Bryan Y. Choi

Relationship between marijuana and other illicit drug use and depression/suicidal thoughts among late middle-aged and older adults.

BACKGROUND Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA. METHODS The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts. RESULTS Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17-2.03), 2.75 (95% CI = 1.75-4.33), and 2.12 (95% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE. CONCLUSIONS Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.

Associations of lifetime abstention and past and current alcohol use with late-life mental health: A propensity score analysis

BACKGROUND Compared to the extensive research on the effects of alcohol intake on physical health, little research has been done on the effects of alcohol use/nonuse patterns on mental disorders in late life. This study examined associations between mental disorders and alcohol use/nonuse patterns among individuals aged 65+ years. METHODS Data came from the public use files of the 2008 to 2012 National Survey on Drug Use and Health. Alcohol use/nonuse groups were lifetime abstainers, ex-drinkers, bingers, and nonbingers. Mental health problems were lifetime major depressive episode (MDE) and anxiety disorder, past-year MDE and anxiety disorder, and past-year serious suicidal ideation. To minimize selection biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity score weights on covariates. Then we employed logistic regression models with mental health outcomes as the dependent variables. RESULTS The four alcohol use/nonuse groups did not differ in past-year MDE. However, odds ratios show that, relative to non-binge drinking, lifetime abstention decreased the odds of lifetime MDE by more than 60% (OR = 0.39, 95% CI = 0.23-0.68, p = .001) and the odds of lifetime anxiety disorder by almost half (OR = 0.55, 95% CI = 0.38-0.79, p = .002). Ex-drinkers were more likely than nonbingers to report past-year serious suicidal thoughts (OR = 2.29, 95% CI = 1.45-3.62, p < .001). CONCLUSIONS While lifetime abstainers had significantly better lifetime mental health histories than nonbingers, ex-drinkers had worse past-year mental health status. Since lifetime abstainers and ex-drinkers have significantly different characteristics, researchers should distinguish between these groups.

Hospital-Directed Feedback to Emergency Medical Services Improves Prehospital Performance

Background and Purpose— A potential way to improve prehospital stroke care and patient handoff is hospital-directed feedback for emergency medical service (EMS) providers. We evaluated whether a hospital-directed EMS stroke follow-up tool improved documentation of adherence to the Rhode Island state prehospital stroke protocol for EMS providers. Methods— A standardized, 10-item feedback tool was developed in 2012 and sent to EMS directors for every transported patient with a discharge diagnosis of ischemic stroke. We reviewed patient charts meeting these criteria between January 2008 and December 2013. Performance on the tool was compared between the preintervention (January 2008 through January 2012) and postintervention (February 2012 through December 2013) periods. Results— We identified 1176 patients with ischemic stroke who arrived by EMS in the study period: 668 in the preintervention period and 508 in the postintervention period. The overall score for the preintervention group was 5.31 and for the postintervention group 6.42 (P<0.001). Each of the 10 items, except checking blood glucose, showed statistically significant improvement in the postintervention period compared with the preintervention period. Conclusions— Hospital-directed feedback to EMS was associated with improved overall compliance with state protocols and documentation of 9 out of 10 individual items. Future confirmatory studies in different locales and studies on the impact of this intervention on actual tissue-type plasminogen activator administration rates and EMS personnel knowledge and behavior are needed.

Identifying Frequent Users of an Urban Emergency Medical Service Using Descriptive Statistics and Regression Analyses

