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CORK Bibliography: The Elderly

83 citations. January 2010 to present

Prepared: September 2011

[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.

Bobo JK; Greek AA; Klepinger DH; Herting JR. Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline. Journal of the American Geriatrics Society 58(12): 2375-2380, 2010. (30 refs.)

OBJECTIVES: To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up. DESIGN: Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age. SETTING: Study data were obtained from detailed interviews conducted in the home or by telephone. PARTICIPANTS: One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995. MEASUREMENTS: Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003. RESULTS: All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively. CONCLUSION: Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

Brennan PL; Schutte KK; Moos RH. Patterns and predictors of late-life drinking trajectories: A 10-year longitudinal study. Psychology of Addictive Behaviors 24(2): 254-264, 2010. (60 refs.)

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

Brennan PL; Schutte KK; Moos RH. Retired status and older adults' 10-year drinking trajectories. Journal of Studies on Alcohol and Drugs 71(2): 165-168, 2010. (19 refs.)

Objective: Little research has examined the role of retirement in shaping late-life drinking careers, and it has generally been limited to cross-sectional designs or short-term follow-ups that emphasize group-level comparisons of retirees and nonretirees. The purpose of this study was to determine the following: (a) the effect of retired status on older adults' 10-year within-person drinking trajectories and (b) whether age, gender, income, health, and problem-drinker status account for or moderate this effect. Method: We first estimated older adults' (baseline M = 62 years; n = 595) 10-year within-person drinking trajectories using three successively predictive multilevel regression models: unconditional growth, retired status alone, and retired status controlling for covariates. Next, we determined whether inclusion of Retired Status x Covariate interactions would improve prediction of the trajectories. Results: Participants' drinking frequency declined moderately over the 10-year interval, and retired status hastened the decline. However, this effect disappeared once covariates were added to the model: Baseline poorer health, lower income, and current problem-drinker status predicted steeper decline in drinking frequency, whereas former problem-drinker status predicted slower decline. Lower income and current drinking problems also predicted steeper declines in amount of alcohol consumed. There were no statistically significant or uniquely contributive interactions between retired status and age, gender, health, income, or drinking problems for predicting late-life drinking trajectories. Conclusions: Baseline health, income, and problem-drinking history are more important than retired status for predicting older adults' long-term within-person drinking trajectories. These factors and recency of drinking problems should be considered in future studies of retirement and late-life drinking patterns.

Buja A; Scafato E; Sergi G; Maggi S; Suhad MA; Rausa G et al. Alcohol consumption and metabolic syndrome in the elderly: Results from the Italian longitudinal study on aging. European Journal of Clinical Nutrition 64(3): 297-307, 2010. (44 refs.)

Background/Objectives: Although there is plenty of evidence of the association between metabolic syndrome ( MS) and cardiovascular disease, the relationship between alcohol consumption and MS is still questioned. The few publications with respect to the elderly seem to indicate that alcohol consumption is unassociated with MS. The aim of this study was to assess the association between alcohol consumption and the prevalence and incidence of MS, as well as its components in a large sample of Italian elderly people. Subjects/Methods: This is a multicenter study on a population-based sample of Italian people aged 65-84 years. The Italian Longitudinal Study on Aging (ILSA) included a prevalence phase in 1992 and an incidence phase from 1995 to 1996. The median length of follow-up was 3.5 years. In the present study, the analysis included 1321 men grouped into five alcohol consumption classes: abstainers, and those consuming <= 12, 13-24, 25-47 or >= 48 g of alcohol in a day. Among the 1122 women considered, the last two of the above five categories were pooled together ( 424 g/day). MS was defined according to ATP III criteria. All statistical analyses were stratified by gender. Results: Adjusted odds ratios showed that categorized alcohol consumption was not significantly associated with the prevalence and incidence of MS when compared with abstainers in either gender. For the MS incidence survey, three of five components (systolic pressure, glycemia and waist circumference) proved to be significantly and harmfully affected by alcohol consumption in males, whereas no such significant association emerged in females. Conclusions: These results suggest that alcohol can modify an individual's metabolic condition and that, even among the elderly, men might be more sensitive to the effects of alcohol than women.

Cabrera MAS; Dellaroza MSG; Trelha CS; Paccola LBB; Perdigao SDD; Pinto MED et al. Psychoactive drugs as risk factors for functional decline among noninstitutionalized dependent elderly people. Journal of the American Medical Directors Association 11(7): 519-522, 2010. (29 refs.)

Objective: To analyze the association between use of psychoactive drugs and functional decline among noninstitutionalized dependent elderly people. Design: Cross-sectional study. Participants: A total of 161 community-dwelling elderly people with functional dependence. Measurements: The data were analyzed using logistic regression with adjustment for age models. The independent variables were the following: use of psychoactive drugs (antidepressants, anticonvulsants, anxiolytics, antipsychotics, or sedatives), cognitive decline (Mini-Mental State Examination score <20), and daytime sleepiness. The dependent variables were the following: dependence relating to activities of daily living (ADLs) and dependence relating to instrumental activities of daily living (IADLs). Results: Data on 131 individuals of mean age 77.5 years were analyzed. Psychoactive drugs were used by 33.6%. Age-adjusted univariate analysis showed associations between psychoactive drug use and both ADLs and IADLs. However, in multivariate analysis, only ADLs showed a significant association with psychoactive drug use, independent of cognitive decline and daytime sleepiness (OR = 2.67; 95% Cl: 1.04-6.85; P = .04). Conclusions: There is a greater risk of impairment of ADLs among noninstitutionalized elderly people using psychoactive drugs. These results indicate the need for rational use of medication groups among this population with greater risk of functional impairment.

Chan KKK; Chiu KC; Chu LW. Association between alcohol consumption and cognitive impairment in Southern Chinese older adults. International Journal of Geriatric Psychiatry 25(12): 1272-1279, 2010. (43 refs.)

