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CORK Bibliography: The Elderly

108 citations. January 2011 to present

Prepared: September 2012

Aalto M; Alho H; Halme JT; Seppa K. The Alcohol Use Disorders Identification Test (AUDIT) and its derivatives in screening for heavy drinking among the elderly. International Journal of Geriatric Psychiatry 26(9): 881-885, 2011. (20 refs.)

Objective: The performance of the Alcohol Use Disorders Identification Test (AUDIT) in screening for heavy drinking among the elderly has been unsatisfactory. The aim of the present study was to determine whether tailoring the cut point improves the performance of the AUDIT and its derivatives in this age group. Methods: From a stratified random sample of 804 Finns aged 65-74 years, 517 subjects (64.3%) completed the AUDIT and the Timeline Follow-back (TLFB) interview regarding alcohol consumption. A subject was defined as a heavy drinker if consumption of >= 8 drinks (approx. 12 g) on average in a week or >= 4 drinks at least in 1 day during the prior 28 days was reported. Combinations in which both sensitivity and specificity are >= 0.8 were defined as optimal. The elderly specific AUDIT-3 is a modification in which the binge drinking threshold is >= 4 drinks. Results: Based on the TLFB, 118 subjects (22.8%) were heavy drinkers. The areas under receiving operating characteristics curves (AUROCs) were equivalent (>= 0.898) for all questionnaires. When using the standard cut point of >= 8 for the AUDIT, the sensitivity was 0.48. Lowering the cut point to >= 5 led to both a sensitivity and specificity over 0.85. The optimal cut point of the AUDIT-C was >= 4. The AUDIT-QF, AUDIT-3 and elderly specific AUDIT-3 did not provide optimal combinations of sensitivity and specificity with any cut point. Conclusions: The AUDIT and AUDIT-C are accurate in screening for heavy drinking among the elderly if the cut points are tailored to this age group.

[Anon]. Study finds different opioids offer variable safety in older adults with noncancer pain. (editorial). Formulary 46(2): 64-64, 2011. (2 refs.)

Azermai M; Elseviers M; Petrovic M; Van Bortel L; Stichele RV. Geriatric drug utilisation of psychotropics in Belgian nursing homes. Human Psychopharmacology: Clinical and Experimental 26(1): 12-20, 2011. (34 refs.)

Objective: To determine the prevalence of psychotropic drug use in Belgian nursing homes, in relation to residents' and institutional characteristics. Methods: The PHEBE project (Prescribing in Homes for the Elderly in Belgium, 2005) was a cross-sectional study, investigating drug use in 76 nursing homes. Psychotropics were categorised into antidepressants, antipsychotics, benzodiazepines and anti-dementia drugs using the ATC classification. Results: Residents' mean age (n = 1730) was 85 (SD: 8) years and 78% were female. The overall prevalence of psychotropic drug use among nursing home residents was 79%. Benzodiazepines were used by 54% and antipsychotics by 33% of all residents. Residents received a higher number of antipsychotics (p < 0.001) but fewer antidepressants (and other medicines) with increasing severity of dementia. Antidepressants were prescribed in 40% of which 2/3 was indicated for depression and 1/3 for insomnia. Anti-dementia drugs were used by 8%. Institutional characteristics showed no relationship with psychotropic drug use, except for a lower use when medication was dispensed by a hospital pharmacist (p = 0.001). Conclusion: As in other European countries, the prevalence of psychotropic utilisation in Belgian nursing homes is exceedingly high, with excessive duplicate use. Guidelines, education and clinical practice recommendations focusing on initiation, reassessment and withdrawal of psychotropic therapy, are needed.

Bazin F; Noize P; Dartigues JF; Ritchie KA; Tavernier B; Moore N et al. Engagement in leisure activities and benzodiazepine use in a French community-dwelling elderly population. International Journal of Geriatric Psychiatry 27(7): 716-721, 2012. (34 refs.)

Objective The prevalence of benzodiazepine use among community-dwelling older persons varies between 10% and 30%. The aim of this study was to explore the association between leisure activities and the use of benzodiazepine among older persons living at home. Methods: The study population included 4,848 persons, aged 65 years and over, living in either of two French cities. Information was collected from a questionnaire administered to the respondents by trained psychologists during face-to-face interviews at home and from a self-administered questionnaire. Baseline examination included socio-demographic characteristics, drug use and leisure activities. We classified as benzodiazepine users subjects who reported use of at least one benzodiazepine during the month preceding the interview. The association between the use of benzodiazepine and leisure activities was assessed by logistic regression adjusted on known potential confounders. Results: More than 18% of participants reported use of at least one benzodiazepine. The adjusted odds ratio (OR) of benzodiazepine use associated with no or lower participation versus participation in the following activities were as follows: OR = 1.31 (95% confidence interval (CI): 1.09 to 1.58) for mental activity; OR = 1.50 (CI: 1.12 to 2.03) for physical activity; OR = 1.28 (CI: 1.05 to 1.55) for productive activity and OR = 0.82 (CI: 0.69 to 0.97) for recreational activity. Conclusion: Low engagement in stimulating activities and high engagement in sedentary activities were associated with recent benzodiazepine use.

Blazer DG; Wu LT. Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States. Aging & Mental Health 16(3): 296-304, 2012. (36 refs.)

Objectives: To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50-64 years of age with those 65+ years of age (N=10, 891). Methods: Data were from the 2008-2009 US National Surveys on Drug Use and Health. Results: Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50-64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8% vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past-year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group. Conclusions: Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.

Bobo JK; Greek AA. Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval. International Journal of Environmental Research and Public Health 8(8): 3263-3276, 2011. (40 refs.)

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U. S. women who enrolled in the Health and Retirement Study (HRS) and completed >= 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

Brook JS; Zhang CS; Brook DW; Koppel J; Whiteman M. Psychosocial predictors of nicotine dependence among women during their mid-sixties. American Journal on Addictions 21(4): 302-312, 2012. (56 refs.)

Although there is considerable research demonstrating the prospective association between earlier maladaptive personal attributes and later nicotine dependence, there is less work on the psychosocial mediators of this relationship. Maladaptive personal attributes appear in the form of depression, anxiety, and interpersonal sensitivity. This study was designed to assess the prospective relationship between earlier maladaptive personal attributes (mean age = 40) and later nicotine dependence ((X) over bar age = 65.2) within an understudied female community sample. The participants were given self-administered questionnaires. The results supported a model by which earlier maladaptive personal attributes predicted later nicotine dependence through several indirect pathways. In addition to cigarette smoking, several domains mediated the relation of earlier maladaptive personal attributes and later nicotine dependence. These domains included internal factors (ie, later maladaptive personal attributes), interpersonal factors (ie, marital/partner conflict), later contextual factors (ie, family financial difficulty). Our multidimensional longitudinal findings have important implications for the prevention and treatment of nicotine dependence. The results identify earlier and later significant psychosocial risk factors to be targeted, and suggest the timing of interventions to reduce or eliminate nicotine dependence.

Bryant AN; Kim G. Racial/ethnic differences in prevalence and correlates of binge drinking among older adults. Aging & Mental Health 16(2): 208-217, 2012. (22 refs.)

Objectives: This study examines how the prevalence and correlates of binge drinking among older adults vary by race/ethnicity. Methods: Drawn from the 2007 California Health Interview Survey, adults aged 60 and older (n = 18, 772) were selected. Binge drinking was measured dichotomously based on whether individuals reported consuming five or more drinks in a single day (four or more for females) in the previous year. Prevalence rates for binge drinking in the past year were calculated by race/ethnicity. A hierarchical logistic regression analysis was conducted using binge drinking in the past year as the dependent variable. Results: Significant racial/ethnic differences were found in prevalence rates: the presence of binge drinking was most common among non-Hispanic Whites (11.9%), followed by Latinos (10.8%), American Indian/Alaska Natives (9.8%), Blacks (8.0%), and Asians (4.2%). Being a current smoker was found to be the strongest predictor of binge drinking and significant main effects were also found for being Black, being Asian, younger age, being male, being unemployed, having a higher poverty threshold, having better self-rated health, and having more psychological distress. Significant interactions between race/ethnicity and age, sex, employment status, educational attainment, smoking status, and self-rated health were found. These findings indicate that certain correlates of binge drinking vary significantly by race/ethnicity among older adults. Conclusions: Apparent racial/ethnic differences existed in the prevalence and correlates of binge drinking among older adults. Identification of more racial/ethnic specific predictors may be important for the development of racial/ethnic appropriate intervention programs.

Caputo F; Vignoli T; Leggio L; Addolorato G; Zoli G; Bernardi M. Alcohol use disorders in the elderly: A brief overview from epidemiology to treatment options. (review). Experimental Gerontology 47(6): 411-416, 2012. (41 refs.)

Alcohol-use-disorders (AUDs) afflict 1-3% of elderly subjects. The CAGE, SMAST-G, and AUDIT are the most common and validated questionnaires used to identify AUDs in the elderly, and some laboratory markers of alcohol abuse (AST, GGT, MCV, and CDT) may also be helpful. In particular, the sensitivity of MCV or GGT in detecting alcohol misuse is higher in older than in younger populations. The incidence of medical and neurological complications during alcohol withdrawal syndrome in elderly alcoholics is higher than in younger alcoholics. Chronic alcohol abuse is associated with tissue damage to several organs. Namely, an increased level of blood pressure is more frequent in the elderly than in younger adults, and a greater vulnerability to the onset of alcoholic liver disease, and an increasing risk of breast cancer in menopausal women have been described. In addition, the prevalence of dementia in elderly alcoholics is almost 5 times higher than in non-alcoholic elderly individuals, approximately 25% of elderly patients with dementia also present AUDs, and almost 20% of individuals aged 65 and over with a diagnosis of depression have a co-occurring AUD. Moreover, prevention of drinking relapse in older alcoholics is, in some cases, better than in younger patients; indeed, more than 20% of treated elderly alcohol-dependent patients remain abstinent after 4 years. Considering that the incidence of AUDs in the elderly is fairly high, and AUDs in the elderly are still underestimated, more studies in the fields of epidemiology, prevention and pharmacological and psychotherapeutic treatment of AUDs in the elderly are warranted.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Illicit Drug Use among Older Adults. (September 1, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011. (9 refs.)

Illicit drug use generally declines as individuals move through young adulthood into middle adulthood and maturity, but research has shown that the baby-boom generation (persons born between 1946 and 1964) has relatively higher drug use rates than previous generations. It has been predicted that, as the baby boom generation ages, past year marijuana use will almost triple between 1999/2001 and 2020 among persons aged 50 or older. Nonmedical use of prescription-type drugs also has been identified as a concern for this population. Although use of illicit drugs is problematic for individuals of all ages, it may be of particular concern for older adults because they experience physiological, psychological, and social changes that place them at greater risk of harm from illicit drug use. An estimated 4.8 million adults aged 50 or older, or 5.2% of adults in that age range, had used an illicit drug in the past year. Marijuana use was more common than nonmedical use of prescription-type drugs among adults aged 50 to 59 (5.9 vs. 3.6%), while nonmedical use of prescription-type drugs was as common as use of marijuana among adults aged 60 or older (1.2 vs. 1.1%). Marijuana use was more common than nonmedical use of prescription-type drugs among males aged 50 or older (4.7 vs. 2.5 percent); rates of marijuana use and nonmedical use of prescription-type drugs were similar among females aged 50 or older (1.9 and 2.1%, respectively)

Public Domain

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. The DAWN Report: Emergency Department Visits Involving Adverse Reactions to Medications among Older Adults. (February 24, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011. (7 refs.)

In 2008, an estimated 1,111,686 emergency department (ED) visits were made by adults aged 50 or older for adverse reactions to pharmaceuticals or other types of medications. More than half of these visits (61.5%) were made by adults aged 65 or older. Central nervous system (CNS) drugs (e.g., pain relievers and drugs used to treat anxiety and insomnia) were involved in almost one fourth (24.3%) of ED visits for adverse drug reactions among older adults. Nearly two thirds of older adults who visited the ED for adverse drug reactions were treated and released (64.2 percent), and nearly one third were admitted to the hospital (32.9%). As adults age, they experience increased health problems, have more medical visits, and take an increasing number of medications (pharmaceuticals and over-the-counter [OTC] medications) compared with younger persons. Because of physiological changes (e.g., decreased kidney and liver function) and because adults aged 50 or older (hereafter referred to as older adults) often take multiple medications, they are at higher risk of experiencing an adverse reaction

Public Domain

Chang CS; Chang YF; Liu PY; Chen CY; Tsai YS; Wu CH. Smoking, habitual tea drinking and metabolic syndrome in elderly men living in rural community: The Tianliao Old People (TOP) Study 02. PLoS ONE 7(6): e-article 38874, 2012. (55 refs.)

The literature shows an inconsistent relationship between lifestyle behaviors and metabolic syndrome (MetS), especially in the elderly. We designed this study to investigate the interrelationships among cigarette smoking, tea drinking and MetS, and to verify the factors associated with MetS in elderly males dwelling in rural community. In July 2010, with a whole community sampling method, 414 male subjects aged over 65 dwelling in Tianliao township were randomly sampled. The response rate was 60.8%. Each subject completed the structured questionnaires including sociodemographic characteristics, habitual behaviors (including cigarette smoking and tea drinking habits) and medical history. After an overnight fast, the laboratory and anthropometric data were obtained. MetS was confirmed according to the criteria defined by the modified NCEP ATP III for the male Chinese population. Subjects were split into either non-MetS or MetS groups for further analysis. Of the 361 subjects with complete data, 132 (36.6%) elderly men were classified as having MetS. Using binary logistic regression, body mass index, serum uric acid, high sensitivity C-reactive protein, HOMA index, current smokers (OR = 2.72, 95%CI: 1.03 similar to 7.19), total smoking amount > = 30 (OR = 2.78, 95%CI: 1.31 similar to 5.90) and more than 20 cigarettes daily (OR = 2.54, 95%CI: 1.24 similar to 5.18) were positively associated with MetS. Current un- or partial fermented tea drinker (OR = 0.42, 95%CI: 0.22 similar to 0.84), tea drinking habit for 1-9 years (OR = 0.36, 95% CI: 0.15 similar to 0.90) and more than 240cc daily (OR = 0.35, 95%CI: 0.17 similar to 0.72) were negatively associated with MetS. In conclusion, this study suggests that smoking habit was positively associated with MetS, but tea drinking habit was negatively associated with MetS in elderly men dwelling in rural community.

Chang CM; Chen MJ; Tsai CY; Ho LH; Hsieh HL; Chau YL et al. Medical conditions and medications as risk factors of falls in the inpatient older people: A case-control study. International Journal of Geriatric Psychiatry 26(6): 602-607, 2011. (35 refs.)

Objective: The majority of inpatient falls are older people who have various medical conditions and are on several medications. The purpose of this study was to examine the association between medical conditions and medications and falls in older people in hospital. Method: Using a case-control design, we selected older people (aged 65 or over) who were reported to the Taiwan Patient-Safety Reporting System for the fall incidents in a large academic hospital in 2006 (n = 165). They were individually (1:1) matched for gender, age, and period of hospitalization with the control non-faller group. Bivariate and multivariate logistic regressions were used to compare the cases and controls to examine the association of medical conditions and medication exposure within 24 h before the falls. Results: Bivariate analyses showed that older people with cancer, or exposure medications such as zolpidem, benzodiazepines, narcotics, and antihistamines were significantly more likely to have falls during hospitalization. After controlling for cancer, zolpidem, narcotics, and antihistamine, we found benzodiazepine (Odds ratio (OR) = 2.26, 95% confidence interval (CI) = 1.21-4.23) and benzodiazepine doses >= 1 mg/day in diazepam equivalents (OR 2.14, 95% CI = 1.04-4.39) were still significantly associated with the falls of older people in the hospital. Conclusions: Strategies to prevent falls in older people in hospital should include minimizing the use of zolpidem, benzodiazepine, narcotics, and antihistamines, especially in cancer patients.

Chang YP; Wray LO; Sessanna L; Peng HL. Use of prescription opioid medication among community-dwelling older adults with noncancer chronic pain. Journal of Addictions Nursing 22(1-2): 19-24, 2011. (30 refs.)

Research exploring the use of prescription opioid medications among community-dwelling older adults is lacking within the current body of health related literature. Previous studies on prescription opioid use have focused on misuse among young and middle-aged adults. The purpose of this pilot study was to: (1) describe older adults' patterns of adherence to their prescription opioid medication regimens and their reasons for these medication use patterns; and (2) examine the associations between adherence of prescription opioids, pain intensity, and pain interference on daily activity. This study utilized a cross-sectional design. Twenty-one participants aged 65 years and older with non-cancer chronic pain were recruited for this study. Findings: revealed that almost half of the study participants reported taking less prescription opioids than prescribed, with 2 participants taking more than the recommended dose. There was no significant association between prescription opioid medication adherence and pain intensity. Participants with lower medication adherence reported greater pain interference with sleep (r =.595; P < .05). It is imperative that clinicians initiate discussion with older adult clients who are prescribed opioid medications in order to evaluate their patients' adherence and the effectiveness of the medication.

Cherniack EP. Ergogenic dietary aids for the elderly. (review). Nutrition 28(3): 225-229, 2012. (68 refs.)

Ergogenic dietary aids might be useful adjunctive therapy to enhance the effects of exercise in the elderly, who lose physical function with age. Many such aids have been tested in athletes and untrained younger persons in laboratory and athletic performance settings, with positive results, although not all studies have demonstrated benefit. Some substances have been tested in the elderly, including creatine, caffeine, beta-hydroxy-beta-methylbutyrate, ubiquinone, and carnitine. The published medical evidence for the use of these substances is considered in this review article. All studies have involved a few subjects for a short period. Studies of creatine alone or together with exercise in old persons have yielded mixed results. These studies have confirmed that creatine in older individuals, as in younger individuals, can increase the short-term capacity to perform quick, repeated episodes of intense activity. An investigation of caffeine has suggested that in older as in younger individuals, caffeine increases endurance but may not improve other parameters of exercise capacity. Evidence has implied beta-hydroxy-beta-methylbutyrate can increase the ability to perform certain short-term activities requiring strength, but not others. Carnitine has been reported to decrease fatigue and increase endurance in older persons. An investigation of ubiquinone has shown no benefit. Further testing has involved the combinations of agents, such as creatine and caffeine, and combinations of beta-hydroxy-beta-methylbutyrate, showing some small improvements in physical function. Future research with these and potentially other combinations over a longer duration will be needed to establish the safety and efficacy of ergogenic dietary aids.

