and socio-economic position (SEP). SUBJECTS AND METHODS Data were taken from 6,011 participants (4,310 men, 1,701 women, age range 61 to 85 years) who completed questionnaires at phase 11 (2012-2013) of the Whitehall II Cohort Study. RESULTS Over half the study members reported a change in alcohol consumption over the past decade (40% decreased, 11% increased). The most common reasons given for decreases were as a health precaution and fewer social occasions. Common reasons for increases were more social occasions and fewer responsibilities. The lowest SEP group was less likely to increase consumption compared to high SEP (RR 0.57, 95% CI 0.40 to 0.81). Women were more likely to increase consumption in response to stress/depression than men (RR1.53, 95% CI 1.04 to 2.25). Compared to high SEP, the lowest SEP group was less likely to reduce as a health precaution (RR 0.61, 95% CI 0.38 to 0.76). CONCLUSIONS Alcohol consumption in late life is not fixed. Reasons for change vary by age, sex and SEP. Such information could be used to tailor intervention strategies to reduce harmful consumption.
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Affiliation(s)
- Annie Britton
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Steven Bell
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Breslow RA, Dong C, White A. Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res 2015; 39:371-9. [PMID: 25597432 PMCID: PMC4331237 DOI: 10.1111/acer.12633] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The majority of Americans consume alcoholic beverages. Alcohol interacts negatively with numerous commonly prescribed medications. Yet, on a population level, little is known about use of alcohol-interactive (AI) prescription medications among drinkers. The purpose of our study was to determine the prevalence of AI prescription medication use among current drinkers in the U.S. population. METHODS Data were from the National Health and Nutrition Examination Survey (NHANES 1999 to 2010); 26,657 adults aged ≥20 years had data on past year alcohol consumption and past month prescription medication use. Analyses were adjusted for covariates: age, race/ethnicity, education, marital status, and smoking. Statistical procedures accounted for survey stratification, clustering, and nonresponse. Analyses were weighted to be nationally representative. RESULTS The unadjusted total prevalence of AI medication use was 42.8% (95% confidence interval [CI] 41.5 to 44.0). Among current drinkers, adjusted prevalence was 41.5% (CI 40.3 to 42.7). Among participants aged ≥65 total prevalence of AI medication use was 78.6% (CI 77.3 to 79.9) and adjusted prevalence among current drinkers was 77.8% (CI 75.7 to 79.7). The AI medications most commonly used by current drinkers were cardiovascular agents, central nervous system agents, and metabolic agents. CONCLUSIONS Our results suggest that there could be substantial simultaneous exposure to alcohol and AI prescription medications in the U.S. population. Given the adverse health risks of combining alcohol with AI prescription medications, future efforts are needed to collect data to determine actual simultaneous prevalence.
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Affiliation(s)
- Rosalind A Breslow
- Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Silva PVCE, dos Santos MBF, Marchini L. Alcohol and Medication Use Among Elderly Community-dwelling Brazilians. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2013.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vaeth PAC, Caetano R, Durazo EM. Ethnicity and alcohol consumption among US adults with diabetes. Ann Epidemiol 2014; 24:720-6. [PMID: 25169682 DOI: 10.1016/j.annepidem.2014.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 07/05/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The drinking practices of a nationally representative sample of white, black, Mexican American, and other Hispanic adult diabetics are described and compared. METHODS Combined years (2005/2006-2011/2012) of the National Health and Nutrition Examination Survey provided home interview data from 2220 adults with self-reported diabetes of white (n = 875), black (n = 720), Mexican American (n = 402), and other Hispanic (n = 223) ethnicity. Current drinking status, the number of drinks consumed per week, and binge drinking were compared across ethnicity. RESULTS The multivariate findings for both diabetic men and women showed no statistically significant ethnic differences in current drinking status, and among women, there were no statistically significant ethnic differences in binge drinking. Among male diabetics, Mexican Americans consumed more drinks per week than whites (b = 0.35; 95% confidence interval, 0.13-0.58; P = .002) and were at increased risk for binge drinking (odds ratio, 2.04; 95% confidence interval, 1.30-3.21; P = .002). CONCLUSIONS Binge drinking is prevalent among Mexican American male diabetics. This pattern of drinking may put them at risk for poor diabetes management and control. It is important that health care providers routinely assess their patients' drinking practices and address the health risks associated with alcohol consumption.
