Alcohol consumption and psychological distress in recently widowed older men

Family influences on older adults' problem drinking: A representative nationwide study of China

Aim

It is reported that problem drinking is severe among the elderly. The family environment has been regarded as a significant effecting factor in alcohol consumption of the drinker. With the increasing number of older people, paying more attention to this vulnerable group's drinking status and its' influencing factors is substantial for improving older adults' health and the quality of health services.

Methods

This study used data from the Chinese Longitudinal Healthy and Longevity Study (CLHLS), which was a representative survey covering 23 provinces in mainland China. Cross-sectional analyses were conducted with 15,142 older individuals (aged ≥65 years). Three self-reported questions about drinking behavior were examined to calculate alcohol consumption and categorize problem drinkers. Three multi-level models were utilized while adjusting for numerous socio-demographic and self-reported health factors to analyze the effect of family factors associated with problem drinking among the elderly.

Results

A total of 1,800 problem drinkers (12%) were identified in the sample. Key factors for the problem drinker were assessed such as Hukou (governmental household registration system), current marital status, years of schooling, primary caregivers, and financial sources of living were associated with problem drinking. The older population who live in rural areas (OR = 1.702, CI = 1.453, 1.994), with advanced years of education (OR = 1.496, CI = 1.284, 1.744), and making life by themselves (OR = 1.330, CI = 1.139, 1.552) were more likely to engage in problem drinking while those participants who are widowed (OR = 0.678, CI = 0.574, 0.801), cared for by children or other relatives (OR = 0.748, CI = 0.642, 0.871), adult care giver (OR = 0.348, CI = 0.209, 0.578) or by no one (OR = 0.539, CI = 0.348, 0.835), provided with financial support from their children (OR = 0.698, CI = 0.605, 0.806), other relatives (OR = 0.442, CI = 0.332, 0.587), or the government/community (OR = 0.771, CI = 0.650, 0.915), with insufficient financial support (OR = 0.728, CI = 0.608, 0.872) were at lower risk of problem drinking.

Conclusions

This study provides a strong correlation of various family factors that were associated with problem drinking among the elderly. The findings underscore the effort to promote healthy behaviors, including the importance of positive family factors and appropriate levels of alcohol consumption.

Effect of Spousal Loss on Depression in Older Adults: Impacts of Time Passing, Living Arrangement, and Spouse's Health Status before Death

In addition to increasing the mortality among older adults, spousal death (SD) increases their risk of depression. This study explored the factors affecting depression among widowed older adults to provide health care strategies for successful aging. A total of 710 adults older than 60 years completed a questionnaire before and after their spouses’ deaths. The survey data included age, sex, ethnic group, education level, financial station socioeconomic status, SD (including time point), smoking status, alcohol consumption, self-rated health status, Center for Epidemiologic Studies Depression Scale score, mobility, and degree of support from relatives and friends. The proportion of participants with depression after SD was 1.7 times that of before SD (p < 0.0001). Worsened mobility (odds ratio [OR] = 1.3, p < 0.01), low self-rated health status (OR = 0.5, p < 0.01), and a high degree of support from relatives and friends (OR = 1.5, p < 0.01) had a significant positive correlation with depression after SD. The proportion of depression that occurred within 6 months after SD was 6.0 times higher than that of depression before SD. Participants who lived alone after losing their spouses who were healthy before their deaths exhibited a significantly increased proportion of depression after their spouses’ deaths. Male sex, spouse’s health, and the period of 6 months after SD are risk factors for depression in older adults. The maintenance of mobility, positive self-rated health status, and a shorter period of depression after a spouse’s death result in more favorable adaptability among women. Social workers or family members should focus on older adults whose spouses died unexpectedly or within the last 6 months. Living with family members after SD can alleviate depression in older adults.

Self-Reported Patterns of Use of Alcohol and Drugs After Suicide Bereavement and Other Sudden Losses: A Mixed Methods Study of 1,854 Young Bereaved Adults in the UK

Background

Bereavement, particularly by suicide, is associated with an excess risk of mortality and of physical and psychological morbidity. Use of alcohol as a coping mechanism is suggested as a contributing factor. However, studies describing substance use after bereavement rely on diagnostic data, lacking a more fine-grained understanding of patterns of substance use when grieving. We aimed to use mixed methods to compare patterns of substance use after bereavement by suicide and other sudden deaths among young adults in the UK.