Choi NG; DiNitto DM. Drinking, smoking, and psychological distress in middle and late life. Aging & Mental Health 15(6): 720-731, 2011. (75 refs.)

A limited number of studies have examined the co-occurrence of alcohol use and smoking and their mental health effects in middle and late life. In this study, using the 2008 National Survey of Drug Use and Health, the characteristics of individuals aged 50 and older who abstained from both substances, who used both substances, and who used one or the other substance were examined. Then, the main and interaction effects of drinking and smoking on psychological distress were analyzed. Findings show that smoker-nondrinkers are the most disadvantaged group in terms of sociodemographic and health characteristics, while drinker-nonsmokers are the most advantaged group. When sociodemographic, health, and other factors were controlled, no direct effects of drinking or interaction effect of drinking and smoking were detected for either gender. However, heavy smoking (6+ cigarettes on a typical smoking day) was significantly associated with an elevated level of psychological distress among women. The findings highlight the vulnerability of heavy smoking middle-aged and older women. These women are the most psychologically distressed and may need interventions designed to help them quit smoking, reduce or quit drinking, and alleviate psychological distress.

Chou KL; Liang K; Mackenzie CS. Binge drinking and axis I psychiatric disorders in community-dwelling middle-aged and older adults: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry 72(5): 640-647, 2011. (60 refs.)

Objective: The aims of this study were to document the sociodemographic correlates of binge drinking in middle-aged and older adults and to test the association of binge drinking with the occurrence of DSM-IV mood, anxiety, and alcohol use disorders; smoking; and the use of illicit drugs independently of sociodemographic variables and lifetime diagnosis of the disorder in question. Method: We conducted secondary data analyses based on a subsample of a 3-year prospective, population-based study, the National Epidemiologic Survey on Alcohol and Related Conditions, which consisted of a nationally representative sample of 13,489 American community-dwelling adults aged 50 years and above, interviewed in both 2001-2002 and 2004-2005. This survey assessed the occurrence of 11 DSM-IV mood, anxiety, and alcohol use disorders; nicotine dependence; and the use of illicit drugs during the 3-year follow-up period by using the National Institute on Alcohol Abuse and Alcoholism's Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. Results: We found that, among persons aged 50 years and above, 15.6% of men and 5.7% of women reported binge drinking in the year prior to baseline assessment in 2001-2002. After adjustment was made for covariates, both men who were occasional binge drinkers and men who were frequent binge drinkers were significantly more likely than current male drinkers without binge drinking to have alcohol abuse disorder (adjusted odds ratio [AOR] = 2.90 [95% CI, 1.82-4.62] and AOR = 5.68 [95% CI, 3.79-8.51], respectively) and alcohol dependence disorder (AOR = 3.69 [95% CI, 1.75-7.75] and AOR = 9.21 [95% CI, 5.59-15.18], respectively). Similarly, after adjustment was made for covariates, both women who were occasional binge drinkers and women who were frequent binge drinkers were significantly more likely than current female drinkers without binge drinking to have alcohol abuse disorder (AOR = 4.43 [95% CI, 1.85-10.60] and AOR = 3.49 [95% CI, 1.64-7.43], respectively) and alcohol dependence disorder (AOR = 5.20 [95% CI, 1.56-17.33] and AOR = 19.47 [95% CI, 7.59-49.98], respectively). In addition, in female subjects, occasional binge drinking was associated with an increased risk of panic disorder without agoraphobia (AOR = 2.23; 95% CI, 1.01-4.91) and post-traumatic stress disorder (AOR = 2.67; 95% CI, 1.05-6.84). Conclusions: Binge drinking is strongly associated with a higher risk of alcohol use disorder in middle-aged and older adults in the United States. Results provide valuable information on the risks associated with binge drinking and suggest targets for prevention strategies for mental health in middle and old age.

Chou KL; Mackenzie CS; Liang K; Sareen J. Three-year incidence and predictors of first-onset of dsm-iv mood, anxiety, and substance use disorders in older adults: Results from wave 2 of the national epidemiologyogic survey on alcohol and related conditions. Journal of Clinical Psychiatry 72(2): 144-155, 2011. (90 refs.)

Objective: The aim of this study was to determine the incidence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mood disorders, anxiety disorders, and substance use disorders in older adults and to identify sociodemographic, psychopathological, health-related, and stress-related predictors of onset of these disorders. Method: A nationally representative sample of 8,012 community-dwelling adults aged 60 and above was interviewed twice over a period of 3 years, in 2000-2001 and 2004-2005. First incidence of mood, anxiety, and substance use disorders was assessed over a period of 3 years using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV Version. Results: The 3-year incidence rates of DSM-IV mood, anxiety, and substance use disorders were highest for nicotine dependence (3.38%) and major depressive disorder ([MDD] 3.28%) and lowest for drug use disorder (0.29%) and bipolar II disorder (0.34%). Incidence rates were significantly greater among older women for MDD (99% CI, 1.22-3.13) and generalized anxiety disorder (GAD; 99% CI, 1.20-4.26) and greater among older men for nicotine dependence and alcohol abuse and dependence. Posttraumatic stress disorder predicted incidence of MDD, bipolar I disorder, panic disorder, specific phobia, and GAD, while Cluster B personality disorders predicted incident MDD, bipolar I and II disorders, panic disorder, social phobia, GAD, nicotine dependence, and alcohol dependence. Poor self-rated health increased the risk for the onset of MDD, whereas obesity decreased the incidence of nicotine dependence. Conclusions: Information about disorders that are highly incident in late life and risk factors for the onset of psychiatric disorders among older adults are important for effective early intervention and prevention initiatives.

Cohen-Mansfield J; Kivity Y. The relationships among health behaviors in older persons. Journal of Aging and Health 23(5): 822-842, 2011. (60 refs.)

Objective: To examine the relationships among health behaviors in older persons and whether they form related groups of behaviors. Method: Health behaviors (physical activity, alcohol use, nutrition, weight stability, and smoking) were analyzed using factor analysis in two representative samples of two cohorts of Israeli older persons aged 75 to 94. Data collection was conducted during 1989-1992 for the first cohort (N = 1,200) and during 2000-2002 for the second (N = 421). Results: Four factors of health behaviors were found mostly unrelated: (a) physical activity and weight stability, (b) alcohol use, (c) smoking, and (d) nutrition. Discussion: The analysis enables identification of underlying health-behavior dimensions in an understudied population. Furthermore, the findings have important implications for health-promotion policy, indicating that prevention and health-promotion programs for older persons should target each health behavior, and not assume that the practice of any health behavior implies a healthy overall lifestyle in this population.

Corley J; Jia XL; Brett CE; Gow AJ; Starr JM; Kyle JAM et al. Alcohol intake and cognitive abilities in old age: The Lothian Birth Cohort 1936 study. Neuropsychology 25(2): 166-175, 2011. (58 refs.)

Objective: Moderate alcohol consumption has been associated with better cognitive performance in late adulthood, possibly by improving vascular health. Few studies have examined the potentially confounding roles of prior cognitive ability and social class in this relationship. Method: Participants were 922 healthy adults about 70 years old in the Lothian Birth Cohort 1936 study, for whom there are IQ data from age 11. Alcohol consumption was obtained by self-report questionnaire. Cognitive outcome measures included general cognitive ability, speed of information processing, memory, and verbal ability. Results: Moderate to substantial drinking (> 2 units/day) was associated with better performance on cognitive tests than low-level drinking (<= 2 units/day) or nondrinking in men and women. After adjusting for childhood IQ and adult social class, most of these associations were removed or substantially attenuated. After full adjustment, a small, positive association remained between overall alcohol intake and memory (women and men) and verbal ability (women only). Women's overall alcohol intake was derived almost exclusively from wine. In men, effects differed according to beverage type: wine and sherry port consumption was associated with better verbal ability, but beer was associated with a poorer verbal ability and spirits intake was associated with better memory. Conclusions: Prior intelligence and socioeconomic status influence both amount and type of alcohol intake and may partly explain the link between alcohol intake and improved cognitive performance at age 70. Alcohol consumption was found to make a small, independent contribution to memory performance and verbal ability, but these findings' clinical significance is uncertain.

Cropley V; Croft R; Silber B; Neale C; Scholey A; Stough C; Schmitt J. Does coffee enriched with chlorogenic acids improve mood and cognition after acute administration in healthy elderly? A pilot study. Psychopharmacology 219(3): 737-749, 2012. (57 refs.)

Caffeine exerts positive effects on cognitive and behavioral processes, especially in sub-optimal conditions when arousal is low. Apart from caffeine, coffee contains other compounds including the phenolic compounds ferulic acid, caffeic acid, and the chlorogenic acids, which have purported antioxidant properties. The chlorogenic acids are the most abundant family of compounds found in coffee, yet their effects on cognition and mood have not been investigated. This study aims to ascertain whether a coffee rich in chlorogenic acid modulates brain function. The present pilot study examined the acute effects of decaffeinated coffee with regular chlorogenic acid content and decaffeinated coffee with high chlorogenic acid content on mood and cognitive processes, as measured by behavioral tasks and event-related potentials (ERPs). Performance and ERP responses to a battery of cognitive tasks were recorded at baseline and following the equivalent of three cups of coffee in a randomized, double-blind, crossover study of 39 healthy older participants. Compared with the decaffeinated coffee with regular chlorogenic acid and placebo, caffeinated coffee showed a robust positive effect on higher-level mood and attention processes. To a lesser extent, the decaffeinated coffee high in chlorogenic acid also improved some mood and behavioral measures, relative to regular decaffeinated coffee. Our pilot results suggest that non-caffeine compounds in coffee such as the chlorogenic acids may be capable of exerting some acute behavioral effects, thus warranting further investigation.

Culberson JW; Ticker RL; Burnett J; Marcus MT; Pickens SL; Dyer CB. Prescription medication use among self neglecting elderly. Journal of Addictions Nursing 22(1-2): 63-68, 2011. (22 refs.)

The elderly use approximately one-third of the prescription medication in the United States, often for problems such as chronic pain, insomnia, and anxiety. This study will describe the use of prescription medication, specifically drugs of abuse such as benzodiazepines and opioid analgesics, in a sample of community dwelling elderly referred to Texas Adult Protective Services for self-neglect. We hypothesize that self-neglecting behavior may result in increased use of prescription drugs with known abuse potential. Self-neglecting elders (n = 100) were matched with community controls and interviewed by geriatric nurse-practitioners in their homes. Benzodiazepine use among self neglecting elderly was four-fold that of matched controls, (OR = 4.2, 95%% CI = 0.9-20.4), and the use of opioid analgesics slightly higher among self-neglecting elders, (OR = 1.1, 95%% CI = 0.5-2.4). Self-neglecters were significantly less likely to be taking non-opioid pain medications such as acetaminophen (p < .011) and gabapentin (p < .02). Self-neglecting elders using benzodiazepines were less likely to be female (OR =.81, 95%% CI, 0.2-3.6), live alone (OR =.94, 95%% CI, 0.2-4.0), report pain (OR =0.2, 95%% CI, 0.1-2.0), or depression (OR =.66, 95%% CI, 0.1-3.2). Those using opioid analgesics were less likely to be female, (OR =0.6, 95%% CI, 0.2-1.9), however, more likely to live alone (OR =1.7, 95%% CI, 0.6-1.9), report pain (OR =1.5, 95%% CI, 0.5-4.5), or depression (OR =3.2, 95%% CI, 1.1-4.9). Self-neglecting elders demonstrate a unique pattern of prescription drug use. Further studies are required to determine if self-neglecting behavior in the elderly increases the prescription of benzodiazepine and opiate drugs.

Dassanayake T; Michie P; Carter G; Jones A. Effects of benzodiazepines, antidepressants and opioids on driving: A systematic review and meta-analysis of epidemiological and experimental evidence. (review). Drug Safety 34(2): 125-156, 2011. (102 refs.)

Background: Many individuals in the community are prescribed psychoactive drugs with sedative effects. These drugs may affect their daily functions, of which automobile driving is a major component. Objective: To examine the association of three classes of commonly used psychoactive drugs (viz. benzodiazepines and newer non-benzodiazepine hypnotics, antidepressants and opioids) with (i) the risk of traffic accidents (as indexed by epidemiological indicators of risk); and (ii) driving performance (as indexed by experimental measures of driving performance). Methods: A literature search for material published in the English language between January 1966 and January 2010 in PubMed and EMBASE databases was combined with a search for other relevant material referenced in the retrieved articles. Retrieved articles were systematically reviewed, carrying out meta-analyses where possible. Twenty-one epidemiological studies (13 case-control and 8 cohort studies) fulfilled the inclusion criteria by estimating the accident risk associated with drug exposure (ascertained by blood/urine analysis or prescription records). Sixty-nine experimental studies fulfilled the inclusion criteria by testing actual or simulated driving performance after administering a single dose or multiple doses. Results: Two meta-analyses showed that benzodiazepines are associated with a 60% (for case-control studies: pooled odds ratio [OR] 1.59; 95% CI 1.10, 2.31) to 80% (for cohort studies: pooled incidence rate ratio 1.81; 95% CI 1.35, 2.43) increase in the risk of traffic accidents and a 40% (pooled OR 1.41; 95% CI 1.03, 1.94) increase in 'accident responsibility'. Co-ingestion of benzodiazepines and alcohol was associated with a 7.7-fold increase in the accident risk (pooled OR 7.69; 95% CI 4.33, 13.65). Subgroup analysis of case-control studies showed a lower benzodiazepine-associated accident risk in elderly (>65 years of age) drivers (pooled OR 1.13; 95% CI 0.97, 1.31) than in drivers <65 years of age (pooled OR 2.21; 95% CI 1.31, 3.73), a result consistent with age-stratified risk differences reported in cohort studies. Anxiolytics, taken in single or multiple doses during the daytime, impaired driving performance independent of their half-lives. With hypnotics, converging evidence from experimental and epidemiological studies indicates that diazepam, flurazepam, flunitrazepam, nitrazepam and the short half-life non-benzodiazepine hypnotic zopiclone significantly impair driving, at least during the first 2-4 weeks of treatment. The accident risk was higher in the elderly (>65 years of age) who use tricyclic antidepressants (TCAs); however, the evidence for an association of antidepressants with accident risk in younger drivers was equivocal. Sedative but not non-sedative antidepressants were found to cause short-term impairment of several measures of driving performance. Limited epidemiological research reported that opioids may be associated with increased accident risk in the first few weeks of treatment. Conclusions: Benzodiazepine use was associated with a significant increase in the risk of traffic accidents and responsibility of drivers for accidents. The association was more pronounced in the younger drivers. The accident risk was markedly increased by co-ingestion of alcohol. Driving impairment was generally related to plasma half-lives of hypnotics, but with notable exceptions. Anxiolytics, with daytime dosing, impaired driving independent of their half-lives. TCAs appeared to be associated with increased accident risk, at least in the elderly, and caused short-term impairment in driving performance. Opioid users may be at a higher risk of traffic accidents; however, experimental evidence is limited on their effects on driving.

Desplenter F; Caenen C; Meelberghs J; Hartikainen S; Sulkava R; Bell JS. Change in psychotropic drug use among community-dwelling people aged 75 years and older in Finland: Repeated cross-sectional population studies. International Psychogeriatrics 23(8): 1278-1284, 2011. (29 refs.)

Background: Older people are at high risk of experiencing psychotropic-related adverse drug events. The objective of this study was to compare and contrast the use of psychotropic drugs among community-dwelling people aged >= 75 years in 1998 and 2004. Methods: Comparable random samples of people aged >= 75 years were extracted from the population register in Kuopio, Finland, in 1998 (n = 700) and 2003 (n = 1000). In 1998 and 2004, 523 and 700 community-dwelling people respectively participated in nurse interviews, during which demographic, diagnostic and drug use data were elicited. Logistic regression was used to compute unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of psychotropic drug use in 2004 compared to 1998. Results: The unadjusted prevalence of total psychotropic (37.3% and 38.4%, OR 1.05; 95% CI 0.83-1.33), anxiolytic, hypnotic and sedative (29.6% and 31.3%, OR 1.08, 95% CI 0.85-1.38), and antidepressant (10.7% and 11.9%, OR 1.12, 95% CI 0.78-1.61) use were similar in 1998 and 2004. There was a decrease in the unadjusted prevalence of antipsychotic use (9.2% and 5.7%, OR 0.60; 95% CI 0.39-0.93). After adjusting for socioeconomic and health status differences, there was an increase in the prevalence of total psychotropic (adjusted OR 1.31, 95% CI 1.01-1.70) and antidepressant (OR 1.59, 95% CI 1.06-2.40) use. Conclusion: The unadjusted prevalence of psychotropic drug use remained stable between 1998 and 2004. However, in adjusted analyses there was a small increase in the prevalence of any psychotropic drug use and antidepressant use specifically.

DiNitto DM; Choi NG. Marijuana use among older adults in the USA: User characteristics, patterns of use, and implications for intervention. International Psychogeriatrics 23(5): 732- 741, 2011. (21 refs.)

Background: Epidemiology studies show that the number of older adults using marijuana is increasing. This study aimed to determine the correlates and patterns of marijuana use among older adults that might help health and social service providers better assist this group. Methods: Data are from the 2008 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration in the U.S.A. The sample consisted of 5,325 adults aged 50 years and older. Results: Of the sample, 2.8% were past-year marijuana users. Of them, 23% had used marijuana on at least half the days of the year. Past-year users were more likely to be younger (50-64 years old), black, and not married, and they had significantly higher psychological distress scores, but they did not rate their health as poorer than others in the sample, nor did they attribute many problems, including psychological problems, as being related to their marijuana use. Nevertheless, past-year users present a high-risk profile because, in addition to frequent marijuana use, they also are more likely to smoke cigarettes, engage in binge drinking, and use other illicit drugs. Conclusions: Health and social service providers should be alert to the small number of routine marijuana users among the younger members of the older adult population, especially those suffering significant psychological distress, so that these individuals can be encouraged to utilize services that will help alleviate this distress and promote a healthier lifestyle and increase general well being.

Du F; Qiukui H; Birong D; Changquan H; Hongmei W; Yanling Z et al. Association of osteoporotic fracture with smoking, alcohol consumption, tea consumption and exercise among Chinese nonagenarians/centenarians. Journal of Nutrition, Health & Aging 15(5): 327-331, 2011. (37 refs.)

