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Han BH, Orozco MA, Miyoshi M, Doland H, Moore AA, Jones KF. Experiences of Aging with Opioid Use Disorder and Comorbidity in Opioid Treatment Programs: A Qualitative Analysis. J Gen Intern Med 2024; 39:1673-1680. [PMID: 38436883 PMCID: PMC11255154 DOI: 10.1007/s11606-024-08676-z] [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] [Received: 11/13/2023] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The number of older adults entering opioid treatment programs (OTPs) to treat opioid use disorder (OUD) is increasing. However, the lived experiences of aging in OTPs have not been examined. OBJECTIVE To explore the aging experience with OUD and barriers to medical care for older adults who receive care in OTPs. DESIGN From November 2021 to July 2022, we conducted 1-to-1, semi-structured qualitative interviews in English and Spanish, audio-recorded, transcribed, systematically coded, and analyzed to identify key themes regarding the challenges of aging with OUD and managing chronic diseases. PARTICIPANTS Thirty-six adults aged ≥ 55 enrolled in OTPs in San Diego, California. APPROACH A descriptive qualitative approach was used. Major themes and subthemes were identified through thematic analysis until thematic saturation was reached. KEY RESULTS All participants were on methadone and had a mean age of 63.4 (SD 5.1) years; 11 (30.6%) identified as female, 14 (39%) as Hispanic/Latino, and 11 (36%) as Black, with a mean duration of methadone treatment of 5.6 years. Chronic diseases were common, with 21 (58.3%) reporting hypertension, 9 (25%) reporting untreated hepatitis C, and 32 (88.9%) having ≥ 2 chronic diseases. Three major themes emerged: (1) avoidance of medical care due to multiple intersectional stigmas, including those related to drug use, substance use disorder (SUD) treatment, ageism, and housing insecurity; (2) increasing isolation with aging and loss of family and peer groups; (3) the urgent need for integrating medical and aging-focused care with OUD treatment in the setting of increasing health and functional challenges. CONCLUSIONS Older adults with OUD reported increasing social isolation and declining health while experiencing multilevel stigma and discrimination. The US healthcare system must transform to deliver age-friendly care that integrates evidence-based geriatric models of care incorporated with substance use disorder treatment and addresses the intersectional stigma this population has experienced in healthcare settings.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Mirella A Orozco
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Mari Miyoshi
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Heidi Doland
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Alison A Moore
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Katie Fitzgerald Jones
- New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, MA, USA
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Russell ML, Justice A. Human Immunodeficiency Virus in Older Adults. Clin Geriatr Med 2024; 40:285-298. [PMID: 38521599 DOI: 10.1016/j.cger.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
As people with HIV live longer, they can experience increased incidence and earlier onset of chronic conditions and geriatric syndromes. Older people are also at substantially increased risk of delayed diagnosis and treatment for HIV. Increasing provider awareness of this is pivotal in ensuring adequate consideration of HIV testing and earlier screening for chronic conditions. In addition, evaluating patients for common geriatric syndromes such as polypharmacy, frailty, falls, and cognitive impairment should be contextualized based on how they present.
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Affiliation(s)
- Matthew L Russell
- Harvard University, Massachusetts General Hospital, 55 Fruit Street, Yawkey 2C, Boston, MA 02114, USA.
| | - Amy Justice
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516, USA
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Van Hove L, Baetens I, Vanderstichelen S. Conceptualizing Self-Harm through the Experiences of Psychogeriatric Experts. Psychopathology 2024:1-9. [PMID: 38599197 DOI: 10.1159/000537809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/11/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Fewer studies thus far have focused on self-harm and its specific forms among older adults. Moreover, the limited available literature applies varying terminology. The categorization of self-harm used in younger populations may not be as appropriate for this population. This means that less is known about this phenomenon in older adults. The current study aimed to reduce this gap. METHODS Nine Flemish psychogeriatric experts participated in a semi-structured interview. Transcripts were thematically analyzed. RESULTS Themes emerging from the interviews suggest that self-harm in older adults may also include distinct elements, such as the omission of certain behaviours and engagement in indirect self-harm to cause bodily harm. According to the experts, self-harm may be engaged in to cope with emotions, express life fatigue, hasten death, and communicate a cry for help. DISCUSSION Self-harm is prevalent in older adults, and some characteristics may be specific to self-harm in an older age group. These findings may enable clinicians to be more alert to self-harm in older adults and consequently prevent serious suicidal behaviour. More research is needed to further uncover this phenomenon.
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Affiliation(s)
- Lisa Van Hove
- Brussels University Consultation Center (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Imke Baetens
- Brussels University Consultation Center (BRUCC), Department of Clinical Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Vanderstichelen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels/Ghent University, Ghent, Belgium
- Compassionate Communities Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels/Ghent University, Ghent, Belgium
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Kuerbis A. Expanding and adapting prevention and treatment options for older adults who engage in harmful use of substances. Addiction 2024. [PMID: 38590265 DOI: 10.1111/add.16499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Alexis Kuerbis
- Silberman School of Social Work, Hunter College at CUNY, New York, New York, USA
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LaManna JB, Loerzel V, Conner NE. Lived experiences of older male caregivers: "That was the Worst!". Geriatr Nurs 2024; 55:277-285. [PMID: 38104439 DOI: 10.1016/j.gerinurse.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Although caregiving is a traditional female role, older men represent an increasing proportion of family caregivers. This study's aim was to describe lived experiences of men who engaged in later-life caregiving. METHOD Streubert's phenomenological method, inclusive of unstructured interviews and respondent validation of a single formalized description, was applied to explore lived experiences of eight older male caregivers. RESULTS Three overarching themes characterized older male caregiving: 1) role and life changes, 2) "taking care of business," and 3) getting over "the worst". All caregivers spent extensive time in anticipatory planning for potential problems and were dissatisfied with existing resources and services. Each man described a profound, mentally-challenging caregiving crisis that triggered important caregiving decisions. DISCUSSION Study findings support an urgent need for research to clarify the mental health needs of older male caregivers and to test interventions that better meet the unique needs of this growing caregiver demographic.
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Affiliation(s)
| | - Victoria Loerzel
- University of Central Florida College of Nursing, Orlando, FL, United States
| | - Norma E Conner
- University of Central Florida College of Nursing, Orlando, FL, United States
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Dhinsa J, Roman-Urrestarazu A, van Kessel R, Humphreys K. Understanding predictors of mental health and substance use treatment utilization among US adults: A repeated cross-sectional study. GLOBAL EPIDEMIOLOGY 2023; 5:100109. [PMID: 37638373 PMCID: PMC10445987 DOI: 10.1016/j.gloepi.2023.100109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 08/29/2023] Open
Abstract
Background Understanding discrepancies in mental health and substance use treatment utilization can help identify inequities in access to health services. We investigate mental health and substance use treatment utilization as function of demographic and social determinants, as well as pre-existing mental health and substance use disorders. Methods In this repeated cross-sectional study, we used the 2017-2019 National Survey on Drug Use and Health data on US adults above age 18. Two logistic regression models were conducted, using predictors of age, gender, race/Hispanicity, sexual identity, education, insurance, family income, and past year mental health and substance use disorders, with outcomes of mental health or substance use treatment utilization. Weighted estimates of substance use disorders and insurance types and Pearson's correlation tests of vulnerability among age, gender, and treatment type were reported. Findings Racial minorities, uninsured populations, sexual minorities, and females had lower odds of receiving mental health treatment, while older populations, lower income groups, and dual eligible enrollees had higher odds. Individuals with substance use disorders but no mental illness had higher odds of receiving mental health treatment. Those utilizing mental health treatment were mostly of high income, privately insured, and using cannabis, cocaine, and opioids. Older populations, men, and Medicaid only enrollees had higher odds of receiving substance use disorder treatment, whereas racial minorities had lower odds. Distribution of income, insurance type, and substance use were more widespread than mental health treatment. Interpretation Mental health treatment can be used as an avenue for substance use treatment, particularly opioid use disorders. It is important to target vulnerable populations, like racial minorities and uninsured populations to improve access to mental health and substance use treatment.
