Psychoactive drugs, alcohol, and stress and coping processes in older adults

Substance-use coping and self-rated health among US middle-aged and older adults

The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.

Protective factors against suicide among young-old Chinese outpatients

BACKGROUND

Suicide is common among the elderly worldwide. However, no literature could be found on the beliefs/expectations that protect young-old people from attempting suicide. The purpose of this study was to explore young-old outpatients' reasons for not killing themselves in Taiwan.

METHOD

Data for this qualitative descriptive study were extracted from a large research series. From the 83 elderly outpatients in the original sample, 31 were chosen for this study because they were young-old (65-74 years old) and from two randomly selected medical centers in northern Taiwan. Data on participants' reasons for not killing themselves in unhappy situations were collected in individual interviews using a semi-structured guide and analyzed by content analysis.

RESULTS

Analysis of interview data identified six major themes: satisfied with one's life, suicide cannot resolve problems, fear of humiliating one's children, religious beliefs, never thought about suicide, and living in harmony with nature.

CONCLUSION

These identified protective factors (reasons for living) could be added to suicide-prevention programs for the elderly. Our findings may also serve as a reference for geriatric researchers in western countries with increasing numbers of elderly ethnic minority immigrants.

The impact of retirement on the drinking patterns of older adults: a review

OBJECTIVE

Due to the aging of the population, there is renewed focus on the public health issues of middle-aged and older adults. One area of such focus is unhealthy drinking, and researchers seek to understand the unique developmental risk and protective factors among those entering older adulthood. Retirement has been hypothesized as a contributing factor in the onset and maintenance of unhealthy drinking in late life. This review describes the relevant theories and critically reviews empirical evidence that explores the relationship between alcohol and retirement drawn from both the industrial and organizational psychology and substance misuse literatures.

METHOD

Using four research databases, thirteen studies published in the last 25years that investigated the relationship of retirement and alcohol use and met specific selection criteria were reviewed.

RESULTS

The literature suggests that retirement may not have a strong direct impact on drinking behaviors or problems, but attributes of the process (e.g. retirement voluntariness) of transition to retirement and individual attributes, such as having a history of problem drinking, may facilitate or inhibit drinking.

CONCLUSIONS

Future research should delve into the social context of drinking in retirement with a goal of understanding the aspects and conditions of retirement that increase risk of alcohol problems. Investigation should also examine heterogeneity in retirement drinking patterns with a goal of identifying subpopulations that are at greater risk.

Stress and Psychotropic Drug Use among the Elderly: An Exploratory Model

L'objectif de la présente étude était de tester un modèle de cheminement causal de l'effet du stress et divers autres facteurs sur l'utilisation de psychotropes par des personnes âgées en nous appuyant sur des facteurs d'ordre individuel plutôt que social. Les participants étaient des bénéficiaires d'un service de maintien plutôt que de soins à domicile. Les données sont basées sur une série de deux entrevues (à une semaine d'intervalle) faites au domicile de 99 utilisateurs de médicaments psychotropes provenant d'une banlieue socialement défavorisée d'une grande ville canadienne. Le modèle de cheminement causal initial contribue à une partie appréciable (19%) de la variance dans la consommation de psychotropes. Les prédicteurs qui composent notre modèle final, expliquant 17 pour cent de la variance dans la consommation de médicaments sont l'âge, le sexe, les attitudes envers les psychotropes et les événements de vie. Les personnes plus jeunes consomment plus de psychotropes que les plus vieux. Une attitude positive envers les psychotropes et le fait d'appartenir au sexe féminin est associée à un niveau de consommation élevé. L'analyse de cheminement causal n'a pas confirmé notre modèle de consommation de psychotropes en fonction du stress et a plutôt mis à jour de nouvelles questions liées aux facteurs sociaux. Des explications sont offertes à cet effet. Des suggestions de recherche futures ainsi que les retombées cliniques des données sont présentées dans la conclusion.

Building interdisciplinary/intersectoral research partnerships for community-based mental health research with older minority adults

Community-based research often brings investigators from different disciplinary backgrounds together with community representatives to conduct research on topics of mutual concern. This paper describes a case example that illustrates an interdisciplinary/intersectoral study of depression and barriers to mental health care among older adults and illustrate the factors central to implementing a successful research partnership. It will address the following conditions that facilitate and challenge interdisciplinary/intersectoral research: (1) achieving commonality of purpose in study design and research and referral approaches; (2) ensuring the ability to develop, field-test and implement psychometrically rigorous and culturally and qualitatively appropriate instruments; (3) building effective management structures for interdisciplinary/intersectoral research partnerships; and (4) identifying, training and supporting qualified researchers to carry out a mental health study with older ethnically diverse adults. The paper concludes with strengths and limitations of the approach.

