Stressors and Pain across the Late-Life Span: Findings from Two Parent Longitudinal Studies of Aging and Health

OBJECTIVE

The objective is to determine associations between stressors and pain across the late-life span.

METHOD

Multilevel linear modeling was applied separately to harmonized repeated measures data from the Longitudinal Late-Life Health study (LLLH; n = 342; 13-year interval) and the Health and Retirement Study (HRS; n = 2959; 8-year interval).

RESULTS

In both the LLLH and HRS samples, independent of age, gender, and race, participants with higher average stressor levels experienced more numerous painful conditions and higher pain severity over the study intervals. In the HRS sample, they also experienced higher levels of pain interference. In general, participants' stressor levels did not influence rates of increase in their pain. Gender and race had few moderating effects on associations between stressors and pain.

DISCUSSION

Stressors and pain are associated across the late-life span. Future research should focus on the mediating mechanisms that account for this association and the moderating factors that affect its strength.

History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND

OBJECTIVE

To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later.

METHOD

A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later.

RESULTS

Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND.

CONCLUSIONS

For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

Life Stressors: Elevations and Disparities Among Older Adults with Pain

OBJECTIVE

To examine stressor elevations among older adults with pain, and gender and race disparities in the dual burdens of late-life pain and stressors.

DESIGN

Cross-sectional.

SETTING

Community.

SUBJECTS

Participants in the Longitudinal Late-Life Health study (LLLH; N = 1,884) and the Health and Retirement Study (HRS; N = 7,704).

METHODS

Pain and stressor measures were harmonized across the LLLH and HRS samples. Analyses of covariance were conducted to determine the effects of older adults' pain, gender, race, and interactions between these factors, on their stressors in nine separate life domains, and in stressors overall.

RESULTS

In both the LLLH and HRS samples, older adults with painful conditions (joint, back, headache, chest pain), more numerous painful conditions, more severe pain, and more pain interference had elevated stressors in all life domains, compared with older adults without or with less serious pain. Pain was more prevalent among women and nonwhites than men and whites. Stressor exposure was higher for men than women in most life domains; it was higher for nonwhites than whites in all life domains. For certain types of pain and life domains, pain and gender, as well as pain and race, interacted to predict stressor elevations.

CONCLUSIONS

Late-life pain is associated with elevations in stressors, and there are gender and race disparities in the dual burdens of heightened pain and elevated stressors in later life. Pain and stressors are not consistently more strongly linked among older women than older men, or among older nonwhite than older white persons.

Effects of Mental Health Disorders on Nursing Home Residents' Nine-Month Pain Trajectories

OBJECTIVE

To determine the key classes of nursing home residents' nine-month pain trajectories, the influence of residents' mental health disorders on membership in these classes, and nine-month health-related outcomes associated with pain trajectory class membership.

METHODS

Four times over a nine-month period, the MDS 3.0 resident assessment instrument was used to record the demographic characteristics, mental health disorder diagnoses, pain characteristics, and health and functioning outcomes of 2,539 Department of Veterans Affairs Community Living Center (VA CLC) residents. Growth mixture modeling was used to estimate the key classes of residents' nine-month pain trajectories, the influence of residents' mental health disorders on their pain trajectory class membership, and the associations of class membership with residents' health and functioning outcomes at nine-month follow-up.

RESULTS

Four-class solutions best described nursing home residents' nine-month trajectories of pain frequency, severity, and interference. Residents with dementia and severe mental illness diagnoses were less likely, and those with depressive disorder, PTSD, and substance use disorder diagnoses more likely, to belong to adverse nine-month pain trajectory classes. Membership in adverse pain frequency and pain severity trajectory classes, and in trajectory classes characterized by initially high but steeply declining pain interference, portended more depressive symptoms but better cognitive and physical functioning at nine-month follow-up.

CONCLUSIONS

Nursing home residents' mental health disorder diagnoses help predict their subsequent pain frequency, severity, and interference trajectories. This may be clinically useful information for improving pain assessment and treatment approaches for nursing home residents.

Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0

Objective: This study evaluated: (a) associations between long-term care residents' mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders. Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments. Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. Among residents affirming recent pain, those with dementia or SMI diagnoses were twice as likely to obtain no treatment for their pain and significantly less likely to receive as-needed pain medication and non-pharmacological pain treatments than were other residents. Those with either depressive disorder or PTSD were more likely, and those with SUD less likely, to obtain scheduled pain medication. In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning. Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.

Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults

BACKGROUND

There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers.

METHODS

We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals.

RESULTS

A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality.

CONCLUSIONS

Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.

Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern

OBJECTIVE

Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems.