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Affiliation(s)
- Jaskiran Dhinsa
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Andres Roman-Urrestarazu
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
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Bormann NL, Weber AN, Miskle B, Woodson-DeFauw N, Arndt S, Lynch AC. Perceived risk of LSD varies with age and race: evidence from 2019 United States cross-sectional data. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1503-1508. [PMID: 36879096 DOI: 10.1007/s00127-023-02448-6] [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] [Received: 07/09/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Psychedelics are being explored for their potential therapeutic benefits across a wide range of psychiatric diagnoses and may usher in a new age in psychiatric treatment. There is stigma associated with these currently illegal substances, and use varies by race and age. We hypothesized that minoritized racial and ethnic populations, relative to White respondents, would perceive psychedelic use as riskier. METHODS Using 2019 cross-sectional data from the National Survey of Drug Use and Health, we conducted a secondary analysis of 41,679 respondents. Perceived risk of heroin was used as a surrogate for overall risk of illegal substance use; heroin and lysergic acid diethylamide were the only substances queried this way in the sample. RESULTS A majority regarded lysergic acid diethylamide (66.7%) and heroin (87.3%) as a great risk if used once or twice. There were clear differences by race, with White respondents and those indicating more than one race having significantly lower perceived risk of lysergic acid diethylamide than respondents from other groups. Perceived risk of use also significantly increased with age. CONCLUSION Perceived risk of lysergic acid diethylamide is unevenly distributed across the population. Stigma and racial disparities in drug-related crimes likely contribute to this. As research into potential therapeutic indications for psychedelics continues, perceived risk of use may change.
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Affiliation(s)
- Nicholas L Bormann
- Department of Psychiatry, Indiana University, 355 W 16th St.,, Indianapolis, IN, 46202, USA.
| | - Andrea N Weber
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Benjamin Miskle
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Pharmacy, University of Iowa, Iowa City, IA, USA
| | - Nicole Woodson-DeFauw
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Alison C Lynch
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, University of Iowa, Iowa City, IA, USA
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Mason M, Post LA, Aggarwal R. Health care and harm reduction provider perspectives on treating older adults who use non-medical opioids: a qualitative study set in Chicago. BMC Health Serv Res 2023; 23:876. [PMID: 37598163 PMCID: PMC10439613 DOI: 10.1186/s12913-023-09843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Opioid overdose death rates are increasing for adults aged 55 and older, with especially high rates in large urban areas. In parallel, admissions to treatment programs for older adults using illicit substances are increasing as well. Despite these trends, there is a lack of information about older adults who use non-medical opioids (NMO) and even less knowledge about their health and service encounters. Conducted in Chicago, Illinois, this qualitative study explores the perspectives of health care and harm reduction service providers who work with older adults using non-medical opioids. METHODS The study used snowball sampling to locate participants with expertise in working with older adults who use non-medical opioids. In total, we conducted 26 semi-structured interviews from September 2021-August 2022. We explored questions regarding participants' perceptions of older adult opioid use patterns, comorbidities, and involvement in harm reduction outreach and opioid use disorder treatment. RESULTS Many of the providers we interviewed consider older adults who use NMO as a distinct population that employ unique use behaviors with the intent to protect them from opioid overdose. However, these same unique behaviors may potentiate their risk for overdose in today's climate. Providers report initial encounters that are not care seeking for opioid use and primarily oriented around health conditions. Older adults who use non-medical opioids are seen as complex patients due to the need to diagnostically untangle symptoms of substance use from co-morbidities and conditions associated with aging. Treatment for this population is also viewed as complicated due to the interactions between aging, comorbidities, and substance use. Providers also noted that older adults who use NMO have use behaviors that make them less visible to outreach and treatment service providers, potentially putting them at increased risk for overdose and health conditions associated with opioid use. CONCLUSIONS Findings from this study are intended to inform future research on care provision for older adults who use non-medical opioids and may be especially applicable to large urban reas with histories of opioid use dating back to earlier drug epidemics of the 1970s, 1980s, and 1990s.
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Affiliation(s)
- Maryann Mason
- Feinberg School of Medicine, Northwestern University, Chicago, 60611, USA.
- Buehler Center for Health Policy and Economics, Northwestern University, 420 E. Superior St., Rubloff Building 9th floor, Room 939, Chicago, IL, 60611, USA.
| | - Lori Ann Post
- Department of Emergency Medicine, The Buehler Center for Health Policy & Economics, Institute for Global Health, Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, 9-915 Rubloff Building, 420 E. Superior St, Chicago, Il, 60611, USA
| | - Rahul Aggarwal
- Weinberg School of Arts and Sciences, Northwestern University, 1918 Sheridan Rd, Evanston, IL, 60208, USA
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Paun O, Loukissa D. Substance Use Disorders in Older Adults. J Psychosoc Nurs Ment Health Serv 2023; 61:15-19. [PMID: 37389940 DOI: 10.3928/02793695-20230607-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Although substance misuse (primarily alcohol and prescribed benzodiazepines and opioids) among Americans aged ≥60 years is becoming an escalating health concern, substance use disorder (SUD) is often underestimated and/or undiagnosed, preventing older adults from receiving needed treatment. Chronic medical conditions, mental health issues, and psychosocial stressors increase older adults' risks for developing SUD. Racial/ethnic minority groups (e.g., American Indian, Alaska Native) experiencing health care inequities and limited resources are more vulnerable to developing SUD. It is recommended that SUD screening be included in annual check-ups using tools adapted to older adults. Clinicians should consider older adults' comorbidities to differentiate symptoms of substance use from neurocognitive disorders, depression, anxiety, and metabolic disorders. To ensure successful outcomes, interventions must be tailored to the specific needs of older adults. Building on the current federal government administration's support, SUD practice guidelines should be updated with older adults in mind. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 15-19.].
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Harris SJ, Yarbrough CR, Abraham AJ. Changes In County-Level Access To Medications For Opioid Use Disorder After Medicare Coverage Of Methadone Treatment Began. Health Aff (Millwood) 2023; 42:991-996. [PMID: 37406230 PMCID: PMC11332379 DOI: 10.1377/hlthaff.2023.00148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
In 2020 Medicare began reimbursing for opioid treatment program (OTP) services, including methadone maintenance treatment for opioid use disorder (OUD), for the first time. Methadone is highly effective for OUD, yet its availability is restricted to OTPs. We used 2021 data from the National Directory of Drug and Alcohol Abuse Treatment Facilities to examine county-level factors associated with OTPs accepting Medicare. In 2021, 16.3 percent of counties had at least one OTP that accepted Medicare. In 124 counties the OTP was the only specialty treatment facility offering any form of medication for opioid use disorder (MOUD). Regression results showed that the odds of a county having an OTP that accepted Medicare were lower for counties with higher versus lower percentages of rural residents and lower for counties located in the Midwest, South, and West compared with the Northeast. The new OTP benefit improved the availability of MOUD treatment for beneficiaries, although geographic gaps in access remain.
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Saldivia S, Aslan J, Cova F, Bustos C, Inostroza C, Castillo-Carreño A. Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile. Front Psychiatry 2023; 14:1203590. [PMID: 37441146 PMCID: PMC10333485 DOI: 10.3389/fpsyt.2023.1203590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Background This study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups. Methods We evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60-80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups. Results We found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001). Conclusion Simultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions.
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Affiliation(s)
- Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Joseph Aslan
- Doctoral Program in Psychology, Universidad de Concepción, Concepción, Chile
| | - Félix Cova
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Claudio Bustos
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Carolina Inostroza
- Department of Psychology, Faculty of Social Sciences, Universidad de Concepción, Concepción, Chile
| | - Anabel Castillo-Carreño
- Department of Fundamentals of Nursing and Public Health, Faculty of Nursing, Universidad de Concepción, Concepción, Chile
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Palamar JJ, Le A. Prevalence of self-reported adverse effects associated with drug use among nightclub and festival attendees, 2019-2022. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100149. [PMID: 37025564 PMCID: PMC10070077 DOI: 10.1016/j.dadr.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/18/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Research investigating adverse effects from drug use has focused extensively on poisonings and mortality. This study focuses on drug-related adverse effects not necessarily resulting in hospitalization or death among a population known for high prevalence of party drug use-electronic dance music (EDM) nightclub and festival attendees. METHODS Adults entering EDM venues were surveyed in 2019-2022 (n = 1952). Those reporting past-month use of a drug were asked whether they had experienced a harmful or very unpleasant effect after use. We examined 20 drugs and drug classes with a particular focus on alcohol, cannabis, cocaine, and ecstasy. Prevalence and correlates of adverse effects were estimated. RESULTS Almost half (47.6%) of adverse effects involved alcohol and 19.0% involved cannabis. 27.6% of those using alcohol reported an adverse effect, while 19.5%, 15.0%, and 14.9% of participants reported an effect from use of cocaine, ecstasy, and cannabis, respectively. Use of less prevalent drugs, such as NBOMe, methamphetamine, fentanyls, and synthetic cathinones, tended to be associated with higher prevalence of adverse effects. The most consistent risk factor was younger age, while past-month use of a greater number of drugs was often a protective factor against adverse effects. For most drugs, taking too much was the most common perceived reason for the adverse effect, and visiting a hospital after use was most prevalent among those experiencing an adverse effect from cocaine (11.0%). CONCLUSIONS Adverse drug effects are common in this population and results can inform prevention and harm reduction in this population and the general population.