Background: There is limited data on the effects of alcohol consumption on cognitive impairment in Chinese populations. Objectives: To investigate the association between alcohol consumption and the risk of cognitive impairment in Southern Chinese older adults in Hong Kong. Method: This was a cross-sectional study of 314 Chinese older participants, aged 65 years or over. Participants' socio-demographic, co-morbid diseases, alcohol drinking habits, and Mini Mental State Examination (MMSE) for cognitive function were obtained by a face-to-face interview. Participants were categorized into normal cognitive and cognitively impaired groups by education-adjusted MMSE cut-off scores. Result: The mean (SD) age of the participants was 79.9 (6.5) years. The average weekly alcohol consumption in the cognitively impaired group was significantly higher than that of the normal cognition group [mean (SD): 861.89 (673.03) versus 241.21 (276.26) grams per week respectively; p < 0.001, t-test]. Drinkers with light to moderate alcohol consumption were associated with higher MMSE scores than non-drinkers and heavy drinkers. Logistic regression analyses showed that heavy drinkers (>400 g alcohol for men and >280 g for women) were associated with an increased risk of cognitive impairment (OR = 4.99, 95% CI = 1.8-13.82), while light drinkers and moderated drinkers (< 400 g for men and < 280 g for women) were associated with reduced risks (OR = 0.32, 95% CI = 0.12-0.86; OR = 0.17, 95% CI = 0.06-0.51, respectively). Exercise and age were independent protective and risk factors respectively. Conclusion: Heavy alcohol consumption is associated with an increased risk of cognitive impairment while light to moderate alcohol consumption is associated with reduced risk among Southern Chinese older adults in Hong Kong.

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.

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.

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.

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.

Dixon MR; Nastally BL; Waterman A. The effect of gambling activities on happiness levels of nursing home residents. Journal of Applied Behavior Analysis 43(3): 531-535, 2010. (7 refs.)

The current study evaluated the effect of participating in simulated gambling activities on happiness levels of 3 nursing home residents. A 4-component analysis was used to measure objective responses associated with happiness during baseline, varying durations of engagement in simulated gambling activities, and 2 follow-up periods. Results indicated that all residents exhibited a higher percentage of happiness levels while engaged in simulated gambling activities compared with baseline. Follow-up assessment took place 10 min and 30 min following the intervention; no lasting effects were observed.

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.

Duncan DF; Nicholson T; White JB; Bradley DB; Bonaguro J. The baby boomer effect: Changing patterns of substance abuse among adults ages 55 and older. Journal of Aging & Social Policy 22(3): 237-248, 2010. (28 refs.)

Between now and 2030, the number of adults aged 65 and older in the United States will almost double, from around 37 million to more than 70 million, an increase from 12% of the U. S. population to almost 20%. It was long held that, with only a few isolated exceptions, substance abuse simply did not exist among this population. In light of the impact of the baby boom generation, this assumption may no longer be valid. The authors examined admissions of persons 55 years and older (n = 918,955) from the Treatment Episode Data Set (1998-2006). Total admissions with a primary drug problem with alcohol have remained relatively stable over this time. Admissions for problems with a primary drug other than alcohol have shown a steady and substantial increase. Clearly, data from the Treatment Episode Data Set indicate a coming wave of older addicts whose primary problem is not alcohol. The authors suspect that this wave is led primarily by the continuing emergence of the baby boomer generation.

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.

Duru OK; Xu HY; Tseng CH; Mirkin M; Ang A; Tallen L et al. Correlates of alcohol-related discussions between older adults and their physicians. Journal of the American Geriatrics Society 58(12): 2369-2374, 2010. (29 refs.)

OBJECTIVES: To identify predictors of alcohol-related patient-physician discussions. DESIGN Cross-sectional study using baseline data from a randomized controlled trial. SETTING: Community-based group practice. PARTICIPANTS: Thirty-one physicians in Project Senior Health and Alcohol Risk Education and 3,305 of their patients aged 60 and older who use alcohol and completed a survey that included the Comorbidity Alcohol Risk Evaluation Tool (CARET). MEASUREMENTS: At study baseline, older adults were asked whether alcohol-related discussions with a physician had occurred in the prior year. This outcome was modeled using logistic regression models with physician random effects. Predictor variables included patient-level variables such as demographics and seven CARET-defined risk factors, specifically a medical or psychiatric comorbidity that alcohol might worsen, a potentially alcohol-related symptom, use of a medication that may interact negatively with alcohol, excessive quantity or frequency of alcohol use, binge drinking, concern from others about drinking, and drinking and driving. Physician-level predictors (age, sex, years since graduation, specialty) were also included. RESULTS: The probability of reporting alcohol-related discussions declined with patient age (e.g., odds ratio (OR)=0.40 for patients aged >= 80) and was significantly lower for Latinos (OR=0.38). Drinking and driving (OR=1.69) or concern from others (OR=6.04) were significantly associated with alcohol-related discussions; having comorbidities or using medications that may interact with alcohol were not. CONCLUSION: Although patient demographics, including age and ethnicity, are associated with the occurrence of alcohol-related discussions, clinical factors that may negatively interact with alcohol to increase risk are not. This suggests that physicians may not be attuned to the entire spectrum of alcohol-related risks for older adults.

Gardiner C; Ingleton C. Commentary on Green AJ & De-Vries K (2010) Cannabis use in palliative care - an examination of the evidence and the implications for nurses. (editorial). Journal of Clinical Nursing 19(21-22): 3253-3255, 2010. (13 refs.)

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.

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.

Guo S; Winslow M; Manning V; Thane KKW. Monthly take-home methadone maintenance regime for elderly opium-dependent users in Singapore. Annals of the Academy of Medicine (Singapore) 39(6): 429-434, 2010. (28 refs.)

Introduction: Research suggests that methadone maintenance treatment (MMT) effectively reduces opiate dependence and related health and social problems. However, few studies have examined its effectiveness among the elderly. This study examined a monthly MMT regime for elderly opium addicts attending the National Addictions Management Service, Singapore. Materials and Methods: This study used a cross-sectional design and comprised 40 patients attending the addiction service and 40 caregivers who monitored methadone consumption (mostly patients' sons and daughters). Participants completed a semi-structured interview comprising measures of opiate craving and withdrawal, physical and psychological health. Objective measures were urine drug screens and blood tests. Results: Participants who averaged 74.8 years old had been using opium for around 44 years and had been in MMT for an average of 35 months. The maintenance dose of methadone was 9.2 mg/day. At interview, no opiate usage (other than methadone) was detected in urine screens; however, clinical records indicated that 6 had tested positive during the previous 6 months of MMT. No major withdrawal symptoms, side effects, or incidents of diversion were reported. Quality-of-life scores were in the normal range and satisfaction with the treatment regime was expressed by caregivers. Conclusion: Whilst MMT is the predominant pharmacotherapy for opiate dependence for users of all ages elsewhere, our study group constitutes a unique population that differs markedly from younger opiate users who will eventually grow old. In Singapore, MMT appears to be an effective treatment for stable, elderly opium-dependent patients where families are fully engaged in the treatment regime.

