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Castellanos-Perilla N, Borda MG, Cataño S, Giraldo S, Vik-Mo AO, Aarsland D, Rao RT. Specific depressive symptoms are related with different patterns of alcohol use in community-dwelling older adults. Arch Gerontol Geriatr 2022; 101:104696. [DOI: 10.1016/j.archger.2022.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
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Abstract
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.
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Affiliation(s)
- Cristina B. Bares
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Ariel Kennedy
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Suanrueang P, Shen YJ, Lin HF, Er TK, Suen MW, Shieh FA. Gender differences in geriatric syndromes as mental illness and nervous system diseases in hospitalized Thai older patients. Psychogeriatrics 2021; 21:453-465. [PMID: 33847418 DOI: 10.1111/psyg.12679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/23/2021] [Accepted: 02/14/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Older persons are affected by mental and neurological disorders differently, and gender plays a significant role influencing geriatric disorder differentiation. Accordingly this study characterized gender differences in geriatric syndromes among hospitalized elderly Thai patients. METHODS Probabilities of disease occurrence reflecting gender differences were calculated using historical data obtained from the Ministry of Public Health website, Thailand. We selected older patients aged 60 years and above admitted to inpatient departments in public hospitals with mental disorders and nervous system diseases from 2014 to 2018, counting over 160 000 cases each year. Descriptive statistics and odds ratios (ORs) were used to analyse and demonstrate gender differences. RESULTS Compared to older females, older males had higher occurrences of four mental disorders revealed by OR and 95% confidence interval (CI) values: substance abuse (5.74, 5.08-6.49), alcohol use (5.66, 5.44-5.89), behavioural problems (1.34, 1.31-1.37), and schizophrenia (1.10, 1.06-1.14). Lower incidences for older males were seen in the same values for three mental disorders: neurotic issues (0.46, 0.44-0.49), mood disorders (0.58, 0.56-0.60), and dementia (0.91, 0.88-0.94). For neurological disorders, men had similar higher incidences for epilepsy (1.67, 1.63-1.72), cerebral palsy (1.61, 1.57-1.65), nervous system inflammatory diseases (1.53, 1.46-1.60), ischaemic attacks (1.42, 1.36-1.48), miscellaneous other nervous disorders (1.20; 1.18-1.22), and Parkinson's disease (1.15, 1.12-1.19). By contrast, older men had lower incidences of multiple sclerosis (0.55, 0.35-0.86), migraines (0.66, 0.62-0.70), and Alzheimer's disease (0.75, 0.71-0.78). CONCLUSION Accurate characterization of gender differences in geriatric syndromes can better inform policies for appropriate early detection and prevention, and contribute to the development of treatment and intervention for various issues affecting elderly men and women's health.
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Affiliation(s)
- Passakorn Suanrueang
- Department of Healthcare Administration Specialty in Psychology, College of Medical and Health Science, Asia University, Taichung City, Taiwan
| | - Yong-Jiang Shen
- Professor of School of Educational Science, Nantong University, Nantong, China
| | - Hsiao-Fang Lin
- Associate Professor of Department and Graduate Institute of Early Childhood Development and Education, Chaoyang University of Technology, Taichung City, Taiwan
| | - Tze-Kiong Er
- Associate Professor of Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung City, Taiwan.,Division of Laboratory Medicine, Asia University Hospital, Asia University, Taichung City, Taiwan
| | - Mein-Woei Suen
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung City, Taiwan.,Gender Equality Education and Research Center, Asia University, Taichung City, Taiwan.,Department of Medical Research, Asia University Hospital, Asia University, Taichung City, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan
| | - Fu-An Shieh
- Lecturer of Department of Food and Beverage Management, Jin-Wen University of Science and Technology, New Taipei City, Taiwan
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Calvo E, Allel K, Staudinger UM, Castillo-Carniglia A, Medina JT, Keyes KM. Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50 years and older in 22 countries. Addiction 2021; 116:1399-1412. [PMID: 33241648 PMCID: PMC8131222 DOI: 10.1111/add.15292] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/01/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50 years and older. DESIGN Cross-sectional observational study using previously harmonized survey data. SETTING Twenty-two countries surveyed in 2010 or the closest available year. PARTICIPANTS A total of 106 180 adults aged 50 years and over. MEASUREMENTS Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking. FINDINGS Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P-value < 0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value < 0.001], even after adjusting for the composition of populations. Countries' development level and alcohol prices explained 31% of cross-country variability in SDUs (LR test P-value < 0.001) but did not explain cross-country variability in the prevalence of heavy drinkers. CONCLUSIONS Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.