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Affiliation(s)
- Joseph J. Palamar
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
| | - Austin Le
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, Room 1752, New York, NY 10016, USA
- New York University College of Dentistry, New York, NY, USA
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Han BH, Brennan JJ, Orozco MA, Moore AA, Castillo EM. Trends in emergency department visits associated with cannabis use among older adults in California, 2005-2019. J Am Geriatr Soc 2023; 71:1267-1274. [PMID: 36622838 PMCID: PMC10089945 DOI: 10.1111/jgs.18180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California. METHODS Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code. RESULTS The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period. CONCLUSION Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults.
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Affiliation(s)
- Benjamin H. Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Jesse J. Brennan
- Department of Emergency Medicine, University of California San Diego School of Medicine
| | - Mirella A. Orozco
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Alison A. Moore
- Division of Geriatrics, Gerontology, and Palliative Care, University of California San Diego School of Medicine
| | - Edward M. Castillo
- Department of Emergency Medicine, University of California San Diego School of Medicine
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Yang M, Beiting KJ, Levine S. Barriers to Care for Nursing Home Residents With Substance Use Disorders: A Qualitative Study. J Addict Med 2023; 17:155-162. [PMID: 36044314 PMCID: PMC10804858 DOI: 10.1097/adm.0000000000001061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Over the past decade, the numbers of older adults with opioid and substance use disorders (OUD/SUD) have increased. As this population enters nursing homes (NHs) in increasing numbers, it is crucial to consider their capacity to manage issues related to OUD/SUD. This study aimed to examine current NH protocols for care coordination of residents with OUD/SUD as well as facility-related barriers to providing care to this vulnerable population within the NH. METHODS Twenty-four semistructured interviews were conducted with NH staff including directors of nursing, administrators, nurses, and physicians in July 2020. Staff were recruited from 11 different post-acute care and long-term care facilities located in urban and suburban communities of Chicago. Interviews were conducted virtually (via teleconference platform or by telephone) and subsequently coded using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany) using constant comparative method. RESULTS Qualitative analyses identified 3 themes around NH barriers to care for residents with SUD/OUD: (1) staff preparedness, (2) staff perceptions of addiction, and (3) overall lack of resources. Results revealed a strong need for the development of consistent policies, as well as standardized, educational interventions for NH staff that target SUD/OUD management in this vulnerable population. CONCLUSIONS The evaluation and impact of persons with SUD/OUD entering NHs are an important topic that requires further study. More resources and staff training are necessary to ensure that residents with SUD/OUD have access to appropriate care within these settings.
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Affiliation(s)
- Meredith Yang
- From the Pritzker School of Medicine, University of Chicago, Chicago, IL (MY); Division of Geriatric Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (KJB); and Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, IL (SL)
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15
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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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16
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Kepner WE, Han BH, Nguyen D, Han SS, Lopez FA, Palamar JJ. Past-month binge drinking and cannabis use among middle-aged and older adults in the United States, 2015-2019. Alcohol 2023; 107:32-37. [PMID: 35934163 PMCID: PMC9933134 DOI: 10.1016/j.alcohol.2022.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 02/06/2023]
Abstract
The aging United States population, which includes the large Baby Boomer generation, is leading to an increasing number of middle-aged and older adults who engage in psychoactive substance use. Due to the size of this cohort, and their changing attitudes around psychoactive substance use, there has been a sharp increase in prevalence of past-month cannabis use among adults aged ≥50; however, little is understood about recent trends in the use of both cannabis and excess alcohol use, such as binge drinking, in this population. The current use of both alcohol and cannabis has important health implications for older adults, given their higher prevalence of chronic diseases and prescribed medications. This study aimed to 1) estimate national trends among older adults who report both past-month binge drinking and cannabis use, and 2) examine correlates of reporting both. We examined aggregated data from a nationally representative sample of noninstitutionalized adults aged ≥50 from the 2015 to 2019 National Survey on Drug Use and Health. During the study period, there was an estimated 2.5% increase (a 64.1% relative increase) in past-month cannabis use (linear trend p < 0.001), a non-significant decrease in past-month binge drinking, and a 0.5% estimated increase in both past-month cannabis use and binge drinking (a 26.3% relative increase) (p = 0.03). The sharpest increase in both past-month cannabis use and binge drinking was among adults aged ≥65, with the estimated prevalence increasing from 0.2% in 2015 to 1.1% in 2019 (a 450% relative increase, p < 0.001). Those engaging in past-month binge drinking and cannabis use were more likely to be younger, male, non-Hispanic Black, use tobacco, and report past-year mental health treatment. Results suggest that the prevalence of both past-month cannabis use and binge drinking among middle-aged and older adults increased between 2015 and 2019, especially among adults aged ≥65, which indicates an increased need to screen for both excess alcohol and cannabis use to minimize potential harm.
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Affiliation(s)
- Wayne E Kepner
- University of California San Diego, Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Benjamin H Han
- University of California San Diego, Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, 9500 Gilman Drive, San Diego, CA 92093, United States.
| | - Daniel Nguyen
- University of California San Diego, Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Stacy S Han
- University of California San Diego, Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Francisco A Lopez
- University of California San Diego, Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Joseph J Palamar
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue, New York, NY 10016, United States
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17
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Kermel-Schiffman I, Afuta M, Zur A, Gavriel-Fried B. Recovery from Alcohol Use Disorder among Older Adults: A Scoping Review. J Appl Gerontol 2023; 42:1137-1150. [PMID: 36609180 DOI: 10.1177/07334648221149284] [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: 01/09/2023] Open
Abstract
Alcohol Use Disorder (AUD) among older people is under-diagnosed even though the population of older people is rising. Recovery from AUD among older people is a challenging process. A scoping review of the literature on recovery from AUD among older people was conducted to characterize the main topics in recovery. A systematic search was conducted in five databases: Psycinfo, Medline, CINHAL, WoS, and Embase from January 2000 to May 2021 using the PRISMA-ScR. Twenty-five studies met the inclusion criteria. The concept of recovery was defined in 20 studies, where the most frequent term was "abstinence." 16 studies described treatment programs with different types of interventions. Six studies described specific programs for older people; five reported positive outcomes. Future studies should implement a broader definition of recovery that reflects the dimensions of the concept and refers to different age groups, to enable interdisciplinary professionals to develop holistic interventions.
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Affiliation(s)
| | - May Afuta
- The Bob Shapell School of Social Work, 26745Tel Aviv University, Israel
| | - Amit Zur
- The Bob Shapell School of Social Work, 26745Tel Aviv University, Israel
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18
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Falise AM, Sharma V, Hoeflich CC, Lopez-Quintero C, Striley CW. Screening the "Invisible Population" of Older Adult Patients for Prescription Pain Reliever Non-Medical Use and Use Disorders. Subst Use Misuse 2022; 58:153-159. [PMID: 36519790 PMCID: PMC10104763 DOI: 10.1080/10826084.2022.2148483] [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: 12/23/2022]
Abstract
Background: In the United States, the number of older adults reporting non-medical use of prescription pain relievers (NMUPPR) between 2015 and 2019 has remained constant, while those meeting criteria for opioid use disorders (OUDs) between 2013 and 2018 increased three-fold. These rates are expected to increase due to increased life expectancy among this population coupled with higher rates of substance use. However, they have consistently lower screening rates for problematic prescription pain reliever use, compared to younger cohorts. Objectives: This commentary reviewed trends in older adult NMUPPR and OUDs and reviewed several available screening tools. We then considered reasons why providers may not be screening their patients, with a focus on older adults, for NMUPPR and OUDs. Finally, we provided recommendations to increase screenings in healthcare settings. Results: Low screening rates in older adult patients may be due to several contributing factors, such as providers' implicit biases and lack of training, time constraints, and comorbid conditions that mask NMUPPR and OUD-related symptoms. Recommendations include incorporating more addiction-related curricula in medical schools, encouraging participation in CME training focused on substance use, attending implicit bias training, and breaking down the silos between pharmacy and geriatric, addiction, and family medicine. Conclusions: There is a growing need for older adult drug screenings, and we have provided several recommendations for improvement. By increasing screenings among older populations, providers will assist in the identification and referral of patients to appropriate and timely substance use treatment and resources to ultimately ameliorate the health of older adult patients.
