1
|
Kim TW, Bertholet N, Magane KM, Lloyd-Travaglini C, Winter MR, Samet JH, Erlandson KM, Stein MD, Bryant KJ, Saitz R, Heeren TC. Alcohol Consumption and Illicit Drug Use: Associations With Fall, Fracture, and Acute Health Care Utilization Among People With HIV Infection. J Acquir Immune Defic Syndr 2024; 95:391-398. [PMID: 38133581 PMCID: PMC10922845 DOI: 10.1097/qai.0000000000003372] [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] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association. SETTING Northeastern US city. METHODS We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome. RESULTS Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture-related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail. CONCLUSION The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.
Collapse
Affiliation(s)
- Theresa W Kim
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
| | - Nicolas Bertholet
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kara M Magane
- Boston University School of Public Health, Boston, MA
| | | | | | - Jeffrey H Samet
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | | | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD
| | - Richard Saitz
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
- Boston University School of Public Health, Boston, MA
| | | |
Collapse
|
2
|
Shin D, Gill SV, Kim TW, Magane KM, Mason T, Heeren T, Winter M, Helfrich C, Saitz R. Study Protocol for a Pilot Randomized Trial of a Virtual Occupational Therapy Fall Prevention Intervention for People With HIV and Alcohol Use. Subst Abuse 2022; 16:11782218221145548. [PMID: 36578450 PMCID: PMC9791282 DOI: 10.1177/11782218221145548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Background People living with HIV (PLWH) are at risk for falls due to polypharmacy, unhealthy substance (risky alcohol and/or illicit drug) use, low physical activity, and frailty combined with typical age-related physical changes. Fall prevention is needed to reduce the morbidity related to falls and fractures, however, there is a paucity of data on the design of a fall prevention intervention and whether it can be delivered virtually. We describe the protocol of a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV at high risk for falls and recent alcohol and/or drug use. Method PLWH will be recruited from the Boston ARCH 4F Cohort study, an observational study of PLWH to examine the impact of alcohol on falls. Trial participants will be randomized to either an occupational therapy-led fall prevention intervention or provided with written education about fall prevention and alcohol use (control). The 10-week fall prevention intervention was based upon results from qualitative interviews with PLWH about falls and will consist of weekly virtual group sessions, home exercises and phone-check-ins, delivered by occupational therapists. The primary outcome measures will be number of groups attended and a participant-completed satisfaction survey. Change in number of falls, alcohol and other drug use, and physical functioning will be examined. Discussion A virtual occupational therapy fall prevention intervention addresses the emerging concern of fall risk in PLWH and alcohol use. This pilot study will provide preliminary estimates of fall-related outcomes as well as feasibility of study procedures for a larger trial. ClinicalTrialsgov Identifier NCT04804579. Boston University Protocol Record H-41041.
