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

Women over 50 who use alcohol and their engagement with primary and preventative health services: a narrative review using a systematic approach

BACKGROUND

Women who are over 50 years are drinking alcohol in higher quantities and more frequently than in previous decades. Good engagement with primary care is crucial for women's physical and psychological health, particularly if they use alcohol. However, there is little known about the alcohol use of women over 50 and their use of primary care.

METHODS

A systematic search was conducted on six databases; CINAHL, Medline, PsycINFO, Academic Search Complete, EMBASE and Web of Science to identify literature on primary health care engagement of women 50 years and older (50+) who use alcohol. Titles and abstracts were reviewed and full texts were independently reviewed by two researchers. A narrative review, critical appraisal and synthesis of the eligible studies produced common themes and key findings.

RESULTS

After excluding 3822 articles, 13 articles were deemed eligible for the review. For this age group (50+), findings were: 1) women who drink heavily were less likely than men to attend General Practitioners (GPs), moderate drinkers were more likely than abstainers to attend mammogram screening, 2) GPs were less likely to ask questions or discuss alcohol with women than with men, 3) GPs offered less advice on alcohol to women than to men, and 4) less women than men received alcohol screening from their GP.

DISCUSSION

While women 50+ are drinking more, their alcohol use is underreported and insufficiently provided for in primary health. As women's life expectancy increases, improved GP engagement will benefit women's health and reduce future healthcare costs.

Current drinking patterns in US veterans with a lifetime history of alcohol use disorder: Results from the National Health and Resilience in Veterans Study

Background: Although more than 40% of US military veterans have lifetime histories of alcohol use disorder (AUD), little is known about the prevalence and correlates of current drinking patterns (i.e., abstinent, subthreshold, hazardous drinking) in this population. Objectives: To characterize the prevalence and key correlates of abstinence, subthreshold drinking, and hazardous drinking in a nationally representative sample of US veterans with lifetime AUD. Methods: Data from 1,282 veterans with lifetime AUD who participated in the National Health and Resilience in Veterans Study were analyzed using analyses of variance, chi-square analyses, and multinomial regression models. Results: Of the 1,282 veterans with lifetime AUD (of which 94.7% were males), 674 (48.2%) were past-year subthreshold drinkers, 317 (28.0%) were abstinent and 291 (23.8%) were hazardous drinkers. Abstinent veterans were older, less educated, less socially engaged, and had higher levels of religiosity than subthreshold and hazardous drinkers. They were also more likely to smoke, screen positive for PTSD, reported greater somatic symptoms than subthreshold drinkers, and had more physical difficulties and lifetime trauma than hazardous drinkers. Subthreshold drinkers were more likely than hazardous drinkers to be female and report physical health problems and less likely to smoke and be depressed. Conclusion: More than three-quarters of US veterans with lifetime AUD are currently abstinent or subthreshold drinkers. Factors associated with abstinence included older age, health problems, religiosity and social engagement. Results suggest a "J-shaped" relationship between current drinking patterns and health and psychosocial factors in veterans, with subthreshold drinkers generally having better health than abstinent and hazardous drinkers.

Interactive Effects of Quality of Life and Related Factors on Alcohol Use Outcomes

This investigation derives its impetus from public health concerns around detecting, mitigating, and preventing the deleterious effects that alcohol use can cause particularly in advanced age. We aim to complement gerontological research by exploring the interactive effects of quality of life and related factors on alcohol use outcomes assessed by the Drinking Problem Index. The study is based on cross-sectional data collected from questionnaires mailed to a randomly drawn sample of 6,000 Norwegian adults aged 62 and older (participation rate: 32%). According to the Chi-square Automatic Interaction Detection (CHAID) analysis, constellations of interactive factors emerged differently for women and men, and, between non-problem and problem drinkers. For women, drinking outcomes were related to intra-psychic functioning, and for men, to physical health and social situation. An ongoing quality-of-life assessment may be very important in the comprehensive assistance provided to those older people who are vulnerable to undergoing alcohol-related harms.

Smoking cessation mutually facilitates alcohol drinking cessation among tobacco and alcohol co-users: A cross-sectional study in a rural area of Shanghai, China

INTRODUCTION

Tobacco smoking and alcohol drinking are strongly paired behaviours, affecting millions of people worldwide. Studies in western countries demonstrate that alcohol use among smokers makes it harder to quit smoking, and addressing alcohol use is particularly important for smoking cessation, but the evidence is limited in China. We conducted a cross-sectional study to understand the prevalence of smoking, drinking, as well as tobacco and alcohol co-use, and to explore how smoking cessation mutually facilitates drinking cessation among tobacco and alcohol co-users.