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Affiliation(s)
- Esteban Calvo
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, NY, USA
| | - Kasim Allel
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
- Institute for Global Health, University College London, London, UK
| | - Ursula M. Staudinger
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, NY, USA
| | - Alvaro Castillo-Carniglia
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
- Department of Population Health, New York University School of Medicine, NY, USA
| | - José T. Medina
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Laboratory on Aging and Social Epidemiology, Facultad de Humanidades, Universidad Mayor, Santiago, Chile
| | - Katherine M. Keyes
- Society and Health Research Center, School of Public Health, Universidad Mayor, Santiago, Chile
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
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Stubbs B, Perara G, Koyanagi A, Veronese N, Vancampfort D, Firth J, Sheehan K, De Hert M, Stewart R, Mueller C. Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study. J Am Med Dir Assoc 2020; 21:1893-1899. [PMID: 32321678 PMCID: PMC7723983 DOI: 10.1016/j.jamda.2020.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016. MEASURES Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes. RESULTS In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures. CONCLUSION AND IMPLICATIONS Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.
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Affiliation(s)
- Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom.
| | - Gayan Perara
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain; ICREA, Barcelona, Spain
| | - Nicola Veronese
- Primary Care Department, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima," Dolo, Venice, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium; University Psychiatric Centre, KU Leuven, University of Leuven, Kortenberg, Belgium
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Katie Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, United Kingdom
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium; Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Christoph Mueller
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
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Ruangritchankul S, Srisuma S. The pattern of substance abuse in Thai elderly: Ramathibodi Poison Center. SAGE Open Med 2019; 7:2050312119873513. [PMID: 31516704 PMCID: PMC6719469 DOI: 10.1177/2050312119873513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/07/2019] [Indexed: 11/17/2022] Open
Abstract
Objective To describe substances, clinical manifestations, treatment, and medical outcomes of substance abuse exposures among older adults in Thailand. Method This is a retrospective study of individuals aged 60 years or older with intentional abuse exposures reported to the Ramathibodi Poison Center from 1 January 2010 to 31 December 2017. Results Forty-four cases were reported. The most common manifestation was somnolence (20, 45.5%). The most common substance used was kratom. There were 12 severe and fatal cases. Only one died due to methadone abuse. The most frequent manifestation among severe cases was respiratory failure (8 of 12 cases, 66.7%). Two cases had severe metabolic acidosis and were treated with hemodialysis. Three cases received norepinephrine. Conclusion Substance abuse in the elderly is a serious problem that is often overlooked. Health personnel should promptly recognize and address this issue in order to reduce morbidity and mortality in the elderly population.
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Affiliation(s)
- Sirasa Ruangritchankul
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sahaphume Srisuma
- Ramathibodi Poison Center and Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Michel L, Conq E, Combs E, Cholet J, Bodenez P, Le Reste JY, Landreat MG. Alcohol use by people in their seventies is not an exception: a preliminary prospective study. Br J Community Nurs 2019; 24:128-133. [PMID: 30817203 DOI: 10.12968/bjcn.2019.24.3.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The ageing population is rapidly increasing worldwide, and the alcohol-related disease burden in most Western countries is on the rise. However, very few studies assess alcohol use in older people. Here, a self-reported questionnaire was administered to all individuals aged 70 years or more who visited a social centre for older people in western France. The average age of the 98 subjects included in the survey was 79 years (range, 70-97 years; SD=6), and 57.1% (n=56) reported weekly alcohol consumption. An average consumption of over two standard units each day during weekends was reported by 53% subjects (n=52), and the same on each weekday was reported by 34% (n=33). Thus, a significant proportion of subjects aged 70 years or over consumed more alcohol than is recommended in current guidelines. The participants also reported that they rarely discussed alcohol consumption with their general practitioners. Alcohol use should be assessed regularly. District nurses and members of the primary care team should recommend strategies to help older people reduce their alcohol consumption.
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Affiliation(s)
- Lenaig Michel
- Specialised Nurse, Addictive Disorders Unit, University Hospital of Brest, Brest, France
| | - Estelle Conq
- EA Soins primaires, Santé publique, Registre des cancers de Bretagne Occidentale (SPURBO), Family Practice Department, Université Bretagne Occidentale, Brest, France
| | | | - Jennyfer Cholet
- Addictive Disorders Unit, University Hospital of Nantes, Nantes, France
| | - Pierre Bodenez
- EA SPURBO, Université Bretagne Occidentale, Brest, France
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8
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Ouellette L, TenBrink W, Gier C, Shepherd S, Mitten S, Steinberger M, Riley B, Sutliffe C, Jones J. Alcoholism in elderly patients: Characteristics of patients and impact on the emergency department. Am J Emerg Med 2018; 37:776-777. [PMID: 30170930 DOI: 10.1016/j.ajem.2018.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lindsey Ouellette
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - William TenBrink
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Chad Gier
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Spencer Shepherd
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Sadie Mitten
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Matthew Steinberger
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Brad Riley
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States; Spectrum Health Hospitals, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Chad Sutliffe
- Grand Valley State University, Department of Allied Health Sciences, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States
| | - Jeffrey Jones
- Department of Emergency Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States; Spectrum Health Hospitals, 15 Michigan St NE 736B, Grand Rapids, MI 49503, United States.