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Affiliation(s)
- Alyssa M. Falise
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Vinita Sharma
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- School of Public and Population Health, Boise State University, Boise, ID, USA
| | - Carolin C. Hoeflich
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Catalina Lopez-Quintero
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine W. Striley
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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19
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Monnat SM, Elo IT. Enhancing the Utility of the Health and Retirement Study (HRS) to Identify Drivers of Rising Mortality Rates in the United States. Forum Health Econ Policy 2022; 25:57-84. [PMID: 35254742 PMCID: PMC9448826 DOI: 10.1515/fhep-2021-0058] [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: 12/02/2021] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
Abstract
A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) highlights rising rates of working-age mortality in the United States, portending troubling population health trends for this group as they age. The Health and Retirement Study (HRS) is an invaluable resource for researchers studying health and aging dynamics among Americans ages 50 and above and has strong potential to be used by researchers to provide insights about the drivers of rising U.S. mortality rates. This paper assesses the strengths and limitations of HRS data for identifying drivers of rising mortality rates in the U.S. and provides recommendations to enhance the utility of the HRS in this regard. Among our many recommendations, we encourage the HRS to prioritize the following: link cause of death information to respondents; reduce the age of eligibility for inclusion in the sample; increase the rural sample size; enhance the existing HRS Contextual Data Resource by incorporating longitudinal measures of structural determinants of health; develop additional data linkages to capture residential settings and characteristics across the life course; and add measures that capture drug use, gun ownership, and social media use.
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Affiliation(s)
- Shannon M. Monnat
- Lerner Chair for Public Health Promotion and Lerner Center Director, Associate Professor of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, 426 Eggers Hall, Syracuse, NY13244, USA
| | - Irma T. Elo
- Professor and Chair of Sociology and Chair of the Graduate Group in Demography, University of Pennsylvania, 229 McNeil Building, Philadelphia, PA, USA
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20
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van Gils Y, Dom G, Dierckx E, van Alphen SPJ, Franck E. Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium. Clin Gerontol 2022; 46:433-445. [PMID: 36255289 DOI: 10.1080/07317115.2022.2137074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults. METHODS This is a retrospective cross-sectional study in 1.406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU. RESULTS Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU. CONCLUSIONS Different characteristics were found as predictors for AU among older men and women. CLINICAL IMPLICATIONS Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults.
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Affiliation(s)
- Y van Gils
- Faculty of Medicine and Social Sciences, University of Antwerp, Wilrijk, Belgium.,Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium
| | - G Dom
- Faculty of Medicine and Social Sciences, University of Antwerp, Wilrijk, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - E Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Elsene, Belgium.,Alexianen Zorggroep Tienen, Psychiatric Hospital, Tienen, Belgium
| | - S P J van Alphen
- Faculty of Psychology and Educational Sciences, Vrije Universiteit 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
| | - E Franck
- Faculty of Medicine and Social Sciences, University of Antwerp, Wilrijk, Belgium
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21
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Zhang S, Silverman A, Suen SC, Andrews C, Chen BK. Differential patterns of opioid misuse between younger and older adults - a retrospective observational study using data from South Carolina's prescription drug monitoring program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:618-628. [PMID: 36194086 DOI: 10.1080/00952990.2022.2124380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Most research on opioid misuse focuses on younger adults, yet opioid-related mortality has risen fastest among older Americans over age 55.Objectives: To assess whether there are differential patterns of opioid misuse over time between younger and older adults and whether South Carolina's mandatory Prescription Drug Monitoring Program (PDMP) affected opioid misuse differentially between the two groups.Methods: We used South Carolina's Reporting and Identification Prescription Tracking System from 2010 to 2018 to calculate an opioid misuse score for 193,073 patients (sex unknown) using days' supply, morphine milligram equivalents (MME), and the numbers of unique prescribers and dispensaries. Multivariable regression was used to assess differential opioid misuse patterns by age group over time and in response to implementation of South Carolina's mandatory PDMP in 2017.Results: We found that between 2011 and 2018, older adults received 57% (p < .01) more in total MME and 25.4 days more (p < .01) in supply, but received prescriptions from fewer doctors (-0.063 doctors, p < 01) and pharmacies (-0.11 pharmacies, p < 01) per year versus younger adults. However, older adults had lower odds of receiving a high misuse score (OR 0.88, p < .01). After the 2017 legislation, misuse scores fell among younger adults (OR 0.79, p < .01) relative to 2011, but not among older adults.Conclusion: Older adults may misuse opioids differently compared to younger adults. Assessment of policies to reduce opioid misuse should take into account subgroup differences that may be masked at the population level.
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Affiliation(s)
- Suyanpeng Zhang
- Daniel J. Epstein Department of Industrial & Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Allie Silverman
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial & Systems Engineering, University of Southern California, Los Angeles, CA, USA
| | - Christina Andrews
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Brian K Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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22
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Jemberie WB, Padyab M, McCarty D, Lundgren LM. Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure-time analysis with a discontinuous risk model. Addiction 2022; 117:2415-2430. [PMID: 35470927 PMCID: PMC9543276 DOI: 10.1111/add.15907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Older people with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all-cause, alcohol-, polydrug- and psychiatric-related repeated hospitalizations among older people with problematic alcohol use. DESIGN A linked register-based cohort study with discontinuous multiple-failure (time-to-repeated-event) data. Hospitalization and mortality were considered as failure. SETTING Sweden, March 2003-November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish cause of death register. PARTICIPANTS Participants aged 50 years and older (n = 1741; 28.2% women), with one or more alcohol problem days in the 30 days before an ASI assessment. MEASUREMENTS Five mutually exclusive latent classes of problematic alcohol use, identified with 11 ASI items, were the independent variables: 'late onset with fewer consequences (LO:FC; reference group)'; 'early onset/prevalent multi-dimensional problems (EO:MD)'; 'late onset with co-occurring anxiety and depression (LO:AD)'; 'early onset with co-occurring psychiatric problems (EO:PP)'; and 'early onset with major alcohol problem (EO:AP)'. Covariates included socio-demographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization and/or mortality due to: (a) all-cause, (b) alcohol-related disorders and diseases (c) polydrug use and (d) other psychiatric disorders. FINDINGS During the study period, more than 75% were hospitalized at least once or died. 57.3% were hospitalized with alcohol-related, 8.5% with polydrug use and 18.5% with psychiatric-related diagnoses. Compared with LO:FC, EO:PP had higher risk for all-cause [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02-1.59] and alcohol-related (aHR = 1.34, 95% CI = 1.02-1.75) hospitalizations. Adjusted risks for polydrug-related hospitalization were 2.55, 95% CI = 1.04-6.27 for EO:MD and 2.62, 95% CI = 1.07-6.40 for EO:PP. Adjusted risk for psychiatric-related hospitalization was higher for LO:AD (aHR = 1.78, 95% CI = 1.16-2.73 and EO:PP (aHR = 2.03, 95% CI = 1.22-3.38). CONCLUSIONS Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older people with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social WorkUmeå UniversityUmeåSweden,Centre for Demographic and Ageing Research (CEDAR)Umeå UniversityUmeåSweden,The Swedish National Graduate School on Aging and Health (SWEAH), Faculty of MedicineLund UniversityLundSweden
| | - Mojgan Padyab
- Department of Social WorkUmeå UniversityUmeåSweden,Centre for Demographic and Ageing Research (CEDAR)Umeå UniversityUmeåSweden
| | - Dennis McCarty
- Oregon Health and Science University‐ Portland State UniversitySchool of Public HealthPortlandORUSA
| | - Lena M. Lundgren
- Department of Social WorkUmeå UniversityUmeåSweden,Cross‐National Behavioral Health Laboratory, Graduate School of Social WorkUniversity of DenverDenverCOUSA
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23
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Christiansen R, Nielsen AS. Bring me my alcohol!-On the continuum of pleasure and pain. Nurs Philos 2022; 24:e12403. [PMID: 35909307 PMCID: PMC10078244 DOI: 10.1111/nup.12403] [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: 04/06/2021] [Revised: 04/22/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
Alcohol use has been recognized as a challenge in eldercare and social care, and some anticipate that problems related to alcohol use will increase in the future as the current adult generation has high alcohol consumption rates. Accordingly, it is suggested that care workers are at risk of becoming passive bystanders to the destructive lifestyles of vulnerable older adults and even facilitating these lifestyles. In the present paper, we suggest that alcohol exacerbates and underscores inherent difficulties in eldercare, such as finding an appropriate balance between the personal freedom of the older adult and the responsibility of the care worker to provide care. The specific focus in the paper regard the communication and interaction involving values between people in eldercare in cases of problematic alcohol-related situations to uncover the difficulties. We found it noteworthy that the objectives and perspectives of older adults, care workers, managers and relatives have implications regarding their interactions and communications because their varying experiences involve values that are not necessarily aligned. Sometimes, care workers have no choice but to act against what, in the public sphere and to the other care workers, is ruled out by virtue of their professional ethics. It is suggested that care workers describe and judge situations where alcohol is present paradoxically by virtue of their professional ethics, yet regulate their care to preserve the dignity of older adults, even when they find the situation to be an apparent dilemma.