This retrospective cohort study provides a descriptive analysis of a population that frequently uses an urban emergency medical service (EMS) and identifies factors that contribute to use among all frequent users. For purposes of this study we divided frequent users into the following groups: low- frequent users (4 EMS transports in 2012), medium-frequent users (5 to 6 EMS transports in 2012), high-frequent users (7 to 10 EMS transports in 2012) and super-frequent users (11 or more EMS transports in 2012). Overall, we identified 539 individuals as frequent users. For all groups of EMS frequent users (i.e. low, medium, high and super) one or more hospital admissions, receiving a referral for follow-up care upon discharge, and having no insurance were found to be statistically significant with frequent EMS use (P<0.05). Within the diagnostic categories, 41.61% of super-frequent users had a diagnosis of “primarily substance abuse/misuse” and among low-frequent users a majority, 53.33%, were identified as having a “reoccurring (medical) diagnosis.” Lastly, relative risk ratios for the highest group of users, super-frequent users, were 3.34 (95% CI [1.90–5.87]) for obtaining at least one referral for follow-up care, 13.67 (95% CI [5.60–33.34]) for having four or more hospital admissions and 5.95 (95% CI [1.80–19.63]) for having a diagnoses of primarily substance abuse/misuse. Findings from this study demonstrate that among low- and medium-frequent users a majority of patients are using EMS for reoccurring medical conditions. This could potentially be avoided with better care management. In addition, this study adds to the current literature that illustrates a strong correlation between substance abuse/misuse and high/super-frequent EMS use. For the subgroup analysis among individuals 65 years of age and older, we did not find any of the independent variables included in our model to be statistically significant with frequent EMS use.

Sociodemographic characteristics and health status of lifetime abstainers, ex-drinkers, bingers, and nonbingers among baby boomers and older adults

ABSTRACT Background: Health risks associated with abstention from alcohol drinking in previous studies may have been exaggerated because the pool of abstainers in many studies included both lifetime abstainers and ex-drinkers, including sick-quitters. Objectives: This study compared sociodemographic and health statuses among lifetime abstainers, exdrinkers, bingers, and nonbingers in the 50–64 age group (baby boomers) and the 65+ age group. Methods: Data are from the 2008 to 2012 National Survey on Drug Use and Health (N = 18,443 for the 50–64 age group and N = 11,191 for the 65+ age group). Descriptive statistics and multinomial and binary logistic regression analyses were used to examine the study questions. Results: 10% of the 50–64 age group and 20% of the 65+ age group reported lifetime abstention, and 21% and 28% of each group, respectively, reported being ex-drinkers (i.e., last used alcohol more than 12 months ago). In both age groups, lifetime abstainers, exdrinkers, and bingers had lower socioeconomic status than nonbingers. In the 50–64 age group, lifetime abstainers did not differ from or were less likely than nonbingers to have vascular and hepatic/gastrointestinal (HGI) disorders, but exdrinkers were more likely to have these diseases, and both lifetime abstainers and exdrinkers were more likely to have diabetes. In the 65+ age group, lifetime abstainers did not differ from nonbingers on high blood pressure, heart disease, and HGI, but both they and the exdrinkers were more likely to have stroke and diabetes. Conclusions/Importance: Diabetes screening/monitoring and stroke prevention/care are recommended for both age groups of abstainers and exdrinkers.

Association between Nonmedical Marijuana and Pain Reliever Uses among Individuals Aged 50

ABSTRACT Marijuana and pain reliever use for medical and nonmedical purposes has been increasing among older adults. Using the 2012–2013 U.S. National Survey on Alcohol and Related Conditions (NESARC-III), this study examined: (1) the association between past-year nonmedical marijuana and pain reliever use among adults aged 50+ years (N = 14,715); and (2) sociodemographic, health, and pain-related correlates of nonmedical marijuana and/or pain reliever use. The findings show that 3.87% and 3.12%, respectively, used marijuana and pain relievers nonmedically and 14.40% of marijuana users, compared to 2.67% of nonusers, used pain relievers nonmedically. Controlling for sociodemographics, health status, pain interference, and mental and other substance use disorders, marijuana use anduse disorder were significantly associated with nonmedical pain reliever use and opioid use disorder, respectively. Compared to marijuana users (with or without nonmedical use of pain relievers), nonmedical pain reliever users (without marijuana) are older, married, and women. Users of both substances nonmedically are a small group (0.56% of the 50+ age group), but they are at greatest risk of lifetime opioid, alcohol, and nicotine use disorders. Pain interference is a significant correlate of nonmedical pain reliever use. Healthcare providers should assess for the nonmedical use of these medicines/drugs and help older adults receive effective pain treatment.