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Abstract
Thirty percent of emergency department admissions are related to an alcohol misuse. Eighty percent of acute intoxications admitted in emergency departments concern patients with alcohol addiction. Care protocols validated in all of emergency departments are necessary for prevention of alcohol withdrawal syndrome. Risky uses require ultra-brief interventions, situations of abuse (light use disorders) require brief interventions and situations of dependence (moderate to severe use disorders) require motivational interviews to promote the emergence of a process of change. The key word for alcohol intervention in emergencies is: empathy. Search addictive comorbidities (tobacco and cannabis) and psychiatric comorbidities (depression and suicidal risk) must be systematic. The coordination between emergency departments and addictology departments is essential. In the emergency department, the goal is to optimise patient care path for all addictive behaviors.
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Affiliation(s)
- Georges Brousse
- Université Clermont Auvergne 1, UFR médecine, EA7280, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, psychiatrie addictologie B, 63003 Clermont-Ferrand, France.
| | | | - Julien Cabe
- Université Clermont Auvergne 1, UFR médecine, EA7280, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, psychiatrie addictologie B, 63003 Clermont-Ferrand, France
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Bessey LJ, Radue RM, Chapman EN, Boyle LL, Shah MN. Behavioral Health Needs of Older Adults in the Emergency Department. Clin Geriatr Med 2018; 34:469-489. [PMID: 30031428 DOI: 10.1016/j.cger.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Behavioral health disorders are common among older adults and, owing to limited access to resources for mental health care in the community, emergency department providers are often on the front lines of mental health crises. This article reviews the available literature regarding the care of behavioral health emergencies in older adults and provides a framework for navigating the evaluation and management of older adults presenting to the emergency department with behavioral health concerns.
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Affiliation(s)
- Laurel J Bessey
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Rebecca M Radue
- Department of Psychiatry, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA
| | - Elizabeth N Chapman
- Department of Medicine, Division of Geriatrics, William S. Middleton Memorial VA Hospital, Geriatrics Research Education and Clinical Center, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Lisa L Boyle
- Department of Psychiatry, William S. Middleton Memorial VA Hospital, University of Wisconsin School of Medicine and Public Health, 2500 Overlook Terrace, Box 116A, Madison, WI 53705, USA.
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, MC9123, Madison, WI 53705, USA
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Searby A, Maude P, McGrath I. The Experiences of Older Adults with Dual Diagnosis in an Inner Melbourne Community Mental Health Service. Issues Ment Health Nurs 2018; 39:420-426. [PMID: 29370568 DOI: 10.1080/01612840.2017.1413458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Less is known about the experiences of older adults (65+ years of age) with co-occurring mental health and alcohol and other drug use disorders (dual diagnosis) than is known about the experiences of their younger counterparts. This exploratory qualitative study sought to interview individuals receiving case management from an inner Melbourne community mental health service to determine their experiences of living with dual diagnosis and explore their interactions with mental health and addiction treatment, and general medical services alike. Six older adults with a dual mental health and substance disorder agreed to participate in a semi-structured interview process and provided their perspectives about living with complex mental illness and alcohol and other drug use. Several key themes emerged throughout the interview process, mirroring the notion of dual diagnosis being a complex phenomenon involving a number of interrelated factors: these include medical complexity, poor service engagement and long-term use of alcohol and other drugs. Interviews also demonstrate the challenges inherent in providing care to this cohort, with the participants frequently describing their experiences with services as being fraught with difficulty. The increased understanding of the perspectives of older adults with dual diagnosis provides the foundation for further research into this population in addition to influencing future nursing care provided to this cohort.
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Affiliation(s)
- Adam Searby
- a RMIT University (School of Health and Biomedical Sciences - Nursing) , Bundoora , Australia
| | - Phillip Maude
- b RMIT University (School of Health and Biomedical Sciences - Nursing), Bundoora, Australia/University of Tasmania, School of Health Sciences (Nursing) , Hobart , Australia
| | - Ian McGrath
- c RMIT University (School of Health and Biomedical Sciences - Nursing) , Bundoora , Australia
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Substance Use Disorders in Elderly Admissions to an Academic Psychiatric Inpatient Service over a 10-Year Period. JOURNAL OF ADDICTION 2016; 2016:4973018. [PMID: 27840765 PMCID: PMC5090103 DOI: 10.1155/2016/4973018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/14/2016] [Accepted: 09/29/2016] [Indexed: 12/02/2022]
Abstract
Objective. There is a paucity of research on substance use disorders (SUDs) in the elderly psychiatric population. This study examines SUDs in a geriatric psychiatry inpatient service over a 10-year period. Methods. Data from 1788 elderly psychiatric inpatients from a ten-year period was collected. Variables collected included psychiatric diagnoses, SUD, number of psychiatric admissions, and length of stay. Those with and without a SUD were compared using Chi-Square or Student's t-test as appropriate using SPSS. Results. 11.7% (N = 210) of patients had a SUD, and the most common substance was alcohol at 73.3% (N = 154) or 8.6% of all admissions. Other SUDs were sedative-hypnotics (11%), opiate (2.9%), cannabis (1%), tobacco (1.4%), and unspecified SUD (38.6%). SUD patients were significantly younger, divorced, male, and less frequently readmitted and had shorter lengths of stay. The most common comorbid diagnoses were major depression (26.1%), bipolar disorder (10.5%), and dementia (17.1%). Conclusions. Over 10% of psychogeriatric admissions were associated with a SUD, with alcohol being the most common. Considering the difficulties in diagnosing SUD in this population and the retrospective study design, the true prevalence in elderly psychiatric inpatients is likely higher. This study adds to sparse literature on SUD in elderly psychiatric patients.