METHOD

The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years).

RESULTS

Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%.

CONCLUSIONS

Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.

Healthcare system-wide implementation of opioid-safety guideline recommendations: the case of urine drug screening and opioid-patient suicide- and overdose-related events in the Veterans Health Administration

This study provides an example of how healthcare system-wide progress in implementation of opioid-therapy guideline recommendations can be longitudinally assessed and then related to subsequent opioid-prescribed patient health and safety outcomes. Using longitudinal linear mixed effects analyses, we determined that in the Department of Veterans Affairs (VA) healthcare system (n = 141 facilities), over the 4-year interval from 2010 to 2013, a key opioid therapy guideline recommendation, urine drug screening (UDS), increased from 29 to 42 %, with an average within-facility increase rate of 4.5 % per year. Higher levels of UDS implementation from 2010 to 2013 were associated with lower risk of suicide and drug overdose events among VA opioid-prescribed patients in 2013, even after adjusting for patients' 2012 demographic characteristics and medical and mental health comorbidities. Findings suggest that VA clinicians and healthcare policymakers have been responsive to the 2010 VA/Department of Defense (DOD) UDS treatment guideline recommendation, resulting in improved patient safety for VA opioid-prescribed patients.

Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers

OBJECTIVE

Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers.

METHOD

The sample comprised 1,121 adults ages 55-65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates.

RESULTS

Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk.

CONCLUSIONS

Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers.

Alcohol Use Predicts 10-Year Depressive Symptom Trajectories in the Health and Retirement Study

OBJECTIVE

To determine effects of late-middle-aged adults' baseline drinking behavior on their subsequent 10-year depressive symptom trajectories.

METHOD

Health and Retirement Study participants (N = 7,939) were assessed on baseline demographic, health, and drinking characteristics, and biennially assessed for the next 10 years on their depressive symptoms.

RESULTS

Growth mixture modeling generated four classes of depressive symptom trajectories: Consistently low (72%), consistently elevated (6%), increasing (12%), and decreasing (10%). Baseline abstinence from alcohol, possibly enforced by poorer health and a history of drinking problems, and heavier drinking, "binge" drinking, and having a history of drinking problems, raised risk of membership in the "consistently elevated" class. Abstinence by participants without history of drinking problems-and light, moderate, and heavier drinking-protected against membership in the "increasing" class. Abstinence by participants without history of drinking problems elevated-and moderate drinking reduced-likelihood of membership in the "decreasing" class.

DISCUSSION

Late-middle-aged adults' alcohol use is associated with the subsequent long-term course of their depressive symptoms.

Psychiatric disorders and pain treatment in community nursing homes

OBJECTIVE

Effective pain assessment and pain treatment are key goals in community nursing homes, but residents' psychiatric disorders may interfere with attaining these goals. This study addressed whether (1) pain assessment and treatment obtained by nursing home residents with psychiatric disorders differs from that obtained by residents without psychiatric disorders; (2) this difference is found consistently across the four types of psychiatric disorder most prevalent in nursing homes (dementia, depression, serious mental illness, and substance use disorder); and (3) male gender, non-white, and longer length of stay add to psychiatric disorders to elevate risk of potentially adverse pain ratings and pain treatments.

METHODS

In this cross-sectional study, we examined relationships among National Nursing Home Survey 2004 residents' demographic, diagnostic, pain, and pain treatment characteristics.

RESULTS

Compared with residents without psychiatric disorders, those with psychiatric disorders were less likely to be rated as having pain in the last 7 days and had lower and more "missing" or "don't know" pain severity ratings. They also were less likely to obtain opioids and more likely to be given only nonopioid pain medications, even after statistically adjusting for demographic factors, physical functioning, and pain severity. These effects generally held across all four types of psychiatric disorders most prevalent in nursing homes and were compounded by male, non-white, and longer-stay status.

CONCLUSION

Psychiatric disorders besides dementia may impact pain assessment and treatment in nursing homes. Nursing home residents with psychiatric disorders, especially male, non-white, and longer-stay residents, should be targeted for improved pain care.

Episodic heavy drinking and 20-year total mortality among late-life moderate drinkers

BACKGROUND

Analyses of moderate drinking have focused overwhelmingly on average consumption, which masks diverse underlying drinking patterns. This study examined the association between episodic heavy drinking and total mortality among moderate-drinking older adults.

METHODS

At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who engaged in episodic heavy drinking and 372 regular moderate drinkers. The database at baseline also included a broad set of sociodemographic, behavioral, and health status covariates. Death across a 20-year follow-up period was confirmed primarily by death certificate.