Halme JT; Seppa K; Alho H; Poikolainen K; Pirkola S; Aalto M. Alcohol consumption and all-cause mortality among elderly in Finland. Drug and Alcohol Dependence 106(2): 212-218, 2010. (40 refs.)

Aims: To estimate the gender-specific prevalences of alcohol consumption levels and to investigate the association between heavy drinking and all-cause mortality among elderly males. Design: A cohort derived from a nationally representative sample of Finns aged >65 years was followed for six years. Number of subjects was 1569 (72.7% of the original sample, 65.3% females, weighted n = 1357). Measurements: Alcohol consumption was retrospectively measured by beverage-specific quantity and frequency over a 12-month period. Mortality data were obtained from the official Cause-of-Death Register. Cox proportional hazards models were used to analyse the relative risks (RRs) of death. Findings: The prevalence of heavy drinking (>8 standard drinks per week) was 20.3% in males and 1.2% in females. Over one-tenth (11.4%) of males reported drinking :l 5 standard drinks per week. Relative death risks suggested a J-curved relationship between alcohol consumption levels and mortality. However, significant curvilinear relationship was not found, when using alcohol consumption as continuous variable. The multivariate adjusted RR of death among moderate drinkers (1-7 drinks per week) vs. abstinent subjects was 0.41 (95% CI=.23-.72). Males drinking >= 15 standard drinks per week had a two-fold multivariate adjusted risk of death (RR = 2.11, 95% CI = 1.19-3.75) compared with abstinent males. The level of alcohol consumption by females was too low for analysis. Conclusions: Heavy drinking is common among Finnish elderly males but not among females. The present study shows an increased all-cause mortality risk for males drinking, on average, more than two standard drinks per day.

Han DH; Lim SY; Sun BC; Paek D; Kim HD. The association of metabolic syndrome with periodontal disease is confounded by age and smoking in a Korean population: the Shiwha-Banwol Environmental Health Study. Journal of Clinical Peridontology 37(7): 609-616, 2010. (42 refs.)

Aim: Because metabolic syndrome (MS) is pro-inflammatory and periodontitis is inflammatory, we issued the hypothesis that MS (the explanatory variable) is associated with periodontitis (the outcome variable). This study aimed to examine the link between MS and periodontitis among Koreans. Materials and Methods: From the Shiwha-Banwol Environmental Health Study, 1046 subjects aged 18 years or older were cross-sectionally surveyed. All participants underwent comprehensive dental and medical health examinations. The community periodontal index was used to assess periodontitis. Age, gender, monthly family income, smoking, drinking, frequency of daily teeth brushing, and physical activity were evaluated as confounders. Results: MS was strongly associated with periodontitis [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.22-2.37], and MS with more components had a higher association. The association was higher for elders aged 65 years or more, males, and smokers. MS including both high glucose and hypertension had a higher association with the OR of 2.19 (95% CI: 1.23-3.90) comparing with other types of MS. Conclusions: Our results suggested that MS might be associated with periodontitis and the association was confounded by age, gender, and smoking. MS with high glucose and hypertension showed the higher impact on this link.

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.

Holahan CJ; Schutte KK; Brennan PL; Holahan CK; Moos BS; Moos RH. Late-life alcohol consumption and 20-year mortality. Alcoholism: Clinical and Experimental Research 34(11): 1961-1971, 2010. (59 refs.)

Background: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. Methods: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate. Results: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. Conclusions: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.

Hunter B; Lubman DI. Substance misuse: Management in the older population. Australian Family Physician 39(10): 738-741, 2010. (32 refs.)

BackgroundL The proportion of Australians aged over 65 years is increasing. Although screening and treatment for alcohol and drug issues has traditionally focused on those aged less than 65 years, there is growing evidence of alcohol and drug related harm among older people. Objective: This article broadly discusses our current understanding of alcohol and drug problems among people aged over 65 years, as well as recommended approaches to this issue within primary care. Discussion: Current prevalence estimates are likely to underestimate the number of older people with alcohol and drug misuse. Further, only a small number of older people seek specialist treatment for alcohol or drug problems, despite documented harms. Enhanced screening and assessment practices in primary healthcare settings are critical for improving health outcomes for older people with substance use disorders.

Jenkins KR; Zucker RA. The prospective relationship between binge drinking and physician visits among older adults. Journal of Aging and Health 22(8): 1099-1113, 2010. (44 refs.)

Objectives: The objectives are to (a) determine if binge drinking is related to physician visits and (b) estimate the degree to which the relationship between binge drinking and physician visits can be explained by other health characteristics. Method: Data on a sample of 4,960 older adults (70+ years of age in 2002) from the Health and Retirement Study (HRS) were used. Three linear regression models estimated the impact of binge drinking on physician visits. Results: In the fully adjusted models, binge drinking did have an effect on the number of physician visits by older adults, with more frequent binge drinkers having fewer physician visits. This negative relationship exists even when demographic as well as other current health characteristics are controlled. Discussion: The implications of these results are discussed in terms of more broadly communicating the risks associated with binge drinking and more effectively targeting interventions to older binge drinkers.

Jutberger H; Lorentzon M; Barrett-Connor E; Johansson H; Kanis JA; Ljunggren O et al. Smoking predicts incident fractures in elderly men: Mr os sweden. Journal of Bone and Mineral Research 25(5): 1010-1016, 2010. (35 refs.)