Older adults’ marijuana use, injuries, and emergency department visits

ABSTRACT Background: Despite increasing marijuana use among older adults, little research has been done on marijuana’s effects on their healthcare use. Objectives: To examine whether (1) marijuana use is associated with the likelihood of emergency department (ED) visits through increased injury risk, and (2) marijuana use patterns are associated with injury risk and ED visits among older adults. Methods: Using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Problems (N = 14,715 aged 50+; 6,379 men and 8,336 women), descriptive statistics were used to compare past-year marijuana users to nonusers on sociodemographic and physical/mental health characteristics. Structural equation modeling was used to simultaneously estimate whether injury mediates past-year marijuana use’s association with ED visits. Logistic regression analysis was used to examine associations of marijuana use patterns with injury and ED visits. Results: Past-year injury rates were 18.9% for nonusers and 28.8% for users (3.9% of the 50+ age group), and past-year ED visit rates were 23.5% for nonusers and 30.9% for users (p < .001). Logistic regression models showed that marijuana use was associated with injury (OR = 1.48, 95% CI = 1.18–1.85), and injury was associated with ED visits (OR = 6.14, 95% CI = 1.70–1.93). Mediation analysis found significant indirect effect (z = 2.86, p = .004) and direct effect not significantly differing from zero (OR = 1.16, 95% CI = 0.90–1.50), indicating that marijuana use increases the likelihood of ED visits through increased injury risk. Marijuana use patterns were not associated with injuries or ED visits. Conclusions: Healthcare providers should screen for marijuana and other substance use among older adults and provide education about associated injury risks.

Alcohol, Injury, and Aging

Unintentional falls, unintentional motor vehicle crashes (MVCs), and suicides are top three leading causes of injury deaths among older adults. Unintentional falls and unintentional MVCs also rank among the causes of nonfatal injuries treated in hospital emergency departments (ED) for the 65+ age group. As in younger adults, alcohol use in older adults increases the risk of injuries and injury-related (and noninjury-related) mortality. Because of aging-related physiological changes, multiple chronic medical conditions, and use more prescription drugs in older adults than younger adults, alcohol use can be especially harmful in late life. In this chapter, we summarize previous research on alcohol-related injury and death in older adults, focusing on falls, MVCs while driving under the influence, and suicide and suicide attempts. We then discuss clinical implications of the research findings including prevention strategies for both unintentional and intentional injuries among the growing numbers of older adults.

Association of Traffic Injuries, Substance Use Disorders, and ED Visit Outcomes among Individuals Aged 50+ Years

Abstract Objectives: Motor vehicle traffic (MVT) injury is the second most frequent type of injury among older emergency department (ED) patients. We examined the role of substance use disorders (SUD) in ED visit outcomes among older MVT injury patients either as drivers, passengers, or pedestrians. Methods: Using the 2012 U.S. National Emergency Department Sample, we employed multinomial logistic regression to analyze the association of SUD with ED visit outcomes among 171,145 ED events by MVT injury patients aged 50+. We estimated marginal probabilities of ED outcomes in three age groups (50–64, 65–74, and 75+) by SUD status. Results: MVT injuries were 2.31%, 1.46%, and 0.73% of ED visits in the 50–64, 65–74, and 75+ age groups, and SUDs were found in 4.08%, 1.92%, and 0.94% of the MVT-injury visits in these age groups. SUD had small to medium effects on the risk of hospital admission (RRR = 3.39, 95% CI = 3.14–3.66), transfer to a facility or discharge with initiation of home health care (RRR = 3.18, 95% CI = 2.28–4.44), relative to treat-and-release. Conclusions: A larger proportion of those with SUD than those without SUD had multiple and more severe injuries that required hospitalization and institutional care. It is important to include MVT injury prevention in the treatment of older substance misusers.

Alcohol Use as Risk Factors for Older Adults' Emergency Department Visits: A Latent Class Analysis

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.