RESULTS

In multiple logistic regression analyses, after adjusting for all covariates, as well as overall alcohol consumption, moderate drinkers who engaged in episodic heavy drinking had more than 2 times higher odds of 20-year mortality in comparison with regular moderate drinkers.

CONCLUSIONS

Among older moderate drinkers, those who engage in episodic heavy drinking show significantly increased total mortality risk compared to regular moderate drinkers. Episodic heavy drinking-even when average consumption remains moderate-is a significant public health concern.

Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?

OBJECTIVE

Benzodiazepines, other anxiolytics, or sedative hypnotics are prescribed for 30%-50% of posttraumatic stress disorder (PTSD) patients. Prior data and theory suggest that these medications may inhibit response to exposure therapy, one of the most effective PTSD treatments. The present post hoc study reanalyzed results from a psychotherapy trial to assess whether benzodiazepine use was associated with reduced response to exposure therapy.

METHOD

Between August 2002 and October 2005, 283 female veterans and soldiers meeting DSM-IV criteria for PTSD were randomly assigned to 10 weekly 90-minute sessions of either prolonged exposure (n = 140) or present-centered psychotherapy (n = 143). Benzodiazepine use (n = 57) or non-use (n = 226) at intake was not randomly assigned. Multilevel modeling was used to assess the effects of benzodiazepine status, psychotherapy condition, and their interaction on changes on the Clinician-Administered PTSD Scale and the PTSD Checklist during the treatment and 6-month follow-up periods.

RESULTS

Consistent with prior reports from these data, prolonged exposure psychotherapy produced greater reductions per week in PTSD symptoms than did present-centered psychotherapy (b = -0.48, P = .02). Patients prescribed benzodiazepines did not have weaker response to prolonged exposure, but demonstrated poorer posttreatment maintenance of gains from present-centered psychotherapy (b = -0.78, P < .001).

CONCLUSIONS

Prolonged exposure is a sufficiently robust treatment that patients who are taking benzodiazepines can benefit from it. It is unclear whether benzodiazepine use or other patient factors accounted for benzodiazepine recipients' poorer maintenance of gains in present-centered psychotherapy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00032617.

Pain and use of alcohol in later life: prospective evidence from the health and retirement study

OBJECTIVE

To determine whether (a) late-life pain predicts growth in older adults' use of alcohol, and elevated risk of drinking problems; and (b) sociodemographic characteristics moderate these relationships.

METHOD

Five times over an 8-year interval, N = 5,446 Health and Retirement Study (HRS) participants provided information about their pain and alcohol use. Two-part latent growth modeling and logistic regression were used to analyze these data.

RESULTS

Participants with more pain at baseline had lower initial levels and a faster rate of decline over the next 8 years in alcohol consumption, but they also were at elevated risk of having drinking problems. Income and African American background interacted with pain to predict 8-year change in alcohol consumption and presence of drinking problems.

DISCUSSION

Late-life pain does not predict growth in older adults' alcohol consumption, but is nonetheless linked to elevated risk of drinking problems, especially among African Americans.

Coping trajectories in later life: a 20-year predictive study

OBJECTIVES AND METHOD

Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults' (n = 719; baseline M = 61 years) 20-year, intraindividual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories.

RESULTS

Over the 20-year study interval, participants declined in the use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms, and fewer financial resources were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant.

CONCLUSION

Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults' stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle-age.

Twenty-year alcohol-consumption and drinking-problem trajectories of older men and women

OBJECTIVE

The aim of this study was to describe older adults' 20-year alcohol-consumption and drinking-problem trajectories, identify baseline predictors of them, and determine whether older men and women differ on late-life drinking trajectory characteristics and predictors.

METHOD

Two-group simultaneous latent growth modeling was used to describe the characteristics and baseline predictors of older community-residing men's (n = 399) and women's (n = 320) 20-year drinking trajectories. Chi-square difference tests of increment in fit of latent growth models with and without gender invariance constraints were used to determine gender differences in drinking trajectory characteristics and predictors.

RESULTS

Unconditional quadratic growth models best described older individuals' within-individual, 20-year drinking trajectories, with alcohol consumption following an average pattern of delayed decline, and drinking problems an average pattern of decline followed by leveling off. On average, older men declined in alcohol consumption somewhat later than did older women. The best baseline predictors of more rapid decline in alcohol consumption and drinking problems were drinking variables indicative of heavier, more problematic alcohol use at late middle age.

CONCLUSIONS

The course of alcohol consumption and drinking problems from late middle age onward is one of net decline, but this decline is neither swift nor invariable. Gender differences in the timing of decline in drinking suggest that ongoing monitoring of alcohol consumption may be especially important for older men. Further research is needed to identify factors known at late middle age that prospectively explain long-term change in late-life use of alcohol.

