Kathleen K. Schutte

Stress Generation, Avoidance Coping, and Depressive Symptoms: A 10-Year Model.

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective.

AIMS The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. DESIGN, PARTICIPANTS AND MEASURES: A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later. FINDINGS The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75-85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems. CONCLUSIONS A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.

Late-Life Alcohol Consumption and 20-Year Mortality

BACKGROUND Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. METHODS The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate. RESULTS Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. CONCLUSIONS Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.

High-Risk Alcohol Consumption and Late-Life Alcohol Use Problems

OBJECTIVES We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems. METHODS A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later. RESULTS Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals. CONCLUSION Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.

Gender differences in the relations between depressive symptoms and drinking behavior among problem drinkers: a three-wave study.

Prior research has suggested that the relation between depression and drinking behavior is stronger for women than for men. In a 3-wave study spanning 3 years, we examined the nature of reciprocal relations between depressive symptoms and drinking behavior among women (n = 207) and men (n = 207) seeking detoxification or referral services for their drinking problems. Latent variable structural equation modeling analyses revealed that more baseline depression was associated with less alcohol consumption 1 year later among women and men. However, later on, more depression predicted heavier alcohol consumption, but only among women. Among women and men, heavier alcohol consumption predicted more subsequent depression, although the timing of this effect differed by gender. Reciprocal effects between depression and drinking problems were found only among men.

Older adults’ health and late-life drinking patterns: A 20-year perspective

Objectives: This study focused on the associations between older adults’ health-related problems and their late-life alcohol consumption and drinking problems. Methods: A sample of 719 late-middle-aged community residents (55–65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later. Results: Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individuals overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems. Conclusion: Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Older adults’ health and changes in late-life drinking patterns

This study focused on the prospective associations between older adults’ health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55–65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

Late-life and life history predictors of older adults’ high-risk alcohol consumption and drinking problems

AIMS This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55-65 to 75-85. DESIGN, SETTING, PARTICIPANTS A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later. MEASUREMENTS At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking. RESULTS Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems. CONCLUSION Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Depressive symptoms, drinking problems, and smoking cessation in older smokers

This study modeled the predictive association between depressive symptoms and smoking cessation in a sample of 442 late-middle-aged smokers; assessments occurred at four time-points across a 10-year period. In addition, the study examined the role of baseline drinking problems in moderating the relationship between depressive symptoms and smoking cessation. Findings supported hypotheses. More depressive symptoms prospectively predicted a lower likelihood of smoking cessation. In addition, the presence of baseline drinking problems strengthened the relationship between depressive symptoms and a lower likelihood of smoking cessation. Understanding the mechanisms underlying depression and cigarette smoking among older adults is applicable to secondary prevention and treatment and suggests additional public health benefits from treating depression in older persons.

Coping trajectories in later life: A 20-year predictive study

Objectives and method: Information about aging-related change in coping is limited mainly to results of cross-sectional studies of age differences in coping, and no research has focused on predictors of aging-related change in coping behavior. To extend research in this area, we used longitudinal multilevel modeling to describe older adults’ (n = 719; baseline M = 61 years) 20-year, intraindividual approach and avoidance coping trajectories, and to determine the influence of two sets of predictors (threat appraisal and stressor characteristics; gender and baseline personal and social resources) on level and rate of change in these trajectories. Results: Over the 20-year study interval, participants declined in the use of approach coping and most avoidance coping strategies, but there was significant variation in this trend. In simultaneous predictive models, female gender, more threat appraisal, stressor severity, social resources, and depressive symptoms, and fewer financial resources were independently associated with higher initial levels of coping responses. Having more social resources, and fewer financial resources, at baseline in late-middle-age predicted faster decline over time in approach coping. Having more baseline depressive symptoms, and fewer baseline financial resources, hastened decline in use of avoidance coping. Independent of other variables in these models, decline over time in approach coping and avoidance coping remained statistically significant. Conclusion: Overall decline in coping may be a normative pattern of coping change in later life. However, it also is modifiable by older adults’ stressor appraisals, their stressors, and the personal and social resources they possess at entry to later life, in late-middle-age.