The aim of this study was to investigate the association between smoking and bone mineral density (BMD) and radiographically verified prevalent vertebral fractures and incident fractures in elderly men. At baseline 3003 men aged 69 to 80 years of age from the Swedish Mr Os Study completed a standard questionnaire concerning smoking habits and had BMD of the hip and spine measured using dual-energy X-ray absorptiometry (DXA); 1412 men had an X-ray of the thoracic- and lumbar spine. Radiologic registers were used to confirm reported new fractures after the baseline visit. At baseline, 8.4% were current smokers. Current smokers had a 6.2% lower BMD at the total hip and a 5.4% lower BMD at the lumbar spine (p < .001). Current smoking remained independently inversely associated with BMD at the hip and lumbar spine after adjusting for age, height, weight, calcium intake, physical activity, and centers as covariates. Prevalent vertebral fractures among current smokers were increased in unadjusted analyses [odds ratio (OR) = 1.90, 95% confidence interval (Cl) 1.26-2.87] and after adjustment for lumbar BMD (OR = 1.67, 95% Cl 1.09-2.55). Smokers had a high risk for two or more prevalent vertebral fractures (OR = 3.18, 95% Cl 1.88-5.36). During the average follow-up of 3.3 years, 209 men sustained an X-ray-verified fracture. Incident fracture risk among smokers was calculated with Cox proportional hazard models. Current smokers had an increased risk of all new fractures [hazard ratio (HR) = 1.76, 95% Cl 1.19-2.61]; nonvertebral osteoporotic fractures, defined as humerus, radius, pelvis, and hip fractures (HR = 2.14, 95% Cl 1.18-3.88); clinical and X-ray-verified vertebral fractures (HR = 2.53, 95% Cl 1.37-4.65); and hip fractures (HR = 3.16, 95% Cl 1.44-6.95). After adjustment for BMD, including other covariates, no significant association between smoking and incident fractures was found. Current tobacco smoking in elderly men is associated with low BMD, prevalent vertebral fractures, and incident fractures, especially vertebral and hip fractures.

Kalapatapu RK; Paris P; Neugroschl JA. Alcohol use disorders in geriatrics. (review). International Journal of Psychiatry in Medicine 40(3): 321-337, 2010. (68 refs.)

Alcohol use disorders cause significant morbidity and mortality in the geriatric population This review article begins with a hypothetical case for illustration, asking what the primary care physician could do for a geriatric patient with alcohol abuse over a course of four office visits. Various aspects of alcohol use disorders in the geriatric population are reviewed such as range of alcohol use, epidemiology medical/psychiatric impact, detection, comprehensive treatment planning, modalities of psychotherapy, medication management, and resources for clinicians/patients.

Kalapatapu RK; Sullivan MA. Prescription use disorders in older adults. (review). American Journal on Addictions 19(6): 515-522, 2010. (105 refs.)

The number of older adults needing substance abuse treatment is projected to rise significantly in the next few decades. This paper will focus on the epidemic of prescription use disorders in older adults. Particular vulnerabilities of older adults to addiction will be considered. Specifically, the prevalence and patterns of use of opioids, stimulants, and benzodiazepines will be explored, including the effects of these substances on morbidity and mortality. Treatment intervention strategies will be briefly discussed, and areas for future research are suggested.

Kann IC; Biorn E; Luras H. Competition in general practice: Prescriptions to the elderly in a list patient system. Journal of Health Economics 29(5): 751-764, 2010. (43 refs.)

Income motivation among general practitioners (GPs) is frequently discussed in the health economics literature. The question addressed in the present study on reimbursement drugs and addictive drugs is whether increased competition among GPs, which is part of a declared health policy to improve efficiency, contributes to more prescriptions for the elderly. The dataset comprises registered data of all prescribed drugs dispensed at pharmacies from the Norwegian Prescription Database merged with data on GPs. In choosing a method, particular attention is given to the fact that patients tend to be attracted to GPs who fit their preferences. Hence, we treat the composition of the patient list as endogenous. The results indicate that the stronger competition a GP faces, the more drugs are prescribed, which implies that GPs' prescription style may conflict with their role as gatekeepers, and even worse, it may be a hazard to patients' health.

Landreat MG; Vigneau CV; Hardouin JB; Bronnec MG; Marais M; Venisse JL et al. Can we say that seniors are addicted to benzodiazepines? Substance Use & Misuse 45(12): 1988-1999, 2010. (14 refs.)

Introduction: The elderly are the biggest consumers of Benzodiazepines (BZD) and/or BZD equivalents. However, the risks of developing addiction in this age group are often underestimated. Method: This study describes the nature and extent of addiction in the elderly using DSM IV items. Results: We noted a high prevalence of addiction in our population and identified a two-factor profile in subjects of 65 years of age and older addicted to BZD/equivalents. Conclusion: This profile led us to reconsider anew the definition of addiction, the approach to addiction in this age group, and the way to prescribe treatment by BZD/equivalents in this population.

Lee Y; Back JH; Kim J; Kim SH; Na DL; Cheong HK et al. Systematic review of health behavioral risks and cognitive health in older adults. (review). International Psychogeriatrics 22(2): 174-187, 2010. (57 refs.)

Background: An increasing body of evidence suggests that health behaviors may protect against cognitive impairment and dementia. The purpose of this study was to summarize the current evidence on health behavioral factors predicting cognitive health through a systematic review of the published literature. Methods: PubMedicine, Embase, and PsycINFO databases were searched for studies on community representative samples aged 65 and older, with prospective cohort design and multivariate analysis. The outcome - cognitive health - was defined as a continuum of cognitive function ranging from cognitive decline to impairment and dementia, and health behaviors included physical activity, smoking, alcohol drinking, body mass index, and diet and nutrition. Results: Of 12,105 abstracts identified, 690 relevant full-texts were reviewed. The final yield amounted to 115 articles of which 37 studies were chosen that met the highest standards of quality. Leisure time physical activity, even of moderate level, showed protective effects against dementia, whereas smoking elevated the risk of Alzheimer's disease. Moderate alcohol consumption tended to be protective against cognitive decline and dementia, but nondrinkers and frequent drinkers exhibited a higher risk for dementia and cognitive impairment. Midlife obesity had an adverse effect on cognitive function in later life. Analysis showed vegetable and fish consumption to be of benefit, whereas, persons consuming a diet high in saturated fat had an increased dementia risk. Conclusion: The review demonstrates accumulating evidence supporting health behavioral effects in reducing the risk of cognitive decline and dementia. Results indicate potential benefits of healthy lifestyles in protecting cognitive health in later life.