METHODS

During 2016 and 2017, we sampled 36698 participants aged >18 years in Songjiang district, Shanghai. A questionnaire was designed to collect data, and participants were classified into non-smokers and smokers (current and former smokers), as well as non-alcohol drinkers and alcohol drinkers (current and former alcohol drinkers). SAS software was applied to analyse the differences by weighted logistic regressions.

RESULTS

The prevalence of tobacco smoking, alcohol drinking, and tobacco and alcohol co-use was 23.53%, 13.52% and 9.85%, respectively. Smoking cessation prevalence was 15.93%, which was higher than drinking cessation prevalence (8.22%). Tobacco and alcohol co-users had a higher prevalence of smoking cessation (16.95%) than participants who were only smokers (15.20%) and had higher prevalence of alcohol drinking cessation (8.71%) than residents who were only drinkers (6.91%). Tobacco and alcohol co-users who stopped alcohol drinking were much more likely to stop smoking than those who still drank alcohol (OR=8.83; 95% CI: 6.91–11.28) or those who only smoked (OR=7.51; 95% CI: 5.93–9.52).

CONCLUSIONS

Drinking cessation prevalence was lower than that of smoking cessation, and drinking cessation could mutually facilitate smoking cessation among tobacco and alcohol co-users. Tobacco smoking cessation programs could incorporate alcohol drinking cessation measures to achieve higher public health benefits.

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

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

METHOD

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

RESULTS

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

CONCLUSION

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

Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005-2014

BACKGROUND

Alcohol use is common among older adults, and this population has unique risks with alcohol consumption in even lower amounts than younger persons. No recent studies have estimated trends in alcohol use including binge alcohol use and alcohol use disorders (AUD) among older adults.

METHODS

We examined alcohol use among adults age ≥50 in the National Survey on Drug Use and Health (NSDUH) from 2005 to 2014. Trends of self-reported past-month binge alcohol use and AUD were estimated. Logistic regression models were used to examine correlates of binge alcohol use and AUD.

RESULTS

The prevalence of both past-month binge alcohol use and AUD increased significantly among adults age ≥50 from 2005/2006 to 2013/2014, with a relative increase of 19.2% for binge drinking (linear trend p<0.001) and a 23.3% relative increase for AUD (linear trend p=0.035). While males had a higher prevalence of binge alcohol use and AUD compared to females, there were significant increases in both among females. In adjusted models of aggregated data, being Hispanic, male, and a smoker or illicit drug user were associated with binge alcohol use, while being male, a smoker, an illicit drug user, or reporting past-year depression or mental health treatment were associated with AUD.

CONCLUSIONS

Alcohol use among older adults is increasing in the US, including past-month binge alcohol use and AUD with increasing trends among females. Providers and policymakers need to be aware of these changes to address the increase of older adults with unhealthy drinking.

Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview

BACKGROUND

Although alcohol consumption has long been considered as a risk factor for chronic disease, the relationship to cardiovascular disease (CVD) is complex and involves at least two dimensions: average volume of alcohol consumption and patterns of drinking. The objective of this contribution was to estimate the burden of CVD mortality caused by alcohol consumption.

METHODS

Risk assessment modelling with alcohol-attributable CVD mortality as primary outcome. The mortality burden of ischaemic heart disease (IHD) and ischaemic stroke (IS) attributable to alcohol consumption was estimated using attributable-fraction methodology. Relative Risk (RR) data for IHD and IS were obtained from the most comprehensive meta-analyses (except for Russia and surrounding countries where alcohol RR data were obtained from a large cohort study). Age-group specific RRs were calculated, based on large studies. Data on mortality were obtained from the World Health Organization's Global Health Estimates and alcohol consumption data were obtained from the Global Information System on Alcohol and Health. Risk of former drinkers was modelled taking into account global differences in the prevalence of sick quitters among former drinkers. Alcohol-attributable mortality estimates for all other CVD causes except IHD and IS were obtained from the 2014 Global Status Report on Alcohol and Health.

