James C. Lin

Primary Care Based Intervention to Reduce At-Risk Drinking in Older Adults: A Randomized Controlled Trial

AIMS To examine whether a multi-faceted intervention among older at-risk drinking primary care patients reduced at-risk drinking and alcohol consumption at 3 and 12 months. DESIGN Randomized controlled trial. SETTING Three primary care sites in southern California. PARTICIPANTS Six hundred and thirty-one adults aged ≥ 55 years who were at-risk drinkers identified by the Comorbidity Alcohol Risk Evaluation Tool (CARET) were assigned randomly between October 2004 and April 2007 during an office visit to receive a booklet on healthy behaviors or an intervention including a personalized report, booklet on alcohol and aging, drinking diary, advice from the primary care provider and telephone counseling from a health educator at 2, 4 and 8 weeks. MEASUREMENTS The primary outcome was the proportion of participants meeting at-risk criteria, and secondary outcomes were number of drinks in past 7 days, heavy drinking (four or more drinks in a day) in the past 7 days and risk score. FINDINGS At 3 months, relative to controls, fewer intervention group participants were at-risk drinkers [odds ratio (OR) 0.41; 95% confidence interval (CI) 0.22-0.75]; they reported drinking fewer drinks in the past 7 days [rate ratio (RR) 0.79; 95% CI 0.70-0.90], less heavy drinking (OR 0.46; 95% CI 0.22-0.99) and had lower risk scores (RR 0.77 95% CI 0.63-0.94). At 12 months, only the difference in number of drinks remained statistically significant (RR 0.87; 95% CI 0.76-0.99). CONCLUSIONS A multi-faceted intervention among older at-risk drinkers in primary care does not reduce the proportions of at-risk or heavy drinkers, but does reduce amount of drinking at 12 months.

Alcohol, Tobacco, and Nonmedical Drug Use in Older U.S. Adults: Data from the 2001/02 National Epidemiologic Survey of Alcohol and Related Conditions

OBJECTIVES: To examine the prevalence and sociodemographic and health‐related correlates of substance use, including alcohol, tobacco, and nonmedical drug use, in adults aged 65 and older.

Nonsurgical Treatment for Rotator Cuff Injury in the Elderly

Shoulder pain is a common musculoskeletal complaint in the general population. The elderly population is often afflicted, and rotator cuff problems are among the most common causes of shoulder pain seen in primary care practices. The prevalence of shoulder pain in the elderly has been estimated to range from 21% to 27%, and the prevalence of rotator cuff tear increases with advanced age. The etiology of rotator cuff disease is likely multifactorial, including both extrinsic and intrinsic factors. Rotator cuff dysfunction encompasses a spectrum of pathological changes, ranging from impingement syndrome to rotator cuff tendonitis to rotator cuff tendon tear. In the elderly population, the clinical manifestations from rotator cuff dysfunction can translate into significant morbidity and disabilities, interfering with ability for self care and functional independence. The goals of managing rotator cuff disease are to regain normal shoulder function and biomechanics, and to improve functional abilities in elderly patients. Treatment can consist of various conservative therapies (including ice, simple exercises, medications), and progress to more intensive physical therapy and/or corticosteroid injections. Rotator cuff dysfunction is a common musculoskeletal disorder in elderly patients and is often underdiagnosed and undertreated. Physicians should be aware of the prevalence of rotator cuff disease in this population and provide early diagnosis and treatment to help preserve the functional ability and independence of older patients.

Alcohol, Tobacco, and Nonmedical Drug Use Disorders in U.S. Adults Aged 65 Years and Older: Data From the 2001–2002 National Epidemiologic Survey of Alcohol and Related Conditions

OBJECTIVES To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older. DESIGN The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample. SETTING The United States. PARTICIPANTS Eight thousand two hundred five adults aged 65 years and older. MEASUREMENTS Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders. RESULTS Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder. CONCLUSIONS More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use.

Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey.

Objective: To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults. Method: Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods. Results: Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged ≥65 years. Other drinking patterns were not associated with lower odds of incident functional limitation. Discussion: Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

Why Do Older Unhealthy Drinkers Decide to Make Changes or Not in Their Alcohol Consumption? Data from the Healthy Living as You Age Study

To understand characteristics of older at‐risk drinkers and reasons why they decide to change or maintain their alcohol consumption.

Determinants of early reductions in drinking in older at-risk drinkers participating in the intervention arm of a trial to reduce at-risk drinking in primary care.

OBJECTIVES: To describe differences between older at‐risk drinkers, as determined using the Comorbidity Alcohol Risk Evaluation Tool, who reduced drinking and those who did not after an initial intervention and to determine factors associated with early reductions in drinking.

Alcohol, Tobacco and Non-Medical Drug Use in U.S. Adults Aged 65 Years and Older: Data from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions

OBJECTIVES: To examine the prevalence and sociodemographic and health‐related correlates of substance use, including alcohol, tobacco, and nonmedical drug use, in adults aged 65 and older.

Alcohol, Tobacco, and Nonmedical Drug Use in Older U.S. Adults: Data from the 2001/02 National Epidemiologic Survey of Alcohol and Related Conditions: ALCOHOL, TOBACCO, AND NONMEDICAL DRUG USE IN OLDER ADULTS

OBJECTIVES: To examine the prevalence and sociodemographic and health‐related correlates of substance use, including alcohol, tobacco, and nonmedical drug use, in adults aged 65 and older.