Methods

Using an online survey throughout 37 UK higher education institutions we collected free text responses from 1,854 young adults who had experienced sudden bereavement. We conducted content analysis of free text responses to an open question about patterns of alcohol and drug use following the bereavement, measuring frequencies of coded categories. Collapsing these categories into binary outcomes reflecting increased use of alcohol or drugs, we used multivariable logistic regression to quantify the associations between mode of bereavement and increased post-bereavement substance use.

Results

Of 1,854 eligible respondents, 353 reported bereavement by suicide, 395 by accidental death, and 1,106 by sudden natural causes. The majority of the sample reported no increase in their use of alcohol (58%) or unprescribed drugs (85%) after the bereavement. Overall 33% had increased their alcohol use at some point after the bereavement, whilst 12% had increased their use of drugs. People bereaved by suicide were significantly more likely to describe an increase in substance use (adjusted OR = 1.29; 95% CI = 1.00–1.66; p = 0.049) than people bereaved by sudden natural causes, as were people bereaved by non-suicide unnatural deaths (adjusted OR = 1.32; 95% CI = 1.03–1.68; p = 0.026).

Conclusion

Just under half of young UK adults who experience sudden bereavement increase their alcohol use afterwards, and very few increase their use of drugs. People bereaved by suicide or non-suicide unnatural deaths may be more likely than people bereaved by sudden natural causes to use substances as part of the grieving process, and may have a greater need for monitoring of potential harms. Understanding the reasons for substance use will help primary care and bereavement practitioners screen and address needs appropriately.

Impact of the interaction between alexithymia and the adult attachment styles in participants with alcohol use disorder

The current study aims to investigate the effect of the interaction between adult attachment styles and alexithymia among participants with alcohol use disorder (AUD). This study is cross-sectional, conducted between November 2017 and March 2018, which enrolled 789 community-dwelling participants. The interaction between alexithymia and secure relationship tended to significance (p = 0.057). Higher interaction between alexithymia and a fearful relationship style (β = 0.04) were significantly associated with higher AUD. The interaction model revealed the importance of stratifying the results according to presence/absence of alexithymia. Being a female and having a secure relationship style were significantly associated with lower AUD in both groups. Being divorced was significantly associated with higher AUD in both groups. Increasing age (β = -1.48), secondary (β = -4.65), and university level of education (β = -6.46) were significantly associated with lower AUD in the non-alexithymic group. Intermediate monthly income (β = 2.69) and being widowed (β = 8.24) were significantly associated with higher AUD in the non-alexithymic group. High monthly income (β = 3.46) was significantly associated with higher AUD in the alexithymic group. The results of this study showed that the consideration of the combination between attachment styles and alexithymia is of significance in the diagnosis and therapy of alcohol use disorders.

Correlates of alcohol consumption among Germans in the second half of life. Results of a population-based observational study

Background

Several studies have investigated the predictors of alcohol consumption behavior among adolescents and young adults. However, the body of evidence about the relationship between in particular psychological factors and alcohol consumption among individuals in the second half of life is still limited. Hence, we aimed at identifying factors associated with alcohol consumption among individuals aged 40 and above, especially focusing on psychological correlates.

Methods

Data were derived from a population-based sample of community-dwelling individuals aged 40 to 95 years (n = 7820) in Germany. Alcohol consumption was rated as ‘never’ (never drinkers), ‘rarer than once a month’, ‘one to three times a month’, ‘once a week’, ‘several times a week’ (occasional drinkers), and ‘daily’ (daily drinkers). Socio-economic factors, the illness level and physical activity were considered as possible determinants of alcohol consumption. In addition, positive and negative affect, life satisfaction, optimism, self-esteem, self-efficacy, and self-regulation were included as psychological factors. Multinomial regressions were used to identify factors associated with drinking behavior.