RESULTS

An estimated 780,381 CVD deaths (441,893 and 338,490 CVD deaths among men and women respectively) were attributable to alcohol consumption globally in 2012, accounting for 1.4 % of all deaths and 26.6 % of all alcohol-attributable deaths. This is in contrast to the previously estimated 1,128,273 CVD deaths attributable to alcohol consumption globally, and represents a decrease of 30.8 % in alcohol-attributable CVD mortality and of 10.6 % in the global burden of all alcohol-attributable deaths.

CONCLUSIONS

When the most comprehensive and recent systematic reviews and meta-analyses are taken as bases, the net impact of alcohol consumption on CVD is lower than previously estimated.

Understanding older adults' attitudes and beliefs about drinking: perspectives of residents in congregate living

Drinking motives may change as adults age, yet few studies in the United States of America have examined older adults' perspectives about their own drinking habits. The current study explored beliefs and attitudes of alcohol use of retired adults residing in a congregate care setting in the Baltimore/Washington DC metro area. Individual interviews were conducted with a sub-sample of 11 individuals who participated in a daily diary study on alcohol use among older adults. All participants in the study were identified as regular drinkers, meaning they had an alcoholic beverage on at least six of the eight days prior to screening. The participants' mean age was 81.5 years with a majority being women (54.5%). Older adults reported alcohol use as a long-term habit or routine. Participants also recognised that their alcohol use was influenced by peer drinking and by the availability of alcohol at the congregate care setting. Participants normalised their drinking as a form of routine socialisation carried from earlier life stages. Participants did not report reactive drinking, suggesting that older drinkers do not see their alcohol use as driven by specific reactions to life stresses or losses associated with ageing. The study also indicates that drinking may provide older adults in congregate care with a sense of continuity from before retirement and preserve their identity and autonomy.

Why do older unhealthy drinkers decide to make changes or not in their alcohol consumption? Data from the Healthy Living as You Age study

OBJECTIVES

To understand characteristics of older at-risk drinkers and reasons why they decide to change or maintain their alcohol consumption.

DESIGN

Secondary analysis of data from a randomized controlled trial to reduce drinking in at-risk drinkers.

SETTING

Three primary care sites in southern California.

PARTICIPANTS

Six hundred thirty-one adults aged 55 and older who were at-risk drinkers at baseline, 521 of whom who completed a 12-month assessment.

MEASUREMENTS

Sociodemographic and alcohol-related characteristics of 12-month assessment completers and noncompleters and among those completing the 12-month assessment by telephone or mail were compared using descriptive statistics. Reasons why respondents maintained or changed average alcohol consumption were asked of those who completed a 12-month assessment by telephone. Factors that might motivate at-risk drinkers to reduce drinking were asked about, and frequencies were calculated for these responses.

RESULTS

Participants were primarily male, white, highly educated, and in good health. Those who responded to the 12-month assessment by mail were more likely to be working, to be in the intervention arm, and to drink more. Most who reduced alcohol consumption and heavy drinking did so because they thought it would benefit them. Those who did not thought that drinking was not a problem for them. Both groups cited their environment and circumstances as influencing their drinking. Remaining at-risk drinkers reported that medical evidence that alcohol was harming them would motivate them to reduce drinking.

CONCLUSION

Older adults report that they reduce their drinking when they recognize that their drinking habits may be causing them harm; one's environment can hinder or help one to reduce drinking.

Prospective correlates of drinking cessation: variation across the life-course

AIMS

To assess age variation in correlates of drinking cessation.

DESIGN

Prospective study of a US general population sample.

SETTING

Face-to-face household interviews.

PARTICIPANTS

Past-year ≥ monthly drinkers interviewed at baseline and 3-year follow-up (n = 14 885).

MEASUREMENTS

Baseline values and selected changes over follow-up in alcohol consumption, alcohol use disorder (AUD), socio-demographic and health characteristics, other substance use and psychiatric comorbidity were used to predict drinking cessation in three age groups.

FINDINGS

Correlates of drinking cessation varied over the life-course, with pregnancy/presence of an infant, nicotine or drug use disorder, incident AUD, cluster A personality disorder, liver disease and incident retirement being important at younger ages and high-school graduation, family income ≥ $70 000, volume of ethanol intake, Asian race/ethnicity, mood disorder and incident cardiovascular disease being significant at older ages. Age-invariant correlates included smoking cessation over follow-up, odds ratio (OR) = 2.82 [95% confidence interval (CI): 1.62-4.92] to 3.45 (2.20-5.39); college education, OR = 0.42 (0.27-0.65) to 0.54 (0.36-0.83); black and Hispanic race/ethnicity, OR = 1.74 (1.18-2.29) to 1.88 (1.21-2.93) and 1.58 (1.11-1.25) to 1.73 (0.83-3.63), respectively, and months since last drink, OR = 1.24 (1.13-1.36) to 1.29 (1.19-1.39).