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Affiliation(s)
- Patrice A C Vaeth
- Prevention Research Center, Oakland, CA; Pacific Institute for Research and Evaluation, Calverton, MD.
| | - Raul Caetano
- University of Texas School of Public Health, Dallas Regional Campus, Dallas
| | - Eva M Durazo
- Prevention Research Center, Oakland, CA; Pacific Institute for Research and Evaluation, Calverton, MD
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Cousins G, Galvin R, Flood M, Kennedy MC, Motterlini N, Henman MC, Kenny RA, Fahey T. Potential for alcohol and drug interactions in older adults: evidence from the Irish longitudinal study on ageing. BMC Geriatr 2014; 14:57. [PMID: 24766969 PMCID: PMC4008399 DOI: 10.1186/1471-2318-14-57] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults are susceptible to adverse effects from the concomitant use of prescription medications and alcohol. This study estimates the prevalence of exposure to alcohol interactive (AI) medications and concomitant alcohol use by therapeutic class in a large, nationally representative sample of older adults. METHODS Cross-sectional analysis of a population based sample of older Irish adults aged ≥60 years using data from The Irish Longitudinal Study on Ageing (TILDA) (N = 3,815). AI medications were identified using Stockley's Drug Interactions, the British National Formulary and the Irish Medicines Formulary. An in-home inventory of medications was used to characterise AI drug exposure by therapeutic class. Self-reported alcohol use was classified as non-drinker, light/moderate and heavy drinking. Comorbidities known to be exacerbated by alcohol were also recorded (diabetes mellitus, hypertension, peptic ulcer disease, liver disease, depression, gout or breast cancer), as well as sociodemographic and health factors. RESULTS Seventy-two per cent of participants were exposed to AI medications, with greatest exposure to cardiovascular and CNS agents. Overall, 60% of participants exposed to AI medications reported concomitant alcohol use, compared with 69.5% of non-AI exposed people (p < 0.001). Almost 28% of those reporting anti-histamine use were identified as heavy drinkers. Similarly almost one in five, combined heavy drinking with anti-coagulants/anti-platelets and cardiovascular agents, with 16% combining heavy drinking with CNS agents. Multinomial logistic regression showed that being male, younger, urban dwelling, with higher levels of education and a history of smoking, were associated with an increased risk for concomitant exposure to alcohol consumption (both light/moderate and heavier) and AI medications. Current smokers and people with increasing co-morbidities were also at greatest risk for heavy drinking in combination with AI medications. CONCLUSIONS The concurrent use of alcohol with AI medications, or with conditions known to be exacerbated by alcohol, is common among older Irish adults. Prescribers should be aware of potential interactions, and screen patients for alcohol use and provide warnings to minimize patient risk.