To observe the association of osteoporotic fracture with habits of smoking, alcohol consumption, tea consumption and exercise among very old people. A cross sectional study conducted in Dujiangyan Sichuan China. 703 unrelated Chinese nonagenarians and centenarians (67.7(1% women, mean age 93.48 years) resident in Dujiangyan. Medical history of osteoporosis and the statement of fracture and habits (current and former) of smoking, alcohol consumption, tea consumption and exercise were collected. In women, subjects with current or former habit of alcohol consumption had significantly higher prevalence osteoporotic fracture than those without this habit; but subjects with former habit of exercise had significantly lower prevalence osteoporotic fracture than those without tills habit. However, in men, there was no significant difference in prevalence of these habits between subjects with and without osteoporotic fracture. After adjust for age, gender, sleep habits educational levels, religion habits and temperament, we found that former habit of alcohol consumption had a significant odds ratio (OR=2.473 95% CI (1.074, 5.526)) for osteoporotic fracture. In summary, among nonagenarians and centenarians, among habits (current and former) of smoking, alcohol consumption, tea consumption and exercise, there seems to be significant association of osteoporotic fracture only with current or former habits of alcohol consumption, former habit of exercise. The habit of alcohol consumption might be associated with a greater risk of osteoporotic fracture, but the former habit of exercise might be associated with a lower risk of osteoporotic fracture.

Duffy SA; Kilbourne AM; Austin KL; Dalack GW; Woltmann EM; Waxmonsky J et al. Risk of smoking and receipt of cessation services among Veterans with mental disorders. Psychiatric Services 63(4): 325-332, 2012. (60 refs.)

Objective: The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. Methods: The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. Results: Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). Conclusions: The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.

Durai UNB; Chopra MP; Coakley E; Llorente MD; Kirchner JE; Cook JM et al. Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: Comorbid conditions and self-rated health status. Journal of the American Geriatrics Society 59(6): 1087-1092, 2011. (30 refs.)

OBJECTIVES: Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population. DESIGN: Cross-sectional screening assessments during a multisite trial for the treatment of depression, anxiety, and at-risk drinking. SETTING: Department of Veterans Affairs (VA)-based primary care clinics across the United States. PARTICIPANTS: Seventeen thousand two hundred five veterans aged 65 and older. MEASUREMENTS: Sociodemographic information, the General Health Questionnaire (GHQ-12), questions about death wishes and suicidal ideation, quantity and frequency of alcohol use, smoking, exposure to traumatic events, and PTSD symptom clusters. RESULTS: Twelve percent (2,041/17,205) of participants screened endorsed PTSD symptoms. Veterans with PTSD symptoms from some (partial PTSD) or each (PTSD all clusters) of the symptom clusters were significantly more likely to report poor general health, currently smoke, be divorced, report little or no social support, and have a higher prevalence of mental distress, death wishes, and suicidal ideation than those with no trauma history or those with trauma but no symptoms. Group differences were most pronounced for mental distress and least for at-risk drinking. Presence of PTSD all clusters was associated with poorer outcomes on all of the above-mentioned health characteristics than partial PTSD. CONCLUSION: PTSD symptoms are common in a substantial minority of older veterans in primary care, and careful inquiry about these symptoms is important for comprehensive assessment in geriatric populations.

Fahmy V; Hatch SL; Hotopf M; Stewart R. Prevalences of illicit drug use in people aged 50 years and over from two surveys. Age and Ageing 41(4): 553-556, 2012. (15 refs.)

Objectives: to quantify illicit drug use in people aged 50 years and over in England and inner London and to compare this between 50 and 64 and 65+ age groups. Methods: primary analyses used data from the 2007 Adult Psychiatric Morbidity Survey (APMS) and the 2008-10 South East London Community Health (SELCoH) Survey. Secondary analyses included additional data on 50-64 year olds from the 1993, 2000 and 2007 APMS, and on 65-74 year olds from the 2000 and 2007 APMS. Results: cannabis was the drug most commonly used in all samples. Prevalences of use within the last 12 months in 50-64 and 65+ age groups were 1.8 and 0.4%, respectively, in England and 9.0 and 1.1%, respectively, in inner London. Prevalences of use at any time previously were 11.4, 1.7, 42.8 and 9.4%, respectively. Lifetime cannabis, amphetamine, cocaine and LSD use in 50-64 year olds had increased approximately tenfold in England from 1993. Lifetime and 12-month trends in tranquilisers were relatively stable. Conclusions: use of some illicit drugs, particularly cannabis, has increased rapidly in mid- and late-life.

Ferri CP; West R; Moriyama TS; Acosta D; Guerra M; Huang YQ et al. Tobacco use and dementia: Evidence from the 1066 dementia population-based surveys in Latin America, China and India. International Journal of Geriatric Psychiatry 26(11): 1177-1185, 2011. (32 refs.)

Objectives: To assess the association between tobacco consumption and dementia using the same methodology in seven developing countries, testing the specific hypotheses that higher exposure to tobacco is associated with a higher prevalence of dementia, that the association is limited to smoked tobacco and is stronger for vascular dementia compared to Alzheimer's disease. Methods: Cross-sectional surveys conducted on individuals aged 65+. A total of 15,022 residents in specified catchment areas were assessed face-to-face using a standardised protocol, which included dementia diagnosis and detailed information on past and current tobacco consumption, and on important potential confounders of this association. Results: A high proportion of participants were never smokers (52% in Dominican Republic to 83% in Peru), most of those who ever used tobacco in China and India were still smoking at age 65 and above (80% and 84%, respectively). There was a positive association between history of tobacco smoke exposure (pack years up to age 50) and dementia (pooled PR = 1.003; 95% CI 1.001-1.005), Alzheimer's disease (pooled PR = 1.007; 95% CI, 1.003-1.011) and Vascular Dementia (pooled PR = 1.003; 95% CI = 1.001-1.005). These associations were attenuated but remained significant if exposure after the age of 50 was included. In India there was no association between smokeless tobacco and dementia. Conclusions: Dementia in developing countries appears to be positively associated with history of tobacco smoking but not smokeless tobacco use. Selective quitting in later life may bias estimation of associations.

Foottit J; Anderson D. Associations between perception of wellness and health-related quality of life, comorbidities, modifiable lifestyle factors and demographics in older Australians. Australasian Journal on Ageing 31(1): 22-27, 2012. (20 refs.)

Aim: The associations between perceived wellness and health-related quality of life, comorbidities and modifiable lifestyle factors in older adults were explored. Methods: Self-administered questionnaires including the Perceived Wellness Survey and the 36-Item Short Form of the Medical Outcomes Study version two were distributed to 328 community-living adults aged 65 years and over. Results: Results showed positive associations between perception of wellness and health-related quality of life. General health (r(249) = 0.66, P < 0.01), vitality (r(249) = 0.59, P < 0.01) and mental health (r(249) = 0.52, P < 0.01) had the strongest association with perceived wellness; and social functioning (r(249) = 0.3, P < 0.01) and pain (r(249) = 0.36, P < 0.01) the lowest. Perceived wellness was influenced by hearing, mobility, memory, chronic disease, exercise, gambling and single status. Conclusion: The study identified that perceived wellness in older adults is a multidimensional construct.

Fortes C; Mastroeni S; Alessandra S; Lindau J; Farchi S; Franco F. The combination of depressive symptoms and smoking shorten life expectancy among the aged. International Psychogeriatrics 24(4): 624-630, 2012. (35 refs.)

Background: Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors. Methods: A cohort of elderly people (N = 167) was followed-up for ten years. Information on sociodemographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality. Results: Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05-2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28-5.31), after controlling for potential confounders. Conclusions: Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

Garcia-Gollarte F; Baleriola-Julvez J; Ferrero-Lopez I; Cruz-Jentoft AJ. Inappropriate drug prescription at nursing home admission. Journal of The American Medical Directors Association 13(1): 83.e9, 2012. (62 refs.)

Background: Inappropriate prescriptions are common in older people admitted to nursing homes. Commonly used instruments to detect potential inappropriate prescriptions have limitations that have precluded wide use, and new instruments are needed. Objective: The goal of this study was to determine the value of the Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right, ie appropriate, indicated Treatment (STOPP-START) criteria and the Australian criteria to detect potentially inappropriate drug prescriptions in older people on admission to nursing home care. Methods: Cross-sectional study of 100 consecutive patients (mean age 84.7 +/- 7.5 years, 80% women) admitted to 6 assisted living nursing homes, with systematic review of prescriptions used at the time of nursing home admission using the STOPP-START and the Australian criteria looking for potentially inappropriate drug treatments. Results: Using the STOPP criteria, 79% of the subjects showed at least one potentially inappropriate prescription. Omissions of potentially appropriate drugs were found by the START criteria in 74% of them. The Australian criteria detected at least one potential problem in 95% of the sample. The number of subjects with 2 or more problems detected was highest using the Australian criteria (72%). The most frequent potentially inappropriately used drugs detected were proton-pump inhibitors, benzodiazepines, antipsychotic drugs, and anticholinergic drugs; many cases of duplicate medications and drug interactions were also detected. Underuse of statins and aspirin in patients with high cardiovascular risk, and of calcium and vitamin D in osteoporosis was also frequent. Conclusions: A high number of potentially inappropriate drug prescriptions can be detected at the time of admission to nursing home care by the use of systematic instruments. Both STOPP-START criteria and the Australian criteria performed well in this setting. The impact of this detection on health outcomes and costs should be assessed before they can be widely recommended.

Gillum RF; Kwagyan J; Obisesan TO. Smoking, cognitive function and mortality in a US national cohort study. International Journal of Environmental Research and Public Health 8(9): 3628-3636, 2011. (12 refs.)

Previous studies report that low levels cognitive function and history of smoking are associated with increased mortality risk. Elderly smokers may have increased risk of dementia, but risk in former smokers is unclear. We tested the hypotheses that the harmful effect of impaired cognitive function as related to mortality is greater in persons smoking at baseline than in others. Further, we used serum cotinine levels to assess recall bias of smoking history by cognitive function level. Data were analyzed from a longitudinal mortality follow-up study of 4,916 American men and women aged 60 years and over, examined in 1988-1994 with complete data followed an average 8.5 years. Measurements at baseline included smoking history, a short index of cognitive function (SICF), serum cotinine and socio-demographics. Death during follow-up occurred in 1,919 persons. In proportional hazards regression analysis, a significant interaction of current smoking with cognitive function was not found; but there was a significant age-smoking interaction. After adjusting for confounding by age or multiple variables, current smoking associated with over 2-fold increased mortality (hazards ratio and 95% confidence limits current versus never smoking 2.13, 1.75-2.59) and SICF with 32% reduction in mortality; top versus bottom SICF stratum 0.68, 0.53-0.88). Serum cotinine data revealed substantial recall bias of smoking history in persons with cognitive impairment. However analyses correcting for this bias did not alter the main conclusions: In a nationwide cohort of older Americans, analyses demonstrated a lower risk of death independent of confounders among those with high SICF scores and never smokers, without a significant interaction of the two.

Gisev N; Hartikainen S; Chen TF; Korhonen M; Bell JS. Mortality associated with benzodiazepines and benzodiazepine-related drugs among community-dwelling older people in Finland: A population-based retrospective cohort study. Canadian Journal of Psychiatry 56(6): 377-381, 2011. (19 refs.)

Objective: To investigate the association between the use of benzodiazepines (BDZs) and BDZ-related drugs and mortality among community-dwelling people aged 65 years and older in Finland. Method: This was a population-based retrospective cohort study. Records of all reimbursed drugs purchased by all 2224 residents of Leppavirta, Finland, aged 65 years and older in 2000 were extracted from the Finnish National Prescription Register. Diagnostic data were extracted from the Special Reimbursement Register. All-cause mortality was assessed after 9 years using national registers. Cox proportional hazards models were used to compute unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals for mortality among prevalent users of BDZs and BDZ-related drugs in 2000 (n = 325), compared with nonusers of BDZs and BDZ-related drugs between 2000 and 2008 (n = 1520). Results: BDZs and BDZ-related drugs were used by 325 out of the 2224 residents (14.6%) in 2000. The 9-year mortality was 50.2% among BDZ and BDZ-related drug users in 2000 and 36.3% among BDZ and BDZ-related drug nonusers between 2000 and 2008 (HR 1.53; 95% Cl 1.28 to 1.82). After adjusting for baseline age, sex, antipsychotic drug use, and diagnostic confounders, the HR was 1.01 (95% Cl 0.84 to 1.21). Conclusions: Use of BDZs and BDZ-related drugs was associated with an increased mortality hazard in unadjusted analyses. However, after adjusting for age, sex, antipsychotic drug use, and diagnostic confounders, the use of BDZs and BDZ-related drugs was not associated with excess mortality.

Grella CE; Lovinger K. Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence. Addictive Behaviors 37(3): 306-312, 2012. (59 refs.)

Background: This paper examines the health status and functioning of an aging cohort of individuals with a history of heroin dependence with a focus on gender differences. Method: Study subjects were originally sampled from methadone maintenance clinics in California in the 1970s and completed follow-up interviews in 2005-09. Out of the original study sample (N=914), 343 participants (44.3% female) were interviewed (70.6% of those not deceased). Bivariate analyses examined gender differences in participants' overall health status and physical and mental health problems. Scores on SF-36 scales were compared with general population norms by gender and age, as well as between participants in the study sample who did and did not report past-year drug use. Results: Average age of the study sample was 58.3 (SD=4.9) years for males and 55.0 (SD=4.1) years for females. There were no significant gender differences in past-year drug use (38% of sample) or injection drug use (19%). Women reported significantly more chronic health problems and psychological distress compared with men, and overall poorer health and functioning compared with general population norms. Men under 65 had poorer physical health and social functioning compared with population norms. Men in the study sample reporting past-year substance use had poorer physical functioning, but less bodily pain, than non-users, whereas women with past-year substance use had poorer mental health than other women. Conclusion: Individuals with a history of heroin dependence have poorer health and functioning than their counterparts in the general population. At a younger age, women reported poorer overall health status and more chronic health and mental health problems than men. Study findings may inform interventions for this population, particularly related to gender-specific treatment needs.

Gross AL; Rebok GW; Ford DE; Chu AY; Gallo JJ; Liang KY et al. Alcohol consumption and domain-specific cognitive function in older adults: Longitudinal data from the Johns Hopkins Precursors Study. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 66(1): 39-47, 2011. (68 refs.)

Objectives. The association of alcohol consumption with performance in different cognitive domains has not been well studied. Methods. The Johns Hopkins Precursors Study was used to examine associations between prospectively collected in about alcohol consumption ascertained on multiple occasions starting at age 55 years on average with domain-specific cognition at age 72 years. Cognitive variables measured phonemic and semantic fluency, attention, verbal memory, and global cognition. Results. Controlling for age, hypertension, smoking status, sex, and other cognitive variables, higher average weekly quantity and frequency of alcohol consumed in midlife were associated with lower phonemic fluency. There were no associations with four other measures of cognitive function. With respect to frequency of alcohol intake, phonemic fluency was significantly better among those who drank three to four alcoholic beverages per week as compared with daily or almost daily drinkers. A measure of global cognition was not associated with alcohol intake at any point over the follow-up. Discussion. Results suggest that higher alcohol consumption in midlife may impair some components of executive function in late life.

Haasum Y; Fastbom J; Johnell K. Institutionalization as a risk factor for inappropriate drug use in the elderly: A Swedish nationwide register-based study. Annals of Pharmacotherapy 46(3): 339-346, 2012. (46 refs.)

Background: Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register. Objective: To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden. Methods: We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs). Results: Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% Cl 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% Cl 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% Cl 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% Cl 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% Cl 0.55 to 0.65). Conclusions: Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Reseaarch is needed to identify underlying risk factors for PIDU within these settings.

Heather N; Paton J; Ashton H. Predictors of response to brief intervention in general practice against long-term benzodiazepine use. Addiction Research & Theory 19(6): 519-527, 2011. (41 refs.)

Aims: To predict the response of mostly elderly patients to brief intervention against long-term benzodiazepine (BZD) use delivered in general medical practice from variables measured at baseline in a randomised controlled trial. Method: Logistic regression was used to identify predictors of a complete cessation of BZD intake or a 'clinically significant reduction' by a half or more from baseline to 6 months follow-up among 183 patients who received a brief intervention. Candidate predictor variables were: (i) stage of change (ii) level of BZD dependence (iii) whether BZDs were prescribed by the patient's usual general practitioner (GP) or by another medical practitioner; (iv) baseline BZD dosage; (v) type of BZD and (vi) gender. Results: Both cessation and reduction were predicted by who prescribed BZDs, with patients whose medication was prescribed by their usual GP more likely to show a positive response to brief intervention than those whose medication was prescribed by another medical practitioner. Stage of change was a significant predictor of a reduction in BZD use, with patients in the Contemplation stage nearly three times more likely, and those in the Action stage over eight times more likely, to achieve a clinically significant reduction than those in the Precontemplation stage. Conclusions: Patients receiving prescriptions from their usual GP are more likely to cease or reduce BZD intake than those receiving prescriptions from another medical practitioner. In managing patients with long-term use of BZDs, general medical practitioners should consider recording the patient's stage of change and tailoring their intervention on that basis.

Hill KD; Wee R. Psychotropic drug-induced falls in older people: A review of interventions aimed at reducing the problem. (review). Drugs & Aging 29(1): 15-30, 2012. (112 refs.)

Falls are a common health problem for older people, and psychotropic medications have been identified as an important independent fall risk factor. The objective of this paper was to review the literature relating to the effect of psychotropic medications on falls in older people, with a particular focus on evidence supporting minimization of their use to reduce risk of falls. A literature search identified 18 randomized trials meeting the inclusion criteria for the review of effectiveness of psychotropic medication withdrawal studies, including four with falls outcomes. One of these, which targeted reduced psychotropic medication use in the community, reported a 66% reduction in falls, while the other studies demonstrated some success in reducing psychotropic medication use but with mixed effects on falls. Other randomized trials evaluated various approaches to reducing psychotropic medications generally or specific classes of psychotropic medications (e.g. benzodiazepines), but did not report fall-related outcomes. Overall, these studies reported moderate success in reducing psychotropic medication use, and a number reported no or limited worsening of key outcomes such as sleep quality or behavioural difficulties associated with withdrawal of psychotropic medication use. Reduced prescription of psychotropic medications (e.g. seeking non-pharmacological alternatives to their use in place of prescription in the first place or, for those patients for whom these medications are deemed necessary, regular monitoring and efforts to cease use or wean off use over time) needs to be a strong focus in clinical practice for three reasons. Firstly, psychotropic medications are commonly prescribed for older people, both in the community and especially in the residential care setting, and their effectiveness in a number of clinical groups has been questioned. Secondly, there is strong evidence of an association between substantially increased risk of falls and use of a number of psychotropic medications, including benzodiazepines (particularly, the long-acting agents), antidepressants and antipsychotic drugs. Finally, the largest effect of any randomized trial of falls prevention to date was achieved with a single intervention consisting of weaning psychotropic drug users off their medications.