CONCLUSIONS

Factors associated with ceasing alcohol use in US adults appear to differ over the life-course, reflecting age variation in both their prevalence and impact and supporting the importance of role transitions and health problems (the 'sick quitter' effect). The most consistent correlates of drinking cessation included factors reflecting ability/inability to give up potentially addictive substances and factors associated with perceived acceptability of drinking and subgroup-specific drinking contexts that might facilitate/impede continued drinking.

Retired status and older adults' 10-year drinking trajectories

OBJECTIVE

Little research has examined the role of retirement in shaping late-life drinking careers, and it has generally been limited to cross-sectional designs or short-term follow-ups that emphasize group-level comparisons of retirees and nonretirees. The purpose of this study was to determine the following: (a) the effect of retired status on older adults' 10-year within-person drinking trajectories and (b) whether age, gender, income, health, and problem-drinker status account for or moderate this effect.

METHOD

We first estimated older adults' (baseline M= 62 years; n = 595) 10-year within-person drinking trajectories using three successively predictive multilevel regression models: unconditional growth, retired status alone, and retired status controlling for covariates. Next, we determined whether inclusion of Retired Status x Covariate interactions would improve prediction of the trajectories.

RESULTS

Participants' drinking frequency declined moderately over the 10-year interval, and retired status hastened the decline. However, this effect disappeared once covariates were added to the model: Baseline poorer health, lower income, and current problem-drinker status predicted steeper decline in drinking frequency, whereas former problem-drinker status predicted slower decline. Lower income and current drinking problems also predicted steeper declines in amount of alcohol consumed. There were no statistically significant or uniquely contributive interactions between retired status and age, gender, health, income, or drinking problems for predicting late-life drinking trajectories.

CONCLUSIONS

Baseline health, income, and problem-drinking history are more important than retired status for predicting older adults' long-term within-person drinking trajectories. These factors-and recency of drinking problems-should be considered in future studies of retirement and late-life drinking patterns.

Psychological distress in non-drinkers: associations with previous heavy drinking and current social relationships

AIMS

The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association. The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers.

METHODS

A national cross-sectional survey yielded data from 2856 Australians aged 20-22, 30-32 and 40-42 years (response rate 15.9%).

RESULTS

The sample was representative for many socio-demographic factors but under-represented people not in the labour force and over-represented those with university qualifications. In the oldest but not the younger age groups, abstainers reported significantly higher psychological distress relative to light/moderate drinkers. While abstainers in the oldest age group who were former heavy drinkers showed the highest levels of distress, excluding them from the analysis did not account for differences in distress between current abstainers and light/moderate drinkers. Abstainers aged 40-42 years were less socially integrated, less extraverted and had lower social support than light/moderate drinkers, and controlling for these factors partially explained their increased distress.

CONCLUSIONS

Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40-42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.

Harm reduction among at-risk elderly drinkers: a site-specific analysis from the multi-site Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study

OBJECTIVES

To assess the efficacy of a harm-reduction based intervention to enhance access to treatment and clinical outcomes among elderly at-risk drinkers.

DESIGN

A site-specific secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for Elders study (PRISM-E).

PARTICIPANTS

Thirty-four at-risk drinkers age 65 or older who were randomized into one of two treatment conditions: an integrated care condition which incorporated a harm-reduction based approach to treatment and an enhanced referral condition.

MEASURES

Access to subsequent services and clinical outcomes were examined 6 months post index-interview date. Clinical outcomes included changes in the number of drinks in the week prior to assessment, changes in the number of binges in the past 3 months prior to assessment, and changes in scores on the Short Michigan Alcoholism Screening Test-Geriatric Version (SMAST-G).

RESULTS

At-risk drinkers in the integrated care condition were more likely to access treatment than at-risk drinkers assigned to the enhanced referral condition (93% vs 35%; chi(2) = 11.38, df = 1, p = 0.001). Among those who received treatment, there were no differences in the total amount of treatment visits or in the number of brief alcohol interventions received among at-risk drinkers in the two conditions. However, those in integrated care condition received services sooner than those in the referral condition. Those in the integrated care condition showed a significant decrease in the number of drinks in the past week and in the number of binge drinking episodes in the past 3 months while there were no significant changes in these outcomes among the at-risk drinkers in the enhanced referral condition.