Collapse
Affiliation(s)
- Danny Shin
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Simone V Gill
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA
| | - Tiana Mason
- Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School Public Health, Boston, MA, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School Public Health, Boston, MA, USA
| | - Christine Helfrich
- School of Health Sciences, American International College, Springfield, MA, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School Public Health, Boston, MA, USA
| |
Collapse
|
3
|
Kim TW, Heeren TC, Samet JH, Bertholet N, Lloyd-Travaglini C, Winter MR, Magane KM, Gnatienko N, Bryant K, Rateau LJ, Muyindike WR, Hahn JA, Blokhina E, Saitz R. Alcohol and falls among people with HIV infection: A view from Russia and the United States. Alcohol Clin Exp Res 2022; 46:1742-1752. [PMID: 35957545 PMCID: PMC9509482 DOI: 10.1111/acer.14915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both human immunodeficiency virus (HIV) infection and alcohol use predispose to autonomic/sensory neuropathy, imbalance symptoms, and cognitive impairment-conditions associated with a greater risk of falls-yet it is unclear how to identify people with HIV (PWH) whose drinking is associated with falls. Research on alcohol and falls using the same instruments in different countries could help to specify the level of alcohol use associated with fall risk. We examined whether a consumption-based measure (the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]) and/or a symptom-based measure (DSM-5 criteria for alcohol use disorder [AUD]) are associated with sustaining a fall among PWH in St Petersburg, Russia and Boston, Massachusetts in the United States. METHODS Separate multivariate logistic regressions were used for each cohort to examine cross-sectional associations for each alcohol measure predicting fall. Potential confounders included physical functioning, depressive symptoms, and other substance use (measured with the Addiction Severity Index). RESULTS A fall was reported by 35% (87/251) of the sample in Boston and 12% (46/400) in St Petersburg. Each additional AUD criterion-but not higher AUDIT-C score-was significantly associated with a fall in both Boston (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.02, 1.18) and St Petersburg (adjusted OR AOR = 1.10; 95% CI 1.02, 1.18). Heavy alcohol use (>6 drinks/occasion, any vs. none) was associated with more than twice the odds of a fall (AOR = 2.24; 95% CI 1.21, 4.13) in Boston. CONCLUSIONS These findings suggest that while fall risk may vary by setting and population, heavy alcohol use and AUD symptom severity are potential targets for interventions to prevent falls. Studies in diverse global settings advance our understanding of the relationship between alcohol and falls in PWH.
Collapse
Affiliation(s)
- Theresa W Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA (TCH)
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
| | - Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (NB)
| | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA (CLT, MRW, LJR)
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA (CLT, MRW, LJR)
| | - Kara M. Magane
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA (JHS, KM, RS)
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland, USA
| | - Lindsey J Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA (CLT, MRW, LJR)
| | - Winnie R Muyindike
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda (WRM)
| | - Judith A Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA (JAH)
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation (EB)
| | - Richard Saitz
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA (TWK, JHS, NG, RS)
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA (TCH)
| |
Collapse
|
4
|
Charumbira MY, Berner K, Louw QA. Falls in people living with HIV: a scoping review. BMJ Open 2020; 10:e034872. [PMID: 33148721 PMCID: PMC7674634 DOI: 10.1136/bmjopen-2019-034872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Recent research has indicated seemingly increased propensity for falls and accelerated bone demineralisation in people living with HIV (PLWH). We aim to map out the extent and nature of existing research relating to falls in PLWH and describe the relationship between bone demineralisation and falls in PLWH. METHODS A scoping review was done following Arksey & O'Malley's methodological framework and recommendations from Joanna Briggs Institute. Four databases were searched until October 2019 for peer-reviewed studies available in English reporting on the definition, prevalence, assessment, risk factors and interventions for falls in PLWH as well as information on bone demineralisation linked to falls in PLWH. Narrative reviews were excluded. Two reviewers independently performed the extraction using a predesigned Excel sheet. A descriptive analysis of extracted information was done. RESULTS Fourteen studies on falls in older PLWH were identified, with all but one study conducted in high-income countries. Prevalence of falls in PLWH ranged from 12% to 41%. Variable assessment tools/tests were used to assess potential risk factors, but it remains to be determined which are more predictive and appropriate for use among PLWH. Considerable agreement existed for risk factors regarding use of medications while evidence regarding functional and cognitive impairments were variable. Few studies compared risk factors for falls in PLWH with those in age-matched and sex-matched seronegative population. There is currently no evidence for interventions to prevent or reduce falls risk in PLWH. CONCLUSION More research is needed on falls in younger cohorts of PLWH and in sub-Saharan Africa where HIV is most prevalent and more robust clades exist. More studies need to report on data in seronegative controls to determine risk factors unique to PLWH. More intervention studies targeted at falls prevention and promotion of bone health are required. Quality clinical practice guidelines highlighting validated assessment tools and outcome measures need to be developed.
Collapse
Affiliation(s)
- Maria Yvonne Charumbira
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karina Berner
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Abegail Louw
- Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|