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Affiliation(s)
- Gráinne Cousins
- School of Pharmacy, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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Alomar MJ. Factors affecting the development of adverse drug reactions (Review article). Saudi Pharm J 2014; 22:83-94. [PMID: 24648818 PMCID: PMC3950535 DOI: 10.1016/j.jsps.2013.02.003] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/13/2013] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To discuss the effect of certain factors on the occurrence of Adverse Drug Reactions (ADRs). DATA SOURCES A systematic review of the literature in the period between 1991 and 2012 was made based on PubMed, the Cochrane database of systematic reviews, EMBASE and IDIS. Key words used were: medication error, adverse drug reaction, iatrogenic disease factors, ambulatory care, primary health care, side effects and treatment hazards. SUMMARY Many factors play a crucial role in the occurrence of ADRs, some of these are patient related, drug related or socially related factors. Age for instance has a very critical impact on the occurrence of ADRs, both very young and very old patients are more vulnerable to these reactions than other age groups. Alcohol intake also has a crucial impact on ADRs. Other factors are gender, race, pregnancy, breast feeding, kidney problems, liver function, drug dose and frequency and many other factors. The effect of these factors on ADRs is well documented in the medical literature. Taking these factors into consideration during medical evaluation enables medical practitioners to choose the best drug regimen. CONCLUSION Many factors affect the occurrence of ADRs. Some of these factors can be changed like smoking or alcohol intake others cannot be changed like age, presence of other diseases or genetic factors. Understanding the different effects of these factors on ADRs enables healthcare professionals to choose the most appropriate medication for that particular patient. It also helps the healthcare professionals to give the best advice to patients. Pharmacogenomics is the most recent science which emphasizes the genetic predisposition of ADRs. This innovative science provides a new perspective in dealing with the decision making process of drug selection.
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Affiliation(s)
- Muaed Jamal Alomar
- Address: P.O. Box 222319, Al Ain, United Arab Emirates. Tel.: +971 507157641; fax: +971 37378728.
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Bright SJ, Fink A, Beck JC, Gabriel J, Singh D. Development of an Australian version of the Alcohol-Related Problems Survey: a comprehensive computerised screening tool for older adults. Australas J Ageing 2013; 34:33-7. [PMID: 24118773 DOI: 10.1111/ajag.12098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM The Alcohol-Related Problems Survey (ARPS) reliably classifies drinking as non-hazardous, hazardous or harmful using scoring algorithms that consider quantity and frequency of alcohol use alone and in combination with health conditions, medication-use and functional status. Because it has been developed using a 14-g US standard drink, it is not valid in Australia where a standard drink contains 10 g of ethanol. METHOD We recalibrated the ARPS scoring algorithms for a 10-g Australian standard drink and updated the list of medications. The Australian ARPS (A-ARPS) was then administered to 50 non-treatment-seeking participants in waves of five. RESULTS The A-ARPS recalibrated scoring algorithms reliably classified all 50 individuals. Sixty-six per cent were classified as hazardous or harmful drinkers. Many were taking medications that interact with alcohol or had medical conditions that can be exacerbated by alcohol consumption. CONCLUSION The A-ARPS is available for use in Australia. Its utilisation could reduce the incidence of alcohol-related harms.
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Affiliation(s)
- Stephen J Bright
- Peninsula Health, Frankston, Victoria, Australia; Curtin University, Perth, Western Australia, Australia
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Ryan M, Merrick EL, Hodgkin D, Horgan CM, Garnick DW, Panas L, Ritter G, Blow FC, Saitz R. Drinking patterns of older adults with chronic medical conditions. J Gen Intern Med 2013; 28:1326-32. [PMID: 23609178 PMCID: PMC3785666 DOI: 10.1007/s11606-013-2409-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 01/10/2013] [Accepted: 02/27/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population. OBJECTIVES To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions. DESIGN/METHODS This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n = 7,422). Based on self-reported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines). RESULTS Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking. CONCLUSIONS Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.