Holahan CK; Holahan CJ; Powers DA; Hayes RB; Marti CN; Ockene JK. Depressive symptoms and smoking in middle-aged and older women. Nicotine & Tobacco Research 13(8): 722-731, 2011. (72 refs.)

Introduction: Smoking research and intervention efforts have neglected older women. Depressive symptoms, which are common in middle-aged and older women, are related to the maintenance of adult smoking. Methods: This study investigated the relation of a composite measure of current depressive symptoms, derived from a short form of the Center for Epidemiological Studies Depression Scale, and history of depressive symptoms, derived from two items from the Diagnostic Interview Schedule, to smoking outcomes in the Women's Health Initiative Observational Study (N = 90,627). Participants were postmenopausal with an average age of 63.6 years at baseline. Participants were recruited from urban, suburban, and rural areas surrounding 40 clinical centers in the United States. Analyses controlled for age, educational level, and ethnicity. Results: In multinomial logistic regression analyses, depressive symptoms were related cross-sectionally to current light (odds ratio [OR] = 1.19, 95% CI = 1.14-1.23) and heavier (OR = 1.28, 95% CI = 1.23-1.32) smoking at baseline compared with nonsmokers. In prospective multiple logistic regression analyses, baseline depressive symptoms were negatively predictive of smoking cessation at a 1-year follow-up (OR = .85, 95% CI = 0.770.93) and at participants' final assessments in the study (OR = .92, 95% CI = 0.85-0.98). Light smokers had more than 2 times higher odds of smoking cessation than did heavier smokers. Conclusions: The present findings demonstrate a consistent link between depressive symptoms and negative smoking-related behaviors among middle-aged and older women at both light and heavier smoking levels.

Huang AR; Mallet L; Rochefort CM; Eguale T; Buckeridge DL; Tamblyn R. Medication-related falls in the elderly causative factors and preventive strategies. (review). Drugs & Aging 29(5): 359-376, 2012. (136 refs.)

People are living to older age. Falls constitute a leading cause of injuries, hospitalization and deaths among the elderly. Older people fall more often for a variety of reasons: alterations in physiology and physical functioning, and the use (and misuse) of medications needed to manage their multiple conditions. Pharmacological factors that place the elderly at greater risk of drug-related side effects include changes in body composition, serum albumin, total body water, and hepatic and renal functioning. Drug use is one of the most modifiable risk factors for falls and falls-related injuries. Fall-risk increasing drugs (FRIDs) include drugs for cardiovascular diseases (such as digoxin, type la anti-arrhythmics and diuretics), benzodiazepines, antidepressants, antiepileptics, antipsychotics, antiparkinsonian drugs, opioids and urological spasmolytics. Psychotropic and benzodiazepine drug use is most consistently associated with falls. Despite the promise of a more favourable side-effect profile, evidence shows that atypical antipsychotic medications and selective serotonin reuptake inhibitor antidepressants do not reduce the risk of falls and hip fractures. Despite multiple efforts with regards to managing medication-associated falls, there is no clear evidence for an effective intervention. Stopping or lowering the dose of psychotropic drugs and benzodiazepines does work, but ensuring a patient remains off these drugs is a challenge. Computer-assisted alerts coupled with electronic prescribing tools are a promising approach to lowering the risk of falls as the use of information technologies expands within healthcare.

Ilomaki J; Bell JS; Kauhanen J; Enlund H. Heavy drinking and use of sedative or anxiolytic drugs among aging men: An 11-year follow-Up of the FinDrink Study. Annals of Pharmacotherapy 45(10): 1240-1247, 2011. (49 refs.)

BACKGROUND: Most studies on heavy drinking and sedative/anxiolytic drug use have been cross-sectional, and evidence for a possible temporal association is lacking. OBJECTIVE: To prospectively investigate whether heavy drinking predicts initiation, continuation, or discontinuation of sedative/anxiolytic drugs at 4 and 11 years and, conversely, whether sedative/anxiolytic drug use predicts heavy drinking. METHOD: This was a longitudinal population-based study conducted in Kuopio, Finland. An age-stratified random sample of 1516 men aged 42, 48, 54, and 60 years received a structured clinical examination at baseline (August 1986-December 1989). Follow-up clinical examinations were conducted at 4 (n = 1038) and 11 (n = 854) years. Multinomial logistic regression was used to compute odds ratios and 95% confidence intervals for the association between sedative/anxiolytic drug use and initiation, continuation, and discontinuation of heavy drinking (>= 14 drinks/wk). The reverse association between heavy drinking and sedative/anxiolytic drug use was also investigated. Regression models were adjusted for age, working status, smoking, and depressive symptoms. RESULTS: At baseline 12.9% (134/1038) of participants were heavy drinkers and 4.0% (41/1030) used sedative/anxiolytic drugs. In multivariate analyses, baseline heavy drinking predicted initiation of sedative/anxiolytic drug use at 4 years (OR 2.96; 95% CI 1.23 to 7.15). Conversely, baseline sedative/anxiolytic drug use predicted continuation of heavy drinking at 11 years in unadjusted analysis (OR 3.30; 95% CI 1.19 to 8.44). However, the association was not statistically significant in adjusted analyses (OR 2.69; 95% CI 0.86 to 8.44). CONCLUSIONS: The main finding of this study was the association between heavy drinking and subsequent initiation of sedative/anxiolytic drugs that was not fully explained by baseline depressive symptoms. This may inform strategies to optimize the use of sedative/anxiolytic drugs, and assist in the early identification of patients at risk of heavy drinking. Clinicians should consider a patient's alcohol consumption prior to prescribing or dispensing sedative/anxiolytic drugs. Clinicians should also monitor patients prescribed sedative/anxiolytic drugs for subsequent heavy drinking.

Immonen S; Valvanne J; Pitkala KH. Older adults' own reasoning for their alcohol consumption. International Journal of Geriatric Psychiatry 26(11): 1169-1176, 2011. (51 refs.)

Objective: The aim of the study was to investigate what the older adults themselves consider to be the reasons for their alcohol consumption. Methods: The data were collected with a postal questionnaire from a random sample of 2100 elderly people (>= 65 years) living in the medium-sized city of Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. Altogether 868 persons responded that they use alcohol. Of them, 831 gave reasons for their drinking. We defined "at-risk users'' as consuming >7 drinks per week, or >= 5 drinks on a typical drinking day, or using >= 3 drinks several times per week. Results: Main reasons given for alcohol consumption were "having fun or celebration'' (58.7%), "for social reasons'' (54.2%), "using alcohol for medicinal purposes'' (20.1%), and "with meals'' (13.8%). Younger age groups reported more often than the older age groups that they use alcohol for "having fun or celebration'' and "for social reasons.'' The older age groups used more often "alcohol for medicinal purposes''. Men used alcohol more often than women "as pastime'' or "as sauna drink''. Those defined as "at-risk users'' reported using alcohol because of "meaningless life,'' for "relieving depression,'' "relieving anxiety,'' and "relieving loneliness.'' Conclusions: Older adults have diverse alcohol consumption habits like people in other age groups. The oldest olds reported that they use alcohol for medicinal purposes. The "at-risk users'' admit they use alcohol because of meaningless life, and relieving depression, anxiety, and loneliness.

Immonen S; Valvanne J; Pitkala KH. Prevalence of at-risk drinking among older adults and associated sociodemographic and health-related factors. Journal of Nutrition, Health & Aging 15(9): 789-794, 2011. (38 refs.)

Recognition of alcohol-related health problems in the elderly is challenging. Alcohol use also tends to be a hidden issue. The aim of this study was to examine the prevalence and at-risk drinking patterns in community-dwelling older adults and their associations with socio-demographic and health-related factors. The data were collected with a postal questionnaire from a random sample of 2100 elderly people (a parts per thousand yen 65 years) living in the medium-sized city of Espoo, Finland. The response rate was 71.6% from the community dwelling sample. We defined the amount of at-risk drinking as 1) consuming > 7 drinks per week or 2) > 5 drinks on a typical drinking day or 3) using > 3 drinks several times per week. of the respondents, 8.2% (N=114) were at-risk drinkers. At-risk drinking was associated with younger age and male sex, higher level of education, good income, living with a spouse, and current smoking. In addition, good functioning was associated with at-risk drinking. Although frequency and quantity of alcohol consumption declined with age, of our respondents nearly one-fifth of men aged 71-80 years and one-tenth of men aged 81-90 years could be classified as at-risk drinkers. At-risk drinkers had comorbidities and multiple medications as often as non-risk group. A significantly larger proportion of the at-risk drinking group relative to the non-risk group admitted falling or injuring themselves (5.3% vs. 0.7%) or forgotten to take their medications because of the use of alcohol. At-risk drinking is prevalent among older adults, particularly among males, despite prevalent comorbidities and multiple medications. At-risk drinking is associated with adverse events such as a tendency for injuries.

Jafri AB. Aging and toxins. Clinics in Geriatric Medicine 27(4): 609+, 2011. (111 refs.)

This article addresses physiologic organ system and cellular mechanisms of common toxic exposure in the elderly population. Air pollution, tobacco, alcohol, heat, cold, water pollution, medications, herbals, radiation, and other chemicals are discussed.

Jeong HG; Kim TH; Lee JJ; Lee SB; Park JH; Huh Y et al. Impact of alcohol use on mortality in the elderly: Results from the Korean Longitudinal Study on Health and Aging. Drug and Alcohol Dependence 121(1-2): 133-139, 2012. (62 refs.)

Background: To examine the effects of problematic drinking, amount of alcohol use and binge drinking on all-cause mortality in the elderly. Methods: We investigated 45-month all-cause mortality of 997 randomly sampled community-dwelling elderly Koreans aged 65 years or older who participated in the Korean Longitudinal Study on Health and Aging. Problematic drinking was defined as having alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria or having 8 or higher of the Alcohol Use Disorders Identification Test. Light drinking was defined as drinking 7 alcoholic drinks or less, and heavy drinking as having 14 alcoholic drinks more per week during past 12 months. Binge drinking was defined as having 6 or more drinks on a single occasion at least monthly. Results: One hundred and thirteen participants (11.3%) died during the 45-month follow-up period. Heavy drinking (>14 alcoholic drinks per week) increased the all-cause mortality risk when in association with problematic drinking (hazard ratio [HR] = 2.604,95% confidence interval [CI] = 1.221-5.553, p = 0.012) or binge drinking (HR = 2.823,95% Cl = 1.259-6.328,p = 0.013). Light drinking (<= 7 alcoholic drinks per week) was associated with decreased all-cause mortality (HR = 0.114, 95% Cl = 0.015-0.833, p = 0.032). Conclusions: Problematic drinking is associated with increased all-cause mortality in elderly Koreas, particularly when it is heavy and/or combined with binge drinking.

Jessup MA; Dibble SL. Unmet mental health and substance abuse treatment needs of sexual minority elders. Journal of Homosexuality 59(5): 656-674, 2012. (44 refs.)

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indicated that elders 55-64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utilization was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Jogerst GJ; Daly JM; Galloway LJ; Zheng SM; Xu YH. Substance abuse associated with elder abuse in the United States. American Journal of Drug and Alcohol Abuse 38(1): 63-69, 2012. (30 refs.)

Background: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. Objective: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Methods: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Results: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. Conclusion: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community's environment, especially if older persons are involved. Scientific Significance: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse.

Kahan M; Wilson L; Mailis-Gagnon A; Srivastava A. Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Clinical summary for family physicians. Part 2: special populations. (review). Canadian Family Physician 57(11): 1269-1276, 2011. (66 refs.)

Objective: To provide family physicians with a practical clinical summary of opioid prescribing for specific populations based on recommendations from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. Quality of evidence: Researchers for the guideline conducted a systematic review of the literature, focusing on reviews of the effectiveness and safety of opioids in specific populations. Main message: Family physicians can minimize the risks of overdose, sedation, misuse, and addiction through the use of strategies tailored to the age and health status of patients. For patients at high risk of addiction, opioids should be reserved for well-defined nociceptive or neuropathic pain conditions that have not responded to first-line treatments. Opioids should be titrated slowly, with frequent dispensing and close monitoring for signs of misuse. Suspected opioid addiction is managed with structured opioid therapy, methadone or buprenorphine treatment, or abstinence-based treatment. Patients with mood and anxiety disorders tend to have a blunted analgesic response to opioids, are at higher risk of misuse, and are often taking sedating drugs that interact adversely with opioids. Precautions similar to those for other high-risk patients should be employed. The opioid should be tapered if the patient's pain remains severe despite an adequate trial of opioid therapy. In the elderly, sedation, falls, and overdose can be minimized through lower initial doses, slower titration, benzodiazepine tapering, and careful patient education. For pregnant women taking daily opioid therapy, the opioids should be slowly tapered and discontinued. If this is not possible, they should be tapered to the lowest effective dose. Opioid-dependent pregnant women should receive methadone treatment. Adolescents are at high risk of opioid overdose, misuse, and addiction. Patients with adolescents living at home should store their opioid medication safely. Adolescents rarely require long-term opioid therapy. Conclusion: Family physicians must take into consideration the patient's age, psychiatric status, level of risk of addiction, and other factors when prescribing opioids for chronic pain.

Khan R; Chatton A; Thorens G; Achab S; Nallet A; Broers B et al. Validation of the French version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in the elderly. Substance Abuse Treatment, Prevention and Policy 7: e-article 14, 2012. (22 refs.)

Background: Substance use disorders seem to be an under considered health problem amongst the elderly. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), was developed by the World Health Organization to detect substance use disorders. The present study evaluates the psychometric properties of the French version of ASSIST in a sample of elderly people attending geriatric outpatient facilities (primary care or psychiatric facilities). Methods: One hundred persons older than 65 years were recruited from clients attending a geriatric policlinic day care centre and from geriatric psychiatric facilities. Measures included ASSIST, Addiction Severity Index (ASI), Mini-International Neuropsychiatric Interview (MINI-Plus), Alcohol Use Disorders Identification Test (AUDIT), Revised Fagerstrom Tolerance Questionnaire-Smoking (RTQ) and MiniMental State(MMS). Results: Concurrent validity was established with significant correlations between ASSIST scores, scores from ASI, AUDIT, RTQ, and significantly higher ASSIST scores for patients with a MINI-Plus diagnosis of abuse or dependence. The ASSIST questionnaire was found to have high internal consistency for the total substance involvement along with specific substance involvement as assessed by Cronbach's alpha, ranging from 0.66, to 0.89. Conclusions: The findings demonstrate that ASSIST is a valid screening test for identifying substance use disorders in elderly.

Kilbourne BJ; Cummings SM; Levine R. Alcohol diagnoses among older Tennessee Medicare beneficiaries: Race and gender differences. International Journal of Geriatric Psychiatry 27(5): 483-490, 2012. (45 refs.)

Background: These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups. Methods: We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered. Results: Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups. Conclusions: Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs.

Kim JW; Lee DY; Lee BC; Jung MH; Kim H; Choi YS et al. Alcohol and cognition in the elderly: A review. (review). Psychiatry Investigation 9(1): 8-16, 2012. (123 refs.)

Consumption of large amounts of alcohol is known to have negative effects, but consumption in smaller amounts may be protective. The effect of alcohol may be greater in the elderly than in younger adults, particularly with regard to cognition. However, the drinking pattern that will provide optimal protection against dementia and cognitive decline in the elderly has not been systematically investigated. The present paper is a critical review of research on the effect of alcohol on cognitive function and dementia in the elderly. Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search. Alcohol may have both a neurotoxic and neuroprotective effect. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits. Evidence suggesting that low to moderate alcohol consumption in the elderly protects against cognitive decline and dementia exists; however, because of varying methodology and a lack of standardized definitions, these findings should be interpreted with caution. It is important to conduct more, well-designed studies to identify the alcohol drinking pattern that will optimally protect the elderly against cognitive decline and dementia.

Kleykamp BA; Heishman SJ. The older smoker. (commentary). Journal of the American Medical Association 306(8): 876-877, 2011. (10 refs.)

The number of persons in the United States 65 and older is projected to double between 2010 and 2050. Clinicians should consider that older smokers will be an increasing portion of the patient population, and that these smokers might require modification of treatment for smoking cessation. Age-related differences are discussed which might be anticipated to impact the efficacy of pharmacotherapy. The author highlights the absence of research on how age-related differences may impact smoking-related outcomes. It is noted that the Affordable Care Act allows individuals not diagnosed with a tobacco-related disease to receive tobacco-cessation counseling, however research is needed to determine whether treatments effective in younger smokers are also effective with older smokers.

Li Y; Jensen GA. Effects of drinking on hospital stays and emergency room visits among older adults. Journal of Aging and Health 24(1): 67-91, 2012. (34 refs.)

Objective: To evaluate whether alcohol drinking influences emergency room (ER) visits or hospital admissions among adults aged 65 and older. Method: Data from two independent national surveys are used to estimate multivariate logit models that quantify the relationship between drinking and ER visits and hospital admissions. The authors distinguish between ER visits linked to a hospital admission for that individual and ER visits not linked to an admission. Results: The authors find no significant effects of alcohol consumption on either ER visits or hospital admissions among older adults. These findings occur in both data sets, and for both men and women. Distinguishing between different types of ER visits makes no difference. Discussion: Analysis of two large and nationally representative data sets suggests that among older adults drinking alcohol, or even heavily drinking alcohol, does not raise or lower the risk of a hospital admission or the risk of an ER visit.

Liew HP. Trajectories of alcohol consumption among the elderly widowed population: A semi-parametric, group-based modeling approach. Advances In Life Course Research 16(3): 124-131, 2011. (41 refs.)