Results

12.0% of the individuals were daily drinkers, 76.5% were occasional drinkers, and 11.5% of the individuals never drank alcohol. After adjusting for various potential confounders, multinomial logistic regressions revealed that, compared with never drinking, occasional and daily drinking were positively associated with a decreased loneliness, a higher life satisfaction, a higher positive affect, a higher optimism, a higher self-efficacy (occasional drinkers), a higher self-esteem, and less perceived stress. In addition, occasional and daily drinking were positively associated with less physical illnesses, male gender, and income as compared with never drinking.

Conclusions

The current study extends the existing literature on alcohol consumption behavior by new insights of correlates of drinking behavior among individuals in the second half of life. Since interventions are available to address this risk factor, this might help to identify individuals with increased alcohol consumption.

Electronic supplementary material

The online version of this article (10.1186/s12877-017-0592-3) contains supplementary material, which is available to authorized users.

Increased risk of death immediately after losing a spouse: Cause-specific mortality following widowhood in Norway

OBJECTIVE

This paper examines the short-term risk of cause-specific death following widowhood.

METHOD

We followed all individuals registered as married in Norway in 1975 for marital status and mortality until 2006. Widowed individuals were followed for mortality for 7years following widowhood. Causes of death were categorized into five cause-groups. Life tables were used in survival analyses.

RESULTS

Deaths among the widowed were most frequent in the week following widowhood. In this week and compared to married individuals, there were more deaths including those from malignant cancer in men (hazard ratio (HR) of 1.51; 95% CI: 1.12, 1.89), from external causes in men (HR=3.64; 95% CI: 2.01, 5.28), and from respiratory diseases (HR=2.18; 95% CI: 1.52, 2.84 in men and HR=3.18; 95% CI: 2.26, 4.09 in women). A majority of respiratory deaths were from pneumonia. Thereafter excess mortality among the widowed dropped gradually. Although these numbers stabilized, they were still elevated in year 7. Excess mortality was particularly high in the youngest age group considered (55-64years) and decreased with age, though more so in men than in women. Only a few more widowed individuals than expected died of a condition in the same cause-group as their spouses.

CONCLUSION

A novel finding was that excess deaths in the week following widowhood also were from cancer and respiratory diseases. Men in the youngest age group seemed most vulnerable. Prevention should be considered directly after the death of a spouse, and measures should be aimed at virtually all causes of death.

Changes in routine health behaviors following late-life bereavement: a systematic review

This systematic review examines the relationship between late-life spousal bereavement and changes in routine health behaviors. We review six behavioral domains/modifiable risk factors that are important for maintaining health among elderly populations: physical activity, nutrition, sleep quality, alcohol consumption, tobacco use, and body weight status. Thirty-four articles were identified, derived from 32 studies. We found strong evidence for a relationship between bereavement and nutritional risk and involuntary weight loss, and moderate evidence for impaired sleep quality and increased alcohol consumption. There was mixed evidence for a relationship between bereavement and physical activity. We identify several methodological shortcomings, and describe the clinical implications of this review for the development of preventive intervention strategies.

Alcohol consumption and tobacco smoking among community-dwelling older Australian men: the Concord Health and Ageing in Men Project

AIM

To describe the prevalence and correlates of alcohol consumption and tobacco smoking among older Australian men.

METHOD

Self-reported alcohol and tobacco use was assessed among a random sample of community-dwelling men aged ≥70 years living in Sydney (n = 1705) from 2005 to 2007. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with alcohol and tobacco use.

RESULTS

The prevalence of heavy/excessive drinking was 19.2%, daily drinking 33.7%, and binge drinking 14.1%. Daily drinking was associated with chronic pain (OR = 1.38, 95% CI: 1.07-1.78). Binge drinking was associated with anxiety (OR = 1.93, 95% CI: 1.05-3.54) and being widowed (OR = 1.74, 95% CI: 1.11-2.73). Six per cent of men were current smokers and 56.7% were former smokers. Former smoking was associated with polypharmacy (OR = 1.47, 95% CI: 1.14-1.91) and each additional comorbid condition (OR = 1.11, 95% CI: 1.03-1.19).

CONCLUSIONS

Nearly one-fifth of older men drank heavily or excessively. This highlights the need for public health initiatives to reduce alcohol consumption in older people.

Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4-5 years later-a population-based study

OBJECTIVE

The focus of this study was on the impact of spousal loss on the development of chronic pain thereafter. More specifically, the aim was to investigate the effect of experiencing low preparedness before a wife's death and the widower's chronic pain 4-5 years after loss.

METHODS

In a population-based study in the years 2004-2005, anonymous questionnaires were sent out to 907 men in Sweden who had lost a wife to cancer in 2000 and 2001. The questionnaires contained questions on the man's preparedness for his wife's death and his physical and psychological health at follow-up.

RESULTS

Altogether, 691 out of 907 questionnaires were retrieved (76%). Younger widowers (38-61 years old) with a low degree of preparedness for their wife's death had an increased risk of experiencing symptoms of chronic pain (odds ratio 6.67; 2.49-17.82) 4-5 years after loss. The same results did not apply for older widowers (62-80 years old) (odds ratio 0.81; 0.32-2.05). Widowers who experienced chronic pain were at an increased risk for psychological morbidity, depression (relative risk [RR] 2.21; 1.31-3.74), anxiety (RR 2.11; 1.33-3.37), and sleep disorders (RR 2.19; 1.30-3.69).

CONCLUSION

Our data suggest that low preparedness for a wife's death may increase risk of chronic pain among younger widowers 4-5 years after loss. In addition, we found comorbidity between psychological symptoms and chronic pain among widowers. These findings call for studies on possible mechanisms in the association between low preparedness and morbidity and on how to increase preparedness for a wife's death to cancer.

Relationship of age and gender to the prevalence and correlates of psychological distress in later life

BACKGROUND

As populations age, psychological distress in late life will become of increasing public health and social importance. This study seeks to bridge the gap in information that exists about psychological distress in late life, by exploring the prevalence of psychological distress among a very large sample of older adults to determine the impact of age and gender, and the modifying effect of these factors on the associations between measures of psychological distress and sociodemographic and comorbid conditions.

METHODS

We analyzed self-reported data from 236,508 men and women in the New South Wales 45 and Up Study, to determine the impact of age and gender, and the modifying effects of these factors on associations between psychological distress and sociodemographic and comorbid conditions.

RESULTS

Higher education, married status, and higher income were associated with lower risk of psychological distress. Although overall prevalence of psychological distress is lower at older ages, this increases after age 80, and is particularly associated with physical disabilities. Some older people (such as those requiring help because of disability and those with multiple comorbid health conditions) are at increased risk of psychological distress.

CONCLUSION

These findings have implications for both healthcare providers and policy-makers in identifying and responding to the needs of older people in our aging society.

Anticipatory Grief Among Close Relatives of Persons With Dementia in Comparison With Close Relatives of Patients With Cancer

Close relatives of persons with dementia self-reported reactions on the Anticipatory Grief Scale (AGS), were observed by nurses (Study I), and compared with relatives of cancer patients in a study using the same methodology (Study II). Study I showed an overall stressful situation including feelings of missing and longing, inability to accept the terminal fact, preoccupation with the ill, tearfulness, sleeping problems, anger, loneliness, and a need to talk. The ability to cope was, however, reported high. Self-assessments and nurses' observations did not always converge, e.g. for the acceptance of the illness. The reactions of the relatives in the dementia and the cancer groups showed more similarities than dissimilarities. However, the higher number of responding spouses in the cancer group may have influenced the outcome.

Alcohol use in the first three years of bereavement: a national representative survey

Background

Earlier results concerning alcohol consumption of bereaved persons are contradictory. The aim of the present study was to analyze the relationship between bereavement and alcohol consumption accounting for time and gender differences on a nationally representative sample from Hungary ("Hungarostudy Epidemiological Panel Survey", N = 4457)

Methods

Drinking characteristics of mourning persons (alcohol consumption, dependence symptoms, and harmful consequences of alcohol use) in the first three years of grief were examined among persons between 18-75 years using the Alcohol Use Disorders Identification Test (AUDIT).