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Affiliation(s)
- Regina Christiansen
- Institute of Cultural Science, Faculty of Humanities, Philosophy, University of Southern Denmark, Odense, Denmark.,The Faculty of Health Sciences, The Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
| | - Anette S Nielsen
- The Faculty of Health Sciences, The Unit of Clinical Alcohol Research, University of Southern Denmark, Odense, Denmark
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Mumba MN, Jaiswal J, Bui C, Evans T, Mainzinger L, Davis L, Mugoya GT. Substance use treatment services for older adults in five states in the Southern United States: a state-by-state comparison of available treatment services. Aging Ment Health 2022; 27:1028-1036. [PMID: 35848207 DOI: 10.1080/13607863.2022.2098911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objectives: Substance use disorders (SUD) among older adults have become a serious public health concern. The purpose of this study was to assess which states in the Southern U.S. are more responsive to SUD treatment needs of older adults.Methods: This study is a secondary data analysis of the N-SSATS-2019 dataset.Results: There were 1,215 substance treatment facilities in the five states. Kentucky had the highest number of substance use treatment facilities (n = 449, 37%), followed by Georgia (357, 29%), Alabama (153, 13%), Louisiana (146, 12%) and then Mississippi (110, 9%). Out of the 1,215 facilities, only 20% (n = 244) indicated that they had programs specifically tailored for older adults. Kentucky had the largest number of facilities per 1 million older adults while Mississippi had the highest number of facilities per 1 million older adults offering detoxification services. Alabama had the lowest number of services per 1 million adults in all categories examined.Conclusion: Across the U.S., most adults with SUD do not have access to substance use treatment; in the southeastern region of the country, higher rates of poverty, rural geography and stigma, and lack of treatment availability may further complicate individuals' ability to access substance use-related medical care.
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Affiliation(s)
- Mercy Ngosa Mumba
- Center for Substance Use Research and Related Conditions, Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL, USA.,Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Jessica Jaiswal
- College of Human and Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Chuong Bui
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, USA
| | | | | | - Lori Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - George T Mugoya
- Department of Educational Studies in Psychology, Research Methodology and Counseling, The University of Alabama, Tuscaloosa, AL, USA
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25
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Mackiewicz M, Brown RE, Price ET, Sargent L. Quality of life in older adults with opioid use disorder: A scoping review. Geriatr Nurs 2022; 46:118-124. [DOI: 10.1016/j.gerinurse.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
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26
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van den Berk Clark C, Pickard JG, Drallmeier T. The role of age and opioid agonist treatment on substance use treatment completion in the United States. Aging Ment Health 2022; 26:1295-1302. [PMID: 33999741 DOI: 10.1080/13607863.2021.1925223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a large body of research indicating that substance use disorder treatment completion leads to higher rates of sustained recovery. However, not much is known about how age and opioid treatment programs (OTPs) OTPinteract to affect treatment completion. The purpose of this article is to better understand the pathway between age, OTP, and treatment completion. METHODS Data from the US 2017 Treatment Episodes Data Set was analyzed. Seemingly unrelated bivariate probit regression was used to determine whether OTP access mediates the relationship between age and treatment completion. We used propensity score matching to simulate the effects of a randomized control trial and to attenuate the likelihood of a Type 1 error. RESULTS Older adults have a higher likelihood than their younger counterparts of completing treatment regardless of OTP status in inpatient and outpatient settings. Those who received OTP in inpatient treatment had a 45% increased probability of completing treatment in detox settings and a 41% increased probability of completing treatment in inpatient settings. Older adults (age 50+) were more likely to receive OTP than their younger counterparts. There is a small but significant indirect effect of age on treatment completion in inpatient settings. CONCLUSIONS Older adults are more likely to receive OTP in both inpatient and outpatient settings. However, age does not appear to affect the probability of treatment completion when individuals receive OTP, except in inpatient settings. Implications are discussed.
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Affiliation(s)
- Carissa van den Berk Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Joseph G Pickard
- School of Social Work, University of Missouri St. Louis, St. Louis, MO, USA
| | - Theresa Drallmeier
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA
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Ahmadi S, Mohaqeqi Kamal SH, Basakha M, Soleimanvandiazar N, Ghaedamini Harouni G. Substance use among Iranian older adults: opium, a substance for all seasons. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2070871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sina Ahmadi
- Social Determinants of Health Research Center, Department of Social Welfare Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Hossein Mohaqeqi Kamal
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Basakha
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Neda Soleimanvandiazar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
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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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Jemberie WB, Padyab M, McCarty D, Lundgren LM. Hospital Admission Rate, Cumulative Hospitalized Days, and Time to Admission Among Older Persons With Substance Use and Psychiatric Conditions. Front Psychiatry 2022; 13:882542. [PMID: 35530023 PMCID: PMC9075517 DOI: 10.3389/fpsyt.2022.882542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Substance use among older persons occurs with medical and psychiatric comorbidities. This study examined the associations of substance use disorder (SUD), psychiatric, and dual diagnoses with 12-month cumulative hospitalized days, hospital admission rate and number of days to first hospitalization. Methods The cohort of 3,624 individuals (28.2% women) aged 50 years or older was assessed for substance use severity in 65 Swedish municipalities during March 2003-May 2017. Addiction Severity Index data were linked to hospital discharge records and crime statistics. The outcomes were (a) 12-month cumulative hospitalized days; (b) Hospital admission rate, and (c) days to first hospitalization. Generalized linear regression techniques investigated associations between outcomes and SUD, psychiatric and dual diagnoses at admission. Results During 2003-2017, 73.5% of the participants were hospitalized. Twelve-month hospitalized days were positively associated with SUD (Incidence rate ratio (IRR) = 1.41, 95%CI: 1.26-1.58), dual diagnosis (IRR = 2.03, 95%CI: 1.74-2.36), and psychiatric diagnoses (IRR = 2.51, 95%CI: 2.09-3.01). Hospital admission rate was positively associated with SUD (IRR = 4.67, 95%CI: 4.28-5.08), dual diagnosis (IRR = 1.83, 95%CI: 1.64-2.04), and psychiatric diagnoses (IRR = 1.73, 95%CI: 1.55-1.92). Days to first hospitalization were negatively associated with SUD (IRR = 0.52, 95%CI: 0.47-0.58), dual diagnosis (IRR = 0.57, 95%CI: 0.50-0.65), and psychiatric diagnoses (IRR = 0.83, 95%CI: 0.73-0.93). The marginal effects of SUD and/or mental disorders increased with age for all outcomes, except for days to first hospitalization. Conclusion Three of four older persons assessed for substance use severity were later hospitalized. Substance use disorders, dual diagnoses and other mental disorders were the primary reasons for hospitalization and were associated with longer stays, earlier hospitalization, and repeated admissions. Sensitizing service providers to old age substance use and sharing data across the care continuum could provide multiple points of contact to reduce the risk of hospitalizations among older persons with problematic substance use.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
- The Swedish National Graduate School on Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden
| | - Mojgan Padyab
- Department of Social Work, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research (CEDAR), Umeå University, Umeå, Sweden
| | - Dennis McCarty
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States
| | - Lena M. Lundgren
- Department of Social Work, Umeå University, Umeå, Sweden
- Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States
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Justice AC, Goetz MB, Stewart CN, Hogan BC, Humes E, Luz PM, Castilho JL, Nash D, Brazier E, Musick B, Yiannoutsos C, Malateste K, Jaquet A, Cornell M, Shamu T, Rajasuriar R, Jiamsakul A, Althoff KN. Delayed presentation of HIV among older individuals: a growing problem. Lancet HIV 2022; 9:e269-e280. [PMID: 35218732 PMCID: PMC9128643 DOI: 10.1016/s2352-3018(22)00003-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/30/2021] [Accepted: 01/05/2022] [Indexed: 12/31/2022]
Abstract
Late presentation for care is a major impediment to the prevention and effective treatment of HIV infection. Older individuals are at increased risk of late presentation, represent a growing proportion of people with late presentation, and might require interventions tailored to their age group. We provide a summary of the literature published globally between 2016-21 (reporting data from 1984-2018) and quantify the association of age with delayed presentation. Using the most common definitions of late presentation and older age from these earlier studies, we update this work with data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium, focusing on data from 2000-19, encompassing four continents. Finally, we consider how late presentation among older individuals might be more effectively addressed as electronic medical records become widely adopted.