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Affiliation(s)
- Marian Ryan
- Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS035, Waltham, MA, 02454-9110, USA,
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Abstract
OBJECTIVES The aim of this study was to assess the possibility of clinically significant drug-alcohol interactions among home-dwelling older adults aged ≥ 65 years. DESIGN This study was a cross-sectional assessment of a stratified random sample of 2100 elderly people (≥ 65 years) in Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. The drugs were coded according to their Anatomical Therapeutic Chemical (ATC) classification index (ATC DDD 2012). Significant alcohol interactive (AI) drugs were examined according to the Swedish, Finnish, INteraction X-referencing (SFINX) interaction database, as well as concomitant use of central nervous system drugs, hypoglycaemics, and warfarin with alcohol. "At-risk alcohol users" were defined consuming > 7 drinks/week, or ≥ 5 drinks on a typical drinking day, or using ≥ 3 drinks several times/week, "moderate users" as consuming at least one drink/month, but less than 7 drinks/week, and "minimal/non-users" less than one drink/month. RESULTS Of the total sample (n = 1395), 1142 respondents responded as using at least one drug. Of the drug users, 715 (62.6%) persons used alcohol. The mean number of medications was 4.2 (SD 2.5) among "at-risk users", 4.0 (SD 2.6) among "moderate users", and 5.4 (SD 3.4) among "minimal/non-users" (p < 0.001). The concomitant use of AI drugs was widespread. Among the "at-risk users", "moderate users", and "minimal/nonusers" 42.2%, 34.9%, and 52.7%, respectively, were on AI drugs (p < 0.001). One in 10 of "at-risk users" used warfarin, hypnotics/sedatives, or metformin. CONCLUSIONS Use of AI drugs is common among older adults, and this increases the potential risks related to the use of alcohol.
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Affiliation(s)
- Sirpa Immonen
- Espoo City Social and Health Services, Network of Academic Health Centers, University of Helsinki, Unit of General Practice, University Hospital of Helsinki, Helsinki, Finland.
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Zanjani F, Hoogland AI, Downer BG. Alcohol and prescription drug safety in older adults. DRUG HEALTHCARE AND PATIENT SAFETY 2013; 5:13-27. [PMID: 23467625 PMCID: PMC3589245 DOI: 10.2147/dhps.s38666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The objectives of this study were to investigate older adults’ knowledge of prescription drug safety and interactions with alcohol, and to identify pharmacists’ willingness to disseminate prescription drug safety information to older adults. Methods The convenience sample consisted of 48 older adults aged 54–89 years who were recruited from a local pharmacy and who completed surveys addressing their alcohol consumption, understanding of alcohol and prescription drug interactions, and willingness to change habits regarding alcohol consumption and prescription drugs. To address pharmacist willingness, 90 pharmacists from local pharmacies volunteered and answered questions regarding their willingness to convey prescription drug safety information to older adults. Results Older adults reported low knowledge of alcohol and prescription drug safety, with women tending to be slightly more knowledgeable. More importantly, those who drank in the previous few months were less willing to talk to family and friends about how alcohol can have harmful interactions with prescription drugs, or to be an advocate for safe alcohol and prescription drug use than those who had not had a drink recently. Pharmacists reported that they were willing to convey prescription drug safety information to older adults via a variety of formats, including displaying or distributing a flyer, and directly administering a brief intervention. Conclusion In this study, older adults were found to have inadequate knowledge of prescription drug safety and interactions with alcohol, but pharmacists who regularly come in contact with older adults indicated that they were ready and willing to talk to older adults about prescription drug safety. Future research should focus on interventions whereby pharmacists disseminate prescription drug safety information to older adults in order to improve healthy prescription drug and alcohol behavior and reduce medical and health costs associated with interactions between alcohol and prescription drugs.
