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Kuerbis A, Behrendt S, Morgenstern J. Age as a moderator of motivational interviewing and nondirective client-centered psychotherapy for alcohol use disorder: An exploratory study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:527-539. [PMID: 36871206 PMCID: PMC10050112 DOI: 10.1111/acer.15015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Motivational interviewing (MI) is a widely used intervention applied to a host of health behaviors, including alcohol consumption among individuals with alcohol use disorder (AUD). Age is an underexplored moderator of MI for treating AUD, with the impact of comparing older individuals with their younger counterparts virtually unexplored. Also unexplored is whether age is associated with distinct mechanisms of change (e.g., motivation and self-efficacy) within treatment. METHODS This secondary data analysis utilizes combined data from two previous studies (total N = 228) that both aimed to test MI's mechanisms of action in the context of a goal for moderated drinking. Both studies had three conditions: MI, nondirective listening (NDL), and a self-change condition (SC). In the current analyses, the moderating impact of continuous age and age group, <51 (younger adults, YA) versus ≥51 (older adults, OA), on the impact of MI on alcohol use compared to NDL and SC were tested using generalized linear models. Age differences in confidence and commitment to reduce heavy drinking during treatment were also explored. RESULTS Age group by condition differences emerged, where NDL significantly reduced drinking among YA but not OA (mean -12 vs. -3 standard drinks, respectively). Among OA, MI outperformed NDL but not SC, though the effect was weak. Confidence and commitment during treatment were not significantly different across age-by-condition groups. CONCLUSION Findings underscore the importance of understanding the impact of age on treatment effectiveness, as providing a nondirective intervention for OA with AUD could provide suboptimal treatment. Further research is needed to explore these differential effects.
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Affiliation(s)
- Alexis Kuerbis
- Silberman School of Social Work, Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035
| | - Silke Behrendt
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, and Psychiatric Department, Region of Southern Denmark, J.B. Winsløws Vej 20, indg. 220 B, 5000 Odense C, Denmark, and OPEN Patient data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; BRIDGE, Brain Research, Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; and Institute of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jon Morgenstern
- Center for Addiction Services and Psychotherapy Research, Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, N.Y., 11021
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Social capital and alcohol risks among older adults (50 years and over): analysis from the Drink Wise Age Well Survey. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Although there has been significant research on the relationship between alcohol consumption and demographic and psychological influences, this does not consider the effect of social influence among older drinkers and if these effects differ between men and women. One aspect of social influence is social capital. The aim of this paper is to examine whether relational and cognitive social capital are associated with higher or lower risk of alcohol use among adults aged 50 years or older and to assess the extent to which this relationship differs between men and women. To investigate this, data were collected from a cross-sectional questionnaire survey of adults over the age of 50 in the United Kingdom who were recruited from general practitioners. The sample consisted of 9,984 individuals whose mean age was 63.87 years. From these data, we developed proxy measures of social capital and associate these with the respondent's level of alcohol consumption as measured on the Alcohol Use Disorders Identification Test (AUDIT-10) scale. In the sample, just over 20 per cent reported an increasing risk or dependency on alcohol. Using two expressions of social capital – relational (social relationships) and cognitive (knowledge acquisition and understanding) – we found that greater levels of both are associated with a reduced risk of higher drinking risk. Being female had no significant effect when combined with relational capital but did have a significant effect when combined with cognitive capital. It is argued that interventions to enhance social relations among older people and education to help understand alcohol risks would be helpful to protect older people from the damaging effects of excessive alcohol consumption.
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Qiu Y, Lv X, Wu T, Zhang Y, Wang H, Li B, Yu X. Prevalence and Correlates of Risky Drinking Among the Oldest-Old in China: A National Community-Based Survey. Front Psychiatry 2022; 13:919888. [PMID: 35711592 PMCID: PMC9195865 DOI: 10.3389/fpsyt.2022.919888] [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: 04/14/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
AIMS To investigate the prevalence and correlates of risky drinking in Chinese elderly people aged 80 and over. METHODS Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2018. A total of 10,141 respondents aged 80 years or older were included in this analysis. Risky drinking was defined as drinking > 2 drinks per day. The participants were divided into no risky drinking, past risky drinking, and current risky drinking groups. The prevalence of risky drinking, daily dosage, and type of alcohol beverages were assessed. The correlates of risky drinking were analyzed using logistic regression. RESULTS The prevalence of past and current risky drinking was 6.2 and 4.4%, respectively. A total of 12.2% of males and 2.1% of females reported past risky drinking, and 8.9% of males and 1.4% of females reported current risky drinking. The median of the daily dosage of the past risky drinking group was 4.5 and 4 drinks in males and females, respectively, and were 4 and 3.3, respectively, of the current risky drinking group. Strong liquor was the most popular alcohol beverage in all groups. Men who were older or had white-collar work were less likely to be past risky drinkers, while those with smoking in past or current or heart disease were more likely to be past risky drinkers. Women who smoked in the past were more likely to be past risky drinkers. Men with older age or living in the urban areas or with heart disease were less likely to be current risky drinkers. Women with higher education or with heart disease were less likely to be current risky drinkers. Women with current smoking were more likely to have current risky drinking. CONCLUSIONS Our findings indicated that risky drinking among the oldest-old was not rare in China. The correlates of past and current risky drinking were different. Men and women had various correlates of risky drinking as well. Those with higher socioeconomic status seemed less likely to be risky drinking. More attention should be given to risky drinking among the oldest old, and sex-specific intervention may be needed.