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Affiliation(s)
- Amy C Justice
- VA Connecticut Healthcare System, Yale Schools of Medicine and Public Health, Yale University, West Haven, CT, USA.
| | - Matthew B Goetz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Cameron N Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Brenna C Hogan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Paula M Luz
- Affiliation Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jessica L Castilho
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Denis Nash
- City University of New York Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Beverly Musick
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Karen Malateste
- Inserm, French National Research Institute for Sustainable Development, Universite de Bordeaux, Bordeaux, France
| | - Antoine Jaquet
- Inserm, French National Research Institute for Sustainable Development, Universite de Bordeaux, Bordeaux, France
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tinei Shamu
- Graduate School of Health Sciences, Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - Reena Rajasuriar
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Awachana Jiamsakul
- Biostatistics and Databases Program, The Kirby Institute, UNSW, Sydney, NSW, Australia
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Al-Rousan T, Moore AA, Han BH, Ko R, Palamar JJ. Trends in binge drinking prevalence among older U.S. men and women, 2015 to 2019. J Am Geriatr Soc 2022; 70:812-819. [PMID: 34877662 PMCID: PMC8904280 DOI: 10.1111/jgs.17573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/13/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent literature suggests that the gap in prevalence of binge drinking between men and women is closing, but little is known about sex-specific differences in trends and correlates of binge drinking among older Americans. METHODS A total of 18,794 adults, aged 65 years and older were surveyed in the 2015-2019 National Survey on Drug Use and Health. We estimated trends in prevalence of past-month binge drinking (≥5 drinks on the same occasion for men and ≥4 drinks for women), stratified by sex. Correlates of binge drinking were estimated for men and women separately, focusing on demographic characteristics, chronic diseases, past-month tobacco and cannabis use, depression, and emergency department use. Multivariable generalized linear models using Poisson and log link were used to examine associations stratified by sex. RESULTS Binge drinking among older men increased from 12.8% in 2015 to 15.7% in 2019 (p = 0.02) but remained stable among older women (7.6% to 7.3%, p = 0.97). In adjusted models, having a college degree was associated with higher risk of binge drinking among women (adjusted prevalence ratio [aPR] = 1.68, 95% CI: 1.13-2.50), but lower risk among men (aPR = 0.69, 95% CI: 0.56-0.85). Men who are separated or divorced were also at higher risk (aPR = 1.25, 95% CI: 1.05-1.50), but women were not. Both men and women reporting past-month use of tobacco (men aPR = 1.87, 95% CI: 1.61-2.17, women aPR = 2.11, 95% CI: 1.71-2.60) and cannabis (men aPR = 2.05, 95% CI: 1.63-2.58, women aPR = 2.77, 95% CI 2.00-3.85) were at higher risk of binge drinking. CONCLUSIONS Binge drinking has increased among older men whereas it has remained stable among older women in the United States. Interventions should consider that although tobacco and cannabis use is associated with an increased risk of binge drinking among both older men and women, demographic correlates tend to differ by sex.
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Affiliation(s)
- Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California, San Diego
| | - Alison A. Moore
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine
| | - Benjamin H. Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine
| | - Roxanne Ko
- Center for Family and Community Medicine, New York-Presbyterian Columbia University Irving Medical Center
| | - Joseph J. Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
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Stelander LT, Høye A, Bramness JG, Wynn R, Grønli OK. Sex differences in at-risk drinking and associated factors-a cross-sectional study of 8,616 community-dwelling adults 60 years and older: the Tromsø study, 2015-16. BMC Geriatr 2022; 22:170. [PMID: 35232388 PMCID: PMC8886794 DOI: 10.1186/s12877-022-02842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol consumption among older adults is on the rise, which may be an increasing public health concern. The proportion of older adults who drink above defined low-risk drinking limits, associated characteristics and the sex distribution of at-risk drinking vary across countries. The aims of this study were to (i) estimate the prevalence of at-risk drinking among older adults in Norway, (ii) investigate factors associated with at-risk drinking, and (iii) examine sex differences in alcohol consumption in the context of sociodemographic and selected health characteristics. METHOD A cross-sectional study based on Tromsø 7 (2015-16), an ongoing population-based cohort survey. Data were retrieved from participants aged 60 and older (60-99 years) who answered questions about alcohol consumption (n = 8,616). Sex-stratified logistic regressions were used to assess the association between three at-risk drinking outcome variables, and sociodemographic and selected health characteristics. The outcome variables were operationalized using the Alcohol Use Disorders Identification Test (AUDIT), and Alcohol Consumption Questions (AUDIT-C), i.e. - cut off for at risk drinking, drinking any 6+ in the past year, and any alcohol problems. RESULTS The overall prevalence of at-risk drinking among those aged 60-99 years was equal in women and men; 44% and 46%, respectively. At-risk drinking was strongly associated with a higher level of education, with OR 2.65 (CI 2.28-3.10) in women and OR 1.73 (CI 1.48-2.04) in men. CONCLUSIONS Almost half of older adults in Norway exceeded sex- and older adult-specific at-risk drinking thresholds. Our findings suggest some differences in factors associated with at-risk drinking between women and men. Explicitly, at-risk drinking was associated with very good health, living with a spouse or partner, and having adequate social support in women, while it was associated with the use of sleeping pills in men. Our findings suggest that women exceed at-risk drinking thresholds with better health, while men exceed at-risk drinking thresholds regardless of good or poor health.
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Affiliation(s)
- Line Tegner Stelander
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, P.O. Box 6124, 9291, Tromsø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Anne Høye
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, P.O. Box 6124, 9291, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jørgen G Bramness
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rolf Wynn
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, P.O. Box 6124, 9291, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ole Kristian Grønli
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, P.O. Box 6124, 9291, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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El Hayek S, Geagea L, El Bourji H, Kadi T, Talih F. Prevention Strategies of Alcohol and Substance Use Disorders in Older Adults. Clin Geriatr Med 2021; 38:169-179. [PMID: 34794700 DOI: 10.1016/j.cger.2021.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Older adults are increasingly engaging in unhealthy substance use. Owing to aging and comorbid medical conditions, older adults are at increased risk of adverse effects from alcohol, tobacco, and illicit drug use. Preventative measures, regular screening, and appropriate intervention can protect older adults from the negative outcomes of substance use and potentially improve their quality of life. This article reviews the latest trends of substance use in older adults, impact on health, and the best practice approaches for the clinical assessment of substance use disorders in this age group.