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; Barry KL; Blow FC; Davis JW; Tang LQ et al. Determinants of early reductions in drinking in older at-risk drinkers participating in the intervention arm of a trial to reduce at-risk drinking in primary care. Journal of the American Geriatrics Society 58(2): 227-233, 2010. (31 refs.)

OBJECTIVES: To describe differences between older at-risk drinkers, as determined using the Comorbidity Alcohol Risk Evaluation Tool, who reduced drinking and those who did not after an initial intervention and to determine factors associated with early reductions in drinking. DESIGN: Secondary analyses of data from a randomized controlled trial. SETTING: Seven primary care sites. PARTICIPANTS: Subjects randomized to the intervention group who completed the first health educator call approximately 2 weeks after enrollment (n = 239). INTERVENTION: Personalized risk reports, booklets on alcohol-associated risks, and advice from physicians, followed by a health educator call. MEASURMENTS: Reductions in number of alcoholic drinks. RESULTS: Thirty-nine percent of the sample had reduced drinking within 2 weeks of receiving the initial intervention. According to the final multiple logistic regression model, those who were concerned about alcohol-related risks (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.01-4.07), read through the educational booklet (OR = 2.97, 95% CI = 1.48-5.95), or perceived that their physicians discussed risks and advised changing drinking behaviors (OR = 4.1, 95% CI = 2.02-8.32) had greater odds of reducing drinking by the first health educator call. CONCLUSION: Concern about risks, reading educational material, and perception of physicians providing advice to reduce drinking were associated with early reductions in alcohol use in older at-risk drinkers. Understanding these factors will enable development of better intervention strategies to reduce unhealthy alcohol use.

Marinho V; Laks J; Coutinho ESF; Blay SL. Tobacco use among the elderly: A systematic review and meta-analysis. (review). Cadernos De Saude Publica 26(12): 2213-2233, 2010. (67 refs.)

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

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.

McCaul KA; Almeida OP; Hankey GJ; Jamrozik K; Byles JE; Flicker L. Alcohol use and mortality in older men and women. Addiction 105(8): 1391-1400, 2010. (38 refs.)

Aims: To compare the effect of alcohol intake on 10-year mortality for men and women over the age of 65 years. Design, setting and participants: Two prospective cohorts of community-dwelling men aged 65-79 years at baseline in 1996 (n = 11 727) and women aged 70-75 years in 1996 (n = 12 432). Measurements: Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all-cause and cause-specific mortality. Findings: Compared with older adults who did not consume alcohol every week, the risk of all-cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol-free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease. Conclusions: In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol-free days per week.

McCreaddie M; Lyons I; Watt D; Ewing E; Croft J; Smith M et al. Routines and rituals: A grounded theory of the pain management of drug users in acute care settings. Journal of Clinical Nursing 19(19-20): 2730-2740, 2010. (67 refs.)

Aim. This study reviewed the perceptions and strategies of drug users and nurses with regard to pain management in acute care settings. Background. Drug users present unique challenges in acute care settings with pain management noted to be at best suboptimal, at worst non-existent. Little is known about why and specifically how therapeutic effectiveness is compromised. Design. Qualitative: constructivist grounded theory Method. A constructivist grounded theory approach incorporating a constant comparative method of data collection and analysis was applied. The data corpus comprised interviews with drug users (n = 11) and five focus groups (n = 22) of nurses and recovering drug users. Results. Moral relativism as the core category both represents the phenomenon and explains the basic social process. Nurses and drug users struggle with moral relativism when addressing the issue of pain management in the acute care setting. Drug users lay claim to expectations of compassionate care and moralise via narration. Paradoxically, nurses report that the caring ideal and mutuality of caring are diminished. Drug users' individual sensitivities, anxieties and felt stigma in conjunction with opioid-induced hyperalgesia complicate the processes. Nurses' and hospitals' organisational routines challenge drug user rituals and vice versa leading both protagonists to become disaffected. Consequently, key clinical issues such as preventing withdrawal and managing pain are left unaddressed and therapeutic effectiveness is compromised. Conclusion. This study provides a robust account of nurses' and drug users' struggle with pain management in the acute care setting. Quick technological fixes such as urine screens, checklists or the transient effects of (cognitive-based) education (or training) are not the answer. This study highlights the need for nurses to engage meaningfully with this perceptibly 'difficult' group of patients. Relevance to clinical practice. The key aspects likely to contribute to problematic interactions with this patient cohort are outlined so that they can be prevented and, or addressed.

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.

Moos RH; Brennan PL; Schutte KK; Moos BS. Older adults' health and late-life drinking patterns: A 20-year perspective. Aging & Mental Health 14(1): 33-43, 2010. (62 refs.)

Objectives: This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. Methods: A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later. Results: Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems. Conclusion: Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Moos RH; Brennan PL; Schutte KK; Moos BS. Social and financial resources and high-risk alcohol consumption among older adults. Alcoholism: Clinical and Experimental Research 34(4): 646-654, 2010. (63 refs.)

Background: This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life. Method: A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption. Results: Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members. Conclusions: These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

Moos RH; Brennan PL; Schutte KK; Moos BS. Spouses of older adults with late-life drinking problems: Health, family, and social functioning. Journal of Studies on Alcohol and Drugs 71(4): 506-514, 2010. (57 refs.)