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Affiliation(s)
- Yujia Qiu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Xiaozhen Lv
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Tingfang Wu
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Huali Wang
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Bing Li
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
| | - Xin Yu
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
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Farinelli LA, Piacentino D, Browning BD, Brewer BB, Leggio L. Cardiovascular Consequences of Excessive Alcohol Drinking via Electrocardiogram: A Systematic Review. J Addict Nurs 2021; 32:39-45. [PMID: 33646717 PMCID: PMC7927905 DOI: 10.1097/jan.0000000000000384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT There is a link between excessive alcohol drinking and an increased risk to develop cardiovascular disease, including alcoholic cardiomyopathy. This association warrants further research on the potential utility for the electrocardiogram (ECG) in the participatory management of the chronic consequences of alcohol use disorder (AUD). Our goal is to enhance understanding about the pernicious role alcohol plays on cardiac health using the ECG, an accessible, cost-effective, validated tool to inform novel targeted treatments for AUD. In this systematic review of human studies, we examine the relationship between abnormal clinically significant changes to ECG variables and excessive alcohol drinking with the goal of identifying key patterns specific to quantity of alcohol consumed. Three independent reviewers and one consensus reviewer, adhering to the PRISMA guidelines, conducted an initial review on studies published from database inception to April 19, 2019, using PubMed, Embase, CINAHL and COCHRANE databases. The initial search generated 2,225 articles. The final selected number included 153 original articles. This systematic review provides evidence of patterns of clinically significant changes to ECG variables as a consequence of excessive alcohol consumption. Future directions include investigating whether a real-time assessment, such as the ECG, in conjunction with other key behavioral and cardiac measures, can help clinicians and patients realize the progressive and insidious cardiac damage because of excessive alcohol consumption. This theory-guided nurse science review supports the development of personalized symptom monitoring to deliver tailored feedback that illuminate risk factors as a potentially transformative approach in the management of AUD.
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Affiliation(s)
- Lisa A. Farinelli
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
- College of Nursing, University of Arizona, Tucson, AZ
| | - Daria Piacentino
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
- Center on Compulsive Behaviors, National Institutes of Health Intramural Research Program, Bethesda, MD
| | - Brittney D. Browning
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
| | | | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
- Center on Compulsive Behaviors, National Institutes of Health Intramural Research Program, Bethesda, MD
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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van Gils Y, Franck E, Dierckx E, van Alphen SPJ, Dom G. The Role of Psychological Distress in the Relationship between Drinking Motives and Hazardous Drinking in Older Adults. Eur Addict Res 2021; 27:33-41. [PMID: 32434195 DOI: 10.1159/000507664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Drinking motives seem to be the most proximal predictors of alcohol outcomes. Consequently, these are an essential factor to consider as they may influence the extent to which alcohol is used in a risky way, even in older adults. OBJECTIVE We studied the moderating effect of distress on the relationship between drinking motives and drinking behaviour in a community-dwelling older adult sample. METHOD In a retrospective cross-sectional research study, participants were community-dwelling older adults aged 65 years and older. All respondents completed a questionnaire covering the Drinking Motives Questionnaire (DMQ), the Alcohol Use Disorders Identification Test (AUDIT), and the General Severity Index (GSI) of the Brief Symptom Inventory (BSI). RESULTS In this sample of 1,148 older adults, drinking motives and hazardous alcohol use were associated (enhancement motives r = 0.478, p < 0.001; coping motives r = 0.367, p < 0.001; and social motives r = 0.235, p < 0.001). Furthermore, moderation analysis showed that older adults drinking predominantly for enhancement or coping motives (respectively, β = 0.433, CI [95%] = 2.557-3.222 and β = 0.327, CI [95%] = 1.077-1.491, p < 0.001), and older adults who had higher levels of psychological distress (β = 2.518, CI [95%] = 2.017-3.019, p < 0.001) were more likely to report higher degree of hazardous alcohol use. CONCLUSION The relations between coping drinking motives and enhancement drinking motives on hazardous drinking depended on the level of distress. The associations between drinking for coping and drinking for enhancement were stronger in high levels of distress. Although causality cannot be interpreted from cross-sectional data, tackling psychological distress and drinking to cope with negative affect or to enhance positive affect might have strong effects on reducing hazardous drinking behaviour among older adults.
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Affiliation(s)
- Yannic van Gils
- Faculty of Medicine and Social Science, University of Antwerp, Wilrijk, Belgium, .,Faculty of Psychology and Educational Science, Free University Brussel, Elsene, Belgium,
| | - Erik Franck
- Faculty of Medicine and Social Science, University of Antwerp, Wilrijk, Belgium
| | - Eva Dierckx
- Faculty of Psychology and Educational Science, Free University Brussel, Elsene, Belgium.,Alexianen Zorggroep Tienen, Psychiatric Hospital, Tienen, Belgium
| | - Sebastiaan P J van Alphen
- Faculty of Psychology and Educational Science, Free University Brussel, Elsene, Belgium.,Clinical Centre of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Geert Dom
- Alexianen Zorggroep Multiversum, Psychiatric Hospital, Boechout, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium
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Mihailovic N, Szőllősi GJ, Rancic N, János S, Boruzs K, Nagy AC, Timofeyev Y, Dragojevic-Simic V, Antunovic M, Reshetnikov V, Ádány R, Jakovljevic M. Alcohol Consumption among the Elderly Citizens in Hungary and Serbia-Comparative Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1289. [PMID: 32079338 PMCID: PMC7068319 DOI: 10.3390/ijerph17041289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 01/03/2023]
Abstract
Studies in the alcohol consumption area are mostly related to the (ab)use of alcohol in young people. However, today, a growing number of researchers are emphasizing the clinical and public health significance of alcohol consumption in the elderly. In the WHO reports, harmful alcohol consumption is responsible for 5.3% of the global burden of the disease. The aim of this study was to investigate the prevalence of alcohol consumption among men and women aged 55 and over in Serbia and Hungary, leveraging data from the 2013 Serbian National Health Survey and from the 2014 Hungarian National Health Survey. Respondents aged 55 and over were analysed based on logistic multivariate models. The prevalence of alcohol consumption was 41.5% and 62.5% in Serbia and Hungary, respectively. It was higher among men in both countries, but among women, it was significantly higher in Hungary than in Serbia. The statistically significant predictors affecting alcohol consumption in Serbia included age, education, well-being index, long-term disease and overall health status, with marital status being an additional factor among men. In Hungary, education and long-term disease affected alcohol consumption in both sexes, while age and employment were additional factors among women. In both countries for both sexes, younger age, more significantly than primary education and good health, was associated with a higher likelihood of alcohol consumption.
