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...on the Elderly
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www.ProjectCork.org
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Summer 2012
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Drinking, smoking, and psychological distress in middle and late life.
Choi NG; DiNitto DM. Aging & Mental Health 15(6): 720-731, 2011. (75 refs.)
A limited number of studies have examined the co-occurrence of alcohol use and smoking and their mental health effects in middle and late life. In this study, using the 2008 National Survey of Drug Use and Health, the characteristics of individuals aged 50 and older who abstained from both substances, who used both substances, and who used one or the other substance were examined. Then, the main and interaction effects of drinking and smoking on psychological distress were analyzed. Findings show that smoker-nondrinkers are the most disadvantaged group in terms of sociodemographic and health characteristics, while drinker-nonsmokers are the most advantaged group. When sociodemographic, health, and other factors were controlled, no direct effects of drinking or interaction effect of drinking and smoking were detected for either gender. However, heavy smoking (6+ cigarettes on a typical smoking day) was significantly associated with an elevated level of psychological distress among women. The findings highlight the vulnerability of heavy smoking middle-aged and older women. These women are the most psychologically distressed and may need interventions designed to help them quit smoking, reduce or quit drinking, and alleviate psychological distress. Copyright 2011, Taylor & Francis.
Racial/ethnic differences in prevalence and correlates of binge drinking among older adults.
Bryant AN; Kim G. Aging & Mental Health 16(2): 208-217, 2012. (22 refs.)
Objectives: This study examines how the prevalence and correlates of binge drinking among older adults vary by race/ethnicity. Methods: Drawn from the 2007 California Health Interview Survey, adults aged 60 and older (n = 18, 772) were selected. Binge drinking was measured dichotomously based on whether individuals reported consuming five or more drinks in a single day (four or more for females) in the previous year. Prevalence rates for binge drinking in the past year were calculated by race/ethnicity. A hierarchical logistic regression analysis was conducted using binge drinking in the past year as the dependent variable. Results: Significant racial/ethnic differences were found in prevalence rates: the presence of binge drinking was most common among non-Hispanic Whites (11.9%), followed by Latinos (10.8%), American Indian/Alaska Natives (9.8%), Blacks (8.0%), and Asians (4.2%). Being a current smoker was found to be the strongest predictor of binge drinking and significant main effects were also found for being Black, being Asian, younger age, being male, being unemployed, having a higher poverty threshold, having better self-rated health, and having more psychological distress. Significant interactions between race/ethnicity and age, sex, employment status, educational attainment, smoking status, and self-rated health were found. These findings indicate that certain correlates of binge drinking vary significantly by race/ethnicity among older adults. Conclusions: Apparent racial/ethnic differences existed in the prevalence and correlates of binge drinking among older adults. Identification of more racial/ethnic specific predictors may be important for the development of racial/ethnic appropriate intervention programs. Copyright 2012, Taylor & Francis.
Substance abuse associated with elder abuse in the United States.
Jogerst GJ; Daly JM; Galloway LJ; Zheng SM; Xu YH. American Journal of Drug and Alcohol Abuse 38(1): 63-69, 2012. (30 refs.)
Background: Substance abuse by either victim or perpetrator has long been associated with violence and abuse. Sparse research is available regarding elder abuse and its association with substance abuse. Objective: The objective of this study was to evaluate the association of state-reported domestic elder abuse with regional levels of substance abuse. Methods: Census demographic and elder abuse data were sorted into substate regions to align with the substance use treatment-planning regions for 2269 US counties. From the 2269 US counties there were 229 substate regions in which there were 213,444 investigations of abuse. For the other Ns (reports and substantiations) there were fewer counties and regions. See first sentence of data analyses and first sentence of results. Results: Elder abuse report rates ranged from .03 to .41% (80 regions), investigation rates .001 to .34% (229 regions), and substantiation rates 0 to .22% (184 regions). Elder abuse investigations and substantiations were associated with various forms of substance abuse. Higher investigation rates were significantly associated with a higher rate of any illicit drug use in the past month, a lower median household income, lower proportion of the population graduated high school, and higher population of Hispanics. Higher substantiation rates were significantly associated with higher rate of illicit drug use in the past month and higher population of Hispanics. Conclusion: It may be worthwhile for administrators of violence programs to pay particular attention to substance abuse among their clients and in their community's environment, especially if older persons are involved. Scientific Significance: Measures of documented elder abuse at the county level are minimal. To be able to associate substance abuse with elder abuse is a significant finding, realizing that the substance abuse can be by the victim or the perpetrator of elder abuse. Copyright 2012, Informa HealthCare.