CONCLUSIONS

At-risk drinkers in the integrated care condition were more likely to access treatment and decrease harmful drinking behaviors than those in the enhanced referral condition. Implications for future research and treatment are discussed.

Drug and Alcohol Use Among Homeless Older Adults

Using data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), predictors of current alcohol and drug misuse problems among homeless, previously homeless, and marginally housed older adults are identified. Childhood sexual assault, victimization, and neglect, being male, being younger, being homeless or previously homeless, being a minority, and having income below US$499 per month increased the odds of reporting a drug problem. Being male, being younger, being homeless, having mental illness increased the odds of reporting an alcohol problem. Reporting any type of substance use problem increased the odds of reporting the other.

The prevalence of mental and physical health disorders among older methadone patients

OBJECTIVES

The aging opioid-addicted cohort from the 1970s has begun to alter the demographic characteristics of individuals in need of services for heroin addiction. Yet, despite clear trends that indicate the population of older methadone patients is increasing, little is known about their well-being and service needs. The goal of this study was to assess the physical and mental health status of older methadone patients.

DESIGN

Face-to-face interviews were conducted with study participants.

SETTING

This study was conducted at a free-standing methadone clinic in a Midwestern industrial city.

PARTICIPANTS

A clinic sample of 140 adult methadone patients over the age of 50 was recruited for face-to-face interviews.

MEASURES

Mental health status was assessed by the Composite International Diagnostic Interview. The SF-12v2 was administered to measure a range of physical health issues. Participants were also asked about a variety of chronic conditions. In addition, respondents provided access to their drug screen results from monthly urine tests for illegal drug use for 1 year before and 1 year after the interview.

RESULTS

Findings revealed that over half (57.1%) of respondents had at least one mental health disorder in the past year. In the year before the interview, the most prevalent mental health disorder experienced by older adult patients was major depressive episode (32.9%). The most prevalent anxiety disorders were posttraumatic stress disorder (27.8%) and generalized anxiety disorder (29.7%). Additionally, women experienced significantly higher levels of depression than males (43.8% versus 27.2%), and nearly twice the prevalence rate of agoraphobia and panic disorders. Regarding physical health, respondents reported high rates of health problems in the past year, including arthritis (54.3%) and hypertension (44.9%). The majority of respondents reported having fair to poor physical health (57.7%). When examining the entire 24-month period during which urine data were collected, three quarters (76.4%) of the respondents had at least 1 month where the urine screen detected illegal drug use.

CONCLUSIONS

In the next decade, the growing and aging substance abusing population will require clinicians trained in both geriatrics and substance abuse. Health and mental health professionals have the opportunity to address the specialized needs of this population and prepare for the shifting service needs these older patients will require.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Predictors of reported current and lifetime substance abuse problems among a national sample of U.S. homeless

Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), this study examined predictors of alcohol and drug problems among a national probability sample of homeless and previously homeless adults in the United States. Consistent with research, about one third and one quarter of the respondents reported a current alcohol and drug problem, respectively. A larger proportion reported lifetime substance abuse problems. As hypothesized, males, younger respondents, veterans, and those with mental and physical health problems were at greater risk. Results reveal that substance abuse treatment and prevention programs for the homeless should take into consideration these characteristics to maximize effectiveness.

The role of medication use and health on the decision to quit drinking among older adults

OBJECTIVE

To determine the extent to which changes in medication use and health influence the decision to quit drinking among older adults.

METHOD

The sample consisted of 8,883 elderly enrolled in Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program who completed surveys in 2000 and 2002. Survey data were linked with prescription claims to examine medication and health factors associated with drinking cessation between baseline and follow-up.

RESULTS

Overall, 3.9% of those using alcohol at baseline quit drinking during the study period. Logistic regression results showed that individuals who initiated antipsychotic (OR = 2.92) and antineoplastic therapies (OR = 2.67) were the most likely to quit drinking.

DISCUSSION

These findings support the hypothesis that elderly quit drinking in response to ill health. Results have implications for alcohol interventions in older adults and underscore the importance of separating former drinkers from lifetime abstainers in the study of alcohol-health relationships.