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Affiliation(s)
- Natasa Mihailovic
- Institute of Public Health Kragujevac, Department of Biostatistics and Informatics, Nikole Pašića 1, 34000 Kragujevac, Serbia
| | - Gergő József Szőllősi
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
| | - Nemanja Rancic
- The Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia
| | - Sándor János
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
| | - Attila Csaba Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, H-4002 Debrecen, Hungary
| | - Yuriy Timofeyev
- National Research University Higher School of Economics, Shabolovka Ulitsa 26-28, 119049 Moscow, Russian
| | - Viktorija Dragojevic-Simic
- The Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia
| | - Marko Antunovic
- National Poison Control Center, Medical Faculty, Military Medical Academy, University of Defence, Crnotravska 17, 11000 Belgrade, Serbia
| | - Vladimir Reshetnikov
- N.A. Semashko Department of Public Health and Healthcare, I.M. Sechenov the First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Róza Ádány
- MTA-DE Public Health Research Group, Public Health Research Institute, University of Debrecen, H-4002 Debrecen, Hungary
| | - Mihajlo Jakovljevic
- N.A. Semashko Department of Public Health and Healthcare, I.M. Sechenov the First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Department of Global Health Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Institute of Comparative Economic Studies, Hosei University, Tokyo 194-0298, Japan
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Interactive Effects of Quality of Life and Related Factors on Alcohol Use Outcomes. Can J Aging 2020; 40:49-67. [PMID: 32029021 DOI: 10.1017/s0714980819000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This investigation derives its impetus from public health concerns around detecting, mitigating, and preventing the deleterious effects that alcohol use can cause particularly in advanced age. We aim to complement gerontological research by exploring the interactive effects of quality of life and related factors on alcohol use outcomes assessed by the Drinking Problem Index. The study is based on cross-sectional data collected from questionnaires mailed to a randomly drawn sample of 6,000 Norwegian adults aged 62 and older (participation rate: 32%). According to the Chi-square Automatic Interaction Detection (CHAID) analysis, constellations of interactive factors emerged differently for women and men, and, between non-problem and problem drinkers. For women, drinking outcomes were related to intra-psychic functioning, and for men, to physical health and social situation. An ongoing quality-of-life assessment may be very important in the comprehensive assistance provided to those older people who are vulnerable to undergoing alcohol-related harms.
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Szabó Á, Towers A, Sheridan J, Newcombe D. Ten-Year Trajectories of Alcohol Consumption in Older Adult New Zealanders. J Gerontol B Psychol Sci Soc Sci 2019; 76:496-506. [PMID: 31680155 DOI: 10.1093/geronb/gbz143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Older adults are often treated as a homogeneous drinking group, but research suggests that they engage with alcohol in various ways, ranging from abstention to heavy drinking. The study aimed to (i) identify subgroups of older adults based on changes in frequency and quantity of alcohol use over 10 years and (ii) examine co-occurring changes in mental and physical health. METHOD Data were collected biennially between 2006 and 2016 from 2,632 New Zealanders (55-70 years old at baseline). Latent class growth analysis was performed to identify trajectories of alcohol use. Co-occurring changes in physical and mental health were examined using latent growth curve analysis. RESULTS Five drinking profiles emerged: (i) infrequent, low-quantity consumers; (ii) highly frequent, low-quantity consumers; (iii) moderately frequent, high-quantity consumers; (iv) moderately frequent, low-quantity consumers; and (v) highly frequent, high-quantity consumers. Drinking trajectories demonstrated no change or slight declines in frequency and quantity over time. Frequent and moderately frequent, high-quantity drinking was more prevalent among men, younger participants, and active smokers. Moderately frequent, heavy drinkers were in very poor health. Frequent and moderately frequent, low-quantity drinking was associated with better health and economic well-being. Infrequent, low-quantity consumers were more likely to be women and in poor health. DISCUSSION The five drinking profiles indicate that older adults engage with alcohol in diverse ways. Two of these patterns indicated potentially hazardous use, which highlights the need for screening and intervention in this age group.