Elderly women show neither a shortage of strategies nor an overreliance on drugs in handling aging and in dealing with minor health problems

Women 65 years old and over make up the fastest growing population segment in North America. They are, particularly among the underprivileged, known to be heavy consumers of prescribed and over-the-counter drugs. The objective of this study was to identify the role of medication in underprivileged elderly women's strategies for aging well and dealing with minor health problems. A qualitative study was conducted among 40 women aged 65 to 75. Results show that elderly women seldom mention resorting to medication to "age well" although they report using this strategy to deal with minor health problems. Overall, the elderly women mentioned a wide range of strategies to cope with aging and minor health problems, which suggests that they are well equipped to face the challenges of aging.

Treatment for alcohol-related problems: special populations: research opportunities

For the subgroups indicated, a few questions/issues are relevant to all three (women, elderly, minorities): 1. Heterogeneity of the special populations, for example, Hispanic-Americans are from different countries with different cultures. Women and the elderly vary by age, education, income, social class, health status, etc., to say nothing of ethnicity/color/religion. 2. Of therapy modalities, professional and indigenous, which are more efficacious? 3. Are group-specific therapies needed, or will sensitivity to a particular group work as well? WOMEN: Stereotypes and myths have prevailed, for example, the long-standing belief that women have poorer prognoses than male alcoholics. When female and male alcoholics are compared, women report more positive family history, a later onset of drinking and problems, more marital disruption, more comorbidity, etc. The review of treatment outcomes (Vannicelli, 1986) showed few significant gender differences in outcomes. Research recommendations include biological and genetic studies, women's view of and use of therapeutic modalities, and outcome studies of different modalities, including all female facilities. ELDERLY: Medications are used more by older patients, and such patients are more likely to experience adverse drug reactions. In the moderate social use of alcohol, there are conflicting reports and the extent of elderly use awaits decisive study. The etiology of problem drinking by older persons is studied rarely. An attempt has been made to explain onset later in life (vs. earlier onset) based on the stresses of aging (loss, loneliness, health problems, etc.); research results have not been supportive. Consequences of older persons' heavy drinking seems to be most often alcohol-related medical disorders, although there are often familial and social consequences. Atkinson (1995) recommended the development of elder-specific outcome measures, study of the efficacy of different treatment modalities, and study of the efficacy of treatment for patients in elder-specific and mixed age groups, etc. MINORITIES: Each of the federally mandated minority groups in the United States is heterogeneous. The epidemiology of use and abuse of alcohol and other drugs is well studied, but treatment issues are not. AMERICAN INDIANS: There are more than 200 tribes; each has its own customs and culture. Some tribes are abstinent; others have big problems with abuse of alcohol, and other drugs. Orthodox treatment methods, used by professional counselors and therapists, have not worked very well.

RECOMMENDATION

study of traditional Indian forms of healing practices combined with other treatment; this would be a culture-sensitive model. BLACK AMERICANS: This includes not only African-Americans but people from the Caribbean, Central and South America, etc. Among African-Americans, there is a history of ambivalence toward alcohol: on the one hand, a tolerant "nightclub culture" and on the other, church beliefs in temperance and abstinence. There is "respectable drinking" and "problem drinking," most often defined as solitary or public drinking. The primary source of support is considered familial, so people tend to be distrustful of therapy from "strangers." They are anonymous in promoting sobriety and study of subcultural norms and the history of slavery. Earlier ethnographic works (Liebow, 1967) were of "street-corner men," slum dwellers, ghetto norms; recommended: studies of middle-class African-American life and drinking behaviors. ASIAN-AMERICANS: A study in Los Angeles reports differences among Chinese, Japanese, Filipinos, and Koreans in drinking beliefs and behavior. Of these groups, the Japanese in Japan and the Japanese-Americans report the largest number of heavy drinkers. It is, however, considered a private matter, even when associated with social problems. Interestingly, there is an organization called the All Nippon Sobriety Association (like Alcoholics Anonymous). RECOMMENDATIONs: studies of generational differences among Japanese-Americans in use and efficacy of treatment. For the Chinese-Americans, who are fairly permissive about older persons' drinking and share a belief in the health benefits of alcohol, a gender/gerontological study is recommended. HISPANIC-AMERICANS: As a total group, they drink more and present more alcohol-related problems than other immigrant minorities. Age, ethnicity, and gender patterns in permissiveness to drink need to be explored. Treatment sought is often in pentecostal churches and Centros for Espiritismo. Hispanics are not likely to seek help in formal clinical settings which emphasize alcohol consumption as the basic, core problem. They are more likely to seek out and be responsive to the perception of their drinking problem as sin and a rejection of Jesus. It is not that minorities do not recognize problems and seek out help. They are not likely to seek out the health profession's offering of outpatient clinics, residential treatments, etc.