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Choi NG, Marti CNN, DiNitto DM, Choi BY. Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis. West J Emerg Med 2015; 16:1146-58. [PMID: 26759670 PMCID: PMC4703192 DOI: 10.5811/westjem.2015.9.27704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Late middle-aged and older adults' share of emergency department (ED) visits is increasing more than other age groups. ED visits by individuals with substance-related problems are also increasing. This paper was intended to identify subgroups of individuals aged 50+ by their risk for ED visits by examining their health/mental health status and alcohol use patterns. METHODS Data came from the 2013 National Health Interview Survey's Sample Adult file (n=15,713). Following descriptive analysis of sample characteristics by alcohol use patterns, latent class analysis (LCA) modeling was fit using alcohol use pattern (lifetime abstainers, ex-drinkers, current infrequent/light/moderate drinkers, and current heavy drinkers), chronic health and mental health status, and past-year ED visits as indicators. RESULTS LCA identified a four-class model. All members of Class 1 (35% of the sample; lowest-risk group) were infrequent/light/moderate drinkers and exhibited the lowest probabilities of chronic health/mental health problems; Class 2 (21%; low-risk group) consisted entirely of lifetime abstainers and, despite being the oldest group, exhibited low probabilities of health/mental health problems; Class 3 (37%; moderate-risk group) was evenly divided between ex-drinkers and heavy drinkers; and Class 4 (7%; high-risk group) included all four groups of drinkers but more ex-drinkers. In addition, Class 4 had the highest probabilities of chronic health/mental problems, unhealthy behaviors, and repeat ED visits, with the highest proportion of Blacks and the lowest proportions of college graduates and employed persons, indicating significant roles of these risk factors. CONCLUSION Alcohol nonuse/use (and quantity of use) and chronic health conditions are significant contributors to varying levels of ED visit risk. Clinicians need to help heavy-drinking older adults reduce unhealthy alcohol consumption and help both heavy drinkers and ex-drinkers improve chronic illnesses self-management.
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Affiliation(s)
- Namkee G. Choi
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | | | - Diana M. DiNitto
- The University of Texas at Austin, School of Social Work, Austin, Texas
| | - Bryan Y. Choi
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
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Searby A, Maude P, McGrath I. Maturing out, natural recovery, and dual diagnosis: What are the implications for older adult mental health services? Int J Ment Health Nurs 2015; 24:478-84. [PMID: 26256656 DOI: 10.1111/inm.12143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In 1962, Charles Winick proposed that addiction was a self-limiting process, whereby individuals stopped using substances once the stresses of life transitions ceased. The notion of maturing out, as labelled by Winick, often forms the basis of the natural recovery movement in alcohol and other drug (AOD) research, aiding the notion that older individuals either cease their substance use or fall victim to the higher mortality rates prevalent in substance-using populations. As more consumers present to adult mental health treatment settings with co-occurring substance use disorders, the idea that individuals will simply cease using AOD is outdated. Given the future challenges of an ageing population, it is prudent to explore those who fail to mature out of substance use, as well as challenge the notion that older adult mental health services rarely encounter substance-using individuals. The present study explores Winick's research in the context of an ageing population and older adult mental health services. It also ponders the proposition put forth in subsequent research that older individuals with lifelong substance use switch to substances that are easier to obtain and better tolerated by their ageing bodies.