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Affiliation(s)
- Ágnes Szabó
- School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Andy Towers
- School of Health Sciences, College of Health, Massey University, Wellington, New Zealand
| | - Janie Sheridan
- Centre for Addiction Research, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
| | - David Newcombe
- Centre for Addiction Research, Faculty of Medical and Health Sciences, the University of Auckland, New Zealand
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Affiliation(s)
- Susan W Lehmann
- From the Johns Hopkins University School of Medicine, Baltimore
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Effect of electronic screening and brief intervention on hazardous or harmful drinking among adults in the hospital outpatient setting: A randomized, double-blind, controlled trial. Drug Alcohol Depend 2018; 191:78-85. [PMID: 30096637 DOI: 10.1016/j.drugalcdep.2018.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/22/2018] [Accepted: 06/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. METHODS This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5-9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. RESULTS 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96-1.31]; P = .17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P = .44). CONCLUSION These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.
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Zanjani F, Allen HK, Schoenberg N, Martin C, Clayton R. Immediate effects of a brief intervention to prevent alcohol and medication interactions among older adults. HEALTH EDUCATION RESEARCH 2018; 33:261-270. [PMID: 29982394 PMCID: PMC6049010 DOI: 10.1093/her/cyy021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
Risk of experiencing alcohol and medication interactions (AMI) is significant among older adults due to the substantial prevalence of alcohol and medication use in this segment of the population. Given the lack of community-level AMI prevention interventions for older adults, this study aimed to examine the immediate effects of a brief, pharmacy-based intervention to prevent AMI among older adults, as well as assess differential effects by past-month drinking status. A convenience sample of 134 adults aged 59 and older was recruited from four pharmacies in rural Virginia. Participants were assessed on their AMI awareness, intentions and importance prior to and immediately after exposure to intervention materials. Findings support immediate, positive intervention effects on AMI awareness, intentions and perceived importance of AMI messaging. Changes from pre to post-test did not differ by drinking status, but participants who consumed alcohol were less likely than non-drinkers to recognize the potential consequential severity of alcohol and medication interactions at both time points. Recommendations and future research to prevent AMI are discussed.
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Affiliation(s)
- Faika Zanjani
- Department of Gerontology, School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Hannah K Allen
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
| | - Catherine Martin
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Richard Clayton
- Department of Health, Behavior, and Society, College of Public Health, University of Kentucky, Lexington, KY, USA
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Abstract
SummaryThe clinical and public mental health aspects of alcohol misuse in older people (both men and women) have increasing relevance for both old age and addiction psychiatrists. Clinical presentations are often complex and involve a number of different psychiatric, physical and psychosocial factors. The assessment, treatment and aftercare of alcohol-related and comorbid other mental disorders will also involve a broad range of interventions from a wide range of practitioners. Given its growing clinical relevance, there are particular areas, such as alcohol-related brain damage and drug interactions with alcohol, that deserve special attention.
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13
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Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
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Kuerbis A, Treloar H, Shao S, Houser J, Muench F, Morgenstern J. Comparing daily drivers of problem drinking among older and younger adults: An electronic daily diary study using smartphones. Drug Alcohol Depend 2018; 183:240-246. [PMID: 29306171 PMCID: PMC5803426 DOI: 10.1016/j.drugalcdep.2017.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND By 2030, numbers and proportions of older adults with substance-use problems are expected to increase. While risk factors for problem drinking in late life have been identified, it remains unknown whether these factors drive daily drinking among older problem drinkers. This study examined the daily drivers of drinking among problem drinkers, moderated by age, utilizing ecological momentary assessment (EMA). METHOD Participants (N = 139), ages 20-73, received daily EMA online surveys completed via a smartphone prior to initiation of treatment. Multilevel modeling tested the moderating impact of age on within- and between-person relationships between drinking and focal predictors (mood, loneliness, boredom, stress, poor sleep, social factors, alcohol salience, commitment and confidence not to drink heavily). RESULTS Older adults reported greater alcohol consumption when daily boredom levels were higher. Heavier drinking among younger adults was associated with poorer sleep quality. Greater daily confidence, daily commitment and daily alcohol salience did not impact drinking to the same extent for older adults as for younger adults. Greater person-level commitment predicted reduced drinking equivalently across age, but low person-level commitment predicted greater drinking among older adults compared to their younger counterparts. CONCLUSION Older adults may have unique daily drivers of drinking that are not fully realized in current research and intervention efforts. Addressing the growing substance-use treatment needs among this population will require identifying the unique drivers of drinking among older adults, such as boredom, when compared to younger adults.
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Affiliation(s)
- Alexis Kuerbis
- Silberman School of Social Work, Hunter College at City University of New York, 2180 Third Avenue, New York, NY 10035, United States.
| | - Hayley Treloar
- Brown University, Department of Psychiatry and Human Behavior, Center for Alcohol and Addiction Studies, BOX G-S121––, Providence, RI 02912, United States
| | - Sijing Shao
- Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, NY, 11021, United States.
| | - Jessica Houser
- Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, NY, 11021, United States.
| | - Fred Muench
- Partnership for Drug Free America/Kids, 352 Park Avenue South, 9th Floor, New York, NY 10010, United States
| | - Jon Morgenstern
- Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, NY, 11021, United States.