Painful medical conditions and alcohol use: a prospective study among older adults

OBJECTIVE

To determine associations between older adults' baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations.

METHODS

At baseline, then, 1, 4, and 10 years later, late-middle-aged community residents (M = 61 years; N = 1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships.

RESULTS

At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems.

CONCLUSIONS

Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men.

Spouses of older adults with late-life drinking problems: health, family, and social functioning

OBJECTIVE

This study focuses on the health, family, and social functioning of spouses of late-life remitted and continuing problem drinkers, and on predictors of spouses' alcohol-related functioning and depressive symptoms.

METHOD

Three groups of spouses were compared at baseline and a 10-year follow-up: (a) spouses (n = 73) of older adults who had no drinking problems at baseline or follow-up, (b) spouses (n = 25) of older adults who had drinking problems at baseline but not follow-up, and (c) spouses (n = 69) of older adults who had drinking problems at both baseline and follow-up. At each contact point, spouses completed an inventory that assessed their alcohol-related, health, family, and social functioning.

RESULTS

At baseline, compared with spouses of problem-free individuals, spouses of older adults whose drinking problems later remitted reported more alcohol consumption, poorer health, more depressive symptoms, and less involvement in domestic tasks and social and religious activities. At the 10-year follow-up, spouses of remitted problem drinkers were comparable to spouses of problem-free individuals, but spouses of continuing problem drinkers consumed more alcohol, incurred more alcohol-related consequences, and had friends who approved more of drinking. Overall, spouses whose friends approved more of drinking and whose partners consumed more alcohol and had drinking problems were likely to consume more alcohol and to have drinking problems themselves.

CONCLUSIONS

Spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption

AIMS

This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption.

DESIGN, PARTICIPANTS, MEASUREMENTS

Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning.

FINDINGS

Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking.

CONCLUSIONS

High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking.

Patterns and predictors of late-life drinking trajectories: a 10-year longitudinal study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

Patterns and predictors of late-life drinking trajectories: a 10-year longitudinal study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

The structure of late-life depressive symptoms across a 20-year span: a taxometric investigation

Past studies of the underlying structure of depressive symptoms have yielded mixed results, with some studies supporting a continuous conceptualization and others supporting a categorical one. However, no study has examined this research question with an exclusively older adult sample, despite the potential uniqueness of late-life depressive symptoms. In the present study, the underlying structure of late-life depressive symptoms was examined among a sample of 1,289 individuals across 3 waves of data collection spanning 20 years. The authors employed a taxometric methodology using indicators of depression derived from the Research Diagnostic Criteria (R. L. Spitzer, J. Endicott, & E. Robins, 1978). Maximum eigenvalue analyses and inchworm consistency tests generally supported a categorical conceptualization and identified a group that was primarily characterized by thoughts about death and suicide. However, compared to a categorical depression variable, depressive symptoms treated continuously were generally better predictors of relevant criterion variables. These findings suggest that thoughts of death and suicide may characterize a specific type of late-life depression, yet a continuous conceptualization still typically maximizes the predictive utility of late-life depressive symptoms.

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.

Late-life and life history predictors of older adults' high-risk alcohol consumption and drinking problems

AIMS

This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85.

DESIGN, SETTING, PARTICIPANTS

A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later.

MEASUREMENTS

At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking.

RESULTS

Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems.

CONCLUSION

Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Social and financial resources and high-risk alcohol consumption among older adults

BACKGROUND

This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life.

METHOD

A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption.

RESULTS

Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members.

CONCLUSIONS

These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

Older adults' health and late-life drinking patterns: a 20-year perspective

OBJECTIVES

This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems.

METHODS

A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later.

RESULTS

Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems.

CONCLUSION

Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective

AIMS

The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. DESIGN, PARTICIPANTS AND MEASURES: A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.

FINDINGS

The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75-85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.

CONCLUSIONS

A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.

Depressive symptoms, drinking problems, and smoking cessation in older smokers

This study modeled the predictive association between depressive symptoms and smoking cessation in a sample of 442 late-middle-aged smokers; assessments occurred at four time-points across a 10-year period. In addition, the study examined the role of baseline drinking problems in moderating the relationship between depressive symptoms and smoking cessation. Findings supported hypotheses. More depressive symptoms prospectively predicted a lower likelihood of smoking cessation. In addition, the presence of baseline drinking problems strengthened the relationship between depressive symptoms and a lower likelihood of smoking cessation. Understanding the mechanisms underlying depression and cigarette smoking among older adults is applicable to secondary prevention and treatment and suggests additional public health benefits from treating depression in older persons.