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Affiliation(s)
- Adam Searby
- Alfred Health, Melbourne, Victoria, Australia.,School of Health Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Phil Maude
- Alfred Health, Melbourne, Victoria, Australia.,School of Health Sciences, RMIT University, Melbourne, Victoria, Australia.,School of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Ian McGrath
- School of Health Sciences, RMIT University, Melbourne, Victoria, Australia
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Choi NG, DiNitto DM, Marti CN, Choi BY. Associations of Mental Health and Substance Use Disorders With Presenting Problems and Outcomes in Older Adults' Emergency Department Visits. Acad Emerg Med 2015; 22:1316-26. [PMID: 26473592 DOI: 10.1111/acem.12803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/24/2015] [Accepted: 06/28/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The increasing prevalence of mental health and/or substance use disorders in older adults is a significant public health issue affecting their health, health care use, and health care outcomes. These disorders are especially prevalent in emergency department (ED) visits. This study examined the effect of mental health and substance use disorders on older adults' ED presenting problems and outcomes. METHODS Data were from the publicly available 2012 Nationwide Emergency Department Sample data set (unweighted n = 5,344,743 visits by the 65+ years age group). We used binary logistic regression analysis to test relationships between mental health and substance use disorders and suicide attempts, falls, and other injuries and multinomial logistic regression analysis to test relationships between the disorders and ED outcomes of death, hospital admission, transfer to institutional care, home health care, leaving against medical advice (AMA), or other or unknown destinations, as opposed to routine care. RESULTS Of ED visits by older adults, 5.1% involved anxiety disorders, 7.1% involved mood disorders, 10.45% involved delirium/dementia, 1.4% involved alcohol use disorders, and 0.6% involved drug use disorders; 0.2% were suicide-related, 12.0% involved falls, and 10.2% involved other injuries. Mental health and substance use disorders had large-to-medium effects on suicide attempts. Both dementia and delirium and alcohol use disorders had a small effect on falls. Drug use disorders had a small effect on other injuries. Anxiety disorder had a small effect on the risk of death in the ED or in the hospital, relative to routine care. Suicide attempts and drug use disorders had a medium effect on hospital admission. Suicide attempts had a large effect, delirium and dementia and other mental disorders had medium effects, and mood disorder had a small effect on the risk of transfer to another facility. Delirium and dementia, suicide attempts, and drug use disorders had small effects on the risk of discharge with home health care. Alcohol use disorders and drug use disorders had a small effect on the risk of leaving AMA. Finally, suicide attempts had a medium effect on the risk of other outcomes and unknown destinations. CONCLUSIONS Late-life mental health and substance use disorders are significant risk factors for both intentional self-harm and unintentional injuries that bring older adults to the ED and contribute to ED dispositions and outcomes that involve more intensive and longer-term health care services. The findings underscore the importance of detection and treatment of these disorders among older adults before they end up in the ED.
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Affiliation(s)
- Namkee G. Choi
- University of Texas at Austin School of Social Work; Austin TX
| | | | - C. Nathan Marti
- University of Texas at Austin School of Social Work; Austin TX
| | - Bryan Y. Choi
- Department of Emergency Medicine; Warren Alpert Medical School; Brown University; Providence RI
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Levola J, Aalto M, Holopainen A, Cieza A, Pitkänen T. Health-related quality of life in alcohol dependence: a systematic literature review with a specific focus on the role of depression and other psychopathology. Nord J Psychiatry 2014; 68:369-84. [PMID: 24228776 DOI: 10.3109/08039488.2013.852242] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) is considered a valid measure of treatment effectiveness in addictions. However, alcohol research has lagged behind other biomedical fields in using HRQOL outcomes as primary or secondary endpoints. Previous work has suggested that psychiatric co-morbidity may mediate the relationship between alcohol dependence and HRQOL. AIM The goal was to summarize the literature on HRQOL and its domains in the context of alcohol dependence. A specific focus was on the impact of depression and other psychopathology on these areas of life. MATERIALS AND METHODS A database search of MEDLINE and PsychINFO was performed within the scope of PARADISE (Psychosocial fActors Relevant to brAin DISorders in Europe); a European Commission funded coordination action. Using pre-defined eligibility criteria, 42 studies were identified. A systematic approach to data collection was employed. RESULTS AND CONCLUSIONS Alcohol dependence was shown to affect overall HRQOL and its domains, including general health, physical and mental health, general and social functioning, activities of daily living, pain and sleep. The evidence demonstrating that alcohol dependence is a primary cause of impairments in overall HRQOL, general health, mental and physical health and social functioning was fairly strong. Treatment interventions helped improve HRQOL and its aforementioned domains. The reduction or cessation of alcohol use facilitated these improvements; however, it was not reported to be predictive of improvement in all instances where improvement was reported. Depression was associated with further decreases in HRQOL. Personality disorders contributed to the severity of social functioning impairment.