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15
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Alcohol and older people: A systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design. PLoS One 2018; 13:e0191189. [PMID: 29370214 PMCID: PMC5784942 DOI: 10.1371/journal.pone.0191189] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022] Open
Abstract
Background Harmful alcohol consumption in older people has increased and effective approaches to understanding and addressing this societal concern are needed. Methods Systematic review of qualitative studies in older populations (55+ years) to identify barriers, facilitators or context of drinking in older people. Multiple databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL, Social Sciences Citation Index, York Centre for Reviews and Dissemination, Cochrane database and grey literature) were searched from 2000 to February 2017 for studies in English, from OECD countries using MeSH terms and text words relating to alcohol combined with older age terms. Study quality was assessed using NICE methodology. The review is reported according to PRISMA. Results Drinking in older people is strongly linked to social engagement and there is scepticism about the health risks of alcohol. Drinking was also linked to difficulties such as social isolation, illness or bereavement. Alcohol can be related to routines and identity. However, older people often regulate their own drinking and strategies that emphasise the life experience of older people to drink wisely could be helpful. Conclusions To be effective societal approaches need to take into account contexts of risks for harmful drinking. The evidence supports a strong social role for drinking alcohol which should be taken into account in any policy development with the potential benefits of social participation for cognitive health. Approaches to reducing alcohol use in older people need to avoid paradoxical harm, with a need for approaches that reduce harm from drinking alcohol but retain the benefit of socialising.
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16
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Li J, Wu B, Selbæk G, Krokstad S, Helvik AS. Factors associated with consumption of alcohol in older adults - a comparison between two cultures, China and Norway: the CLHLS and the HUNT-study. BMC Geriatr 2017; 17:172. [PMID: 28760157 PMCID: PMC5537928 DOI: 10.1186/s12877-017-0562-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/23/2017] [Indexed: 12/03/2022] Open
Abstract
Background There is little knowledge about the consumption of alcohol among Chinese and Norwegian older adults aged 65 years and over. The aim of this study was to investigate the prevalence and factors related to alcohol consumption among older adults in China and Norway. Methods The Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2008–2009 conducted in China and The Nord-Trøndelag Health Study data in 2006–2008 (HUNT3) conducted in Norway were used. Mulitvariable logistic regression was used to test the factors related to alcohol consumption. Results The prevalence of participants who drink alcohol in the Chinese and Norwegian sample were 19.88% and 46.2%, respectively. The weighted prevalence of participants with consumption of alcohol in the Chinese sample of women and men were 7.20% and 34.14%, respectively. In the Norwegian sample, the prevalence of consumption of alcohol were 43.31% and 65.35% for women and men, respectively. Factors such as younger age, higher level of education, living in urban areas, living with spouse or partner, and better health status were related to higher likelihood of alcohol consumption among Norwegian older women and men; while reported better health status and poorer life satisfaction were related to higher likelihood of alcohol consumption among Chinese. In addition, rural males and older females with higher level of education were more likely to consume alcohol. Conclusion The alcohol consumption patterns were quite different between China and Norway. Besides economic development levels and cultures in the two different countries, demographic characteristics, socioeconomic status, overall health status, and life satisfaction were associated with alcohol consumption as well.
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Affiliation(s)
- Juan Li
- Nursing School of Second Military Medical University, Room 207 800 Xiangyin Road, Yangpu District, Shanghai, 200433, China. .,Duke University School of Nursing, Durham, USA.
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, USA.,Shanghai University School of Sociology and Political Science, Shanghai, China
| | - Geir Selbæk
- The Norwegian Advisory unit for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,Center for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Tønsberg, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Tønsberg, Norway
| | - Steinar Krokstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Tønsberg, Norway.,HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
| | - Anne-S Helvik
- The Norwegian Advisory unit for Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Tønsberg, Norway.,St. Olav's University Hospital, Trondheim, Norway
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17
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DiBartolo MC, Jarosinski JM. Alcohol Use Disorder in Older Adults: Challenges in Assessment and Treatment. Issues Ment Health Nurs 2017; 38:25-32. [PMID: 27936333 DOI: 10.1080/01612840.2016.1257076] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcohol use disorder (AUD) is a common, under-recognized, and under-treated health concern in older adults. Its prevalence is expected to reach unprecedented levels as the U.S. population ages; consequently, it is poised to place a significant burden on the healthcare system. Given the growing body of evidence regarding the patterns of use in this age group and the serious consequences of its misuse, it is critical that nurses and other healthcare providers assess for AUD in order to identify older adults in need of treatment. Yet, differences in symptom presentation, problems in isolating the symptoms of AUD from other healthcare complaints associated with aging, as well as the denial and fear of stigma that is especially pervasive in this age group, are major barriers to its identification and subsequent treatment. Furthermore, the lack of consistent use of evidence-based, age-specific screening instruments to identify those at risk is another significant obstacle to successful treatment. Healthcare providers in primary care are especially well-positioned to perform a systematic assessment utilizing appropriate instruments to identify AUD and initiate age-specific interventions, including the use of alcohol screening and brief interventions (ASBIs). The use of ASBIs, along with other targeted interventions such as mutual help groups (MHGs), such as Alcoholics Anonymous, can be key in encouraging insight, dismantling denial, and supporting treatment success, lifelong recovery, and overall quality of life in this vulnerable group.