Even though research on the use, misuse, and abuse of alcohol among the elderly has burgeoned in recent decades (see reviews by Johnson, 2000; Kirchner et al., 2007; Patterson & Jeste, 1999), only a few empirical studies have explored the post-bereavement alcohol consumption trajectories among the elderly widowed population. To fill this research gap, this study aims to examine the temporal processes underlying the relationship between widowhood and subsequent drinking behaviors among the elderly widowed population and to examine the potential predictors of these trajectories. The empirical work of this study is based on longitudinal data from the 1992 to 2008 Health and Retirement Study (HRS). A semi-parametric mixture model (SPMM) is used to estimate the distinctive trajectories of post-bereavement alcohol consumption. Results reveal that the type of drinking trajectory that characterize the post-bereavement drinking behavior of an individual is largely dependent upon the characteristics of the individuals (e.g. gender), the health conditions and health behavior of deceased spouse, pre-bereavement alcohol consumption, and depression. Another important finding is that bereaved men seem to have greater difficulty overcoming the transitional burden associated with widowhood.

Lin JC; Guerrieri JG; Moore AA. Drinking patterns and the development of functional limitations in older adults: Llongitudinal analyses of the Health and Retirement Survey. Journal of Aging and Health 23(5): 806-821, 2011. (37 refs.)

Objective: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults. Method: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods. Results: Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged >= 65 years. Other drinking patterns were not associated with lower odds of incident functional limitation. Discussion: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

Lin JC; Karno MP; Grella CE; Warda U; Liao DH; Hu PF et al. Alcohol, tobacco, and nonmedical drug use disorders in us adults aged 65 years and older: Data From the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions. American Journal of Geriatric Psychiatry 19(3): 292-299, 2011. (48 refs.)

Objectives: To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older. Design: The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample. Setting: The United States. Participants: Eight thousand two hundred five adults aged 65 years and older. Measurements: Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders. Results: Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder. Conclusions: More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use.

Lin WC; Zhang JY; Leung GY; Clark RE. Chronic physical conditions in older adults with mental illness and/or substance use disorders. Journal of the American Geriatrics Society 59(10): 1913-1921, 2011. (30 refs.)

OBJECTIVES: To examine the association between mental illness and chronic physical conditions in older adults and investigate whether co-occurring substance use disorders (SUDs) are associated with greater risk of chronic physical conditions beyond mental illness alone. DESIGN: A retrospective cross-sectional study. SETTING: Medicare and Medicaid programs in Massachusetts. PARTICIPANTS: Massachusetts Medicare and Medicaid members aged 65 and older as of January 1, 2005 (N = 679,182). MEASUREMENTS: Diagnoses recorded on Medicare and Medicaid claims were used to identify mental illness, SUDs, and 15 selected chronic physical conditions. RESULTS: Community-dwelling older adults with mental illness or SUDs had higher adjusted risk for 14 of the 15 selected chronic physical conditions than those without these disorders; the only exception was eye diseases. Moreover, those with co-occurring SUDs and mental illness had the highest adjusted risk for 11 of these chronic conditions. For residents of long-term care facilities, mental illness and SUDs were only moderately associated with the risk of chronic physical conditions. CONCLUSION: Community-dwelling older adults with mental illness or SUDs, particularly when they co-occurred, had substantially greater medical comorbidity than those without these disorders. For residents of long-term care facilities, the generally uniformly high medical comorbidity may have moderated this relationship, although their high prevalence of mental illness and SUDs signified greater healthcare needs. These findings strongly suggest the imminent need for integrating general medical care, mental health services, and addiction health services for older adults with mental illness or SUDs.

Lin WC; Zhang JY; Leung GY; Clark RE. Twelve-month diagnosed prevalence of behavioral health disorders among elderly Medicare and Medicaid members. American Journal of Geriatric Psychiatry 19(11): 970-979, 2011. (37 refs.)

Objectives: We examined the 12-month diagnosed prevalence of behavioral health disorders (BHDs) and dementia among elderly Medicare and Medicaid members in Massachusetts by primary payment source group (dual eligible, Medicare only, and Medicaid only) and age group (65-74 years, 75-84 years, and 85 years and older). Design: A retrospective cross-sectional study. Setting: Medicare and Medicaid programs. Participants: Massachusetts Medicare or Medicaid enrollees age 65 and older as of January 1, 2005, (N = 679,182). Measurements: International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes recorded on Medicare and Medicaid claims were used to identify the BHDs. Results: The 12-month diagnosed prevalence was 19.4% for any BHD and 11.2% for dementia. The most common BHDs by disease category were major depression (severe mental illness [SMI]), other depression (other mental illness [OMI]), and alcohol abuse or dependence (subtance use disorder [SUD]). Dual eligibles had a considerably higher diagnosed prevalence of any BHD (38.8%), compared with 16.1% in the Medicare only group. The 12-month diagnosed prevalence of SMI, OMI, and dementia was higher in the older-age groups. Co-occurring SUD was higher for younger dual eligibiles. Dementia and mental illness co-occurred at much higher rates for dual eligibles than for either of the single-insurance groups. This combination increased with age in all three groups. Conclusions: The 12-month prevalence of BHDs and dementia among elderly dual eligibles was disproportionately higher than other elderly Medicare or Medicaid members. However, access barriers to behavioral health services for this vulnerable population could be significant because Medicare and Medicaid payment limitations resulted in financial disincentives for providing these services.

Lo AHY; Pachana NA; Byrne GJ; Sachdev PS. A review of tobacco, alcohol, adiposity, and activity as predictors of cognitive change. (review). Clinical Gerontologist 35(2): 148-194, 2012. (78 refs.)

The global population is now aging rapidly, and cognitive impairment and dementia will be associated with increased disease burden worldwide. Recent research efforts have been directed at identifying risk and protective factors in both middle and late life in order to identify potential preventive interventions. Evidence from recent reviews indicates that modifiable risk factors such as tobacco smoking, alcohol consumption, adiposity, and activities have significant impacts on cognitive function and dementia. However, it is not clear how these risk factors might influence within-person cognitive changes or rates of cognitive decline. We searched Medline and PsycINFO for prospective studies examining the effects of baseline and within-person changes in drinking, smoking, activity level, and adiposity on either cognitive functioning or cognitive changes. Because of the heterogeneity in methodology, a narrative review was used to summarize the findings. Forty-nine studies were found to be relevant to the current review-10 on smoking, 5 on adiposity, 12 on drinking, and 22 on activity level. This review found that smoking in general increased the rate of memory decline but not decline in language or visuospatial reasoning abilities. No consistent relationship between adiposity and change in global cognitive functioning could be found, regardless of whether adiposity was measured in mid-life or late life. Moderate alcohol consumption was shown to slow down decline in global cognitive functioning but not in specific domains. Finally, an active lifestyle physically, cognitively, and socially appeared to offer the most promise of slowing decline in global cognitive functioning, memory, and perceptual speed. Intervention programs targeted at modifying these lifestyle factors may have the potential of improving physical, mental, and cognitive health of our aging population, as well as enhancing overall quality of life.

Martin F; Lichtenberg PA; Templin TN. A longitudinal study: Casino gambling attitudes, motivations, and gambling patterns among urban elders. Journal of Gambling Studies 27(2): 287-297, 2011. (34 refs.)

Guided by self-determination theory, the main purpose of this study was to explore demographic characteristics, attitudes toward casinos, and self-reported intrinsic and extrinsic reasons for casino gambling by urban elders. The study hypothesized that individuals would more frequently report intrinsic motivations for casino gambling (e.g., entertainment, enjoyment) rather than extrinsic motivation (e.g., financial gain). This longitudinal sample included 247 urban elders older who were 60 years and older and who had participated in surveys in 2002 and 2004. The initial survey consisted of (a) demographic items, (b) five items to measure attitudes toward casino gambling, (c) questions inquiring about motivations for casino gambling, and (d) questions about gambling frequency. The follow-up survey was an expanded questionnaire which still included these items. The sample consisted of the 247 participants, over 200 of whom were African-Americans, 188 were female, and 98 of the participants had a post graduate education. About half were widowed, and the sample generally reported a low income. The results supported the theoretical perspective underlying the project. The hypothesis that more participants would endorse intrinsic motivations for casino gambling rather than extrinsic motivations was supported. The implications of these findings represent for social workers, gambling counselors and health care services providers an important step toward understanding the attitudes, behaviors, and motivational factors involved in casino gambling among older adults.

Mezuk B; Bohnert ASB; Ratliff S; Zivin K. Job strain, depressive symptoms, and drinking behavior among older adults: Results: from the health and retirement study. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 66(4): 426-434, 2011. (56 refs.)

Objective. To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults. Method. Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse. Results. High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age. Discussion. Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.

Moore AA; Blow FC; Hoffing M; Welgreen S; Davis JW; Lin JC et al. Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction 106(1): 111-120, 2011. (36 refs.)

Aims: To examine whether a multi-faceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months. Design: Randomized controlled trial. Setting: Three primary care sites in southern California. Participants: Six hundred and thirty-one adults aged >= 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were assigned randomly between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report, booklet on alcohol and aging, drinking diary, advice from the primary care provider and telephone counseling from a health educator at 2, 4 and 8 weeks. Measurements: The primary outcome was the proportion of participants meeting at-risk criteria, and secondary outcomes were number of drinks in past 7 days, heavy drinking (four or more drinks in a day) in the past 7 days and risk score. Findings: At 3 months, relative to controls, fewer intervention group participants were at-risk drinkers [odds ratio (OR) 0.41; 95% confidence interval (CI) 0.22-0.75]; they reported drinking fewer drinks in the past 7 days [rate ratio (RR) 0.79; 95% CI 0.70-0.90], less heavy drinking (OR 0.46; 95% CI 0.22-0.99) and had lower risk scores (RR 0.77 95% CI 0.63-0.94). At 12 months, only the difference in number of drinks remained statistically significant (RR 0.87; 95% CI 0.76-0.99). Conclusions: A multi-faceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers, but does reduce amount of drinking at 12 months.

Morgan ML; Brosi WA; Brosi MW. Restorying older adults' narratives about self and substance abuse. American Journal of Family Therapy 39(5): 444-455, 2011. (31 refs.)

Substance abuse affects millions of adults each year, of whom one in five are older adults. Given pervasive stereotypes about later life and the ways in which older persons internalize such messages, dealing with and using previous work on substance abuse, the social breakdown syndrome, and narrative therapy, we describe the importance of and ways for marriage and family therapists to work with older persons facing the compounding experiences of ageism and substance abuse. The purpose of this study was to: 1) identify the prevalence of substance abuse among those 65 and older; 2) document and emphasize the unique challenges of addressing this issue among those 65 and older; and 3) provide an application of the narrative approach to working with older persons presenting with substance abuse.

Moy I; Crome P; Crome I; Fisher M. Systematic and narrative review of treatment for older people with substance problems. (review). European Geriatric Medicine 2(4): 212-236, 2011. (47 refs.)

Purpose: Substance misuse among older people is a growing concern. Treatment outcomes are perceived to be poor. The aim of the study was to examine the evidence for effective treatment for older substance misusers. Methods: PubMedicine, The Cochrane Library, Medline, Project CORK, and EMBASE were searched up to January 2007. Trials were included if participants were over the age of 50, sample size was sufficient, follow-up was undertaken, baseline and outcome measures were reported, the design was randomised controlled (RCT), controlled without randomisation or non-experimental descriptive, and pharmacological or psychological treatments for alcohol, nicotine, prescription medications or illicit drugs were investigated. Sixteen papers met inclusion criteria. Results: Most studies were carried out in the USA. Sample sizes ranged from 24 to 3622 (mean = 704) with follow-up from 1 month to 5 years (mean = 18 months). Eight randomised controlled trials and eight descriptive studies, covering alcohol with or without drug misuse (n = 11); methadone maintenance (n = 1), prescription drugs (n = 1), smoking (n = 3) were examined systematically. All had baseline and outcome measures, which varied across studies. Outcome depended on self-report in 11 out of 16 studies: most did not utilise biological measures or other corroboration. A range of psychological treatment interventions was tested. Older people do respond to treatment, do not achieve worse outcomes than younger counterparts, and sometimes do even better. Conclusions: This is the first systematic review on this topic. These preliminary results show an optimistic picture, which provides a foundation for further research to determine the most appropriate treatments for this group.

Nadkarni A; Acosta D; Rodriguez G; Prince M; Ferri CP. The psychological impact of heavy drinking among the elderly on their co-residents: The 10/66 group population based survey in the Dominican Republic. Drug and Alcohol Dependence 114(1): 82-86, 2011. (41 refs.)

Background: There is very limited literature on alcohol use among the elderly and little is known about the impact it has on family and caregivers, especially in low and middle income countries. Aim: To estimate the independent effect of heavy alcohol use among the elderly on the psychological health of their co-residents. Methods: This is a secondary analysis using data from the comprehensive cross-sectional survey of the 10/66 dementia research group population-based research programme in the Dominican Republic. The characteristics of the elderly participants as well as the co-residents were described. The independent association of heavy drinking among the participants with psychological morbidity in their co-residents was estimated. Different models were generated to rule out potential mediating effects of disability and behavioural symptoms. Results: Prevalence of heavy alcohol use in the elderly in Dominican Republic was 10.6%. There was a statistically significant independent effect of heavy alcohol use by the elderly on their co-residents mental health (PR = 1.47; 95% CI 1.07-2.01) which was not accounted by disability (Sobel-Goodman test, p = 0.15). Severity of psychological and behavioural symptoms partially (29.1% of the total effect) explained this association (Sobel-Goodman mediation test, p = 0.006). Conclusions: Health services for the elderly in low and middle income countries will have to be configured around detection of alcohol problems among the elderly as well as offering appropriate support to their co-residents.

Naughton C; Drennan J; Lyons I; Lafferty A; Treacy M; Phelan A et al. Elder abuse and neglect in Ireland: results from a national prevalence survey. Age and Ageing 41(1): 98-103, 2012. (27 refs.)

Objective: to measure the 12-month prevalence of elder abuse and neglect in community-dwelling older people in Ireland and examine the risk profile of people who experienced mistreatment and that of the perpetrators. Design: cross-sectional general population survey. Setting: community. Participants: people aged 65 years or older living in the community. Methods: information was collected in face-to-face interviews on abuse types, socioeconomic, health, and social support characteristics of the population. Data were examined using descriptive statistics and logistic regression, odds ratios (OR) and 95% confidence intervals (95% CI) are presented. Results: the prevalence of elder abuse and neglect was 2.2% (95% CI: 1.41-2.94) in the previous 12 months. The frequency of mistreatment type was financial 1.3%, psychological 1.2%, physical abuse 0.5%, neglect 0.3%, and sexual abuse 0.05%. In the univariate analysis lower income OR 2.39 (95% CI: 1.01-5.69), impaired physical health OR 3.41 (95% CI: 1.74-6.65), mental health OR 6.33 (95% CI: 3.33-12.0), and poor social support OR 4.91 (95% CI: 2.1-11.5) were associated with a higher risk of mistreatment but only social support and mental health remained independent predictors. Among perpetrators adult children (50%) were most frequently identified. Unemployment (50%) and addiction (20%) were characteristics of this group.

Nebes RD; Pollock BG; Halligan EM; Houck P; Saxton JA. Cognitive slowing associated with elevated serum anticholinergic activity in older individuals is decreased by caffeine use. American Journal of Geriatric Psychiatry 19(2): 169-175, 2011. (32 refs.)

Objectives: This study examined whether some of the age-associated decrements in basic cognitive resources (information-processing speed and working memory) result from anticholinergic medication use (as measured by serum anticholinergic activity [SAA]) and whether such decrements are lessened by caffeine. Design: Cross-sectional observational study. Setting: University medical center. Participants: One hundred fifty-two normal-elderly community volunteers. Measurements: Two tests each of information-processing speed and of working memory were administered, and blood samples were drawn before and after cognitive testing to determine serum levels of anticholinergic activity and of paraxanthine-a caffeine metabolite. Results: Elevated SAA was associated with a significant but modest slowing in information-processing time but only in those individuals who had low levels of serum paraxanthine. SAA did not correlate with performance on tests of working memory. Conclusions: These results suggest that anticholinergic medications are a relatively minor contributor to the decrements in basic processing resources commonly found in studies of normal aging.

Nelson R. Cannabis use in long-term care: An emerging issue for nurses. (editorial). American Journal of Nursing 111(4): 19- 20, 2011. (0 refs.)

Norderyd O; Henriksen BM; Jansson H. Periodontal disease in Norwegian old-age pensioners. Gerodontology 29(1): 4-8, 2012. (21 refs.)

Purpose: To identify factors of importance for periodontal health and disease on an old-age Norwegian population. Materials and methods: From a random sample of 1152 urban and rural elderly Norwegians, aged 67 years or older, 582 individuals were agreed to participate in the study. After exclusion of edentulous individuals, 394 individuals were remained. A standardised clinical examination was performed by the same examiner. In conjunction with the clinical examination, a questionnaire was filled out regarding demographic and social status, educational level, tobacco habits and general condition. Results: In the examined population, 33% of the subjects had periodontal disease. Out of those, 12% had severe periodontitis, that is, 3 periodontal pockets 6 mm. All variables were tested separately in a logistic regression model with periodontal pockets 6 mm and above, as the outcome variable. After univariate testing the following variables were included in a multivariate logistic regression model: daily smoking, higher plaque score, rural living and lower education. Only daily smoking remained significantly correlated to periodontal disease in the multivariate model. Conclusions: This study has shown a prevalence of periodontal disease in 33% of the study population. Out of those approximately 12% had more severe periodontitis. Daily tobacco use was the only factor significantly correlated to presence of periodontal disease.

Ong MK; Xu HY; Zhang LL; Azocar F; Ettner SL. Effect of Medicare Part D benzodiazepine exclusion on psychotropic use in benzodiazepine users. Journal of the American Geriatrics Society 60(7): 1292-1297, 2012. (18 refs.)

Objectives: To evaluate the effect of the Medicare benzodiazepine coverage exclusion on psychotropic use of benzodiazepine users. Design: Prepost design with concurrent control group. Setting General community. Participants Intervention and comparison cohorts of individuals drawn from the same insurer who were prescribed benzodiazepines through the end of 2005. Intervention participants (n = 19,339) were elderly adults from a large, national Medicare Advantage plan subject to benzodiazepine exclusion as a result of the Medicare Modernization Act (MMA). Comparison participants (n = 3,488) were near-elderly individuals enrolled in a managed care plan not subject to the MMA benzodiazepine exclusion. Measurements: Any psychotropic drug use and expenditures. Results: In the intervention cohort, benzodiazepine use and expenditures significantly declined from 100% and $134 in 2005 to 74.8% and $59, respectively, in 2007. Nonbenzodiazepine psychotropic drug use and expenditures significantly increased from 35.8% and $163 in 2005 to 39.5% and $207, respectively, in 2007. In the comparison cohort, benzodiazepine use and expenditures also significantly declined from 100% and $173 in 2005 to 57.5% and $105, respectively, in 2007, but nonbenzodiazepine psychotropic drug use and expenditures significantly declined from 55.4% and $647 in 2005 to 45.1% and $572, respectively, in 2007. Changes in antidepressant and anxiolytic use were the primary cause of changes in nonbenzodiazepine psychotropic drugs in both cohorts. Conclusion: Use of benzodiazepines continued in elderly adults despite negative financial incentives, possibly because of the low costs of such medications. Although some substitution occurred with antidepressants and anxiolytics, the magnitude of this increase did not fully offset the reduction in benzodiazepine use.