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Affiliation(s)
- Samer El Hayek
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon. https://twitter.com/samerelhayek
| | - Luna Geagea
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon
| | | | - Tamara Kadi
- American University of Beirut, Beirut, Lebanon
| | - Farid Talih
- Department of Psychiatry, American University of Beirut, P.O. Box: 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon.
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Barros GMD, Horta ALDM, Diehl A, Miranda RODR, Moura AAMD, Seleghim MR, Silva CJD, Santos MAD, Wagstaff C, Pillon SC. Prevalence, consequences and factors associated with drug use among individuals over 50 years of age in the family perspective. Aging Ment Health 2021; 25:2140-2148. [PMID: 32815377 DOI: 10.1080/13607863.2020.1808879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the prevalence, consequences and factors associated with drug use among individuals over 50 years of age, from the perspective of their families, with particularly reference to cocaine use. METHODS Cross-sectional study based on secondary data with 624 family members of substance users who sought family support in 14 units of the Recomeço Família Program in São Paulo, Brazil. RESULTS The participants were predominately men, aged 50 to 59 years (68%); cocaine users (inhaled and/ or smoked); living alone; with a low level of education and were unemployed. They were likely to use family money to pay for their substance use, with a history of theft and aggression against strangers, and were not in treatment. Unlike other participants [≥ 60 years (31.1%)]; who were better educated and retired. In this latter group, 32.8% are alcohol users, 14.8% cocaine users (inhaled and smoked), 32.6% has physically assaulted their family, 39.7% had assaulted someone else and 18.3% had stolen objects or money from home. CONCLUSIONS The population has peculiar characteristics of vulnerability (cocaine use and violence) that remain under investigated; not only do routes into treatment for older adults (≥ 60) but appropriate treatment packages need to be developed too.
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Affiliation(s)
- Gilmar Manoel de Barros
- School Paulista of Nursing, Federal University of São Paulo, Programa Recomeço, Sao Paulo, Brazil
| | | | - Alessandra Diehl
- Faculty of Nursing at Ribeirão Preto, Psychiatric Nursing and Human Science Department, PAHO/WHO Collaborating Centre for Nursing Research Development, University of São Paulo (USP), Ribeirão Preto, Brazil
| | | | | | - Maycon Rogério Seleghim
- Faculty of Nursing at Ribeirão Preto, Psychiatric Nursing and Human Science Department, PAHO/WHO Collaborating Centre for Nursing Research Development, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Claudio Jerônimo da Silva
- Department of Psychiatric, Federal University of Sao Paulo, Programa Recomeço, Paulista Association for Development of Medicine (SPDM), Hospital São Paulo, Sao Paulo, Brazil
| | - Manoel Antônio Dos Santos
- Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo (FFCLRP-USP), Ribeirão Preto, Brazil
| | - Christopher Wagstaff
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Behrendt S, Kuerbis A, Braun-Michl B, Bilberg R, Bühringer G, Bogenschutz M, Mejldal A, Andersen K, Søgaard Nielsen A. Residual alcohol use disorder symptoms after treatment predict long-term drinking outcomes in seniors with DSM-5 alcohol use disorder. Alcohol Clin Exp Res 2021; 45:2396-2405. [PMID: 34585747 DOI: 10.1111/acer.14722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM-5 AUD symptoms after treatment. AIMS To investigate among older adults who received short-term treatment for DSM-5 AUD (1) the prediction of drinking behaviors and quality of life 12 months after treatment initiation by 6-month DSM-5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM-5 AUD indicators provide prognostic information beyond that gained from 6-month alcohol use (AU) status. METHODS The international multicenter RCT "ELDERLY-Study" enrolled adults aged 60+ with DSM-5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM-5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5 years). AU was assessed with Form 90, DSM-5 AUD with the M.I.N.I., and quality of life with the WHOQOL-BREF. Generalized linear models were applied to investigate the associations between 6-month AUD indicators and 12-month AU and quality of life. RESULTS Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12-month "slip," defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p < 0.05). AUD remission was associated with a lower risk of a "slip" at 12 months (p < 0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: -0.4, 95% CI -0.7 to -0.1). CONCLUSION For older adults, residual AUD symptoms in the first months after short-term treatment predict problematic AU outcomes during the first 12 months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings.
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Affiliation(s)
- Silke Behrendt
- Unit of Clinical Alcohol Research, Psychiatric Department, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Open Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Brain Research, Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Institute of Psychology, University of Southern Denmark, Odense M, Denmark
| | - Alexis Kuerbis
- Silberman School of Social Work at Hunter College, New York, New York, USA
| | | | - Randi Bilberg
- Unit of Clinical Alcohol Research, Psychiatric Department, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Open Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Brain Research, Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gerhard Bühringer
- Unit of Clinical Alcohol Research, Psychiatric Department, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Open Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Brain Research, Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,IFT Institut für Therapieforschung, München, Germany.,Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Michael Bogenschutz
- Department of Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Psychiatric Department, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Open Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Brain Research, Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, Psychiatric Department, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Open Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Brain Research, Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Psychiatric Department, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Open Patient data Explorative Network (OPEN), Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Brain Research, Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Cimarolli VR, Burack O, Minahan J, Hennessa A, Stone R, Shi X. Participation in a Substance Misuse Intervention in Post-acute Care Is Associated With More Optimal Rehabilitation Outcomes. THE GERONTOLOGIST 2021; 61:787-796. [PMID: 32776123 DOI: 10.1093/geront/gnaa101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Alcohol and substance misuse is prevalent among older adults, yet underdiagnosed and undertreated. More substance misuse intervention programs specifically designed for older adults and offered in various settings are needed. This project's objectives were to (a) provide a detailed description of a Geriatric Substance Abuse Recovery Program (GSARP) designed and implemented at post-acute rehabilitation units of a skilled nursing facility and (b) report findings of a study conducted to evaluate if GSARP participation among post-acute care patients with substance misuse issues can optimize rehabilitation outcomes (i.e., being discharged home vs. another setting). RESEARCH DESIGN AND METHODS A pretest-posttest study design with data obtained from patients' electronic medical record upon facility admission, during post-acute stay, and after discharge (N = 271). Based on Andersen's model of health care utilization, we investigated which predisposing factors (e.g., ethnicity), enabling factors (e.g., cognition and social support), and need-related factors (e.g., activities of daily living functioning), as well as health behaviors (e.g., GSARP participation) predicted likelihood of being discharged home versus another discharge setting. RESULTS Patients participating in the GSARP and patients who received social support from family members and friends during their post-acute stay were more likely to be discharged home. Patients with severe cognitive impairment were less likely to be discharged home. DISCUSSION AND IMPLICATIONS The GSARP eliminates some common barriers often encountered in the screening and delivery process of substance misuse interventions for older adults. Findings support the effectiveness of the GSARP in optimizing rehabilitation outcomes for older adults with substance misuse issues.
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Affiliation(s)
| | - Orah Burack
- Research Institute on Aging, The New Jewish Home, New York
| | | | | | - Robyn Stone
- LeadingAge LTSS Center @UMass Boston, Washington, District of Columbia
| | - Xiaomei Shi
- LeadingAge LTSS Center @UMass Boston, Massachusetts
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Pickard JG, van den Berk-Clark C, Matthieu MM. Association of Medication-Assisted Treatment and Age With Treatment Completion Among Veterans Seeking Non-VA Treatment for Opioid use Disorder at Non-Veterans Health Administration Facilities. Mil Med 2021; 187:504-512. [PMID: 34173832 DOI: 10.1093/milmed/usab242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Medication-assisted treatment has been shown to be effective in treating opioid use disorder among both older adults and veterans of U.S. Armed Forces. However, limited evidence exists on MAT's differential effect on treatment completion across age groups. This study aims to ascertain the role of MAT and age in treatment completion among veterans seeking treatment in non-Department of Veterans Affairs healthcare facilities for opioid use disorder. METHODS We used the Treatment Episode Data Set-Discharges (TEDS-D; 2006-2017) to examine trends in treatment and MAT usage over time and TEDS-2017 to determine the role of age and MAT in treatment completion. We examined a subset of those who self-identified as veterans and who sought treatment for an opioid use disorder. RESULTS Veterans presented in treatment more often as heroin users than prescription opioid users, and older veterans were more likely to get MAT than younger veterans. We found that before propensity score matching, MAT initially appeared to be associated with a lower likelihood of treatment completion in inpatient ($\beta $ = -1.47, 95% CI -1.56 to -1.39) and outpatient ($\beta $ = -1.40, 95% CI -2.21 to -0.58) settings, and age (50+ years) appeared to mediate the effect of MAT on treatment completion ($\beta $ = -0.54, 95% CI -0.87 to -0.21). After matching, older veterans were more likely to complete substance use disorder treatment ($\beta $ = 0.21, 95% CI 0.01-0.42), while age no longer mediated the effect of MAT, and MAT had a significant positive impact on treatment completion in detox settings ($\beta $ = 1.36, 95% CI 1.15-1.50) and inpatient settings ($\beta $ = 1.54, 95% CI 1.37 -1.71). CONCLUSION The results show that age plays an important role in outpatient treatment completion, while MAT plays an important role in inpatient treatment completion. Implications for veterans are discussed.
