Alcohol Use and Healthcare Utilization Among Midlife and Older Adults.

Substance Use Among Older Adults: Ethical Issues.

Objective Examinations of the association between health care utilization and levels of alcohol use are lacking in nationally representative samples of older adults. The present study set out to fill this gap by demonstrating how various aspects of health care utilization are associated with alcohol use among older adults in the United States. Method Cross-sectional panel data from 11 years of the National Health and Interview Survey were used to examine prevalence and rates of alcohol use among older adults (n = 106,511) and associations with demographic variables and recency of health care use, health care office visits, and use of emergency room/emergency department. Results About 70% of older adults (aged 65+; mean age = 74.1, SD = 0.04) had drunk alcohol in their lifetime, and 15.8% were current moderate or heavy drinkers. Results of an adjusted multinomial logistic regression revealed that individuals with any lifetime alcohol use had more recent health care visits and more office visits (but not current heavy users) than lifetime abstainers. Former alcohol users had more ER/ED visits but current moderate users at all levels had fewer ER/ED visits than lifetime abstainers, controlling for sex, race, educational attainment, marital status, and concurrent tobacco use. Conclusion Older adults who have any history of alcohol use are more likely than abstainers to have had recent health care visits, more office visits, (but not moderate or heavy users), and less likely to have had an emergency department visit.

OBJECTIVE: We sought to examine the independent and interactive effects of common mental health disorders and chronic pain conditions on employment and work outcomes among individuals younger than 65 years of age. METHODS: We analyzed cross-sectional data from the second wave of Healthcare for Communities (HCC2), a household telephone survey of U.S. civilian adults conducted in 2000 to 2001 (N=5328). Common mental disorders were assessed using the short-form versions of the World Health Organization’s Composite International Diagnostic Interview (CIDI-SF). Chronic pain conditions and labor market outcomes were identified by self report. Logistic and linear regression analysis was used to provide estimates for work impairment based on the presence of a mental health disorder and/or a chronic pain condition. RESULTS: The interaction between presence of a mental health disorder and presence of a chronic pain condition was significantly associated with no work for pay in the past 12 months (OR 2.3 [1.2–4.2]) and number of days of work missed in the past month due to health (regression coefficient 1.5 [0.6]). In stratified analyses, this effect persisted in women but not men. The presence of a mental health disorder or chronic pain condition were each independently associated with limitations in work and any work missed in the past 30 days due to health, although the interaction was not significant. CONCLUSION: Mental health disorders and chronic pain are each associated with work disability. Mental health disorders are more highly associated with some work disability outcomes when accompanied by chronic pain, especially in women.

The Evidence for SBIRT in Adolescents

Study Shines Light on ‘Invisible Epidemic’ of Alcohol Use

Letter to editor

BackgroundOlder adults are susceptible to adverse effects from the concurrent use of medications and alcohol. The aim of this study was to systematically review the prevalence of concurrent use of alcohol and alcohol-interactive (AI) medicines in older adults and associated adverse outcomes.MethodsA systematic search was performed using MEDLINE (PubMed), Embase, Scopus and Web of Science (January 1990 to June 2016), and hand searching references of retrieved articles. Observational studies reporting on the concurrent use of alcohol and AI medicines in the same or overlapping recall periods in older adults were included. Two independent reviewers verified that studies met the inclusion criteria, critically appraised included studies and extracted relevant data. A narrative synthesis is provided.ResultsTwenty studies, all cross-sectional, were included. Nine studies classified a wide range of medicines as AI using different medication compendia, thus resulting in heterogeneity across studies. Three studies investigated any medication use and eight focused on psychotropic medications. Based on the quality assessment of included studies, the most reliable estimate of concurrent use in older adults ranges between 21 and 35%. The most reliable estimate of concurrent use of psychotropic medications and alcohol ranges between 7.4 and 7.75%. No study examined longitudinal associations with adverse outcomes. Three cross-sectional studies reported on falls with mixed findings, while one study reported on the association between moderate alcohol consumption and adverse drug reactions at hospital admission.ConclusionsWhile there appears to be a high propensity for alcohol-medication interactions in older adults, there is a lack of consensus regarding what constitutes an AI medication. An explicit list of AI medications needs to be derived and validated prospectively to quantify the magnitude of risk posed by the concurrent use of alcohol for adverse outcomes in older adults. This will allow for risk stratification of older adults at the point of prescribing, and prioritise alcohol screening and brief alcohol interventions in high-risk groups.