Orsitto G; Turi V; Venezia A; Fulvio F; Manca C. Relation of secondhand smoking to mild cognitive impairment in older inpatients. Scientific World Journal : e-article 726948, 2012. (29 refs.)

Up to now, controversy still exists regarding the role of secondhand smoking (SHS) in developing cognitive impairment. This study aimed to evaluate the prevalence of SHS in hospitalized older patients with cognitive deficit, particularly in those with mild cognitive impairment (MCI). Smoking history was classified into four groups: never smokers, former-active smokers/no SHS, active smokers, and secondhand smokers, and cognitive function into three levels: normal cognition (C), MCI, and dementia. A total of 933 older subjects with diagnoses of MCI (n - 98), dementia (n - 124), or C (n - 711) were enrolled in this cross-sectional study. As expected, patients with dementia had significantly higher frequency of former-active smokers than cognitively normal. Moreover, patients with MCI showed a significantly higher frequency of active and secondhand smokers than patients with dementia or normal cognition. A smoking history is very frequent in older patients with dementia. Patients with MCI had even higher rate of exposure to active or secondhand smoking.

Parsons C; Johnston S; Mathie E; Baron N; Machen I; Amador S et al. Potentially inappropriate prescribing in older people with dementia in care homes: A retrospective analysis. Drugs & Aging 29(2): 143-155, 2012. (74 refs.)

Background: Older people in general and care home residents in particular are at high risk of suboptimal or inappropriate prescribing. To date, research into potentially inappropriate prescribing (PIP) has not focused on care home residents and/or has not utilized the recently developed and validated Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria. Objective: The aim of this study was to estimate the prevalence of PIP in older people with dementia living in six residential care homes in England, using the STOPP criteria. Methods: A retrospective analysis was conducted using medication data collected for older people with dementia in six residential care homes in England who participated in the prospective, longitudinal EVIDEM - End of Life (EoL) study. Of the 133 residents recruited to the study, medication administration records were available for and reviewed at two timepoints (approximately 16 weeks apart) for 119 residents and 110 residents, respectively. The prevalence of PIP at these timepoints was determined using 31 of the 65 STOPP criteria applicable when there is no access to residents' medical records. Results: At the first timepoint, 68 potentially inappropriate medications (PIMs) were identified. Fifty-five residents (46.2%) were prescribed one or more PIM(s), eleven (9.2%) were prescribed two or more PIMs and two (1.7%) were prescribed three PIMs. Thirteen of the 31 STOPP criteria utilized in this study (41.9%) were used to identify PIP. Long-term (i.e. >1 month) neuroleptics (antipsychotics) were the most frequently prescribed PIMs (n = 25; 21.0%), followed by non-steroidal anti-inflammatory drugs (NSAIDs) for >3 months, proton pump inhibitors (PPIs) at maximum therapeutic dosage for >8 weeks, tricyclic antidepressants (TCAs) in patients with dementia and long-term (i.e. >1 month), long-acting benzodiazepines. At the second timepoint, 57 PIMs were identified; 45 residents (40.9%) were prescribed one or more PIM(s) and 10 (9.1%) were prescribed two or more PIMs, but only one resident (0.9%) was prescribed three PIMs. Of the 31 STOPP criteria utilized in this study, ten (32.3%) were used to identify PIP. Long-term (i.e. >1 month) antipsychotics were again the most frequently prescribed PIMs (n = 21; 19.1%), followed by PPIs at maximum therapeutic dosage for >8 weeks, NSAIDS for >3 months and TCAs in patients with dementia. A significant correlation was found at both timepoints between the number of medicines prescribed and occurrence of PIP. Conclusions: This study found that over two-fifths of older people with dementia residing in six residential care homes in England were prescribed at least one PIM at each timepoint. Long-term (i.e. >1 month) antipsychotics, NSAID use for >3 months and PPI use at maximum therapeutic dosage for >8 weeks were the most prevalent PIMs. Regular medication review that targets, but is not limited to, these medications is required to reduce PIP in the residential care home setting. The STOPP criteria represent a useful tool to facilitate such review in this patient population.

Payne M; Gething M; Moore AA; Reid MC. Primary care providers' perspectives on psychoactive medication disorders in older adults. American Journal of Geriatric Pharmacotherapy 9(3): 164-172, 2011. (29 refs.)

Background: Compared with younger adults, older adults consume a disproportionate percentage of pain and sleep medications. Some studies have reported that psychoactive medication misuse and abuse in older populations is a significant problem. Objectives: The aim of this study was to understand the perspective of primary care providers (PCPs) regarding the extent and clinical presentations of misuse and abuse of psychoactive medications in older patients and to explore PCPs' perceived barriers to identifying affected individuals. Methods: Seventeen physicians and 5 nurse practitioners from 2 ambulatory care practices serving older adults in New York City participated in this study. Six focus group discussions were audiotaped and transcribed. Two raters coded transcripts to identify recurring themes. Qualitative analysis software was employed for data coding and sorting purposes. Results: Although PCPs indicated that only a small percentage of older patients were actively misusing or abusing their psychoactive medications (average estimate given by providers, 8%), they felt that these patients placed significant time burdens on them. Perceived risk factors included psychiatric disorders, previous substance abuse history, and cognitive impairment, but many PCPs found it impossible to predict which patients were at increased risk. PCPs identified multiple barriers to identifying affected patients, including lack of communication (between provider and patient, provider and patients' caregivers, and between different providers), nonspecific symptoms, and the lack of a clear definition of misuse and abuse. Conclusions: The lack of a clear definition, absence of well-defined risk factors, and ambiguous clinical manifestations of psychoactive medication misuse and abuse present substantial barriers to diagnosis. A standard, age-appropriate definition could help PCPs establish a diagnosis, clarify what constitutes appropriate psychoactive medication use, define the extent of the problem, and pave the way for the development of effective screening and diagnostic tools.

Peisah C; Chan DKY; McKay R; Kurrle SE; Reutens SG. Practical guidelines for the acute emergency sedation of the severely agitated older patient. Internal Medicine Journal 41(9): 651-657, 2011. (31 refs.)

The vulnerability of older people to serious underlying medical illness and adverse effects of psychotropics means that the safe and effective treatment of severe agitation can be lifesaving, the primary management goals being to create a safe environment for the patient and others, and to facilitate assessment and treatment. We review the literature on acute sedation and provide practical guidelines for the management of this problem addressing a range of issues, including aetiology, assessment, pharmacological and non-pharmacological strategies, restraint and consent. The assessment of the agitated older patient must include concurrent assessment of the likely aetiology of, the risks posed by, and the risks/benefits of management options for, the agitation. A range of environmental modifications and non-pharmacological strategies might be implemented to maximize the safety of the patient and others. Physical restraints should only be considered after appropriate assessment and trial of alternative management and if the risk of restraint is less than the risk of the behaviour. Limited evidence supports a range of pharmacological options from traditional antipsychotics to atypical antipsychotics and benzodiazepines. It is advised to start low and go slow, using small increments of dose increase. Medical staff are frequently called to sedate agitated older patients in hospital settings, often after hours, with limited access to relevant medical information and history. Safe and effective management necessitates adequate assessment of the aetiology of the agitation, exhausting all non-pharmacological strategies, and resorting to pharmacological and/or physical restraint only when necessary, judiciously and for a short-term period, with frequent review and the obtaining of consent as soon as possible.

Peron EP; Gray SL; Hanlon JT. Medication use and functional status decline in older adults: A narrative review. (review). American Journal of Geriatric Pharmacotherapy 9(6): 378-391, 2011. (97 refs.)

Background: Functional status is the cornerstone of geriatric care and serves as an indicator of general well-being. A decline in function can increase health care use, worsen quality of life, threaten independence, and increase the risk of mortality. One of several risk factors for decline in functional status is medication use. Objective: Our aim was to critically review published articles that have examined the relationship between medication use and functional status decline in the elderly. Methods: The MEDLINE and EMBASE databases were searched for English-language articles published from January 1986 to June 2011. Search terms included aged, humans, drug utilization, polypharmacy, inappropriate prescribing, anticholinergics, psychotropics, antihypertensives, drug burden index, functional status, function change or decline, activities of daily living, gait, mobility limitation, and disability. A manual search of the reference lists of the identified articles and the authors' article files, book chapters, and recent reviews was conducted to retrieve additional publications. Only articles that used rigorous observational or interventional designs were included. Cross-sectional studies and case series were excluded from this review. Results: Nineteen studies met the inclusion criteria. Five studies addressed the impact of suboptimal prescribing on function, 3 of which found an increased risk of worse function in community-dwelling subjects receiving polypharmacy. Three of the 4 studies that assessed benzodiazepine use and functional status decline found a statistically significant association. One cohort study identified no relationship between antidepressant use and functional status, whereas a randomized trial found that amitriptyline, but not desipramine or paroxetine, impaired certain measures of gait. Two studies found that increasing anticholinergic burden was associated with worse functional status. In a study of hospitalized rehabilitation patients, users of hypnotics/anxiolytics (e.g., phenobarbital, zolpidem) had lower relative functional Independence Measure motor gains than nonusers. Use of multiple central nervous system (CNS) drugs (using different definitions) was linked to greater declines in self-reported mobility and Short Physical Performance Battery (SPPB) scores in 2 community-based studies. Another study of nursing home patients did not report a significant decrease in SPPB scores in those taking multiple CNS drugs. Finally, 2 studies found mixed effects between antihypertensive use and functional status in the elderly. Conclusions: Benzodiazepines and anticholinergics have been consistently associated with impairments in functional status in the elderly. The relationships between suboptimal prescribing, antidepressants, and antihypertensives and functional status decline were mixed. Further research using established measures and methods is needed to better describe the impact of medication use on functional status in older adults.

Preville M; Vasiliadis HM; Bosse C; Dionne PA; Voyer P; Brassard J. Pattern of psychotropic drug use among older adults having a depression or an anxiety disorder: Results from the longitudinal ESA Study. Canadian Journal of Psychiatry 56(6): 348-357, 2011. (48 refs.)

Objective: To document the use of psychotropic drugs in Quebec older adult population with a depressive or anxiety disorder. Method: Data from the Enquete sur la Sante des Nines (ESA) study conducted between 2005 and 2008 using a representative sample (n = 1869) of community-dwelling adults aged 65 years and older were used to examine the use of psychotropic drugs in the Quebec older adult population. Results: Our results indicate that only 46.9% of the older adults with a diagnosis of depression or anxiety during the 24-month period studied according to the Regie de l'assurance maladie du Quebec (RAMQ) register used antidepressants (AD) for 400 days (12.9 months) on average during this period. Also, 59% of the RAMQ's mental health disorder patients used a mean daily dose of 5 mg of a diazepam equivalent for 338 days (10.9 months) on average during the same period. However, 10.0% of the older adults without any symptoms (ESA) at T1 and at T2 and any RAMQ depression and anxiety diagnosis between T0 and T2 were AD users during the 24-month period studied. They represent 26.2% of the AD users and consumed them for 494 days (15.9 months) on average during the 24-month period studied. Finally, the number of days of AD and benzodiazepine use was not associated with partial or total remission. Conclusions: This result questions the population effectiveness of these drugs in this population.

Rapoport MJ; Zagorski B; Seitz D; Herrmann N; Molnar F; Redelmeier DA. At-fault motor vehicle crash risk in elderly patients treated with antidepressants. American Journal of Geriatric Psychiatry 19(12): 998-1006, 2011. (44 refs.)

Objective: To assess whether antidepressant treatment is associated with a temporary increase in the risk of a motor vehicle crash among older adults. Design: Population-based case-only time-to-event analysis. Setting and Subjects: Data from transportation and healthcare databases for adults age 65 and older in Ontario, Canada, between January 1, 2000, and October 31, 2007. Consecutive adults who had a motor vehicle crash anytime following their 66th birthday. Measurements: The primary exposure variable was treatment with antidepressant medication, and the primary outcome measure was a motor vehicle crash. Results: A total of 159,678 individuals had a crash during the study, of whom 7,393 (5%) received an antidepressant in the month prior to the crash. The hazard ratio (HR) of crash associated with second-generation antidepressants was 1.10 (95% confidence interval [CI]: 1.07-1.13, chi(2) = 41.77, df = 1, p < 0.0001), adjusted for gender, license suspensions, and other medications, but the risk for first-generation antidepressants was not significant. The increased risk was restricted to those who were also concurrently prescribed a benzodiazepine (adjusted HR: 1.23, 95% CI: 1.17-1.28, chi(2) = 85.28, df = 1, p < 0.0001) or a strong anticholinergic medication (adjusted HR: 1.63, 95% CI: 1.57-1.69, chi(2) = 627.31, df = 1, p < 0.0001), and was confined to crashes where the patient was at fault. The increased risk was apparent for the first 3-4 months following initiation of an antidepressant and returned to baseline thereafter. Conclusions: Prescriptions for second-generation antidepressants in older adults are associated with a modest increased risk of motor vehicle crashes, when combined with other medications that can impair cognition.

Ricci NA; Francisco CO; Rebelatto MN; Rebelatto JR. Influence of history of smoking on the physical capacity of older people. Archives of Gerontology and Geriatrics 52(1): 79-83, 2011. (38 refs.)

Among the elderly, smoking is related to death and it contributes to disability associated with chronic diseases. This study aims to verify the influence of a history of smoking on the physical capacity of elderly people, and its relationship with the gender. Elderly people beginning to practice physical activity reported questions about their smoking history and underwent a physical evaluation, consisted by hemodynamic data (blood pressure, heart rate and maximum oxygen consumption), body mass index (BMI), muscular strength, flexibility and balance. Mann-Whitney test and Spearman's test was used to data analysis. The sample consisted of 127 subjects, among whom 26.8% were ex-smokers. There were a higher number of nonsmoking women (p < 0.001) than others, and women smoked fewer packets per day (p = 0.047). Among the women, those ex-smokers were younger and more flexible in comparison with those nonsmokers (p < 0.05). Among the men, the ex-smokers were older and walked more slowly than nonsmokers (p < 0.05). There was a correlation between the BMI and duration of smoking time. Smoking cessation benefits the elderly, since the physical variables showed no long-term harm associated with the history of smoking when compared with those of elderly without this habit.

Rikala M; Korhonen MJ; Sulkava R; Hartikainen S. Psychotropic drug use in community-dwelling elderly people: Characteristics of persistent and incident users. European Journal of Clinical Pharmacology 67(7): 731-739, 2011. (42 refs.)

The aim of this prospective cohort study was to analyze psychotropic drug use in community-dwelling elderly people over a 3-year period and characterize those individuals most susceptible to persistent and incident use. Data on demographics, health status, cognition, functional capacity and drug use were gathered by interviews at baseline (2004) and in three follow-ups (2005-2007) in a population-based sample of 700 community-dwelling people aged 75 years and older. Characteristics associated with persistent and incident use were identified using Cox proportional-hazards regression. At baseline, 38% (n = 269) of the participants used psychotropic drugs. Of these, 60% (n = 162) reported use in all three follow-ups, whereas 22% (n = 59) discontinued use. Among the baseline users of antipsychotics (n = 40), antidepressants (n = 83) and benzodiazepines (n = 219), respectively, 43, 51 and 55% reported use in all three follow-ups. The characteristics associated with persistent use of psychotropic drugs included concomitant use of psychotropic drugs, regular use of psychotropic drugs, increasing age and good self-rated health. Among the baseline nonusers of psychotropic drugs (n = 431), 20% (n = 88) initiated use during the follow-up. Incident use of psychotropic drugs was associated with increasing Geriatric Depression Scale scores, a Mini-Mental State Examination score 24 and less, 6 or more visits to physician, moderate/poor self-rated health and moderate/poor life satisfaction. Psychotropic drugs, benzodiazepines in particular, are frequently used for extended periods in community-dwelling people aged 75 years. Individuals with multiple psychotropic drugs and a regular pattern of use are most susceptible to persistent use. Characteristics associated with incident use include depressive symptoms, cognitive decline and poor general health.

Rosen D; Hunsaker A; Albert SM; Cornelius JR; Reynolds CF. Characteristics and consequences of heroin use among older adults in the United States: A review of the literature, treatment implications, and recommendations for further research. (review). Addictive Behaviors 36(4): 279-285, 2011. (46 refs.)

This review reports on the results of a comprehensive literature search of studies examining the physical and mental health characteristics of older adults in the United States who use heroin. Multiple databases were searched for papers meeting the inclusion criteria of heroin users who were age 50 years or older. A total of 14 articles covering 9 different studies met the review inclusion criteria. All of the studies were convenience samples, and seven of the nine studies (77.8%) were entirely drawn from substance abuse treatment programs, primarily methadone maintenance programs. Findings from the qualitative studies suggest that the marginalization of older heroin users was a predominant experience that impacted the intent to seek treatment as well as treatment retention. While articles reported high levels of physical and psychological/ psychiatric comorbidities with substance misuse, research on heroin use and methadone treatment among older adults is scant and the quantitative findings are inconsistent. The articles reviewed in this study demonstrate that the needs of this population will be significant, yet the development of appropriate interventions and treatment for older adult heroin users will be contingent on empirical research that adequately describes mental and physical health problems.

Rossat A; Fantino B; Bongue B; Colvez A; Nitenberg C; Annweiler C et al. Association between benzodiazepines and recurrent falls: A cross-sectional elderly population-based study. Journal of Nutrition, Health & Aging 15(1): 72-77, 2011. (31 refs.)