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Affiliation(s)
- Faika Zanjani
- Department of Gerontology, University of Kentucky, Lexington, KY, USA ; Building Interdisciplinary Research Careers in Women's Health, University of Kentucky, Lexington, KY, USA
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Ilomäki J, Paljärvi T, Korhonen MJ, Enlund H, Alderman CP, Kauhanen J, Bell JS. Prevalence of concomitant use of alcohol and sedative-hypnotic drugs in middle and older aged persons: a systematic review. Ann Pharmacother 2013; 47:257-68. [PMID: 23362039 DOI: 10.1345/aph.1r449] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To systematically review the prevalence of concomitant alcohol and sedative-hypnotic use among middle-aged and older persons. DATA SOURCES A bibliographic search of English-language literature was performed using MEDLINE, EMBASE, and PsycINFO (January 1990-August 2012). The reference lists of all included articles were screened for additional relevant articles not identified by any of the bibliographic searches. STUDY SELECTION AND DATA EXTRACTION Population-based studies in which the mean age of participants was 40 years or older were included. For a study to be included in the review, alcohol use had to be reported in terms of the quantity or frequency consumed. Data from included articles were extracted using a standardized data extraction tool. DATA SYNTHESIS Five population-based studies conducted in North America, 10 in Europe, and 1 in Australia were included in the review. Up to 88% of men and 79% of women who used sedative-hypnotics also consumed alcohol. Up to 28% of those who consumed alcohol were concomitant users of sedative-hypnotics. Alcohol was consumed at higher levels among middle-aged than older persons. Risky drinking (eg, binge drinking, heavy drinking) was more prevalent among middle-aged than older persons. In contrast, sedative-hypnotic use was more prevalent among older persons. CONCLUSIONS Our review identified a higher prevalence of alcohol consumption among middle-aged than older persons. However, middle-aged persons may experience harm from alcohol/sedative-hypnotic drug interactions due to risky drinking behavior. Despite lower levels of alcohol consumption, older persons may be more susceptible to addictive central nervous system effects than younger persons because of physiologic changes in psychotropic drug and alcohol metabolism. Clinicians should consider patients' alcohol consumption patterns before prescribing sedative-hypnotic drugs.
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Affiliation(s)
- Jenni Ilomäki
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
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Smyth T, Sheehan M, Siskind V. Hospital outpatients' responses to taking medications with driving warnings. TRAFFIC INJURY PREVENTION 2013; 14:18-25. [PMID: 23259515 DOI: 10.1080/15389588.2012.684224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The study investigates the knowledge, intentions, and driving behavior of persons prescribed medications that display a warning about driving. It also examines their confidence that they can self-assess possible impairment, as is required by the Australian labeling system. METHOD We surveyed 358 outpatients in an Australian public hospital pharmacy, representing a well-advised group taking a range of medications including those displaying a warning label about driving. A brief telephone follow-up survey was conducted with a subgroup of the participants. RESULTS The sample had a median age of 53.2 years and was 53 percent male. Nearly three quarters (73.2%) had taken a potentially impairing class of medication and more than half (56.1%) had taken more than one such medication in the past 12 months. Knowledge of the potentially impairing effects of medication was relatively high for most items; however, participants underestimated the possibility of increased impairment from exceeding the prescribed dose and at commencing treatment. Participants' responses to the safety implications of taking drugs with the highest level of warning varied. Around two thirds (62.8%) indicated that they would consult a health practitioner for advice and around half would modify their driving in some way. However, one fifth (20.9%) would drive when the traffic was thought to be less heavy and over a third (37.7%) would modify their medication regime so that they could drive. The findings from the follow-up survey of a subsample taking target drugs at the time of the first interview were also of concern. Only just over half (51%) recalled seeing the warning label on their medications and, of this group, three quarters (78%) reported following the warning label advice. These findings indicated that there remains a large proportion of people who either did not notice or did not consider the warning when deciding whether to drive. There was a very high level of confidence in this group that they could determine whether they were personally affected by the medication, which may be a problem from a safety perspective. CONCLUSION This study involved persons who should have had a very high level of knowledge and awareness of medication warning labeling. Even in this group there was a lack of informed response to potential impairment. A review of the Australian warning system and wider dissemination of information on medication treatment effects would be useful. Clarifying the importance of potential risk in the general community context is recommended for consideration and further research.
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Affiliation(s)
- T Smyth
- Centre for Accident Research and Road Safety-Queensland, Queensland University of Technology, Queensland, Australia.