Treated and untreated remission from problem drinking in late life: post-remission functioning and health-related quality of life

OBJECTIVE

To evaluate the post-remission status of older remitted problem drinkers who achieved stable remission without treatment.

METHOD

The post-remission drinking behavior, health-related functioning, life context, coping, and help-seeking of older, untreated (n=330) and treated (n=120) former problem drinkers who had been remitted for a minimum of 6 years were compared twice over the course of 6 years to each other and to lifetime nonproblem drinkers (n=232). Analyses considered the impact of severity of drinking problem history.

RESULTS

Untreated remitters were more likely than treated remitters to continue to drink, exhibited fewer chronic health problems and less depressive symptomatology, and were less likely to smoke. Untreated remitters' life contexts were somewhat more benign than those of treated ones, and they were less likely to describe a coping motive for drinking and engage in post-remission help-seeking. Although untreated remitters more closely resembled lifetime nonproblem drinkers than did treated remitters, both untreated and treated remitter groups exhibited worse health-related functioning, more financial and interpersonal stressors, and more post-remission help-seeking than did lifetime nonproblem drinkers.

CONCLUSIONS

Regardless of whether late-life remission was gained without or with treatment, prior drinking problems conveyed a legacy of health-related and life context deficits.

Gender differences in social influences and stressors linked to increased drinking

OBJECTIVE

To explore reasons for gender differences in problem-drinking prevalence and to compare the experiences of problem-drinking women and men, this article examines gender differences in exposure and drinking reactivity to social influences and stressors during adulthood.

METHOD

A community sample of 831 older adults (347 women and 484 men; average age=69), comprising problem and nonproblem drinkers, provided information about their drinking histories. Respondents indicated whether they had experienced particular social influences and stressors during adulthood (exposure) and, if so, whether they had increased alcohol consumption in response (reactivity).

RESULTS

Overall, women were more likely than men to report exposure to a partner's drinking, family interpersonal problems, death of someone close, and emotional distress. Men reported more exposure to peers' drinking and workplace problems and were more likely to report drinking reactivity to social influences and stressors. Among problem drinkers, gender differences in exposure to social influences and stressors paralleled those in the overall sample, but gender differences in reactivity were minimal.

CONCLUSIONS

Gender differences in exposure to social influences and stressors generally do not help explain men's higher problem-drinking prevalence, but men's overall greater drinking reactivity corresponds with their propensity to develop problem drinking. Problem-drinking women and men tend to be exposed to somewhat different social influences and stressors but share a tendency to respond to these experiences with increased drinking. Information about experiences that may place upward pressure on drinking for men and women can inform efforts to prevent and treat alcohol-use disorders.

Upward Pressures on Drinking: Exposure and Reactivity in Adulthood

OBJECTIVE

The purpose of this study was to identify the situations most commonly linked with increased drinking for different life periods and for nonproblem and problem drinkers.

METHOD

A community sample of older adults (average age 69 years; 42% women), consisting of 480 nonproblem and 351 problem drinkers, provided information about their life history of drinking. For each of three life periods (early adulthood, early middle age, and late middle age), respondents indicated whether they experienced particular situations (exposure) and, if so, whether they increased their alcohol consumption in response to these situations (reactivity). These situations included social influences and stressors.

RESULTS

Exposure to social influences and to stressors varied across life periods, as did drinking reactivity. Overall, the social influences of having peers or a partner who drank and the stressors of family interpersonal problems and emotional distress were common experiences and also were among the most likely to be linked with increased alcohol consumption. Compared with nonproblem drinkers, problem drinkers reported significantly higher levels of exposure to social influences and to stressors and also were much more reactive to them.

CONCLUSIONS

Prevention and treatment of alcohol use disorders can be tailored to take into account variations in exposure and reactivity to situations that may place upward pressure on drinking.

Long-Term Patterns and Predictors of Successful Stressor Resolution in Later Life

At 1 year, 4 years, and 10 years after baseline, late-middle-aged adults reported whether they had successfully resolved their most important stressor of the past year. Compared to individuals who never resolved focal stressors over the 10-year interval, those who always did consistently showed less negative stressor appraisal, less reliance on avoidance coping, and less use of exploratory relative to directed coping responses, independent of type and severity of focal stressor. Less use of exploratory relative to directed coping and having more social resources, fewer health problems, and fewer depressive symptoms at baseline predicted more stressor resolution over the next 10 years. These predictors are promising foci for prospective efforts to optimize ways in which aging adults manage late-life stressors.