Background: While the association between benzodiazepines (BZD) and single fall is long-known, the association between BZD and recurrent falls has been few studied. Objective: The aims of this study were 1) to examine whether BZD were associated with recurrent falls while taking into account the effect of potential confounders, and 2) to determine whether there was an interaction in terms of risk of falls between BZD and balance impairment in a community-dwelling population-based adults aged 65 and older. Study design: Cross-sectional. Setting: Three health centers in North-East of France. Population: 7643 community-dwelling volunteers aged 65 and older. Outcome measures: The use of BZD, the Mini Mental State Examination (MMSE) score, the Clock Drawing Test (CDT), the One Leg Balance (OLB) test, the Five Times Sit-To-Stand test (FTSS), and a history of falls were recorded. Subjects were separated into 4 groups based on the number of falls: 0, 1, 2 and >= 3 falls. Results: Among the 1456 (19.2%) fallers, 994 (13.0%) were single fallers and 462 (6.1%) were recurrent fallers (i.e., > 2 falls). The number of falls increased significantly with age (Incident Rate Ratio (IRR) = 1.04, P < 0.001), female gender (IRR = 2.24, P < 0.001), the use of benzodiazepine (IRR = 1.65 P < 0.001) and especially while subjects used bromazepam (IRR = 1.44, P = 0.006), clobazam (IRR = 3.01, P = 0.014) and prazepam (IRR = 2.29, P < 0.001). A low MMSE score (IRR = 0.96, P < 0.001), an impaired CDT (IRR = 0.91, P < 0.001), and a bad performance at OLB and FTSS (respectively IRR = 1.85, P < 0.001 and IRR = 1.26, P < 0.001) were related to the recurrence of falls. After adjustment only the advance in age (IRR = 1.02, P < 0.001), female gender (IRR = 2.15, P < 0.001), clobazam (IRR = 2.54, P = 0.04), prazepam (IRR = 1.63, P = 0.03) and OLB (IRR = 1.55, P < 0.001) were still significantly related to the number of falls. Conclusion: The current study shows that the age, the female gender, the use of clobazam or prazepam and a low score at OLB are related to the recurrence of falls.

Rostron BL; Wilmoth JR. Estimating the effect of smoking on slowdowns in mortality declines in developed countries. Demography 48(2): 461- 479, 2011. (28 refs.)

Declines in mortality rates for females at older ages in some developed countries, including the United States, have slowed in recent decades even as decreases have steadily continued in some other countries. This study presents a modified version of the indirect Peto-Lopez method, which uses lung cancer mortality rates as a proxy for smoking exposure, to analyze this trend. The modified method estimates smoking-attributable mortality for more-specific age groups than does the Peto-Lopez method. An adjustment factor is also introduced to account for low mortality in the indirect method's study population. These modifications are shown to be useful specifically in the estimation of deaths attributable to smoking for females at older ages, and in the estimation of smoking-attributable mortality more generally. In a comparison made between the United States and France with the modified method, smoking is found to be responsible for approximately one-half the difference in life expectancy for females at age 65.

Rothrauff TC; Abraham AJ; Bride BE; Roman PM. Substance abuse treatment for older adults in private centers. Substance Abuse 32(1): 7-15, 2011. (20 refs.)

By 2020, an estimated 4.4 million older adults will require substance abuse treatment compared to 1.7 million in 2000-01. This study examined the availability of special services for older adults, adoption of recommended treatment approaches, and organizational characteristics of centers that offer special services. Data were collected via face-to-face interviews with administrators and/or clinical directors from a nationally representative sample of 346 private treatment centers participating in the 2006-07 National Treatment Center Study. Results indicated that only 18% provided special services for older adults; age-specific recommendations were generally adopted; more older adult-specialty centers offered prescription drug addiction treatment, primary medical care, and housing assistance. The proportion of patients with Medicare payment predicted availability of special services. As more older adults will seek help with a myriad of substance use disorders (SUDs) over the next decade, treatment centers need to get ready for a plethora of challenges as well as unique opportunities for growth.

Saari TI; Ihmsen H; Neuvonen PJ; Olkkola KT; Schwilden H. Oxycodone clearance is markedly reduced with advancing age: A population pharmacokinetic study. British Journal of Anaesthesia 108(3): 491-498, 2012. (26 refs.)

Oxycodone is a -opioid receptor agonist, the global use of which has increased vigorously during the past decade. The pharmacokinetic data of oxycodone available for elderly are limited, and there appear to be only little data on the population pharmacokinetics of oxycodone. We analysed 1272 plasma oxycodone samples of 77 individuals (range of age 1989 yr) with non-linear mixed effect modelling. Inter- and intra-individual variability of the model was estimated for clearances and distribution volumes. The effect of covariates was studied with simulations. Data were best described with a two-compartment linear model. Lean body mass and age were found to be significant covariates for elimination clearance and the volume of the central compartment. The population estimates of elimination clearance, volume of the central compartment, and the volume of distribution at steady state for a reference individual (male 35 yr, 70 kg, 170 cm) were 51.0 litre h(1), 134, and 258 litres, respectively. The elimination half-life of oxycodone showed an age-dependent increase. The context-sensitive half-time at steady state increased from 3.8 to 4.6 h between the age of 25 and 85 yr, respectively. Simulations of repetitive bolus dosing showed a 20 increase in oxycodone concentration in the elderly. Age was found to be a significant covariate for oxycodone pharmacokinetics. In elderly patients, dosing should therefore be reduced and carefully titrated to avoid considerable accumulation of oxycodone and potentially hazardous side-effects.

Sachs-Ericsson N; Collins N; Schmidt B; Zvolensky M. Older adults and smoking: Characteristics, nicotine dependence and prevalence of DSM-IV 12-month disorders. Aging & Mental Health 15(1): 132-141, 2011. (46 refs.)

Objectives: There are few studies investigating the characteristics of older smokers. Research on younger adults has determined that (1) the diagnostic and statistical manual (DSM) diagnosis of nicotine dependence (ND) excludes a sizable portion of the smoking population, and (2) younger smokers have high rates of comorbid DSM disorders. In this study, we sought to replicate these results in an older population. Method: Based on a large representative sample, we examined the smoking patterns in adults aged 50 and over (N = 2139). We describe the characteristics of the current smokers (n = 410). We identified differences in smoking characteristics and prevalence rates of DSM-IV 12-month diagnoses by smoking severity. Results: Most smokers did not meet the criteria for DSM 12-month ND. Older smokers identified as having ND were first diagnosed at a relatively older age. Smokers with ND differed from smokers without a diagnosis in several ways: they smoked more; they had more symptoms of ND and had substantially higher rates of comorbid DSM 12-month disorders. Nonetheless, there were a number of older smokers with dependency symptoms who continue to smoke throughout their lifetimes, but never meet the criteria for ND. Conclusion: Smokers without ND are most likely to have a mood disorder whereas those smokers with ND are most likely to have an anxiety or substance use disorder. Smokers without ND still have relatively high rates of dependency symptoms. Given the late onset of ND, smoking dependence may be a progressive disorder. High rates of psychiatric disorders may interfere with smoking cessation.

Salonika M; Salminen M; Vahlberg T; Aarnio P; Kivela SL. Withdrawal of psychotropic drugs decreases the risk of falls requiring treatment. Archives of Gerontology and Geriatrics 54(1): 160-167, 2012. (34 refs.)

This non-randomized, controlled trial assessed the effects of ceasing fall-risk-increasing drugs (FRIDs) (psychotropics or opiates or potent anticholinergics) on the risk of falls requiring medical treatment as a sub-analysis of a randomized, controlled multifactorial fall prevention. The population in this 12-month study consisted of 528 community-dwelling subjects aged 65 years or older with a history of at least one fall. The subjects were divided retrospectively into three groups according to the use of any FRID, any psychotropic drug, and benzodiazepine or related drug (BZD/BZDRD). The subjects in the intervention group (IG) ceasing the drug use were compared with the subjects in IG and the control group (CG) not ceasing the use of the corresponding type of drugs during the intervention period. Falls were recorded from medical records. For the year after the 12-month intervention the relative risk ratio (with 95% confidence intervals = CI) for controls in CG compared with the withdrawal group in IG was 8.26 (1.07-63.73) among the users of psychotropics and 8.11 (1.03-63.60) among the users of BZDs/BZDRDs. Withdrawal of psychotropics, especially BZDs/BZDRDs may have played an important role by lowering the risk of falls requiring medical treatment during the year after the 12-month multifactorial intervention.

Schinka JA; Schinka KC; Casey RJ; Kasprow W; Bossarte RM. Suicidal behavior in a national sample of older homeless veterans. American Journal of Public Health 102(Supplement 1): S147-S153, 2012. (24 refs.)

Objectives. We examined self-reported suicidal behavior of older homeless veterans to establish frequencies and predictors of recent suicidal behaviors, and their impact on transitional housing interventions. Methods. We analyzed the records of a national sample of 10 111 veterans who participated in a transition housing program over a 6-year period, ending in 2008. Results. Approximately 12% of homeless veterans reported suicidal ideation before program admission; 3% reported a suicide attempt in the 30 days before program admission. Older homeless veterans exhibiting suicidal behavior had histories of high rates of psychiatric disorders and substance abuse. Regression analyses showed that self-report of depression was the primary correlate of suicidal behavior. Suicidal behavior before program entry did not predict intervention outcomes, such as program completion, housing outcome, and employment. Conclusions. Suicidal behavior was prevalent in older homeless veterans and was associated with a history of psychiatric disorder and substance abuse. Self-reported depression was associated with these behaviors at the time of housing intervention. Despite the association with poor mental health history, suicidal behavior in older homeless veterans did not impact outcomes of transitional housing interventions.

Sharp L; Vacha-Haase T. Physician attitudes regarding alcohol use screening in older adult patients. Journal of Applied Gerontology 30(2): 226-240, 2011. (32 refs.)

Alcohol use among older adults (65+) is thought to be one of the fastest growing health problems in the country. Although proper assessment and diagnosis is crucial in addressing problem drinking in this population, research suggests that physicians are not adequately screening their older adult patients for alcohol use. The present study examined the relationship between family physicians' attitudes and perceptions and their screening prevalence with their new and existing older adult patients collected and analyzed in 2007. Results indicated that physicians in the study reported screening 73% of their new patients on intake and 44% of their existing patients. Family physicians with more positive perceptions of their alcohol-management skills with older adults performed more screening with their new and existing older adult patients. Year of medical school graduation was related to screening but only with new patients.

Shaw BA; Agahi N; Krause N. Are changes in financial strain associated with changes in alcohol use and smoking among older adults? Journal of Studies on Alcohol and Drugs 72(6): 917-925, 2011. (35 refs.)

Objective: This study aimed to assess whether changes in levels of financial strain are associated with changes in alcohol use and smoking among older adults. Method: Multilevel analyses were conducted using longitudinal data from a randomly selected national sample of older adults (N= 2,352; 60% female). The data were collected in six waves during the period of 1992-2006. We estimated associations between within-person changes in levels of financial strain and the odds of engaging in heavy drinking and smoking, while also testing for the moderating effects of gender, education, and age. Results: A direct association was observed between changes in levels of financial strain and the odds of heavy drinking, particularly among elderly men (odds ratio [OR] = 1.31) and those with low levels of education (OR = 1.27). A direct association between changes in levels of financial strain and the odds of smoking was also evident, particularly among the young-old (i.e., age 65 at baseline; OR = 1.44). Conclusions: Exposure to financial strain places some groups of older adults at increased risk for unhealthy drinking and smoking. If the current global financial crisis leads to increases in experiences of financial strain among older adults, alcohol and smoking problems can also be expected to increase in this population.

Simons LA; Simons J; Friedlander Y; McCallum J. Predictors of long-term mortality in the elderly: the Dubbo Study. Internal Medicine Journal 41(7): 555-560, 2011. (31 refs.)

Background: This study examines the predictors of long-term all-causes mortality (ACM) in Australian senior citizens. Methods: We have analysed ACM in a cohort of 2805 citizens, 1233 men and 1572 women aged >= 60 years, first examined in 1988 and followed for 20 years. Hazard ratios and 95% confidence intervals for ACM were obtained from Cox models employing conventional predictors. Results: Over 20 years 66% of men (815/1233) and 53% of women (833/1572) died. Constant proportional hazard over the 20 years was demonstrated for all predictors, indicating similar relative hazard of ACM during long-term or short-term follow up. There was significant prediction of ACM by current smoking (hazard ratio 1.96, 95% confidence interval 1.57-2.43 in men; 1.67, 1.32-2.10 in women), high blood pressure (1.37, 1.03-1.81; 1.41, 1.07-1.86), diabetes (1.46, 1.17-1.82; 1.83, 1.43-2.34), impaired peak expiratory flow (1.39, 1.15-1.69; 1.80, 1.47-2.21), coronary heart disease at study entry in men (1.33, 1.13-1.57), physical disability (1.38, 1.13-1.68; 1.45, 1.17-1.79) and alcohol intake (0.82, 0.69-0.97; 0.77, 0.66-0.8(respectively). ACM was not significantly predicted by standard lipid parameters. Over the 20-year period smoking was associated with reduced survival of 41 months in men and 25 months in women, hypertension with reduced survival of 20 and 17 months, and diabetes with reduced survival of 24 and 30 months respectively. Conclusions: The findings confirm the contribution of cigarette smoking, hypertension and diabetes to ACM in senior citizens, conditions that are potentially amenable to intervention.

Sinforiani E; Zucchella C; Pasotti C; Casoni F; Bini P; Costa A. The effects of alcohol on cognition in the elderly: From protection to neurodegeneration. (review). Functional Neurology 26(2): 103-106, 2011. (50 refs.)

The effects of chronic alcohol abuse on cognition are well known. Memory and executive functions appear to be the cognitive domains primarily impaired, and prefrontal and frontal damage is reported on neuroimaging studies both at micro- and macrostructural levels. Abstinence can partially reverse these alterations through mechanisms of neuroplasticity. Alcohol acts in a dose-dependent fashion, and a light-to-moderate consumption indeed has protective effects on cardiovascular risk factors and promotes anti-inflammatory and anti-oxidative processes. In the elderly on such a regimen, several epidemiological studies have reported a decreased risk of both coronary and cerebrovascular disease and of dementia. However, because of data heterogeneity and the presence of several confounding variables, further studies are needed to clarify these findings. In addition, the complexity of alcohol neurobiology (interaction of alcohol effects with genetic predisposition and environmental factors) and the occurrence of age-related changes should also be taken into account. As dementia, stroke and cardiovascular disease are the leading causes of mortality in older people in developed countries, a better knowledge of the mechanisms underlying the effects of alcohol intake may be helpful from the perspective not only of medical management but also of social health policy.

Skliros EA; Papadodima SA; Sotiropoulos A; Xipnitos C; Kollias A; Spiliopoulou CA. Relationship between alcohol consumption and control of hypertension among elderly Greeks. The Nemea Primary Care Study. Hellenic Journal of Cardiology 53(1): 26-32, 2012. (34 refs.)

Background: The aim of this study was to evaluate the significance of alcohol intake in relation to blood pressure control in treated subjects and to determine if there is a causative link between alcohol and inadequate control of hypertension. Methods: Our study population comprised 637 elderly individuals who reside in Nemea and in four other villages located in Corinthia, Peloponnesus, of which 615 were included in the analysis. The average age was 73.5 +/- 6.15 years. A special epidemiological questionnaire was completed by each participant and the blood pressure (BP) was measured according to a predefined protocol. Odds ratios were calculated and adjusted for potential confounders. Results: The overall prevalence of hypertension was 69.1%, 70.7% in men and 67.0% in women. In total, 11% of the hypertensives were not aware of having hypertension. Of those who were aware of having hypertension 91.0% were being treated. Among treated hypertensives 49.1% had systolic BP<140 mmHg and diastolic BP<90 mmHg. Only heavy drinking (>300 g/week) was found to be related with hypertension control. Conclusions: Our study showed that the level of control among the elderly, in a Greek population, is positively associated with alcohol intake only for heavy drinking. The role of alcohol consumption in hypertension in the elderly needs further investigation.

Smith ML; Colwell B; Ahn S; Ory MG. Factors associated with tobacco smoking practices among middle-aged and older women in Texas. Journal of Women & Aging 24(1): 3-22, 2012. (60 refs.)

This study examines middle-aged and older women's smoking practices and identifies factors associated with tobacco use and cessation in this population. Data of 593 women were analyzed from a seven-county random household sample in Texas. Sequential multinomial logistic regression compared associations with having never smoked, having quit smoking, and currently smoking. Compared to smokers, never smokers and past smokers were significantly more likely to be older, more educated, of better general health, and report past-year physician visits and fewer depressive symptoms. Mental health and smoking are interrelated, indicating the need for addressing depression in smoking-cessation efforts for aging women.

Spanemberg L; Nogueira EL; da Silva CTB; Dargel AA; Menezes FS; Neto AC. High prevalence and prescription of benzodiazepines for elderly: Data from psychiatric consultation to patients from an emergency room of a general hospital. General Hospital Psychiatry 33(1): 45-50, 2011. (33 refs.)

Objectives: The aim of this study is to compare the use and prescription of psychotropic drugs, with emphasis on benzodiazepines, in elderly and non-elderly patients who are assisted at the emergency room by a psychiatric consultation of a university teaching hospital. Method: This is a cross-sectional study. We analyzed all records of psychiatric consultation in an emergency room of a general hospital from March 2009 until March 2010. Sociodemographic and clinical variables were compared between the group of elderly and non-elderly in two cutoff points (>= 60 and >= 65 years), with emphasis on the use and prescription of benzodiazepines. Results: Five hundred seventy-five records were found with 71 elderly and 504 nonelderly for the first cutoff point and 51 elderly and 524 nonelderly in the second. Differences between groups were found in all sociodemographic variables (gender, marital status, education, current occupational status). Elderly patients treated at emergency rooms used more psychotropic drugs, particularly antidepressants and benzodiazepines, than non-elderly. About 25% of the patients received benzodiazepine treatment in the emergency setting, and there was no statistical difference between age groups. Conclusion: There is a wide prevalence of benzodiazepine use among elderly patients in a psychiatric emergency service. Despite the recommendations for its judicious use, benzodiazepines were the most commonly used drug by psychiatrists on duty, regardless of patient's age. These results call for caution in prescribing these drugs and require alternatives to the treatment of psychiatric disorders in the elderly.

Taipale HT; Bell JS; Gnjidic D; Sulkava R; Hartikainen S. Sedative load among community-dwelling people aged 75 years or older: Association with balance and mobility. Journal of Clinical Psychopharmacology 32(2): 218-224, 2012. (58 refs.)