Restorying older adults' narratives about self and substance abuse.
Morgan ML; Brosi WA; Brosi MW. American Journal of Family Therapy 39(5): 444-455, 2011. (31 refs.)
Substance abuse affects millions of adults each year, of whom one in five are older adults. Given pervasive stereotypes about later life and the ways in which older persons internalize such messages, dealing with and using previous work on substance abuse, the social breakdown syndrome, and narrative therapy, we describe the importance of and ways for marriage and family therapists to work with older persons facing the compounding experiences of ageism and substance abuse. The purpose of this study was to: 1) identify the prevalence of substance abuse among those 65 and older; 2) document and emphasize the unique challenges of addressing this issue among those 65 and older; and 3) provide an application of the narrative approach to working with older persons presenting with substance abuse. Copyright 2011, Taylor & Francis.
Suicidal behavior in a national sample of older homeless veterans.
Schinka JA; Schinka KC; Casey RJ; Kasprow W; Bossarte RM. American Journal of Public Health 102(Supplement 1): S147-S153, 2012. (24 refs.)
Objectives. We examined self-reported suicidal behavior of older homeless veterans to establish frequencies and predictors of recent suicidal behaviors, and their impact on transitional housing interventions. Methods. We analyzed the records of a national sample of 10 111 veterans who participated in a transition housing program over a 6-year period, ending in 2008. Results. Approximately 12% of homeless veterans reported suicidal ideation before program admission; 3% reported a suicide attempt in the 30 days before program admission. Older homeless veterans exhibiting suicidal behavior had histories of high rates of psychiatric disorders and substance abuse. Regression analyses showed that self-report of depression was the primary correlate of suicidal behavior. Suicidal behavior before program entry did not predict intervention outcomes, such as program completion, housing outcome, and employment. Conclusions. Suicidal behavior was prevalent in older homeless veterans and was associated with a history of psychiatric disorder and substance abuse. Self-reported depression was associated with these behaviors at the time of housing intervention. Despite the association with poor mental health history, suicidal behavior in older homeless veterans did not impact outcomes of transitional housing interventions. Copyright 2012, American Public Health Association.
Institutionalization as a risk factor for inappropriate drug use in the elderly: A Swedish nationwide register-based study.
Haasum Y; Fastbom J; Johnell K. Annals of Pharmacotherapy 46(3): 339-346, 2012. (46 refs.)
Background: Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register. Objective: To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden. Methods: We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs). Results: Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% Cl 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% Cl 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% Cl 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% Cl 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% Cl 0.55 to 0.65). Conclusions: Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Reseaarch is needed to identify underlying risk factors for PIDU within these settings. Copyright 2012, Harvey Whitney Books.
Associations between perception of wellness and health-related quality of life, comorbidities, modifiable lifestyle factors and demographics in older Australians.
Foottit J; Anderson D. Australasian Journal on Ageing 31(1): 22-27, 2012. (20 refs.)
Aim: The associations between perceived wellness and health-related quality of life, comorbidities and modifiable lifestyle factors in older adults were explored. Methods: Self-administered questionnaires including the Perceived Wellness Survey and the 36-Item Short Form of the Medical Outcomes Study version two were distributed to 328 community-living adults aged 65 years and over. Results: Results showed positive associations between perception of wellness and health-related quality of life. General health (r(249) = 0.66, P < 0.01), vitality (r(249) = 0.59, P < 0.01) and mental health (r(249) = 0.52, P < 0.01) had the strongest association with perceived wellness; and social functioning (r(249) = 0.3, P < 0.01) and pain (r(249) = 0.36, P < 0.01) the lowest. Perceived wellness was influenced by hearing, mobility, memory, chronic disease, exercise, gambling and single status. Conclusion: The study identified that perceived wellness in older adults is a multidimensional construct. Copyright 2012, Wiley-Blackwell.
Impact of alcohol use on mortality in the elderly: Results from the Korean Longitudinal Study on Health and Aging.