Results

Men bereaved for one year scored higher on two dimensions of AUDIT (dependence symptoms and harmful alcohol use), while men bereaved for two years scored higher on all three dimensions of AUDIT compared to the non-bereaved. The rate of men clinically at-risk concerning alcohol consumption among the non-bereaved is 12.9%, and among men bereaved for one year is 18.4% (a non-significant difference), while 29.8% (p < 0.001, OR = 2,781) among men bereaved for two years. However, men bereaved for three years did not differ from the non-bereaved in their drinking habits. In case of bereaved women, again no difference was found with respect to alcohol use compared to the non-bereaved.

Conclusion

Among bereaved men, the risk of alcohol related problems tends to be higher, which can be shown both among men bereaved for one year as well as men bereaved for two years. Considering the higher morbidity and mortality rates of bereaved men, alcohol consumption might play a mediator role. These facts draw attention to the importance of prevention, early recognition, and effective therapy of hazardous drinking in bereaved men.

Long-term mental health of men who lose a wife to cancer--a population-based follow-up

OBJECTIVE

This study investigated the long-term risk of psychological morbidity for men after losing a wife to cancer. A further aim of the study was to investigate if being in a new relationship at the time of follow-up affects the risk of psychological morbidity.

METHOD

In a population-based cohort study, we collected data from 907 men in Sweden who lost a wife to cancer in the breast, ovary or colon 4-5 years earlier. A control group of 330 married men was also included.

RESULTS

Six hundred ninety-one of the widowers (76%) and 262 of the controls (79%) answered a questionnaire. Widowers in a new relationship had a similar risk of psychological morbidity compared with a control group of married men. However, compared with widowers in a new relationship, single widowers reported increased risks of (among other symptoms) the following: depression (RR 2.2, confidence interval [CI] 1.5-3.2), anxiety (RR 1.6, CI 1.1-2.5) emotional numbness (RR 2.2, CI 1.7-2.8), and waking up at night with anxiety (RR 2.2, CI 1.4-3.7).

CONCLUSIONS

Men who lost a wife to cancer in Sweden in 2000 or 2001 and are single 4-5 years later have increased risks of psychological morbidity, both compared with widowers who are in a new relationship at the time of follow-up and with married men. Further scientific effort is needed for improved understanding of the most likely underlying mechanisms; that is, that enhanced emotional support of a new relationship after the loss of a wife protects against psychological morbidity, or alternatively, that the healthiest widowers enter a new relationship.

Inter-rater reliability of the Bereavement Risk Assessment Tool

Objective:

The Bereavement Risk Assessment Tool (BRAT) was designed to consistently communicate information affecting bereavement outcomes; to predict the risk for difficult or complicated bereavement based on information obtained before the death; to consider resiliency as well as risk; and to assist in the efficacy and consistency of bereavement service allocation. Following initial development of the BRAT's 40 items and its clinical use, this study set out to test the BRAT for inter-rater reliability along with some basic validity measures.

Method:

Case studies were designed based on actual patients and families from a hospice palliative care program. Bereavement professionals were recruited via the internet. Thirty-six participants assessed BRAT items in 10 cases and then estimated one of 5 levels of risk for each case. These were compared with an expert group's assignment of risk.

Results:

Inter-rater reliability for the 5-level risk scores yielded a Fleiss’ kappa of 0.37 and an intra-class correlation (ICC) of 0.68 (95% CI 0.5-0.9). By collapsing scores into low and high risk groups, a kappa of 0.63 and an ICC of 0.66 (95% CI 0.5-0.9) was obtained. Participant-estimated risk scores yielded a kappa of 0.24. Although opinion varied on the tool's length, participants indicated it was well organized and easy to use with potential in assessment and allocation of bereavement services. Limitations of the study include a small sample size and the use of case studies. Limitations of the tool include the subjectivity of some items and ambiguousness of unchecked items.

Significance of results:

The collapsed BRAT risk levels show moderately good inter-rater reliability over clinical judgement alone. This study provides introductory evidence of a tool that can be used both prior to and following a death and, in conjunction with professional judgment, can assess the likelihood of bereavement complications.

The prospective relationship between binge drinking and physician visits among older adults

OBJECTIVES

The objectives are to (a) determine if binge drinking is related to physician visits and (b) estimate the degree to which the relationship between binge drinking and physician visits can be explained by other health characteristics.