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Affiliation(s)
- Jonna Levola
- Jonna Levola, A-clinic Foundation, Research Unit ; Helsinki , Finland , and National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services ; Helsinki , Finland
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Wilkinson C, Dare J. Shades of Grey: The Need for a Multi-disciplinary Approach to Research Investigating Alcohol and Ageing. J Public Health Res 2014; 3:180. [PMID: 25170507 PMCID: PMC4140383 DOI: 10.4081/jphr.2014.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/10/2013] [Accepted: 10/16/2013] [Indexed: 11/23/2022] Open
Abstract
This paper calls for an increase in multi-disciplinary research on the issue of alcohol and ageing, to ensure public health interventions reflect the complex and diverse needs of older drinkers. Older people (65+ years) represent a unique segment of the population; compared to adolescents and younger people, they are more likely to have a range of co-morbid conditions and be taking prescribed medication, and are more physiologically vulnerable to the effects of alcohol. This suggests that from a public health perspective, alcohol use by older people is problematic. However, as with younger people, alcohol use is closely associated with socialisation and social engagement. While social engagement is important at all stages of life, it is particularly critical as people age, when many of the formal social roles which provide a catalyst for social integration shift or are lost. Currently, however, there is little evidence of an integrated public health response to the complex issue of alcohol and ageing. That is, what is needed is a concurrent acknowledgement of the health problems that may be associated with contraindicated alcohol use, versus the potential health benefits that can accrue from social drinking. This will require a holistic rather than reductionist approach that integrates biomedical and social science insights to develop a more comprehensive and nuanced understanding of the implications of alcohol use amongst diverse populations of older people. Significance for public healthWith the rapid ageing of the global population and concerns about recent increases in the consumption of alcohol amongst older people, the issue of alcohol and ageing is becoming an important public health issue. However, there remains little research that adopts a holistic multi-disciplinary perspective. Such research is important and may offer the best way forward in terms of unravelling the complexity of competing risks and benefits associated with low to moderate drinking amongst older people.
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Affiliation(s)
- Celia Wilkinson
- Edith Cowan University, Joondalup, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Julie Dare
- Edith Cowan University, Joondalup, Australia
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Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, Cieza A, Pitkänen T. Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disabil Rehabil 2013; 36:1227-39. [DOI: 10.3109/09638288.2013.837104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kowalenko T, Burgess B, Szpunar SM, Irvin-Babcock CB. Alcohol and trauma--in every age group. Am J Emerg Med 2013; 31:705-9. [PMID: 23380101 DOI: 10.1016/j.ajem.2012.12.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/25/2012] [Accepted: 12/29/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose was to determine the proportion of alcohol-positive (AlcPos) trauma patients in different age groups and any association with mortality using the National Trauma Data Bank. METHODS Several variables were extracted from the National Trauma Data Bank (version 6.2) using MS Access 2007: age, alcohol presence, Injury Severity Score (ISS), and discharge status (alive vs dead). Age groups for logistic regression were arbitrarily defined as follows: 0 to 10, 11 to 20, 21 to 39, 40 to 64, and older than 64 years. RESULTS Approximately 47% of all trauma survivors were tested for alcohol (621,174 of a total of 1,311,137), and 28% of those were AlcPos (176,107/621,174). The proportion of AlcPos patients gradually increased to maximum at 22 years, when 46% (6797/14,732) tested were AlcPos. The proportion AlcPos gradually declined to 35% by age 50 years, then to 15% (2516/16,244) by age 66 to 70 years. The ISSs were significantly higher in AlcPos patients in all age groups (P < .01). Mortality rates were higher in AlcPos children (up to age 20 years) and in adults older than 40 years. The AlcPos patients who were 21 to 39 years old had lower mortality compared with alcohol-negative patients. Logistic regression analysis (controlling for ISSs) revealed that being AlcPos did not play a role in mortality until age 21 to 39 years (AlcPos lower mortality) and in age 40 to 64 years and older than 65 years (AlcPos higher mortality). CONCLUSIONS Trauma patients of all ages may be AlcPos. Being AlcPos is a marker for greater injury in all age groups. After controlling for ISSs, trauma patients 40 years and older who were AlcPos have increased mortality. This study suggests a role for alcohol testing in all age groups.
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Affiliation(s)
- Terry Kowalenko
- Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
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Huang AR, Mallet L, Rochefort CM, Eguale T, Buckeridge DL, Tamblyn R. Medication-Related Falls in the Elderly. Drugs Aging 2012; 29:359-76. [DOI: 10.2165/11599460-000000000-00000] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Rakshi M, Wilson I, Burrow S, Holland M. How can older people's mental health services in the UK respond to the escalating prevalence of alcohol misuse among older adults? ADVANCES IN DUAL DIAGNOSIS 2011. [DOI: 10.1108/17570971111155586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of "boomers" who believe that alcohol intake improves health comes of age.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, MI 48859, USA.
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Salve A, Leclercq S, Ponavoy E, Trojak B, Chauvet-Gelinier JC, Vandel P, Bonin B. Conduites addictives du sujet âgé. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s0246-1072(11)57929-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Samaras N, Chevalley T, Samaras D, Gold G. Older Patients in the Emergency Department: A Review. Ann Emerg Med 2010; 56:261-9. [PMID: 20619500 DOI: 10.1016/j.annemergmed.2010.04.015] [Citation(s) in RCA: 390] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 03/18/2010] [Accepted: 04/19/2010] [Indexed: 10/19/2022]
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Abstract
This article discusses the physiology and clinical syndromes involved in ethanol absorption, intoxication, and withdrawal, with special emphasis on the evidentiary backing for common treatments, as well as some discussion of the medicolegal sequelae of treatment of ethanol abusers in the emergency department.