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Castle NG, Wagner LM, Ferguson-Rome JC, Smith ML, Handler SM. Alcohol Misuse and Abuse Reported by Nurse Aides in Assisted Living. Res Aging 2011. [DOI: 10.1177/0164027511423929] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alcohol misuse and abuse in Assisted Living (AL) as reported by nurse aides is examined. Data came from a secondary analysis of nurse aides included in the Pennsylvania nurse aide registry. A total of 832 nurse aides had a prior place of employment in AL. Information reported from these nurse aides include the percent of residents identified as drinking alcohol, opinions of alcohol misuse and abuse, and the prevalence of alcohol misuse and abuse. Nurse aides believe a majority (69%) of AL residents drink alcohol. Of these residents, 34% are thought to drink alcohol daily. Estimated prevalence rates show that in 19% of cases nurse aides believe alcohol consumption has influenced residents’ health and 28% are suspected to make poor choices for alcohol consumption. The findings present preliminary evidence that alcohol misuse and abuse may be a problem of importance in AL. Given the potential impact of this on the health, safety, and quality of life for elders, more attention should be focused on alcohol misuse and abuse by residents living in AL.
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Affiliation(s)
| | - Laura M. Wagner
- New York University College of Nursing, New York, New York, USA
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Ilomäki J, Bell JS, Kauhanen J, Enlund H. Heavy drinking and use of sedative or anxiolytic drugs among aging men: an 11-year follow-up of the FinDrink study. Ann Pharmacother 2011; 45:1240-7. [PMID: 21896919 DOI: 10.1345/aph.1q375] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Most studies on heavy drinking and sedative/anxiolytic drug use have been cross-sectional, and evidence for a possible temporal association is lacking. OBJECTIVE To prospectively investigate whether heavy drinking predicts initiation, continuation, or discontinuation of sedative/anxiolytic drugs at 4 and 11 years and, conversely, whether sedative/anxiolytic drug use predicts heavy drinking. METHOD This was a longitudinal population-based study conducted in Kuopio, Finland. An age-stratified random sample of 1516 men aged 42, 48, 54, and 60 years received a structured clinical examination at baseline (August 1986-December 1989). Follow-up clinical examinations were conducted at 4 (n = 1038) and 11 (n = 854) years. Multinomial logistic regression was used to compute odds ratios and 95% confidence intervals for the association between sedative/anxiolytic drug use and initiation, continuation, and discontinuation of heavy drinking (≥ 14 drinks/wk). The reverse association between heavy drinking and sedative/anxiolytic drug use was also investigated. Regression models were adjusted for age, working status, smoking, and depressive symptoms. RESULTS At baseline 12.9% (134/1038) of participants were heavy drinkers and 4.0% (41/1030) used sedative/anxiolytic drugs. In multivariate analyses, baseline heavy drinking predicted initiation of sedative/anxiolytic drug use at 4 years (OR 2.96; 95% CI 1.23 to 7.15). Conversely, baseline sedative/anxiolytic drug use predicted continuation of heavy drinking at 11 years in unadjusted analysis (OR 3.30; 95% CI 1.19 to 8.44). However, the association was not statistically significant in adjusted analyses (OR 2.69; 95% CI 0.86 to 8.44). CONCLUSIONS The main finding of this study was the association between heavy drinking and subsequent initiation of sedative/anxiolytic drugs that was not fully explained by baseline depressive symptoms. This may inform strategies to optimize the use of sedative/anxiolytic drugs, and assist in the early identification of patients at risk of heavy drinking. Clinicians should consider a patient's alcohol consumption prior to prescribing or dispensing sedative/anxiolytic drugs. Clinicians should also monitor patients prescribed sedative/anxiolytic drugs for subsequent heavy drinking.
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Affiliation(s)
- Jenni Ilomäki
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
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Brennan PL, Schutte KK, SooHoo S, Moos RH. Painful medical conditions and alcohol use: a prospective study among older adults. PAIN MEDICINE 2011; 12:1049-59. [PMID: 21668742 DOI: 10.1111/j.1526-4637.2011.01156.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Penny L Brennan
- Center for Health Care Evaluation, VA Palo Alto Health Care System & Stanford University Medical Center, Palo Alto, CA 94025, USA.
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Abstract
Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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