Drugs with sedative properties are frequently used among older people. Sedative load is a measure of the cumulative effect of taking multiple drugs with sedative properties. The objective of this study was to investigate the association between sedative load and balance and mobility. A random sample of 1000 people 75 years or older was invited to participate. Seven hundred community-dwelling participants (mean age, 81.3 years; 69% women) were included in the present study. Demographic, diagnostic, and drug use data were elicited during nurse interviews in 2004. Balance and mobility were tested by physiotherapists. Sedative load was calculated using a previously published model for each participant by summing the sedative ratings of primary sedatives (rating 2) and drugs with sedation as a prominent adverse effect (rating 1). Analyses of covariance and logistic regression analyses were used to assess the association between sedative load and balance and mobility. Of the 700 participants, 21% (n = 147) had a sedative load of 1-2, and 8% (n = 58) had sedative load of 3 or greater. After adjusting for covariates, exposure to higher sedative load ranges was associated with slower walking speed (P = 0.0003), longer time to perform Timed Up and Go test (P = 0.005), and lower scores on Berg Balance Scale (P = 0.005), but not with self-reported ability to walk 400 m. In conclusion, having a higher sedative load was associated with impaired balance and mobility among community-dwelling older people. Clinicians should remain cognizant of this association and regularly reevaluate drug therapy prescribed to older people.

Tait RJ; French DJ; Burns R; Anstey KJ. Alcohol use and depression from middle age to the oldest old: Gender is more important than age. International Psychogeriatrics 24(8, special issue): 1275-1283, 2012. (30 refs.)

Background: Alcohol use disorders are associated with other mental health disorders in young adults, but there are few data on alcohol use and mental health outcomes in older adults, particularly the oldest old. This study examines the relationship between alcohol consumption and depressive symptoms. Methods: Data were collected from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project, which has pooled nine Australian longitudinal studies. Alcohol consumption was classified using standard drinks (10 g alcohol)/day as: abstinent, low risk (<0-<= 2 standard drinks), long-term risk (>2-<= 4) and short-term risk (>4). Probable depression was classified from harmonized scores on various standard instruments (e.g. Centre for Epidemiological Studies Depression scale). Results: Overall, 39,104 (86%) participants contributed data. Alcohol classification at baseline showed 7,526 abstinent, 28,112 low risk, 2,271 long-term risk, and 1,195 short-term risk participants. Age ranged from 45 to 103 year (median 60). Using generalized estimating equations (GEE), there were significant gender by alcohol and gender by age interactions, so the analysis was split by gender. Among males, the abstinent and short-term risk groups had increased likelihood of depression: in females the abstinent, long- and short-term risk groups had increased odds of depression. Increased odds of depression was also associated with former and current smoking, younger age-group, not being partnered, leaving school before age 15 and increasing levels of health-impaired walking, dressing, or bathing. Conclusion: The impact of alcohol use differs by gender, nevertheless those using higher levels of alcohol or who smoke should be screened for depression and may benefit from interventions.

Tian XB; Tang Z; Jiang JM; Fang XH; Wu XG; Han W et al. Effects of smoking and smoking cessation on life expectancy in an elderly population in Beijing, China, 1992-2000: An 8-year follow-up study. Journal of Epidemiology 21(5): 376-384, 2011. (29 refs.)

Background: We assessed the effects of smoking and smoking cessation on life expectancy and active life expectancy among persons aged 55 years or older in Beijing. Methods: This study included 1593 men and 1664 women who participated in the Beijing Longitudinal Study of Aging, which commenced in 1992 and had 4 survey waves up to year 2000. An abridged life table was used to estimate life expectancy, in which age-specific mortality and age-specific disability rates were adjusted by using a discrete-time hazard model to control confounders. Results: The mean ages (SD) for men and women were 70.1 (9.25) and 70.2 (8.72) years, respectively; mortality and disability rates during follow-up were 34.7% and 8.0%, respectively. In both sexes, never smokers had the highest life expectancy and active life expectancy across ages, as compared with current and former smokers. Current heavy smokers had a shorter life expectancy and a shorter active life expectancy than light smokers. Among former smokers, male long-term quitters had a longer life expectancy and longer active life expectancy than short-term quitters, but this was not the case in women. Conclusions: Older adults remain at higher risk of mortality and morbidity from smoking and can expect to live a longer and healthier life after smoking cessation.

Towers A; Stephens C; Dulin P; Kostick M; Noone J; Alpass F. Estimating older hazardous and binge drinking prevalence using AUDIT-C and AUDIT-3 thresholds specific to older adults. Drug and Alcohol Dependence 117(2-3): 211-218, 2011. (51 refs.)

Background: This study aimed to provide hazardous and binge drinking prevalence, odds and risk attributable to specific demographic correlates in community dwelling older adults using both the standard and new older-specific AUDIT-C thresholds. Methods: Hazardous drinking was assessed using the AUDIT-C in a cross-sectional postal survey of 6662 New Zealanders aged 55-70 years old (m = 60.94, SD = 4.70) randomly selected from the New Zealand Electoral Roll. Prevalence data is presented for whole sample and stratified by key demographic correlates using standard and older-specific threshold scores on the AUDIT-C. Hazardous drinking prevalence using the standard AUDIT-C threshold was 56.01%, as compared to 42.28% and 50.20% under two older-specific thresholds. Results: Being younger, male, and wealthy were consistent drinking predictors across thresholds but the older-specific thresholds substantially altered the prevalence and risk for females, Asians, and poorer people. Past-month binge prevalence of 18.18% was considerably lower than the past-year prevalence of 33.51%, but change from past-month to past-year binge threshold had no significant effect on the demographic composition of binge drinkers. The standard AUDIT-C threshold over-estimates hazardous drinking prevalence in older adults by up to 33%, but even the most conservative rates in this study are cause for concern regarding the level of drinking by older people in New Zealand. Conclusion: Older hazardous drinkers are predominantly younger, wealthier, white, partnered males, whichever threshold is used, but binge drinkers are more likely to be rural, Maori, and lack tertiary education. Further efforts are needed to determine factors underpinning hazardous drinking, especially in older Maori.

Voyer P; Preville M; Martin LS; Roussel ME; Beland SG; Berbiche D. Factors associated with self-rated benzodiazepine addiction among community-dwelling seniors. Journal of Addictions Nursing 22(1-2): 46-56, 2011. (57 refs.)

Long-term use of benzodiazepines carries considerable personal consequences such as memory loss and functional impairment. In addition, use over time may bring about dependence and habituation thus leading older persons to believe they cannotdiscontinue the drug and to experience withdrawal symptoms should its use suddenly cease. The frequency of such negative consequences remains unclear. The purpose of this study is to determine the prevalence of self-rated addiction among older persons and its associated factors. Face-to-face computer-assisted interviews were conducted in the homes of 2,785 persons aged 65 years and over, randomly selected from across the Province of Quebec, Canada. Of the 707 users of benzodiazepines, 43%% considered themselves addicted. They were more likely to be 75 years or over, to suffer from panic disorder, to believe that health professionals are ready and available to discuss emotional problems with them, and to be less than satisfied with their social relationships. This study showed that a large proportion of benzodiazepine users rated themselves as addicted. These findings indicate that it is important for nurses to screen older adults living in the community to identify those who continue to use benzodiazepine beyond the recommended therapeutic time frame, perceive themselves to be dependent, and could potentially benefit from participation in a withdrawal program.

Wastesson JW; Parker MG; Fastbom J; Thorslund M; Johnell K. Drug use in centenarians compared with nonagenarians and octogenarians in Sweden: A nationwide register-based study. Age and Ageing 41(2): 218-224, 2012. (32 refs.)

Background: The number of centenarians increases rapidly. Yet, little is known about their health and use of medications. Objective: to investigate pharmacological drug use in community-dwelling and institutionalised centenarians compared with nonagenarians and octogenarians. Methods: we analysed data on dispensed drugs for centenarians (n = 1,672), nonagenarians (n = 76,584) and octogenarians (n = 383,878) from the Swedish Prescribed Drug Register, record-linked to the Swedish Social Services Register. Multivariate logistic regression analysis was used to analyse whether age was associated with use of drugs, after adjustment for sex, living situation and co-morbidity. Results: In the adjusted analysis, centenarians were more likely to use analgesics, hypnotics/sedatives and anxiolytics, but less likely to use antidepressants than nonagenarians and octogenarians. Moreover, centenarians were more likely to use high-ceiling diuretics, but less likely to use beta-blockers and ACE-inhibitors. Conclusions: Centenarians high use of analgesics, hypnotics/sedatives and anxiolytics either reflects a palliative approach to drug treatment in centenarians or that pain and mental health problems increase into extreme old age. Also, centenarians do not seem to be prescribed cardiovascular drug therapy according to guidelines to the same extent as nonagenarians and octogenarians. Whether this reflects an age or cohort effect should be evaluated in longitudinal studies.

Weuve J; Tchetgen EJT; Glymour MM; Beck TL; Aggarwal NT; Wilson RS et al. Accounting for bias due to selective attrition: The example of smoking and cognitive decline. Epidemiology 23(1): 119-128, 2012. (58 refs.)

Background: Selective attrition may introduce bias into analyses of the determinants of cognitive decline. This is a concern especially for risk factors, such as smoking, that strongly influence mortality and dropout. Using inverse-probability-of-attrition weights, we examined the influence of selective attrition on the estimated association of current smoking (vs. never smoking) with cognitive decline. Methods: Chicago Health and Aging Project participants (n = 3713), aged 65-109 years, who were current smokers or never-smokers, underwent cognitive assessments up to 5 times at 3-year interval. We used pooled logistic regression to fit predictive models of attrition due to death or study dropout across the follow-up waves. With these models, we computed inverse-probability-of-attrition weights for each observation. We fit unweighted and weighted, multivariable-adjusted generalized-estimating-equation models, contrasting rates of change in cognitive scores in current versus never-smokers. Estimates are expressed as rates of change in z score per decade. Results: During the 12 years of follow-up, smokers had higher mortality than never-smokers (hazard ratio = 1.93 [95% confidence interval = 1.67 to 2.23]). Higher previous cognitive score was associated with increased likelihood of survival and continued participation. In unweighted analyses, current smokers' cognitive scores declined 0.11 standard units per decade more rapidly than never-smokers' (95% CI = -0.20 to -0.02). Weighting to account for attrition yielded estimates that were 56% to 86% larger, with smokers' estimated 10-year rate of decline up to 0.20 units faster than never-smokers' (95% CI = -0.36 to -0.04). Conclusions: Estimates of smoking's effects on cognitive decline may be underestimated due to differential attrition. Analyses that weight for the inverse probability of attrition help compensate for this attrition.

Wiemeyer J; Kliem A. Serious games in prevention and rehabilitation: A new panacea for elderly people? (review). European Review of Aging and Physical Activity 9(1): 41-50, 2012. (80 refs.)

Digital games cannot only be used for fun and entertainment. The term "serious games" (SG) denotes digital games serving serious purposes like education, training, advertising, research and health. Recently, a new generation of games has emerged involving whole-body movements. Compared to traditional interventions, these games may help elderly people to improve their health by enhancing physical fitness and coordinative abilities by combining increased motivation, game experience like fun and game flow and training. Serious games, particularly adventure and shooter games, already play an important role in health education, prevention and rehabilitation, e.g. to enhance health-related physical activity, improve sensory-motor coordination, prevent asthma, change nutrition behaviour and alleviate diabetes and prevent smoking or HIV. In this paper, the impact of SG on prevention and rehabilitation is discussed. Three criteria are applied. Beyond effectivity and efficiency, the additional benefits of serious games can be described and explained by different models including social, psychological, physiological and sensory-motor factors. The quality of study serves as a third criterion. Despite first promising results, there are only few high-quality studies. Adequate content, game interfaces, sustainability and appropriate settings are critical factors for the success of SG. In this regard, (sport) science can help to develop and evaluate SG and test appropriate settings that ensure sustainable use of serious games.

Wilkinson C; Allsop S; Chikritzhs T. Alcohol pouring practices among 65- to 74-year-olds in Western Australia. Drug and Alcohol Review 30(2): 200-206, 2011. (34 refs.)

Introduction and Aims. Alcohol pouring practices have relevance to the validity of self-reported alcohol consumption. However, little research has focused on older populations nor investigated relationships between volumes poured and participants' estimations of beverages in terms of Australian standard drinks. The aim of this study was to address these issues. Design and Methods. Interviews were conducted (in participants' homes) with 844 current drinkers, aged 65-74 years, from Perth, Western Australia. Participants: poured their 'usual' serving of alcohol into their 'usual' drinking vessel and were asked questions regarding the volumes poured. Results. Older men poured drinks that were 32% larger than a standard drink (10 g of ethanol). The comparable figure for older women was 16%. However, over 25% of all men and 20% of all women indicated they would not record (in a self-report assessment of consumption) the amount poured as one standard drink. Despite participants making corrections, men and women still underestimated amounts poured (men by 23% and women by 16%). Discussion and Conclusions. As with younger populations, older people pour drinks that are, on average, larger than standard drinks. To increase the accuracy of self-reported consumption, it is recommended that researchers consider pouring practices and people's perceptions of alcohol volumes poured in relation to a standard drink. Further research on this issue may reduce the discrepancy between self-reported levels of consumption and national per capita alcohol sales.

Wray LO; Mavandadi S; Klaus JR; Tew JD; Oslin DW; Sweet RA. The association between mental health and cognitive screening scores in older veterans. American Journal of Geriatric Psychiatry 20(3): 215-227, 2012. (51 refs.)

Objectives: To examine overall cognitive screening results and the relationship between cognitive screen score and sociodemographic characteristics, reason for referral, and clinical outcomes of older veterans referred by primary care for a behavioral health assessment. Design: Cross-sectional, naturalistic study. Setting: Primary care clinics affiliated with two VA Medical Centers. Participants: The sample included 4,325 older veterans referred to the Behavioral Health Laboratory who completed an initial mental health/substance abuse assessment. Veterans were categorized into the following three groups on the basis of cognitive status: within normal limits, possible cognitive impairment, and possible dementia. Measurements: Sociodemographic and clinical data on reason for referral, cognitive functioning (i.e., Blessed Orientation-Memory-Concentration test), and behavioral health assessment outcomes were extracted from patients' medical records. Data were analyzed using multiple linear and logistic regressions. Results: Results of cognitive screenings indicated that the majority of the sample was within normal limits (62.5%), with 25.8%, 8.1%, and 3.6% of patients evidencing possible cognitive impairment, possible dementia, and Blessed Orientation-Memory-Concentration scores of 17 or more, respectively. With regard to reason for referral, patients with greater cognitive impairment were more likely to be identified by the antidepressant case finder than patients with less impairment. Increased age, non-white ethnicity, self-perceived inadequate finances, major depressive disorder, and symptoms of psychosis were associated with greater cognitive impairment. Conclusions: Findings highlight the importance of evaluating cognitive status in older adults who are referred for a behavioral health assessment and/or receive a new mental health/substance abuse diagnosis. Doing so has the potential to improve recognition and treatment of cognitive impairment and dementia, thereby improving quality of care for many older adults.

Wu LT; Blazer DG. Illicit and nonmedical drug use among older adults: A review. (review). Journal of Aging and Health 23(3): 481-504, 2011. (54 refs.)

Objective: Substance abuse among older adults is a looming public health concern. The number of Americans aged 50+ years with a substance use disorder is projected to double from 2.8 million in 2002-2006 to 5.7 million in 2020. The authors provide a review of epidemiological findings for this understudied area of research by focusing on illicit drug use disorders and nonmedical use of prescription drugs among adults aged 50+ years. Method: MEDLINE and PsychInfo were searched using keywords drug use, drug abuse, drug misuse, substance use disorder, and prescription drug abuse. Using the related-articles link, additional articles were screened for inclusion. This review included articles published between 1990 and 2010. Result: Results from multiple sources indicated a much higher rate of illicit drug use and nonmedical use of prescription drugs and drug-related treatment admissions for persons 50 to 64 years of age compared with adults 65+ years of age. Rates of treatment admissions involving primary use of illicit and misuse of prescription drugs have increased, while rates involving primary use of alcohol only have decreased. Alcohol, opioids/heroin, and cocaine were more likely than other substances to be associated with treatment use. Limited research data suggested the effectiveness of treatments, especially for women. Furthermore, older adults appeared to be less likely than younger adults to perceive substance use as problematic or to use treatment services. Discussion: There is robust evidence showing that an increased number of older adults will need substance abuse care in the coming decades. Increasing demands on the substance abuse treatment system will require expansion of treatment facilities and development of effective service programs to address emerging needs of the aging drug-using population.

Zhang XZ; Kahende J; Fan AZ; Barker L; Thompson TJ; Mokdad AH et al. Smoking and visual impairment among older adults with age-related eye diseases. Preventing Chronic Disease 8(4): A84, 2011. (34 refs.)

Introduction: Tobacco use is the leading preventable cause of death in the United States. Visual impairment, a common cause of disability in the United States, is associated with shorter life expectancy and lower quality of life. The relationship between smoking and visual impairment is not clearly understood. We assessed the association between smoking and visual impairment among older adults with age-related eye diseases. Methods: We analyzed Behavioral Risk Factor Surveillance System data from 2005 through 2008 on older adults with age-related eye diseases (cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy; age >= 50 y, N = 36,522). Visual impairment was defined by self-reported difficulty in recognizing a friend across the street or difficulty in reading print or numbers. Current smokers were respondents who reported having smoked at least 100 cigarettes ever and still smoked at the time of interview. Former smokers were respondents who reported having ever smoked at least 100 cigarettes but currently did not smoke. We used multivariate logistic regressions to examine the association and to adjust for potential confounders. Results: Among respondents with age-related eye diseases, the estimated prevalence of visual impairment was higher among current smokers (48%) than among former smokers (41%, P < .05) and respondents who had never smoked (42%, P < .05). After adjustment for age, sex, race/ethnicity, education, and general health status, current smokers with age-related eye diseases were more likely to have visual impairment than respondents with age-related eye diseases who had never smoked (odds ratio, 1.16, P < .05). Furthermore, respondents with cataract who were current smokers were more likely to have visual impairment than respondents with cataract who had never smoked (predictive margin, 44% vs 40%, P =.03), and the same was true for respondents with age-related macular degeneration (65% of current smokers vs 57% of never smokers, P = .02). This association did not hold true among respondents with glaucoma or diabetic retinopathy. Conclusion: Smoking is linked to self-reported visual impairment among older adults with age-related eye diseases, particularly cataract and age-related macular degeneration. Longitudinal evaluation is needed to assess smoking cessation's effect on vision preservation.