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Abstract
With the growth of the elderly population, and the female elderly population in particular, healthcare providers will see increasing numbers of elderly women with psychiatric disorders. To properly care for this group of patients, better understanding is needed not only of group differences in this patient population but also of the differences in each individual, as they age, given their unique life experiences, cohort effects, medical comorbidity, social situation, and personality traits. Understandably, these characteristics will interact with psychiatric disorders in ways that may increase the challenge to correctly diagnose and treat these patients. In addition, understanding late life changes, the prevalence of various mental disorders and the sometimes unique presentation of mental disorders in this age group is required to better diagnose and treat this population.
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Affiliation(s)
- Mudhasir Bashir
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Box 800623, Charlottesville, VA 22908, USA.
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Hirata ES, Nakano EY, Junior JAP, Litvoc J, Bottino CMC. Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil. Int J Geriatr Psychiatry 2009; 24:1045-53. [PMID: 19768699 DOI: 10.1002/gps.2224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors. METHODS A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment. RESULTS Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, 'mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism. CONCLUSIONS The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries.
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Affiliation(s)
- Edson Shiguemi Hirata
- Old Age Research Group (PROTER), Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil.
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Balsa AI, Homer JF, Fleming MF, French MT. Alcohol consumption and health among elders. THE GERONTOLOGIST 2009; 48:622-36. [PMID: 18981279 DOI: 10.1093/geront/48.5.622] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This article estimates the effects of alcohol consumption on self-reported overall health status, injuries, heart problems, emergency room use, and hospitalizations among persons older than the age of 65. DESIGN AND METHODS We analyzed data from the first wave of the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative study. We used multivariate regression and instrumental variables methods to study the associations between alcohol consumption (current drinking, binge drinking, and average number of drinks consumed) and several indicators of health status and health care utilization. RESULTS Alcohol consumption by women was associated with better self-perceived health status, improved cardiovascular health, and lower rates of hospitalizations. We detected no significant negative or positive associations for older men. IMPLICATIONS These findings suggest that light to moderate alcohol use by older women may have beneficial health effects. Experimental trials, however, are needed to more rigorously assess the potential benefits of alcohol use by elders due to the inherent biases of observational studies.
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Affiliation(s)
- Ana I Balsa
- Health Economics Research Group, University of Miami, Coral Gables, FL 33124-2030, USA
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30
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Affiliation(s)
- Dimitra Loukissa
- Johnson Bowman Center, Rush University Medical Center, Chicago, Illinois, United States of America
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Chang JT, Ganz DA. Quality Indicators for Falls and Mobility Problems in Vulnerable Elders. J Am Geriatr Soc 2007; 55 Suppl 2:S327-34. [PMID: 17910554 DOI: 10.1111/j.1532-5415.2007.01339.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John T Chang
- Division of General Internal Medicine and Health Services Research, and Speciality Training and Advanced Research Program, University of California at Lost Angeles, Los Angeles, CA 90095, USA.
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Abstract
PURPOSE OF REVIEW This paper briefly outlines new research on the epidemiology of alcohol and drug use in the older population, describes mental and cognitive consequences of substance use and summarizes recent treatment trials for alcohol dependence. RECENT FINDINGS Cross-sectional and longitudinal studies indicate that alcohol use is less prevalent in older groups, and it decreases over time. Comorbidity (alcohol and other drugs, alcohol with mental health disorders) is high. An inverse-U-shaped curve describes the association between alcohol consumption and cognitive impairment with increased impairment for abstainers and high users as compared with moderate users. Trials of alcohol use in the older population are rare, but they suggest that brief patient education may reduce drinking levels in primary care populations, and that, for some users, integrated primary care may be more useful than referral to specialist care. SUMMARY The basis for higher risk in abstainers is not resolved. More randomized controlled trials are needed, which target alcohol use and dependence and also focus on comorbid disorders.
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Affiliation(s)
- Helen Christensen
- Centre for Mental Health Research, The Australian National University, Canberra, Australia.