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Affiliation(s)
- Mary C DiBartolo
- a Salisbury University , Department of Nursing , Salisbury , Maryland , USA
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18
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Gavens L, Goyder E, Hock ES, Harris J, Meier PS. Alcohol consumption after health deterioration in older adults: a mixed-methods study. Public Health 2016; 139:79-87. [PMID: 27387049 DOI: 10.1016/j.puhe.2016.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/21/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine if and how older adults modify their drinking after health deterioration, and the factors that motivate changing or maintaining stable drinking behaviour. STUDY DESIGN Explanatory follow-up mixed-methods research. METHODS The association between health deterioration and changes in alcohol consumption was examined using secondary data from the English Longitudinal Study of Ageing, a biennial prospective cohort study of a random sample of adults aged 50 years and older living in England. Data were collected through a personal interview and self-completion questionnaire across three waves between 2004 and 2009. The sample size (response rate) across the three waves was 8781 (49.9%), 7168 (40.3%) and 6623 (37.3%). The Chi-squared test was used to examine associations between diagnosis with a long-term condition or a worsening of self-rated health (e.g. from good to fair or fair to poor) and changes in drinking frequency (e.g. everyday, 5-6 days per week, etc.) and volume (ethanol consumed on a drinking day) between successive waves. In-depth interviews with 19 older adults recently diagnosed with a long-term condition were used to explore the factors that influenced change or maintenance in alcohol consumption over time. A purposive sampling strategy was used to recruit a diverse sample of current and former drinkers from voluntary and community organizations in the north of England. An inductive approach was used to analyze the data, facilitating the development of an a posteriori framework for understanding drinking change. RESULTS There was no significant relationship between health deterioration and changes in drinking volume over time. There was however a significant association between health deterioration and changes in drinking frequency between successive waves (χ2 = 15.24, P < 0.001 and χ2 = 17.28, P < 0.001). For example, of participants reporting health deterioration between the first two waves, 47.6% had stable drinking frequency, 23.4% increased their drinking frequency and 29% reported decreased drinking frequency. In comparison, of participants reporting no health deterioration, 52.7% reported stable frequency, 20.8% increased frequency and 26.4% decreased frequency. In qualitative interviews, older adults described a wide range of factors that influence changes in drinking behaviour: knowledge gained from talking to healthcare professionals, online and in the media; tangible negative experiences that were attributed to drinking; mood and emotions (e.g. joy); the cost of alcohol; pub closures; and changes in social roles and activities. Health was just one part of a complex mix of factors that influenced drinking among older adults. CONCLUSION Patterns of drinking change after health deterioration in older adults are diverse, including stable, increasing and decreasing alcohol consumption over time. Although health motivations to change drinking influence behaviour in some older adults, social and financial motivations to drink are also important in later life and thus a holistic approach is required to influence behaviour.
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Affiliation(s)
- L Gavens
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - E Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - E S Hock
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - J Harris
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - P S Meier
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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León-Muñoz LM, Guallar-Castillón P, García-Esquinas E, Galán I, Rodríguez-Artalejo F. Alcohol drinking patterns and risk of functional limitations in two cohorts of older adults. Clin Nutr 2016; 36:831-838. [PMID: 27256558 DOI: 10.1016/j.clnu.2016.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/08/2016] [Accepted: 05/10/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Several studies have found that moderate alcohol intake is associated with lower risk of functional limitations in older adults. However, no previous investigation has assessed this association in older adults from Mediterranean countries, who show characteristic drinking patterns. METHODS Data were taken from the UAM and the Seniors-ENRICA cohorts in Spain, comprising community-dwelling people aged ≥60 years. At baseline, participants in both cohorts were classified as non-drinkers, ex-drinkers, moderate drinkers and heavy drinkers (the threshold between moderate and heavy intake was ≥40 g/day in men and ≥24 g/day in women). The Seniors-ENRICA cohort allowed assessment of a Mediterranean Drinking Pattern (MDP), defined as moderate alcohol intake, with wine preference (≥80% of alcohol consumed as wine) and drinking only with meals. The incidence of limitation in mobility, agility, and instrumental activities of daily living (IADL) was ascertained in each cohort at the end of a 3.5-year follow-up. Analyses were adjusted for sex, age, education, lifestyle, BMI, chronic conditions, and functional limitations at baseline others than the studied limitation. RESULTS Compared with non-drinkers, ex-drinkers showed a higher risk of IADL limitation (pooled adjusted odds ratio [paOR]: 1.63; 95% confidence interval [CI]: 1.04-2.21). By contrast, moderate drinkers had a lower risk of limitations in mobility (paOR: 0.80; 95% CI: 0.63-0.97), agility (paOR: 0.82; 95% CI: 0.65-0.99) and IADL (paOR: 0.54; 95% CI: 0.39-0.69). Among individuals reporting poor or fair health, the MDP was associated with lower risk of mobility limitation (aOR: 0.51; 95% CI: 0.27-0.97). CONCLUSION In older adults, moderate alcohol consumption, as well as the MDP in specific subgroups, is associated with lower risk of functional limitation. These results should not serve to promote alcohol intake, because older adults are particularly vulnerable to its harmful effects.
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Affiliation(s)
- Luz Ma León-Muñoz
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; CIBER of Epidemioloy and Public Health (CIBERESP), Madrid, Spain.
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; CIBER of Epidemioloy and Public Health (CIBERESP), Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; CIBER of Epidemioloy and Public Health (CIBERESP), Madrid, Spain
| | - Iñaki Galán
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; CIBER of Epidemioloy and Public Health (CIBERESP), Madrid, Spain.