Objective: This study focuses on the health, family, and social functioning of spouses of late-life remitted and continuing problem drinkers, and on predictors of spouses' alcohol-related functioning and depressive symptoms. Method: Three groups of spouses were compared at baseline and a 10-year follow-up: (a) spouses (n = 73) of older adults who had no drinking problems at baseline or followup, (b) spouses (n = 25) of older adults who had drinking problems at baseline but not follow-up, and (c) spouses (n = 69) of older adults who had drinking problems at both baseline and follow-up. At each contact point, spouses completed an inventory that assessed their alcohol-related, health, family, and social functioning. Results: At baseline, compared with spouses of problem-free individuals, spouses of older adults whose drinking problems later remitted reported more alcohol consumption, poorer health, more depressive symptoms, and less involvement in domestic tasks and social and religious activities. At the 10-year follow-up, spouses of remitted problem drinkers were comparable to spouses of problem-free individuals, but spouses of continuing problem drinkers consumed more alcohol, incurred more alcohol-related consequences, and had friends who approved more of drinking. Overall, spouses whose friends approved more of drinking and whose partners consumed more alcohol and had drinking problems were likely to consume more alcohol and to have drinking problems themselves. Conclusions: Spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.

Moos RH; Schutte KK; Brennan PL; Moos BS. Late-life and life history predictors of older adults' high-risk alcohol consumption and drinking problems. Drug and Alcohol Dependence 108(1-2): 13-20, 2010. (64 refs.)

Aims: This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85. Design, setting, participants: A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later. Measurements: At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking. Results: Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems. Conclusion: Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking. Published by Elsevier Ireland Ltd.

Mosier KE; Vasiliadis HM; Lepnurm M; Puchala C; Pekrul C; Tempier R. Prevalence of mental disorders and service utilization in seniors: Results from the Canadian community health survey cycle 1.2. International Journal of Geriatric Psychiatry 25(10): 960-967, 2010. (32 refs.)

Objective: This paper examined the 12-month rate of mental disorders and subsequent service use among Canadian seniors aged 65-79 and 80 and over and adults aged 20-49 and 50-64. Methods: This is a secondary analysis of data [n = 33 695] of the population-based Canadian Community Health survey, Cycle 1.2 (CO-IS 1.2). Major Depressive Episodes (MDEs), specific Anxiety Disorders (AD) and Alcohol Abuse/Dependence rates were assessed. Results: The 12-month rates for the two senior groups aged 65-79 and 80+ for MDEs, ADs, and Substance Dependence (SD) are 1.7% and 1.6%; 1.4% and 0.8%; and 0.1% and 0.0%, respectively. Seniors aged 65-79 and 80+ had significantly lower rates than adults aged 20-49 and 50-64 for all mental disorders and SD. Among the total sample, seniors aged 65-79 and 80+ had significantly lower utilization rates than adults aged 20-49 and 50-64 for all three provider categories (GP only, GP and Other Health Professional, Any Other Health Professional but GP). Females aged 65-79 and 80+ were less likely to have reported service use for mental health reasons as opposed to those females aged 20-49 and 50-64. Males aged 65-79 and 80+ were more likely to have reported having used mental health services in the past 12 months as opposed to males aged 20-49 and 50-64. Conclusions: The presence of common mental disorders is lower in seniors as compared to younger adults. Age and gender influence mental health service utilization rates.

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.

Naimi T. Commentary on McCaul et al. (2010): Observational studies about average alcohol consumption and health - closing time for a limited evidence base. (commentary). Addiction 105(8): 1401-1402, 2010. (19 refs.)

Nanjayya SB; Murthy P; Chand PK; Kandaswamy A; Nikketha B; Benegal V et al. A case of poppy tea dependence in an octogenarian lady. Drug and Alcohol Review 29(2): 216-218, 2010. (6 refs.)

While poppy seed and poppy tea dependence has been described, it is unusual to see such patients actively seek treatment in India. We report the case of an 82-year-old client with dependent use of poppy for 55 years. She was brought for treatment as access to poppy became difficult following legal restrictions. She was successfully maintained on buprenorphine maintainence.

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.)

Ohar JA; Sadeghnejad A; Meyers DA; Donohue JF; Bleecker ER. Do symptoms predict COPD in smokers? Chest 137(6): 1345-1353, 2010. (63 refs.)

Background: The US Preventive Services Task Force recommends against spirometry in the absence of symptoms. However, as much as 50% of COPD cases in the United States remain undiagnosed. Methods: Report of symptoms, smoking history, and spirometric data were collected from subjects screened for a work-related medical evaluation (N = 3,955). Prevalence of airflow obstruction and respiratory symptoms were assessed. Sensitivity, specificity, positive and negative predictive values, and relative risks of predicting symptoms and smoking history for COPD were calculated. Results: Forty-four percent of smokers in our sample had airways obstruction (AO). Of these, 36% reported a diagnosis of or treatment for COPD. Odds ratio (95% CI) for AO with smoking (>= 20 pack-years) was 3.73 (3.12- 4.45), 1.98 (1.73-2.27) for cough, 1.79 (1.55-2.08) for dyspnea, 1.95 (1.70-2.34) for sputum, and 2.59 (2.26-2.97) for wheeze. Respiratory symptoms were reported by 92% of smokers with AO, 86% smokers with restriction, 76% smokers with normal spirometry, and 73% of nonsmokers. Sensitivity (92% vs 90%), specificity (19% vs 22%), positive (47% vs 40%) and negative (75% vs 80%) predictive values for the presence of one or more symptoms were similar between smokers and all subjects. Conclusions: COPD is underdiagnosed in the United States. Symptoms are frequent in subjects with AO and increase their risk for COPD, but add little beyond age and smoking history to the predictive value of spirometry. In view of the high prevalence of symptoms and their poor predictive value, a simpler and more effective approach would be to screen older smokers.

Park J; Lavin R. Risk factors associated with opioid medication misuse in community-dwelling older adults with chronic pain. Clinical Journal of Pain 26(8): 647-655, 2010. (72 refs.)

Objectives: The aim of the study was to identify physical, psychological, and social risk factors associated with opioid medication misuse among community-dwelling older adults with chronic pain. Methods: Using a cross-sectional research design, a confidential survey was administered at 11 outpatient clinics affiliated with the Baltimore Veterans Affairs Medical Center and the University of Maryland Medical System. A sample of 163 older adults (response rate 80.7%) with chronic pain and receiving opioid medications provided demographic information and responded to survey items. Severity of pain, alcohol problems, physical disability, depressive symptoms, spirituality, social support, and social network were assessed. Descriptive statistics and exploratory regression analyses were employed to determine factors independently associated with misuse. Results: Higher levels of pain severity and depressive symptoms, and lower physical disability scores were significantly associated with increased risk of opioid medication misuse. Alcohol problems, spirituality, social support, and social network were not associated with opioid medication misuse. Discussion: High pain intensity scores may indicate undertreatment of pain or may represent a rationalization to justify opioid medication use. Higher levels of depressive symptoms have been noted in the chronic pain population and may contribute to misuse of opioid medications for psychic effects. Less physically disabled persons are more likely to misuse opioid medications or older person receiving multiple medications may wish to avoid potential adverse drug effects. While there was an association between lower levels of disability and higher risk for opioid medication misuse, a causal relationship could not be determined.