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Bhalla A, Dutta S, Chakrabarti A. A profile of substance abusers using the emergency services in a tertiary care hospital in Sikkim. Indian J Psychiatry 2006; 48:243-7. [PMID: 20703344 PMCID: PMC2915595 DOI: 10.4103/0019-5545.31556] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sikkim, a state in Northeast India with a population of more than 500,000 and inhabited by indigenous population of Lepchas, Bhutias and Nepalis, lies in the foothills of the Himalayas sharing borders with Tibet, Nepal and Bhutan. Northeast India is a major source of injection drug users (IDUs) and associated HIV/AIDS. Alcohol use is traditionally prevalent in Sikkim and recently, IDU behaviour has also been reported, although systematic information on epidemiology and treatment availability of substance abuse in Sikkim is not available. AIM To study the sociodemographic and drug use profile of substance abusers using the emergency services in a tertiary care hospital. METHODS A retrospective chart review was used. Patients with history of current drug use seeking emergency services for any medical or surgical consequence incident to substance abuse from July 2000 to June 2005 (60 months) were included in the study. Data were generated from emergency case register, hospital records and case sheets. SPSS 10.0 was used for data analysis. RESULTS Out of 54 patients seeking emergency services with substance abuse (1.16% of all psychiatric consultations), alcohol abusers were 77.8% and other opioid abusers 14.8%. Prevalence of IDU was 16.66%. Common opioids abused were dextrpropoxyphene and pentazocine, both analgesics. A significant number of patients (46.3%) had a history of >20 days/month frequency of abuse. Median of duration of abuse with all drugs was 12 years, while that with IDU population was 3 years. Alcohol withdrawal was the commonest cause (57.4%) of reporting to the emergency. Psychiatric comorbidity was found among 7.4%. Commonest medications used were chlordiazepoxide and clonidine, for withdrawal and naltrexone, for substitution. No standardized treatment protocol for substitution treatment was available. CONCLUSIONS This is an initial attempt to study the sociodemographic and drug use profile of substance abusers in Sikkim. Demographic and socioeconomic characteristics of substance abusers seeking emergency services are not significantly different from treatment-seeking substance abusers in other parts of India. IDU behaviour has been detected and low median duration of use suggests an emerging problem and need for urgent harm reduction. Alcohol withdrawal was the commonest cause of seeking emergency services, which is related to high prevalence of alcohol abuse in Sikkim. No standardized substitution treatment is available for substance abusers, which may lead to higher rates of relapse.
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Affiliation(s)
- Akhil Bhalla
- Student, MBBS, Semester VII Sikkim Manipal Institute of Medical Sciences, 5th Mile, Tadong, Gangtok 737102, Sikkim
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Paniagua MA, Malphurs JE, Phelan EA. Older patients presenting to a county hospital ED after a fall: missed opportunities for prevention. Am J Emerg Med 2006; 24:413-7. [PMID: 16787797 DOI: 10.1016/j.ajem.2005.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 11/23/2005] [Accepted: 12/06/2005] [Indexed: 10/24/2022] Open
Abstract
Little is known about the characteristics of elderly persons who present to an ED after a fall or about the nature of the care received for the fall itself. We identified elders presenting to a large urban United States ED after a fall, determined risk factors that may have contributed to the fall, and assessed the extent to which falls were addressed in the ED setting. One hundred seventeen fallers were identified. Nearly half were aged 80 years or older. After age, polypharmacy was the most common fall risk factor, followed by more than 1 contributing medical condition and cognitive impairment. Fall risk factors differed significantly for older compared with younger subgroups. More than half (57%) who had fallen were admitted. Of the remainder who fell and were discharged, more than half were scheduled for follow-up of their fall-related injury only, with no follow-up scheduled to address prevention of future falls. In summary, elders who present to an ED after having fallen have a variety of risk factors for falls that can be addressed to reduce their risk of future falls and injury; however, many may not receive such follow-up care. There must be increased awareness among ED providers of the need for a medical evaluation of a fall. Randomized trials evaluating the effect of a focused fall risk factor assessment after presentation to the ED may be warranted.
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Affiliation(s)
- Miguel A Paniagua
- University of Miami Miller School of Medicine, Miami VA Medical Center, GRECC and Research Service, Miami, FL 33125, USA.
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Saleh SS, Szebenyi SE. Resource use of elderly emergency department patients with alcohol-related diagnoses. J Subst Abuse Treat 2005; 29:313-9. [PMID: 16311184 DOI: 10.1016/j.jsat.2005.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 08/10/2005] [Accepted: 08/23/2005] [Indexed: 11/29/2022]
Abstract
This study evaluates resource use associated with alcohol-related admissions through the emergency department (ED) by older adults. Data from 11 states were extracted from the Healthcare Cost and Utilization Project State Inpatient Databases. The study results revealed that the presence of a secondary alcohol-related diagnosis significantly increased resource use (37-119% for length of stay and 126-343% for charges; p < .05) associated with the top 10 International Classification of Diseases, Ninth Revision, Clinical Modification Clinical Classifications Software diagnoses. They also showed that admissions with an alcohol-related primary diagnosis had lower associated charges (2,172 dollars; p < .05) and longer lengths of stay (0.3 days; p < .05) than other types of ED admissions. Proper linkages to substance abuse treatment services should be instituted and coupled with medical treatment to limit the additional resource use burden of alcohol-related admissions.
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Affiliation(s)
- Shadi S Saleh
- Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York at Albany, One University Place, Rensselaer, NY 12144, USA.
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