Jeong HG; Kim TH; Lee JJ; Lee SB; Park JH; Huh Y et al. Drug and Alcohol Dependence 121(1-2): 133-139, 2012. (62 refs.)
Background: To examine the effects of problematic drinking, amount of alcohol use and binge drinking on all-cause mortality in the elderly. Methods: We investigated 45-month all-cause mortality of 997 randomly sampled community-dwelling elderly Koreans aged 65 years or older who participated in the Korean Longitudinal Study on Health and Aging. Problematic drinking was defined as having alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria or having 8 or higher of the Alcohol Use Disorders Identification Test. Light drinking was defined as drinking 7 alcoholic drinks or less, and heavy drinking as having 14 alcoholic drinks more per week during past 12 months. Binge drinking was defined as having 6 or more drinks on a single occasion at least monthly. Results: One hundred and thirteen participants (11.3%) died during the 45-month follow-up period. Heavy drinking (>14 alcoholic drinks per week) increased the all-cause mortality risk when in association with problematic drinking (hazard ratio [HR] = 2.604,95% confidence interval [CI] = 1.221-5.553, p = 0.012) or binge drinking (HR = 2.823,95% Cl = 1.259-6.328,p = 0.013). Light drinking (<= 7 alcoholic drinks per week) was associated with decreased all-cause mortality (HR = 0.114, 95% Cl = 0.015-0.833, p = 0.032). Conclusions: Problematic drinking is associated with increased all-cause mortality in elderly Koreas, particularly when it is heavy and/or combined with binge drinking. Copyright 2012, Elsevier Science.
Alcohol diagnoses among older Tennessee Medicare beneficiaries: Race and gender differences.
Kilbourne BJ; Cummings SM; Levine R. International Journal of Geriatric Psychiatry 27(5): 483-490, 2012. (45 refs.)
Background: These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups. Methods: We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered. Results: Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups. Conclusions: Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs. Copyright 2012, Wiley-Blackwell.
Effects of drinking on hospital stays and emergency room visits among older adults.
Li Y; Jensen GA. Journal of Aging and Health 24(1): 67-91, 2012. (34 refs.)
Objective: To evaluate whether alcohol drinking influences emergency room (ER) visits or hospital admissions among adults aged 65 and older. Method: Data from two independent national surveys are used to estimate multivariate logit models that quantify the relationship between drinking and ER visits and hospital admissions. The authors distinguish between ER visits linked to a hospital admission for that individual and ER visits not linked to an admission. Results: The authors find no significant effects of alcohol consumption on either ER visits or hospital admissions among older adults. These findings occur in both data sets, and for both men and women. Distinguishing between different types of ER visits makes no difference. Discussion: Analysis of two large and nationally representative data sets suggests that among older adults drinking alcohol, or even heavily drinking alcohol, does not raise or lower the risk of a hospital admission or the risk of an ER visit. Copyright 2012, Sage Publications.
Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence.
Grella CE; Lovinger K. Addictive Behaviors 37(3): 306-312, 2012. (59 refs.)
Background: This paper examines the health status and functioning of an aging cohort of individuals with a history of heroin dependence with a focus on gender differences. Method: Study subjects were originally sampled from methadone maintenance clinics in California in the 1970s and completed follow-up interviews in 2005-09. Out of the original study sample (N=914), 343 participants (44.3% female) were interviewed (70.6% of those not deceased). Bivariate analyses examined gender differences in participants' overall health status and physical and mental health problems. Scores on SF-36 scales were compared with general population norms by gender and age, as well as between participants in the study sample who did and did not report past-year drug use. Results: Average age of the study sample was 58.3 (SD=4.9) years for males and 55.0 (SD=4.1) years for females. There were no significant gender differences in past-year drug use (38% of sample) or injection drug use (19%). Women reported significantly more chronic health problems and psychological distress compared with men, and overall poorer health and functioning compared with general population norms. Men under 65 had poorer physical health and social functioning compared with population norms. Men in the study sample reporting past-year substance use had poorer physical functioning, but less bodily pain, than non-users, whereas women with past-year substance use had poorer mental health than other women. Conclusion: Individuals with a history of heroin dependence have poorer health and functioning than their counterparts in the general population. At a younger age, women reported poorer overall health status and more chronic health and mental health problems than men. Study findings may inform interventions for this population, particularly related to gender-specific treatment needs. Copyright 2012, Elsevier Science.
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