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.

Perissinotto E; Buja A; Maggi S; Enzi G; Manzato E; Scafato E et al. Alcohol consumption and cardiovascular risk factors in older lifelong wine drinkers: The Italian Longitudinal Study on Aging. Nutrition, Metabolism, and Cardiovascular Diseases 20(9): 647-655, 2010. (38 refs.)

Background and aims: A protective effect of moderate alcohol consumption on the cardiovascular system has consistently been reported, but limited evidence has been produced on the association of alcohol with metabolic factors in the elderly. The aim of this study was to investigate the association between different levels of current alcohol consumption and cardiovascular risk factors in a representative sample of elderly Italian men, mainly wine drinkers. Methods: and results: This is a cross-sectional multi-centre study on a population-based sample of Italian men aged 65-84 years, drawn from the Italian Longitudinal Study on Aging (ILSA) cohort. The analyses included 1896 men. Almost all the drinkers (98%) drank wine as a lifelong habit. Adjusted ORs for risk levels for cardiovascular factors (BMI, waist circumference, fibrinogen, alpha 2 protein, white blood cells, HDL cholesterol, Apo A-I, total cholesterol, Apo B-I, triglycerides, LDL, glycated hemoglobin, insulin, fasting plasma glucose, HOMA IR, systolic and diastolic blood pressure) were estimated, comparing drinkers with teetotalers using multivariate logistic regression models. We found alcohol consumption in older age associated with healthier hematological values of fibrinogen, HDL cholesterol, Apo A-I lipoprotein and insulin, but it was also associated with a worse hematological picture of total, LDL cholesterol levels, and systolic pressure. Conclusion: Our results indicated in elderly moderate wine drinkers a noticeably safe metabolic, inflammatory and glycemic profile that might balance higher blood pressure, leading to a net benefit. These findings however need to be placed in relation to the known adverse social and health effects of heavy drinking.

Platt A; Sloan FA; Costanzo P. Alcohol-consumption trajectories and associated characteristics among adults older than age 50. Journal of Studies on Alcohol and Drugs 71(2): 169-179, 2010. (53 refs.)

Objective: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period. Method: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category. Results: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09. 95% Cl [1.05, 1.12]), highly educated (RRR = 1.20, 95% Cl [1.09, 1.31]). male, White (RRR = 3.54, 95% Cl [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems. Conclusions: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

Pope RC; Wallhagen M; Davis H. The social determinants of substance abuse in African American baby boomers: Effects of family, media images, and environment. Journal of Transcultural Nursing 21(3): 246-256, 2010. (68 refs.)

Grounded theory methodology was used to explore the social processes involved in the use of illicit drugs in older African Americans as an underpinning to the development of approaches to nursing care and treatment. Interviews were conducted with six older African American substance users who were currently in drug treatment programs. Responses to the questions were recorded, transcribed, and analyzed using constant comparative methods. Three core themes emerged: (a) family, (b) media images, and (c) environment. The core issues of substance abuse, such as the environment and larger societal forces, cannot be addressed by one discipline and mandate that clinicians move to an interdisciplinary approach to achieve a plan of care for this growing population.

Potempa KM; Butterworth SW; Flaherty-Robb MK; Gaynor WL. The Healthy Ageing Model: Health behaviour change for older adults. Collegian 17(2, special issue): 51-55, 2010. (26 refs.)

Proposed is a model of primary care for older adults with chronic health conditions that focuses on active engagement in health care. The Healthy Ageing Model is anchored in established theory on motivation and health behaviour change. The model draws on empirical and applied clinical underpinnings in such diverse areas as health promotion and education, treatment of addictions or obesity, management of chronic diseases, goal-setting, and coaching techniques. The conceptual foundation for the Healthy Ageing Model is described first, followed by a brief description of the key characteristics of the model. In conclusion, suggestions are offered for the clinical application and for further developing the model.

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.

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.

Roe B; Beynon C; Pickering L; Duffy P. Experiences of drug use and ageing: Health, quality of life, relationship and service implications. Journal of Advanced Nursing 66(9): 1968-1979, 2010. (47 refs.)

Aim. This paper is a report of an exploration of older people's experiences of substance use in the context of ageing, and its impact on health, quality of life, relationships and service use. Background. Use of illicit drugs by older people is a neglected policy, research and service provision and is generally perceived as a lifestyle of younger populations. Method. A convenience sample of 11 people aged 49-61 years (mean 57 years) in contact with voluntary sector drug treatment services participated in qualitative semi-structured tape-recorded interviews and thematic content analysis was performed. The data were collected in 2008. Findings. Drug use can have negative impacts on health status, quality of life, family relationships and social networks that accrue with age. Participants were identified as early or later onset users of drugs due to the impact of life events and relationships. A range of substances had been used currently and throughout their lives, with no single gateway drug identified as a prelude to personal drug careers. Life review and reflection were common, in keeping with ageing populations, along with regret of ever having started to use drugs. Living alone and their accommodation made them more susceptible to social isolation, and they reported experiences of death and dying of their contemporaries and family members earlier than usual in the life course. Conclusion. Older people who continue to use drugs and require the support of services for treatment and care are an important emerging population and their specific needs should recognized.

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.

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.

Schonfeld L; King-Kallimanis BL; Duchene DM; Etheridge RL; Herrera JR; Barry KL et al. Screening and brief intervention for substance misuse among older adults: The Florida BRITE Project. American Journal of Public Health 100(1): 108-114, 2010. (25 refs.)