Background: Physical performance is an important indicator that reflects current and predicts future health. In this study, we examined the association of alcohol use and depression with grip strength a national sample of middle aged and older Chinese adults. Methods: We used the baseline data from the China Health and Retirement Longitudinal Study (CHARLS) and constructed a multivariate linear regression using SAS 9.4 to examine the independent association of alcohol use (never, former, moderate, and at-risk drinkers) and depression with grip strength controlling for socio-economic factors and domestic partner status. Results: The study population consisted of 12,488 Chinese adults（mean age 59）. The prevalence of ever drinking during lifetime and current at-risk drinking (>14 standard drinks [one standard drink contains 14 grams of pure alcohol] per week) in this population was 25.7% and 15.2% respectively. 28.4% of the study population had depression. Compared with never drinkers, moderate and at-risk alcohol use were independently associated with better grip strength (P<0.0001). Depression was independently negatively associated with grip strength (P<0.0001). Conclusions: We found that current alcohol use might be protective of grip strength while depression might be detrimental to grip strength among middle-aged adults. However, the underlying mechanism is unclear. Given the negative impact of alcohol and depression on adults’ overall health, clinicians should assess alcohol use and depression in middle-aged and older patients using validated tools and provide resources. Clinicians should counsel patients that if depression is not managed, patients may suffer from depression associated health consequences such as declined grip strength.

A Need to Study the Immune Status of Frail Older Adults

IntroductionOlder adults with schizophrenia often have multiple chronic conditions, or multimorbidity, yet most prior research has focused on single medical conditions.ObjectivesTo characterize multimorbidity patterns and utilization among older adults with schizophrenia to understand how multimorbidity affects this population and their clinical service needs.MethodsThis retrospective cohort study included veterans aged 50 years and older with schizophrenia and followed their comorbid diagnoses and utilization (outpatient, inpatient, and emergency) from 2012 to 2019. Comorbid diagnoses included myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease (COPD), cancer, dementia, traumatic brain injury, hepatitis C, osteoarthritis, renal disease, chronic pain, sleep disorder, depression, dysthymia, posttraumatic stress disorder (PTSD), general anxiety disorder, alcohol use disorder, other substance use disorder, and tobacco use disorder. Latent class analysis was used to identify latent profiles of psychiatric and medical comorbidity. Chi-square and F-tests were used to assess differences in demographics, comorbidities, and utilization across the latent classes.ResultsThe cohort included 82,495 adults with schizophrenia. Three distinct multimorbidity classes were identified: Minimal Comorbidity (67.0% of the cohort), High Comorbidity (17.6%) and Substance Use Disorders and Related Conditions (SUDRC) (15.4%). The Minimal Comorbidity class had &lt;10% prevalence of all comorbid diagnoses. The High Comorbidity class had &gt;20% prevalence of congestive heart failure, COPD, dementia, renal disease, sleep disorder, and depression. The SUDRC class had &gt;70% prevalence of alcohol and drug use disorders and &gt;20% prevalence of COPD, hepatitis C, depression, and PTSD. Although the High Comorbidity class had the highest rates of chronic medical conditions, the SUDRC class had the highest rates of emergency and inpatient medical care and emergency, inpatient, and outpatient mental health care utilization. Comparing across classes, all p-values were &lt;.001 for utilization.ConclusionsOlder adults with schizophrenia are a heterogeneous group with distinct multimorbidity classes and different patterns of utilization. Those with high prevalence of substance use disorders had the highest rates of emergency and inpatient medical and overall mental health care utilization. Tailoring integrated care services to target specific clinical needs could improve outcomes for this population.Disclosure of InterestNone Declared

Alcohol use and its associated problems are on the rise in China. In this study, we examined the associations between alcohol use and cognitive functioning in a representative sample of adults aged 45years and older in China. Baseline data for 16,328 participants of the China Health and Retirement Longitudinal Study were analyzed. Alcohol use was measured by drinking status (never, former, moderate, and at-risk drinkers), number of standard drinks per week, and years of drinking. Cognitive functioning was assessed for visuospatial ability, episodic memory, orientation/attention, and overall cognitive functioning. Multivariate linear and logistic regressions were used to examine the independent association between alcohol use and cognitive functioning controlling for age, gender, education, domestic partner status, and depressive symptoms. The study participants were, on average, 66years old (median 59, range 45 to 102). The prevalence of ever drinking during lifetime and current at-risk drinking (>14 drinks per week) in this population was 34.6 and 6.7%, respectively. Drinking was more common among men with 48.8% being ever drinkers and 14.4% current at-risk drinkers, respectively. At-risk drinkers, compared to people who never drank alcohol, had worse episodic memory (β=-0.11, p=0.048). Moreover, number of standard drinks per week was associated with worse episodic memory (β=-0.001, p=0.02). None of the other measures of alcohol use was associated with the overall or domain-specific cognitive functioning. At-risk drinking status was associated with worse episodic memory. Clinicians should incorporate alcohol use assessment into routine care for middle-aged and older adults in China and provide them with resources and strategies to effectively manage their alcohol use. This may help preserve episodic memory in this population.