Older adults' coping with negative life events: common processes of managing health, interpersonal, and financial/work stressors

This study examined how older adults cope with negative life events in health, interpersonal, and financial/work domains and whether common stress and coping processes hold across these three domains. On three occasions, older adults identified the most severe negative event they faced in the last year and described how they appraised and coped with that event, their ambient chronic stressors, and event and functioning outcomes. The stress and coping process was largely consistent across the three life domains. Individuals who appraised events as challenging and relied more on approach coping were more likely to report some benefit from those events. Individuals who experienced more chronic stressors and favored avoidance coping were more likely to be depressed and to have late-life drinking problems. Chronic stressors, as well as approach and avoidance coping, were predictably associated with overall outcomes in all three event domains. These findings provide a basis for preventive interventions that may help older adults' address the most prevalent stressors of aging more effectively.

Predictors of Untreated Remission From Late-Life Drinking Problems

OBJECTIVE

Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally", without formal treatment. We sought to describe the life history predictors of untreated remission among older adults.

METHOD

We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters.

RESULTS

A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption.

CONCLUSIONS

Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.

Stress generation, avoidance coping, and depressive symptoms: a 10-year model

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

Functioning, problem behavior and health services use among nursing home residents with alcohol-use disorders: nationwide data from the VA minimum data set

OBJECTIVE

We examined (1) whether nursing home residents with alcohol-use disorders (AUDs) function more poorly, have more behavioral problems and use more health services than do demographically matched controls without such disorders, and (2) whether AUDs interact with alcohol consumption to predict poorer behavioral and health services outcomes among nursing home residents.

METHOD

We used Department of Veterans Affairs (VA) Patient Treatment File data to identify a nationwide sample of older VA nursing home residents with recent AUD diagnoses (n = 3,336) and a demographically matched sample without such diagnoses (n = 3,336). The groups were compared on the Resident Assessment Instrument Minimum Data Set indices of health-related functioning, substance use, problem behavior and health services use. We conducted two-way analyses of variance to determine interactions between presence of an AUD and alcohol consumption on problem behavior and health services use.

RESULTS

Residents with AUD diagnoses functioned somewhat better than demographically matched controls. However, they were more likely to have falls and fractures, difficulties in social functioning and to use more health services. AUD diagnoses interacted with alcohol consumption to predict an elevated risk of falls and fractures and more mental health services use.

CONCLUSIONS

Older residents with an AUD form a distinct nursing home population that functions somewhat better than residents without such disorders but they may pose more challenges to staff and use more health care services. Residents' drinking histories should be considered in formulating nursing home policies about alcohol consumption.

Sequencing the lifetime onset of alcohol-related symptoms in older adults: is there evidence of disease progression?

OBJECTIVE

The purpose of this study was to evaluate evidence of orderly symptom progression in alcohol-use disorders (disease-progression model).

METHOD

A sample of community-residing older problem drinkers provided information about their life history of drinking, including the age at which they had experienced alcohol-related symptoms that correspond to criteria for alcohol abuse and dependence. Symptom sets and possible sequences were formulated separately for women and men, based on the average number of years from drinking initiation to symptom onset and on symptom prevalence. We assessed how well the ordering of symptoms experienced by individual respondents matched the sequences derived with these group-level measures; we also assessed whether individuals progress from alcohol abuse to dependence as is implied in some conceptualizations of alcohol-use disorders.

RESULTS

Half or more of these older adults experienced symptom onset in an order that was inconsistent with the possible symptom sequences derived from group-level analysis (e.g., reversals from the expected order or concurrent onset of symptoms expected to occur sequentially). Similarly, alcohol abuse did not appear to be a precursor to the development of alcohol dependence in individual patterns of symptom onset.

CONCLUSIONS

Although group-level results based on the number of years from drinking initiation to symptom onset or on symptom prevalence may seem to point to orderly progression in the development of alcohol-related symptoms, these group-level results do not capture individual experiences very well. In this community-residing sample of problem drinkers, most of whom had never sought treatment, there was marked variability in the course of symptom development, which raises questions about the utility of a disease-progression model.

The interplay between life stressors and depressive symptoms among older adults

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.

Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers

AIMS

Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol.

DESIGN

Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury.

FINDINGS

At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later.

CONCLUSIONS

The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.

Functioning and health service use among elderly nursing home residents with alcohol use disorders: findings from the National Nursing Home Survey

OBJECTIVE

The author asked whether older nursing home residents with alcohol use disorders differ from demographically-matched residents without alcohol use disorders on functioning, admission characteristics, and health services use.