Older women and alcohol. Use and abuse

Although estimates of elderly problem drinkers and alcohol-related health problems among the elderly are approximate, there does appear to be a decline in the number of drinkers and the number of heavy drinkers. As with all age groups, there are fewer women who drink than men and fewer women problem drinkers. Moderate social drinking varies with health and income. Among older women, there may well be more problematic use of prescribed psychoactive drugs than alcohol. In the few studies of older problem drinkers available, there are gender differences: Older men are more likely to be married, divorced, or separated, but older women problem drinkers show a hgh rate of widowhood; onset is more recent for older women than for older men; older women are more problematic users of prescribed psychoactive drugs; and the prevailing comorbidity among older women alcohol abusers is probably depressive disorder.

Mental health, stress correlates and psychotropic drug use or non-use among aged caregivers to elders with dementia

The goal of the study was to compare caregivers who used psychotropic drugs with caregivers who were non-users in order to pinpoint differences in coping styles between the two groups. We performed a secondary analysis of a study on the stress and psychological well-being of persons caring for relatives with dementia. We compared elderly caregivers, as either psychotropic drug users (n = 61) or non-users (n = 133), over various psychosocial characteristics relating to the care-giving context. Results reveal that users, as compared to non-users were: (a) more disturbed (appraised a greater stress) by the relative's dysfunctional behaviours, after controlling for the frequency of the behaviours; and (b) experienced more conflict during interpersonal interactions, although their appraisal of self-satisfaction with formal and informal support to their care-giving activities did not differ significantly. Strikingly, users combined and called on a greater number of problem-focused and emotion-reducing coping strategies than did non-users. They more frequently used affective regulation and information seeking coping styles. Stress-related measures (especially stress appraisal and conflict) contributed more to the variation in mental distress of users than of non-users. Results provide a theoretical and empirical rationale for therapeutic interventions such as the cognitive behavioural approach.

An exploratory study of the hardy personality at work in the health care industry

The concept of personality hardiness is tested for its contribution to perceptions of the nursing work environment. Hardiness has been traditionally linked to positive health outcomes and stress resistance, but the traits which lead to disease-resistance logically have other effects on the individual. Results of this exploratory study indicate that hardiness is negatively linked to perceptions of work pressure and role ambiguity. Positive relationships were found between hardiness and job clarity, organizational involvement, and peer cohesion. Suggestions for additional study are enumerated.

Prescription drug dependence in the elderly population: demographic and clinical features of 100 inpatients

OBJECTIVE

To determine the prevalence of prescription drug dependence among elderly persons in an inpatient treatment setting, to identify apparent risk factors for drug dependence, and to ascertain what factors led to admission of these patients.

DESIGN

We reviewed the medical records of 100 elderly patients dependent on prescription drugs who were admitted to the Mayo Inpatient Addiction Program between 1974 and 1993.

MATERIAL AND METHODS

Demographic features, chronic medical disorders, categories of substance dependence, diagnoses of mental disorders, and Minnesota Multiphasic Personality Inventory data were compiled and analyzed.

RESULTS

The mean annual admissions rates for three substance use disorder groups among all elderly persons treated during the 20-year period of study were as follows: alcohol only, 72%; prescription drugs, 16%; and both alcohol and drugs, 12%. The group as a whole was socially intact. Female gender seemed to be a risk factor for drug dependence. By several measures, these elderly patients were characterized as a psychiatric population. The most frequent drug dependence involved sedatives or hypnotics. General medical data did not suggest that these elderly persons were more physically impaired than the general population.