To examine the association between alcohol use and self-reported health status. In particular, we sought to determine whether moderate drinkers are more likely to self-report above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. Cross-sectional survey. Continental United States. The sample adult component of the 2002 U.S. National Health Interview Survey (n = 31,044), representative of the U.S. noninstitutionalized civilian household population. Dichotomous measure of above-average self-reported health status relative to all other health states. Several measures characterized alcohol use patterns (i.e., continuous and categorical measure of alcohol use, a proxy measure of problem drinking, former drinking, lifetime abstaining). Chronic health conditions and various demographic and lifestyle factors were included as covariates in all regression models. For both men and women, current moderate drinkers had the highest odds (OR = 1.27 for men, p < .01; OR = 2.03 for women, p < .01) of reporting above-average health status compared with other current drinkers, former drinkers, and lifetime abstainers. The odds dropped to 1.12 and 1.34, respectively, when all past-year drinkers were collapsed into a single group. Moderate alcohol consumption was associated with the highest odds of reporting above-average health status, even after controlling for chronic health conditions and demographic and lifestyle factors associated with health.

Underserved older adults face increased risk for certain chronic conditions and multimorbidity, yet research on healthcare spending and utilization in these groups is limited. For example, there is a glaring absence of research on sexual and gender minority (SGM) Medicare beneficiaries. To address this gap, this study uses linked data from Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS) and CMS Chronic Conditions Warehouse data (n = 902) to examine chronic conditions, healthcare spending and utilization among a diverse sample of SGM older adult Medicare beneficiaries. Chronic condition complexity was identified using the Medicare Chronic Conditions/Other Chronic Conditions files. Additional explanatory variables included adverse experiences, psychological and social resources, health-related indicators, socioeconomic factors, and background characteristics. The Cost and Use file was used to calculate four outcome variables: total Medicare spending, spending on physician services, high-cost beneficiary status, and healthcare utilization. A series of linear and logistic regressions were used to estimate the association between explanatory and outcome variables. SGM older adult participants with the greatest severity and complexity of chronic conditions had significantly higher total Medicare spending, spending on physician services, and were more likely to be a high-cost beneficiary and higher use of healthcare services compared to those who were comparatively healthy. We also find strong evidence linking higher Medicare spending to disability and dual eligibility, highlighting an urgent need for research given SGM older adults' increased risk for disabling chronic conditions, yet at times lower healthcare utilization. Higher day-to-day discrimination was associated with greater likelihood of chronic condition complexity and lower Medicare spending. Understanding the relationship between chronic health conditions and healthcare cost and utilization is a critical step in developing responsive health services and effective interventions to promote healthy aging in our increasingly diverse yet often underserved communities.

There has been lack of studies that examine the relationship between self-rated health (SRH) and alcohol consumption, particularly in middle-aged and older adult populations. This study aims to investigate association of SRH status with alcohol consumption in middle-aged and older adult populations. The study is a cross-sectional study design that was based on the China Health and Retired Longitudinal study (CHARLS) and the Canadian Alcohol and Drug Monitoring Survey (CADUMS) and the Canadian Alcohol, Tobacco and Drug Survey (CTADS). Measure of health is SRH status and self-reported alcohol use. Multinomial logistic regression was performed to model the data and the odds ratio of self-reported excellent, very good, good and fair (versus poor) for current and former drinkers versus nondrinkers and current drinkers versus former drinkers was estimated in models after adjusting for covariates. This study found that in both Chinese and Canadian adult populations, current drinkers reported better health status than former drinkers; lifetime nondrinkers reported better health status than former drinkers. Current drinkers reported better health status than nondrinkers. Canadian moderate drinkers (1.3–44 g per day) tended to report better health compared with occasional drinkers and Chinese heavy drinkers (45 + grams per day) reported better health status compared with occasional drinkers in both populations. This study found current drinkers tended to have better health status than former drinker and lifetime nondrinkers in adult populations. Nondrinkers tended to report better health status than former drinkers. Low and medium drinkers reported better health status.

Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.