Functioning and health service use among elderly nursing home residents with alcohol use disorders: findings from the National Nursing Home Survey

Alcohol in long-term care homes: A qualitative investigation with residents, relatives, care workers and managers

Introduction

Western societies are aging rapidly, and habitual use of alcohol is changing among older adults. Hence, care facilities are facing novel challenges regarding alcohol use. This pioneering qualitative study seeks to investigate the role of alcohol in care homes, as seen from the perspectives of residents, care workers, relatives, and institution management simultaneously.

Method

Five residents, four care workers, three relatives, and two care home managers participated in semi-structured interviews lasting 60 minutes maximum. An interpretative phenomenological analysis framework were utilised for the analysis.

Results

It seems that there is a positive attitude towards the use of alcohol in care homes across the four groups of participants. They find that the use of alcohol is presently low among the residents. Importantly there appears to be an important symbolic value in the rituals surrounding alcohol which is upheld by all four groups.

Conclusion

While experiences between the four groups seem to converge regarding the use of alcohol, there are still some important differences. Importantly, we suggest that these unique views be utilised in developing methods for handling alcohol use in care homes in the future.

Health service use among Manitobans with alcohol use disorder: a population-based matched cohort study

BACKGROUND

Alcohol is the drug most commonly used by Canadians, with multiple impacts on health and health service use. We examined patterns of short- and long-term health service use among people with a diagnosis of alcohol use disorder.

METHODS

In this retrospective matched cohort study, we used population-based administrative data from the province of Manitoba, Canada, to identify individuals aged 12 years or older with a first indication of alcohol use disorder (index date) in the period 1990 to 2015. We matched cases (those with diagnosis of alcohol use disorder) to controls (those without this diagnosis), at a 1:5 ratio, on the basis of age, sex, geographic region and income quintile at the index date. The outcome measures were inpatient hospital admission, outpatient physician visits, emergency department visits and use of prescription medications. We modelled crude rates using generalized estimating equations with either a negative binomial or a Poisson distribution RESULTS: We identified 53 410 people with alcohol use disorder and 264 857 matched controls. All outcomes occurred at a higher rate among people with the disorder than among controls. For example, during the year of diagnosis, the rate ratio for hospital admission was 4.0 (95% confidence interval [CI] 3.9-4.2) for women and 4.5 (95% CI 4.4-4.7) for men. All rates of health service use peaked close to the index date, but remained significantly higher among people with alcohol use disorder than among controls for 20 years. Among people with alcohol use disorder, the most commonly filled prescriptions were for psycholeptics, whereas among controls, the most commonly filled prescriptions were for sex hormones (women) and antihypertensives (men).

INTERPRETATION

Compared with controls, people with alcohol use disorder used significantly more health services from the time of diagnosis and over the next 20 years. This finding highlights the need for better detection and early intervention to reduce the need for acute and emergency care, as well as the need for improved management of alcohol use disorder over the longer term.

Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California

Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.