CONCLUSION

In elderly patients, awareness of coexistent diagnoses is essential in avoiding the inappropriate administration of multiple pharmaceutical agents and the possible risk of associated drug abuse and dependence.

Diagnostic conundrums in substance abusers with psychiatric symptoms: variables suggestive of dual diagnosis

Patients with substance dependence and psychiatric symptoms often present a diagnostic conundrum because each of these problems may mutually and reciprocally complicate the other. This may challenge the ability to identify dual-diagnosis patients who have both a substance abuse disorder and a definitive symptom-based psychiatric disorder. The main purpose of this explorative study was to identify variables suggestive of dual diagnosis in the population of substance-dependent patients with psychiatric symptoms. A secondary purpose was to examine the subgroups in this population for their distinctiveness from one another. Based upon clinical experience and the literature, seven independent variables were hypothesized as suggestive of dual diagnosis. Seventy-nine patients with substance dependence and psychiatric symptoms of depression, anxiety, and/or psychosis were assessed for symptom and disorder status generating three subgroups: I) 20 patients with psychiatric symptoms not meeting thresholds for clinical significance; II) 36 patients exhibiting a psychiatric disorder (dual diagnosis); and III) 23 patients with psychiatric symptoms meeting thresholds for clinical significance but not for a disorder. Odds ratios were calculated to examine the risk for dual diagnosis using the seven independent variables. A persistent increased risk for dual diagnosis was observed in patients who were positive for the seven variables. The seven variables were combined into an overall measure of patients' risk for dual diagnosis. Mean scores were significantly different for the three groups F(2, 76) = 8.4, p < .001. This study indicates variables that may be suggestive of dual diagnosis and finds subgroup distinctiveness in this sample. Both of these findings have treatment implications.

Examining personal control beliefs as a mediating variable in the health-damaging behavior of substance use: an alternative approach

Substance use continues to be a concern for researchers and health professionals alike. One of the most extensive areas of research on health-related behaviors such as smoking and drug use has been on personal control beliefs. Since many health actions (both facilitative and deleterious) depend on voluntary behaviors, and many health-related prevention and intervention programs are predicted on an assumption of controllability, this is an important area to consider. This article is a review of some of the literature and presents an alternative approach that entails using area-specific and domain-specific methods to examine the role that control beliefs play in the health-damaging behavior of substance use.

Agreement between two measures of drug use in a low-prevalence population

The present study examined the agreement between two measures of prevalence of drug use in the community: self-report and specific pharmacological analyses of urine samples. The data were collected in the context of a random community survey of health practices and attitudes. A random 20% of the households participating in the health study were targeted for biochemical assay. Compliance with urine delivery was relatively high at 79%. Urine samples were screened qualitatively for cannabinoids and benzodiazepines using the enzyme multiplied immunoassay technique (EMIT) (Syva Diagnostics, Palo Alto, CA). Screening for pharmaceuticals used a standard thin-layer chromatography (TLC) technique. Agreement between the self-report and biochemical assay estimates of prevalence was statistically significant (p less than .05). While self-report of substance use is not a perfect measure of consumption, it remains a relatively economical and reasonably accurate method of obtaining estimates of substance use in community samples.

Medical and psychosocial factors predictive of psychotropic drug use in elderly patients

The purpose of this study was to investigate medical and psychosocial factors that may be used to identify patients at risk of psychotropic drug use. Population-based surveys were completed by 278 elderly health maintenance organization (HMO) patients in August 1984. Physical and mental health status and social support were measured in the survey. Automated prescription records from the year prior to and the year after the survey were linked to data from the survey. Patients received 737 prescriptions for psychotropic drugs during the two-year period under study. Doxepin (20.2 percent), flurazepam (15.2 percent), and diazepam (14.8 percent) were dispensed most frequently. Nearly 30 percent of the patients received a prescription for at least one psychotropic drug during the two-year period, and 14 percent received at least one prescription during both years. Three significant predictors of subsequent psychotropic drug use were: prior use (odds ratio = 17.2, 95% CI = 6.25, 47.33), the number of physical impairments (OR = 1.73, 95% CI = 1.05, 2.84), and the respondent's rating on the Alameda Health Scale (OR = 1.65, 95% CI = 0.99, 2.75). Patients' self-reported mental health status and sociodemographic characteristics were not significant predictors of subsequent use.