METHOD

National Nursing Home Survey data were used to compare nursing home residents with alcohol use disorders (N=216) with demographically-matched residents without alcohol use disorders (N=216) on functioning, admission characteristics, and health services use.

RESULTS

Residents with alcohol use disorders functioned somewhat better than did residents in the demographically-matched sample group, as indicated by performance of basic activities of daily living. However, they were significantly more likely to have lived alone before admission and to have obtained mental health and social services. There was a significant group x gender interaction on length of stay: men with alcohol use disorders had shorter lengths of stay than did men without alcohol use disorders; women with alcohol use disorders had longer lengths of stay than did women without such disorders.

CONCLUSIONS

Having fewer social resources may contribute to elevated admission risk and need for mental health and social services among older nursing home residents who have alcohol use disorders. Duration and severity of alcohol problems may help explain gender differences in length of stay among these residents.

Older adults' health and changes in late-life drinking patterns

This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

High-risk alcohol consumption and late-life alcohol use problems

OBJECTIVES

We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.

METHODS

A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.

RESULTS

Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.

CONCLUSION

Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.

A ten-year follow-up of older former problem drinkers: risk of relapse and implications of successfully sustained remission

OBJECTIVE

This study examines the risk, predictors of relapse and the effects of successfully sustained remission on the drinking behavior, functioning, life context, coping and help seeking of older adults who were problem drinkers earlier in life.

METHOD

Older former problem drinkers (n = 447) were prospectively followed for 10 years and compared to lifetime nonproblem drinkers.

RESULTS

Of former problem drinkers, 31% (n = 141) died over the 10-year interval, a rate 1.6 times higher than that of lifetime nonproblem drinkers. Among surviving former problem drinkers, although relapse was relatively uncommon (11%), a less severe drinking history, heavier baseline alcohol consumption, and lower baseline income were associated with relapse. The majority (63%) of former problem drinkers who successfully achieved sustained remission continued to drink alcohol, though at levels below those consumed by older lifetime nonproblem drinkers (n = 339). Stably remitted problem drinkers who were abstinent (SRAs) generally reported more severe drinking histories, greater functioning and life context deficits and more help seeking than did stably remitted problem drinkers who were nonabstinent (SRNs). Although SRAs and SRNs both experienced improvements in functioning over the 10-year interval, they continued to experience financial, health-related and life context deficits relative to older lifetime nonproblem drinkers.

CONCLUSIONS

Results suggest there are long-term costs associated with earlier drinking problems, even when remission is maintained. Both current drinking behavior and drinking history are worth considering when making recommendations regarding older adults' alcohol consumption.

Older and younger patients with substance use disorders: outpatient mental health service use and functioning over a 12-month interval

This observational study compared a nationwide sample of older patients with substance use disorders (n = 3,598; age > 55) with a demographically and diagnostically matched sample of younger patients on initial functioning, subsequent outpatient mental health service use, and 12-month follow-up outcomes. Older patents were initially functioning a well as or better than younger patients according to substance use, psychiatric, family, and legal criteria. The groups received comparable amounts of outpatient mental health care. At a 12-month follow-up, older patients generally had better substance use and functioning outcomes than did younger patients. The findings suggest that older patients with substance use disorders are keeping pace with demographically and diagnostically comparable younger patients in obtaining specialized outpatient mental health services and that they have positive treatment prognoses.

Long-term use of VA mental health services by older patients with substance use disorders

OBJECTIVE

The authors studied long-term patterns and predictors of use of mental health services by older surviving patients with substance use disorders in the Veterans Affairs (VA) health care system.

METHODS

In this prospective longitudinal study, patient treatment records were used to determine long-term (ten-year) patterns and predictors of use of VA mental health services in a nationwide cohort of 10,678 surviving patients with a substance use disorder who were 55 years of age or older. The patients were categorized into three groups based on diagnosis during the index episode: patients with alcohol or drug abuse or dependence, patients with alcohol or drug psychosis, and patients with both a substance use and a psychiatric disorder. Most of the patients had alcohol use disorders.

RESULTS

Over the ten-year period, successively fewer patients obtained outpatient and inpatient mental health care. Among patients who did obtain such care, the intensity of service use increased. Medical care did not substitute for mental health treatment. Younger age, being unmarried, and having a more severe disorder were associated with a greater likelihood of mental health service use over the ten-year period. Patients with a dual diagnosis were significantly more likely to obtain outpatient mental health care. Treatment on a residential care unit and longer initial hospital stay were associated with a lower rate of mental health readmissions.

CONCLUSIONS

Of the substantial number of patients with substance use disorders who survive into old age, those with more long-standing substance use problems and with dual diagnoses have the greatest need for long-term mental health treatment.