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Choi NG, DiNitto DM, Marti CN, Choi BY. Sociodemographic Characteristics and Health Status of Lifetime Abstainers, Ex-Drinkers, Bingers, and Nonbingers Among Baby Boomers and Older Adults. Subst Use Misuse 2016; 51:637-48. [PMID: 27007029 DOI: 10.3109/10826084.2015.1133645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health risks associated with abstention from alcohol drinking in previous studies may have been exaggerated because the pool of abstainers in many studies included both lifetime abstainers and ex-drinkers, including sick-quitters. OBJECTIVES This study compared sociodemographic and health statuses among lifetime abstainers, exdrinkers, bingers, and nonbingers in the 50-64 age group (baby boomers) and the 65+ age group. METHODS Data are from the 2008 to 2012 National Survey on Drug Use and Health (N = 18,443 for the 50-64 age group and N = 11,191 for the 65+ age group). Descriptive statistics and multinomial and binary logistic regression analyses were used to examine the study questions. RESULTS 10% of the 50-64 age group and 20% of the 65+ age group reported lifetime abstention, and 21% and 28% of each group, respectively, reported being ex-drinkers (i.e., last used alcohol more than 12 months ago). In both age groups, lifetime abstainers, exdrinkers, and bingers had lower socioeconomic status than nonbingers. In the 50-64 age group, lifetime abstainers did not differ from or were less likely than nonbingers to have vascular and hepatic/gastrointestinal (HGI) disorders, but exdrinkers were more likely to have these diseases, and both lifetime abstainers and exdrinkers were more likely to have diabetes. In the 65+ age group, lifetime abstainers did not differ from nonbingers on high blood pressure, heart disease, and HGI, but both they and the exdrinkers were more likely to have stroke and diabetes. CONCLUSIONS/IMPORTANCE Diabetes screening/monitoring and stroke prevention/care are recommended for both age groups of abstainers and exdrinkers.
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Affiliation(s)
- Namkee G Choi
- a School of Social Work, University of Texas at Austin , Austin , Texas , USA
| | - Diana M DiNitto
- a School of Social Work, University of Texas at Austin , Austin , Texas , USA
| | - C Nathan Marti
- a School of Social Work, University of Texas at Austin , Austin , Texas , USA
| | - Bryan Y Choi
- b Department of Emergency Medicine , Warren Alpert Medical School, Brown University , Providence , Rhode Island , USA
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Ford CL, Mulatu MS, Godette DC, Gaines TL. Trends in HIV Testing Among U.S. Older Adults Prior to and Since Release of CDC's Routine HIV Testing Recommendations: National Findings from the BRFSS. Public Health Rep 2015; 130:514-25. [PMID: 26327729 PMCID: PMC4529835 DOI: 10.1177/003335491513000514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study examined temporal trends in HIV testing among U.S. older adults (50-64 years of age) before and after the release of CDC's routine HIV testing recommendations in 2006. METHODS The sample (n=872,797; 51.4% female) comprised 2003-2010 Behavioral Risk Factor Surveillance System respondents in the oldest categories to which the recommendations apply: 50-54 years (34.5%, n=301,519), 55-59 years (34.1%, n=297,865), and 60-64 years (31.3%, n=273,413). We calculated (1) four-year pooled prevalences of past-year HIV testing before and after 2006, when the recommendations were released; and (2) annual prevalences of HIV testing overall and by age category from 2003-2010. Using weighted, multivariable logistic regression analyses, we examined binary (pre- vs. post-recommendations) and annual changes in testing, controlling for covariates. We stratified the data by recent doctor visits, examined racial/ethnic differences, and tested for linear and quadratic temporal trends. RESULTS Overall and within age categories, the pooled prevalence of past-year HIV testing decreased following release of the recommendations (p<0.001). The annual prevalence decreased monotonically from 2003 (5.5%) to 2006 (3.6%) (b=-0.16, p<0.001) and then increased immediately after release of the recommendations, but decreased to 3.7% after 2009 (b=0.01, p<0.001). By race/ethnicity, testing increased over time among non-Hispanic black people only. Annual prevalence also increased among respondents with recent doctor visits. CONCLUSION CDC's HIV testing recommendations were associated with a reversal in the downward trend in past-year HIV testing among older adults; however, the gains were neither universal nor sustained over time.
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Affiliation(s)
- Chandra L. Ford
- University of California at Los Angeles, Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA
| | - Mesfin S. Mulatu
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Dionne C. Godette
- National Institutes of Health, National Institute of Alcohol Abuse and Alcoholism, Division of Epidemiology and Prevention Research, Rockville, MD
| | - Tommi L. Gaines
- University of California at San Diego, Division of Global Public Health, Department of Medicine, San Diego, CA
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Rao R, Schofield P, Ashworth M. Alcohol use, socioeconomic deprivation and ethnicity in older people. BMJ Open 2015; 5:e007525. [PMID: 26303334 PMCID: PMC4550718 DOI: 10.1136/bmjopen-2014-007525] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/15/2015] [Accepted: 07/17/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES This study explores the relationship between alcohol consumption, health, ethnicity and socioeconomic deprivation. PARTICIPANTS 27,991 people aged 65 and over from an inner-city population, using a primary care database. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures were alcohol use and misuse (>21 units per week for men and >14 for units per week women). RESULTS Older people of black and minority ethnic (BME) origin from four distinct ethnic groups comprised 29% of the sample. A total of 9248 older drinkers were identified, of whom 1980 (21.4%) drank above safe limits. Compared with older drinkers, older unsafe drinkers contained a higher proportion of males, white and Irish ethnic groups and a lower proportion of Caribbean, African and Asian groups. For older drinkers, the strongest independent predictors of higher alcohol consumption were younger age, male gender and Irish ethnicity. Independent predictors of lower alcohol consumption were Asian, black Caribbean and black African ethnicity. Socioeconomic deprivation and comorbidity were not significant predictors of alcohol consumption in older drinkers. For older unsafe drinkers, the strongest predictor variables were younger age, male gender and Irish ethnicity; comorbidity was not a significant predictor. Lower socioeconomic deprivation was a significant predictor of unsafe consumption whereas African, Caribbean and Asian ethnicity were not. CONCLUSIONS Although under-reporting in high-alcohol consumption groups and poor health in older people who have stopped or controlled their drinking may have limited the interpretation of our results, we suggest that closer attention is paid to 'young older' male drinkers, as well as to older drinkers born outside the UK and those with lower levels of socioeconomic deprivation who are drinking above safe limits.