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Affiliation(s)
- Joseph G Pickard
- School of Social Work, University of Missouri-Saint Louis, 63121, USA
| | | | - Monica M Matthieu
- College for Public Health and Social Justice, Saint Louis University, 63103, USA
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Han BH, Funk-White M, Ko R, Al-Rousan T, Palamar JJ. Decreasing perceived risk associated with regular cannabis use among older adults in the United States from 2015 to 2019. J Am Geriatr Soc 2021; 69:2591-2597. [PMID: 34037250 DOI: 10.1111/jgs.17213] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Cannabis use among older adults is increasing sharply in the United States. While the risks and benefits of cannabis use remain unclear, it is important to monitor risk factors for use, including low perception of harm. The objective of this study was to estimate recent national trends in perceived risk associated with cannabis use among older adults. DESIGN Trend analysis. SETTING/PARTICIPANTS A total of 18,794 adults aged 65 and older participating in the 2015-2019 National Survey on Drug Use and Health, a cross-sectional nationally representative survey of non-institutionalized individuals in the United States. MEASUREMENTS We estimated the prevalence of older adults who believe that people who smoke cannabis once or twice a week are at great risk of harming themselves physically and in other ways. This was examined across cohort years and stratified by demographic characteristics, diagnosis of chronic disease, past-month tobacco and binge alcohol use, and all-cause emergency department use. RESULTS Between 2015 and 2019, perceived risk associated with regular use decreased from 52.6% to 42.7%, an 18.8% relative decrease (p < 0.001). Decreases in perceived risk were detected in particular among those never married (a 32.6% relative decrease), those who binge drink (a 31.3% relative decrease), use tobacco (a 26.8% relative decrease), have kidney disease (a 32.1% relative decrease), asthma (a 31.7% relative decrease), heart disease (a 16.5% relative decrease), chronic obstructive pulmonary disease (a 21.5% relative decrease), two or more chronic conditions (a 20.2% relative decrease), and among those reporting past-year emergency department use (a 21.0% relative decrease) (ps < 0.05). CONCLUSIONS The perceived risk of regular cannabis use is decreasing among older adults. We detected sharp decreases in risk perception among those with chronic disease and high-risk behaviors, including tobacco and binge alcohol use. As the number of older adults who use cannabis increases, efforts are needed to raise awareness of the possible adverse effects with special emphasis on vulnerable groups.
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Affiliation(s)
- Benjamin H Han
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Makaya Funk-White
- Division of Geriatrics, Gerontology, and Palliative Care, University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Roxanne Ko
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Joseph J Palamar
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Mejldal A, Andersen K, Behrendt S, Bilberg R, Bogenschutz M, Braun‐Michl B, Bühringer G, Søgaard Nielsen A. Stability of Posttreatment Reductions in World Health Organization (WHO) Drinking Risk Levels and Posttreatment Functioning in Older Adults with DSM‐5 Alcohol Use Disorder: Secondary Data Analysis of the Elderly Study. Alcohol Clin Exp Res 2021; 45:638-649. [DOI: 10.1111/acer.14562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/15/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Anna Mejldal
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Department of Mental Health Odense Region of Southern Denmark Vejle Denmark
- Brain Research‐Inter‐Disciplinary Guided Excellence (BRIDGE) Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Silke Behrendt
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Brain Research‐Inter‐Disciplinary Guided Excellence (BRIDGE) Department of Clinical Research University of Southern Denmark Odense Denmark
- Institute of Psychology Faculty of Health University of Southern Denmark Odense Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Department of Mental Health Odense Region of Southern Denmark Vejle Denmark
| | - Michael Bogenschutz
- NYU Langone Medical Center New York NY USA
- Health Sciences Center University of New Mexico Albuquerque NM USA
| | | | - Gerhard Bühringer
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- IFT Institut für Therapieforschung Munich Germany
- Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Dresden Germany
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Department of Mental Health Odense Region of Southern Denmark Vejle Denmark
- Brain Research‐Inter‐Disciplinary Guided Excellence (BRIDGE) Department of Clinical Research University of Southern Denmark Odense Denmark
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Reyes L, Treitler P, Peterson NA. Testing Relationships Between Racial-Ethnic Identity, Racial-Ethnic Discrimination, and Substance Misuse Among Black and Latinx Older Adults in a Nationally Representative Sample. Res Aging 2021; 44:96-106. [PMID: 33472550 DOI: 10.1177/0164027520986952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults (aged 55+) comprise a rapidly growing population both in number and racial-ethnic diversity. In recent years, substance misuse prevalence among older adults has increased and is expected to continue rising, highlighting the need to understand risk and protective factors in this population. Using nationally representative data, this study examines the association of racial-ethnic identity and racial-ethnic discrimination with alcohol and illicit drug use among Black and Latinx older adults, and whether racial-ethnic identity moderates the relationship between discrimination and substance misuse. Findings show that among Latinx older adults discrimination is associated with increased substance misuse, and higher ethnic identity is associated with decreased illicit drug use. Higher racial-ethnic identity buffers the effects of discrimination on illicit drug use for Latinx, but not for Black respondents. Findings of this study highlight the complex associations between racial-ethnic identity, discrimination, and substance misuse, varying across racial-ethnic group, age, context, and other factors.
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Affiliation(s)
- Laurent Reyes
- School of Social Work, 242612Rutgers University, New Jersey, USA
| | - Peter Treitler
- School of Social Work, 242612Rutgers University, New Jersey, USA
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Cimarolli VR, Burack O, Minahan JM, Falzarano F, Reinhardt JP, Shi X. A Substance Misuse Intervention Program in Postacute Care: Who Declines Participation? Am J Geriatr Psychiatry 2021; 29:15-23. [PMID: 32912805 PMCID: PMC7839814 DOI: 10.1016/j.jagp.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Alcohol and substance misuse has been under-acknowledged and underidentified in older adults. However, promising treatment approaches exist (e.g., brief interventions) that can support older adults with at-risk alcohol and substance use. Postacute rehabilitation settings of Skilled Nursing Facilities (SNFs) can offer such programs, but little is known about patient characteristics that are associated with the likelihood of participating in interventions offered in postacute rehabilitation care. Thus, the objective of this study was to identify individual patient characteristics (predisposing, enabling, and need-related factors) associated with participation in a brief alcohol and substance misuse intervention at a SNF. METHODS This cross-sectional study analyzed medical record data of postacute care patients within a SNF referred to a substance misuse intervention. Participants were 271 patients with a history of substance misuse, 177 of whom enrolled in the intervention and 94 refused. Data collected upon patient admission were used to examine predisposing, enabling, and need-related factors related to likelihood of program participation. RESULTS Older age and ethnic minority status were associated with a reduction in likelihood to participate, while widowhood increased the likelihood of participation. CONCLUSION Upon referral to a substance misuse intervention, clinicians in SNFs should be cognizant that some patients may be more likely to refuse intervention, and additional efforts should be made to engage patients at-risk for refusal.
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Affiliation(s)
| | - Orah Burack
- The New Jewish Home, Research Institute on Aging (OB, JPR), New York, NY
| | | | | | - Joann P Reinhardt
- The New Jewish Home, Research Institute on Aging (OB, JPR), New York, NY
| | - Xiaomei Shi
- LeadingAge LTSS Center @UMass Boston (VRC, XS), Washington, DC
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