Successful remission of late-life drinking problems: a 10-year follow-up

OBJECTIVE

This study sought to determine (1) the rate and predictors of long-term remission among a sample of untreated late-life problem drinkers and (2) whether successfully remitted older problem drinkers attain levels of functioning and life contexts comparable to those of lifetime nonproblem drinkers at a 10-year follow-up.

METHOD

We compared 140 older baseline problem drinkers who were successful in achieving long-term remission to 184 baseline problem drinkers whose drinking problems did not remit over the course of 10 years and to 339 lifetime nonproblem drinkers, on functioning and life contexts at baseline and at 4- and 10-year follow-ups.

RESULTS

Being female, having more recent onset of drinking problems, fewer and less severe drinking problems, friends who approved less of drinking, and drinking less and drinking less frequently at baseline predicted long-term remission. In many regards, long-term remitted problem drinkers attained levels of functioning and life context similar to those of lifetime nonproblem drinkers. However, remitted problem drinkers continued to report more incipient drinking problems, depressive symptoms, health and financial stressors, psychoactive medication use, reliance on avoidance coping strategies and less social support from friends than did lifetime nonproblem drinkers at the 10-year follow-up.

CONCLUSIONS

About a third (30%) of an untreated sample of late-life problem drinkers succeeded in attaining stable, long-term remission. The functioning and life contexts of untreated remitted problem drinkers improved significantly over time; however, some deficits persisted at follow-up.

Predictors and outcomes of outpatient mental health care: a 4-year prospective study of elderly Medicare patients with substance use disorders

BACKGROUND

Many elderly inpatients have substance use disorders; recent treatment guidelines suggest that they should receive regular outpatient mental health care after discharge from hospital.

OBJECTIVE

The prevalence, predictors, and outcomes of outpatient mental health care obtained by elderly Medicare patients with substance use disorders were examined.

RESEARCH DESIGN

A longitudinal prospective follow-up was performed.

SUBJECTS

Data from Medicare Provider Analysis and Review Record and Part B Medicare Annual Data were used to identify elderly inpatients with substance use disorders (n = 4,961) and determine their outpatient mental health care 4 years following hospital discharge.

RESULTS

Only 12% to 17% of surviving elderly substance abuse patients received outpatient mental health care in each of 4 years after discharge. Cumulatively over 4 years, approximately 18% of surviving patients obtained diagnostic/evaluative mental health services, 22% obtained psychotherapy, and 9% received medication management. Of patients who obtained outpatient mental health care, 57% made 10 or fewer outpatient mental health visits over the entire 4 years. Younger, non-black, and female patients were more likely to obtain mental health outpatient care, as were patients with prior substance-related hospitalizations, dual diagnoses, and fewer medical conditions. Prompt outpatient mental health care was predictively associated with higher likelihood of mental health readmissions and, among patients with drug disorders, lower mortality.

CONCLUSION

Very few elderly Medicare substance abuse patients obtain outpatient mental health care, perhaps because of health or economic barriers.

Elderly Medicare inpatients with substance use disorders: characteristics and predictors of hospital readmissions over a four-year interval

OBJECTIVE

(1) To describe the characteristics and 4-year readmissions of elderly Medicare inpatients with substance use disorders; (2) to determine whether their readmissions are elevated relative to case controls'; and (3) to examine gender differences in characteristics and predictors of readmissions among elderly inpatients with substance use disorders.

METHOD

Health Care Financing Administration Medicare Provider Analysis and Review data were used to identify elderly patients with substance use disorders and their case controls, and to determine patient characteristics and readmissions over a 4-year interval following hospital discharge.

RESULTS

Of elderly inpatients with substance use disorders (N = 22,768), 37% were women, 11% were black, 22% had previous, substance-related hospitalizations, 14% had concomitant psychiatric disorders and 9% had accident-related diagnoses. Among surviving patients with substance use disorders (N = 12,417), 73% were rehospitalized, a higher rate than among case controls (69%). Women with substance use disorders were more likely to have a psychiatric or accident diagnosis at the index episode than were men with substance use disorders.

CONCLUSIONS

Many women and a disproportionate number of blacks constitute elderly Medicare inpatients with substance use disorders. These patients often have prior substance-related hospitalizations, psychiatric comorbidities, and accidents involving poisoning, adverse drug reactions and falls. They make costly, relatively heavy use of inpatient health services. Elderly women with substance use disorders may benefit from treatment that focuses on their psychiatric disorders and accident risk. Diagnostic information available at discharge can be used to identify patients at higher risk for subsequent rehospitalization and to plan treatment accordingly.