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Affiliation(s)
- Rahul Rao
- Department of Old Age Psychiatry, Institute of Psychiatry, London, UK
| | - Peter Schofield
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Mark Ashworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Abstract
OBJECTIVES This paper looks into the socioeconomic determinants of risk of harmful alcohol drinking and of the transitions between risk categories over time among the population aged 50 or over in England. SETTING Community-dwellers across England. PARTICIPANTS Respondents to the English Longitudinal Survey of Ageing, waves 4 and 5. RESULTS (Confidence level at 95% or higher, except when stated): ▸ Higher risk drinking falls with age and there is a non-linear association between age and risk for men, peaking in their mid-60s. ▸ Retirement and income are positively associated with a higher risk for women but not for men. ▸ Education and smoking are positively associated for both sexes. ▸ Loneliness and depression are not associated. ▸ Caring responsibilities reduce risk among women. ▸ Single, separated or divorced men show a greater risk of harmful drinking (at 10% confidence level). ▸ For women, being younger and having a higher income at baseline increase the probability of becoming a higher risk alcohol drinker over time. ▸ For men, not eating healthily, being younger and having a higher income increase the probability of becoming a higher risk alcohol drinker. Furthermore, the presence of children living in the household, being lonely, being older and having a lower income are associated with ceasing to be a higher risk alcohol drinker over time. CONCLUSIONS Several socioeconomic factors found to be associated with high-risk alcohol consumption behaviour among older people would align with those promoted by the 'successful ageing' policy framework.
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Marti CN, Choi NG, DiNitto DM, Choi BY. Associations of lifetime abstention and past and current alcohol use with late-life mental health: a propensity score analysis. Drug Alcohol Depend 2015; 149:245-51. [PMID: 25725932 DOI: 10.1016/j.drugalcdep.2015.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Compared to the extensive research on the effects of alcohol intake on physical health, little research has been done on the effects of alcohol use/nonuse patterns on mental disorders in late life. This study examined associations between mental disorders and alcohol use/nonuse patterns among individuals aged 65+ years. METHODS Data came from the public use files of the 2008 to 2012 National Survey on Drug Use and Health. Alcohol use/nonuse groups were lifetime abstainers, ex-drinkers, bingers, and nonbingers. Mental health problems were lifetime major depressive episode (MDE) and anxiety disorder, past-year MDE and anxiety disorder, and past-year serious suicidal ideation. To minimize selection biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity score weights on covariates. Then we employed logistic regression models with mental health outcomes as the dependent variables. RESULTS The four alcohol use/nonuse groups did not differ in past-year MDE. However, odds ratios show that, relative to non-binge drinking, lifetime abstention decreased the odds of lifetime MDE by more than 60% (OR = 0.39, 95% CI = 0.23-0.68, p = .001) and the odds of lifetime anxiety disorder by almost half (OR = 0.55, 95% CI = 0.38-0.79, p = .002). Ex-drinkers were more likely than nonbingers to report past-year serious suicidal thoughts (OR = 2.29, 95% CI = 1.45-3.62, p < .001). CONCLUSIONS While lifetime abstainers had significantly better lifetime mental health histories than nonbingers, ex-drinkers had worse past-year mental health status. Since lifetime abstainers and ex-drinkers have significantly different characteristics, researchers should distinguish between these groups.
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Affiliation(s)
- C Nathan Marti
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, Texas, 78702, USA
| | - Namkee G Choi
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, Texas, 78702, USA.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, Texas, 78702, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, 02906, USA
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Choi NG, DiNitto DM, Marti CN. Treatment use, perceived need, and barriers to seeking treatment for substance abuse and mental health problems among older adults compared to younger adults. Drug Alcohol Depend 2014; 145:113-20. [PMID: 25456572 DOI: 10.1016/j.drugalcdep.2014.10.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study examined age group differences in and correlates of treatment use and perceived treatment need for substance use disorders (SUD) and mental health (MH) problems as well as self-reported barriers to treatment among people 65+ years old vs. 26-34, 35-49, and 50-64 years old. METHODS Data are from the 2008 to 2012 National Survey on Drug Use and Health (NSDUH) (N = 96,966). Age group differences were examined using descriptive bivariate analyses and binary logistic regression analyses. RESULTS The 65+ age group was least likely to use treatment and perceive treatment need, but the 50-64 age group was more similar to the younger age groups than the 65+ age group. Controlling for age, other predisposing, and enabling factors, alcohol and illicit drug dependence and comorbid SUD and MH problems increased the odds of SUD treatment use. Of MH problems, anxiety disorder had the largest odds for MH treatment use. Bivariate analyses showed that lack of readiness to stop using and cost/limited insurance were the most frequent barriers to SUD and MH treatment, respectively, among older adults, and they were less likely than younger age groups to report stigma/confidentiality concerns for MH treatment. CONCLUSIONS Older adults will become a larger portion of the total U.S. population with SUD and/or MH problems. Healthcare providers should be alert to the need to help older adults with SUD and/or MH problems obtain treatment.
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Affiliation(s)
- Namkee G Choi
- The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, TX 78712, United States.
| | - Diana M DiNitto
- The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, TX 78712, United States
| | - C Nathan Marti
- The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, D3500, Austin, TX 78712, United States
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