METHOD

Data on a sample of 4,960 older adults (70+ years of age in 2002) from the Health and Retirement Study (HRS) were used. Three linear regression models estimated the impact of binge drinking on physician visits.

RESULTS

In the fully adjusted models, binge drinking did have an effect on the number of physician visits by older adults, with more frequent binge drinkers having fewer physician visits. This negative relationship exists even when demographic as well as other current health characteristics are controlled.

DISCUSSION

The implications of these results are discussed in terms of more broadly communicating the risks associated with binge drinking and more effectively targeting interventions to older binge drinkers.

Unique aspects of women's emotional responses to disability

PURPOSE

To improve rehabilitation clinicians' awareness of gender differences in emotional responses to disability as a means of enhancing accuracy and sensitivity in diagnosis and treatment of persons in their care.

METHOD

A prospective survey study using a new grief measure, the Loss Inventory (LI), with a diverse convenience sample of persons undergoing inpatient rehabilitation in the USA. Focused review of the bereavement, depression, and disability literatures related to observed gender differences.

RESULTS

Study participants reported grief symptoms in varying intensities. Consistent with all literature reviewed, significant gender differences were found in kind and intensity of grief and depression symptoms reported. Ethnicity also significantly affected responses to disability by LI study participant responses.

CONCLUSIONS

While persons with disabilities as a whole may not necessarily develop depression, gender is a risk factor for onset of mood problems after illness or injury-related losses. As compared with study sample disabled men, disabled women reported more intense and different symptoms of grief and depression. Women with disabilities in the LI sample were twice as likely as disabled men to be depressed. Rehabilitation clinicians may wish to incorporate consideration of these differences in their mental health assessments, diagnoses, and treatment plans.

Factors related to alcohol and drug consumption in Swedish widows

The use of alcohol and medications among Swedish widows was analyzed in relation to various background variables. In Total, 1053 widows (640 widows younger than 65 years and 413 widows older than 65 years) answered the questionnaire. Many reported increased fatigue and sleeping problems. Around one-third of the widows reported drinking alcohol for relief of grief and inadequate support. Association existed between grief and increased intake of sedatives and sleeping pills, and between grief and drinking for relief of grief, as well as increase in intake of sedatives. In widows older than 65 years, perception of bad health, negative outlook for the future, and insufficient support seemed to increase the risk of more sedatives and sleeping pills. Negative outlook for the future also tended to lead to a heightened risk for increased intake of alcohol. There seems to be remaining health problems a long time after bereavement, and counseling may be needed especially when drugs and alcohol are extensively used.

A population-based study on binge drinking among elderly Brazilian men: evidence from the Belo Horizonte and Bambuí health surveys

OBJECTIVES: To assess the prevalence and factors associated with binge drinking in two populations of older adults (≥ 60 years). METHOD: A random sample of 685 subjects in the metropolitan area of Belo Horizonte (4.4 million inhabitants) and 643 subjects (92.7% from total residents) in Bambuí City (15,000 inhabitants), both in Southeast Brazil, participated in the study. The dependent variable was binge drinking (≥ 5 drinks on a single occasion in the last 30 days), and independent variables included sociodemographic characteristics, social network, health conditions and use of health services. RESULTS: The prevalence of binge drinking was higher in the metropolitan area of Belo Horizonte (27.0%) than in Bambuí (13.7%). In the multivariate analysis, worse self-rated health was the only variable associated with binge drinking in both populations (Prevalence ratios [PR] 0.62; 95%CI 0.45-0.85 and 0.57; (0.40-0.83), respectively). On the other hand, two important differences were found: 1) in the metropolitan area of Belo Horizonte, binge drinking was associated with higher school level [8+ years] (PR = 1.55; 95%CI 1.07-2.26) and functional disability (PR = 0.12); 95%CI (0.02-0.83) 2) in Bambuí, binge drinking was associated with being divorced or separated (PR = 2.49; 95%CI 1.55-3.99). CONCLUSIONS: Among older adults, differences of prevalence and factors associated with binge drinking can be found in a same country, probably due to sociocultural influences.