Objectives. We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers. Methods. Agencies in 4 counties conducted screenings among 3497 older adults for alcohol, medications, and illicit substance misuse problems and for depression and suicide risk. Screening occurred in elders' homes, senior centers, or other selected sites. Individuals who screened positive for substance misuse were offered brief intervention with evidence-based practices and rescreened at discharge from the intervention program and at follow-up interviews. Results. Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Depression was prevalent among those with alcohol and prescription medication problems. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures. Conclusions. The BRITE program effectively shaped state policy by responding to legislative mandates to address the needs of an increasing, but underserved, elder population. The pilot paved the way for obtaining a federally funded grant to expand BRITE to 27 sites in 17 counties in Florida.

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.

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.

Smith AJ; Tett SE. Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years. BMC Health Services Research 10: e-article 321, 2010. (69 refs.)

Background: Benzodiazepines are often used on a long term basis in the elderly to treat various psychological disorders including sleep disorders, some neurological disorders and anxiety. This is despite the risk of dependence, cognitive impairment, and falls and fractures. Guidelines, campaigns and prescribing restrictions have been used to raise awareness of potentially inappropriate use, however long term use of benzodiazepine and related compounds is currently increasing in Australia and worldwide. The objective of this paper is to explore interventions aimed at improving the prescribing and use of benzodiazepines in the last 20 years. Methods: Medline, EMBASE, PsychINFO, IPA were searched for the period 1987 to June 2007. Results: Thirty-two articles met the study eligibility criteria (interventions solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines) and were appraised. Insufficient data were presented in these studies for systematic data aggregation and synthesis, hence critical appraisal was used to tabulate the studies and draw empirical conclusions. Three major intervention approaches were identified; education, audit and feedback, and alerts. Conclusions: Studies which used a multi-faceted approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. The choice of outcome measures, delivery style of educational messages, and requests by GPs to stop benzodiazepines, either in a letter or face to face, showed no differences on the success rates of the intervention.

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.

Varcoe C; Bottorff JL; Carey J; Sullivan D; Williams W. Wisdom and influence of elders: possibilities for health promotion and decreasing tobacco exposure in First Nations communities. Canadian Journal of Public Health 101(2): 154-158, 2010. (30 refs.)

Objectives: This community-based project examined the interpersonal and system influences on smoking practices and exposure to cigarette smoke that place young pregnant and parenting First Nations women and their children at risk. The aim was to work with the community using this information to develop meaningful strategies to support tobacco reduction and reduce exposure to second-hand smoke. Method: Ethnographic methods informed by decolonizing approaches were used to study smoking practices and exposure within the context of six First Nations rural reserve villages in the Gitxsan territory in North-Western British Columbia. Data were collected through individual interviews with key community members, individual and group interviews with women, men, youth and older people, including Elders, and participant observation. Findings: Older people, including grandparents and Elders expressed great interest in being more involved in their communities, particularly with youth. Other community members, especially mothers, saw such older people as important in diminishing the tobacco exposure problem, with ideas for their involvement ranging from role modeling non-smoking or respectful smoking to teaching cultural traditions. Conclusion: Elders in First Nations communities represent a culturally-relevant resource for health that is currently underused. Communities might draw upon their wisdom and influence to decrease tobacco exposure and promote community health in other ways. This offers a concrete, practical strategy in response to widespread calls for supporting the culture of Aboriginal people as part of health promotion.

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.

Voyer P; Roussel ME; Berbiche D; Preville M. Effectively detect dependence on benzodiazepines among community-dwelling seniors by asking only two questions. Journal of Psychiatric and Mental Health Nursing 17(4): 328-334, 2010. (41 refs.)

Consumption of benzodiazepines (BZDs) is common among seniors. When used over a long period of time, BZDs can induce dependence. The present study aimed to equip nurses with valid screening questions for detecting BZD dependence among seniors, applicable to clinical practice and based on the DSM-IV-TR version. A random sample of 707 BZD users aged 65 years and over was screened for BZD dependence using the DSM-IV-TR criteria for substance dependence. To predict a diagnosis of BZDs dependence, sensitivity and specificity were computed for each pair of items. Results showed that an affirmative answer to 'Have you tried to stop taking this medication?' and 'Over the past 12 months, have you noticed any decrease in the effect of this medication?' led to a sensitivity of 97.1% and a specificity of 94.9% to detect BZD dependence. Asking these two simple questions can be easily integrated into clinical practice and have considerable potential for identifying cases of BZD dependence.

Wang CC; Lu TH; Liao WC; Yuan SC; Kuo PC; Chuang HL et al. Cigarette smoking and cognitive impairment: A 10-year cohort study in Taiwan. Archives of Gerontology and Geriatrics 51(2): 143-148, 2010. (43 refs.)

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ >= 6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio = OR = 0.31; 95% CI = 0.18-0.53; p < 0.001) and those who continued to smoke (OR = 0.37; 95% CI = 0.20-0.70; p < 0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.

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.

Woo BKP; Chen WL. Substance misuse among older patients in psychiatric emergency service. General Hospital Psychiatry 32(1): 99-101, 2010. (13 refs.)

Objective: To determine the prevalence of substance misuse among older patients presented to a psychiatric emergency service (PES) on involuntary bases. Method: At the time of initial presentation to the PES, all patients received a comprehensive assessment that included a urine toxicology screening. The screening consisted of six substances: barbiturate, benzodiazepine, cocaine, opiate, phencyclidine and amphetamine. Charts of elderly patients (aged 65 and above) with positive urine toxicology were reviewed to ensure that the results were not due to (I) home medications and (2) medications given in the PES. Results: During the 2-year study period (2006-2007), there were 5914 patients under the age of 65 and 104 patients aged 65 and above. Our findings indicated that 471 (8.0%) and 14 (13.4%) urine toxicology screens were not collected during the PES visits in younger and older patients, respectively (P=.04). The positive urine toxicology rate was 31.5% (1716/5443) and 26.7% (24/90) for younger and older patients, respectively (P=.33). Conclusions: Substance misuse in the older population presenting with psychiatric emergency is prevalent in the PES. Urine toxicology screens, as well as patient or collateral report of substance usages, should be obtained from this group of patients to ensure quality of care delivered at the PES.

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.