Older Adults’ Inpatient and Emergency Department Utilization for Ambulatory-Care-Sensitive Conditions: Relationship With Alcohol Consumption

Merrick, Elizabeth S. Levy; Hodgkin, Dominic; Garnick, Deborah W.; Horgan, Constance M.; Panas, Lee; Ryan, Marian; Blow, Frederic C.; Saitz, Richard

doi:10.1177/0898264310383156

Cited by 17 publications

(16 citation statements)

References 49 publications

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“…Factors associated with comorbid alcohol use among older adults, such as low utilization of preventative care and other psychiatric comorbidity, may lower the threshold for admission, leading alcohol comorbid individuals’ lower overall severity to be admitted. Merrick et al (2011) identified a greater likelihood of an emergency department visit for ambulatory care–sensitive conditions among heavy drinking older adults. Similarly, those with alcohol-related diagnoses may be admitted with lower overall depression severity, because alcohol use disorders are associated with increased risk of suicide in older adults (Blow, Brockmann, & Barry, 2004; Conwell, Duberstein, & Caine, 2002).…”

Section: Discussionmentioning

confidence: 99%

Hospital Outcomes in Major Depression Among Older Adults: Differences by Alcohol Comorbidity

Sacco

Unick

Zanjani

et al. 2015

Journal of Dual Diagnosis

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Objective The prevalence of depression in older adults has been increasing over the last 20 years and is associated with economic costs in the form of treatment utilization and caregiving, including inpatient hospitalization. Comorbid alcohol diagnoses may serve as a complicating factor in inpatient admissions and may lead to overutilization of care and greater economic cost. This study sought to isolate the comorbidity effect of alcohol among older adult hospital admissions for depression. Methods We analyzed a subsample (N = 8,480) of older adults (65 + ) from the 2010 Nationwide Inpatient Sample who were hospitalized with primary depression diagnoses, 7,741 of whom had depression only and 739 of whom also had a comorbid alcohol disorder. To address potential selection bias based on drinking and health status, propensity score matching was used to compare length of stay, total costs, and disposition between the two groups. Results Bivariate analyses showed that older persons with depression and alcohol comorbidities were more often male (59.9% versus 34.0%, p < .001) and younger (70.9 versus 75.9 years, p < .001) than those with depression only. In terms of medical comorbidities, those with depression and alcohol disorders experienced more medical issues related to substance use (e.g., drug use diagnoses, liver disease, and suicidality; all p < .001), while those with depression only experienced more general medical problems (e.g., diabetes, renal failure, hypothyroid, and dementia; all p < .001). Propensity score matched models found that alcohol comorbidity was associated with shorter lengths of stay (on average 1.08 days, p < .02) and lower likelihood of post-hospitalization placement in a nursing home or other care facility (OR = 0.64, p < .001). No significant differences were found in overall costs or likelihood of discharge to a psychiatric hospital. Conclusions In older adults, depression with alcohol comorbidity does not lead to increased costs or higher levels of care after discharge. Comorbidity may lead to inpatient hospitalization at lower levels of severity, and depression with alcohol comorbidity may be qualitatively different than non-comorbid depression. Additionally, increased costs and negative outcomes in this population may occur at other levels of care such as outpatient services or emergency department visits.

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Section: Discussionmentioning

confidence: 99%

Hospital Outcomes in Major Depression Among Older Adults: Differences by Alcohol Comorbidity

Sacco

Unick

Zanjani

et al. 2015

Journal of Dual Diagnosis

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“…Older‐adult ED visitors with fall‐related injuries often require substantial recurrent health care use; however, drinking problems can interfere with continuing treatment and recovery. In general, older adults with drinking problems have been found to use primary and preventive care less often than their age peers without drinking problems . One study also found that problem drinking was associated with worse self‐perceived health among older‐adult patients in the year following an ED visit …”

Section: Discussionmentioning

confidence: 99%

“…First, data on substance misuse were limited to diagnoses of alcohol and drug use disorders, which tend to be low among older adults. Adverse effects of drinking that do not meet alcohol use disorder diagnostic criteria may be as likely as alcohol use disorders to precipitate ED use among older adults . NEDS should include data on at‐risk and binge/heavy drinking to provide more insight into the effects of alcohol use on presenting problems and outcomes.…”

Section: Limitationsmentioning

confidence: 99%

Associations of Mental Health and Substance Use Disorders With Presenting Problems and Outcomes in Older Adults’ Emergency Department Visits

Choi

DiNitto

Marti

et al. 2015

Academic Emergency Medicine

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Objectives: The increasing prevalence of mental health and/or substance use disorders in older adults is a significant public health issue affecting their health, health care use, and health care outcomes. These disorders are especially prevalent in emergency department (ED) visits. This study examined the effect of mental health and substance use disorders on older adults' ED presenting problems and outcomes.Methods: Data were from the publicly available 2012 Nationwide Emergency Department Sample data set (unweighted n = 5,344,743 visits by the 65+ years age group). We used binary logistic regression analysis to test relationships between mental health and substance use disorders and suicide attempts, falls, and other injuries and multinomial logistic regression analysis to test relationships between the disorders and ED outcomes of death, hospital admission, transfer to institutional care, home health care, leaving against medical advice (AMA), or other or unknown destinations, as opposed to routine care.Results: Of ED visits by older adults, 5.1% involved anxiety disorders, 7.1% involved mood disorders, 10.45% involved delirium/dementia, 1.4% involved alcohol use disorders, and 0.6% involved drug use disorders; 0.2% were suicide-related, 12.0% involved falls, and 10.2% involved other injuries. Mental health and substance use disorders had large-to-medium effects on suicide attempts. Both dementia and delirium and alcohol use disorders had a small effect on falls. Drug use disorders had a small effect on other injuries. Anxiety disorder had a small effect on the risk of death in the ED or in the hospital, relative to routine care. Suicide attempts and drug use disorders had a medium effect on hospital admission. Suicide attempts had a large effect, delirium and dementia and other mental disorders had medium effects, and mood disorder had a small effect on the risk of transfer to another facility. Delirium and dementia, suicide attempts, and drug use disorders had small effects on the risk of discharge with home health care. Alcohol use disorders and drug use disorders had a small effect on the risk of leaving AMA. Finally, suicide attempts had a medium effect on the risk of other outcomes and unknown destinations.Conclusions: Late-life mental health and substance use disorders are significant risk factors for both intentional self-harm and unintentional injuries that bring older adults to the ED and contribute to ED dispositions and outcomes that involve more intensive and longer-term health care services.

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“…Hearing disability has been shown to compromise well-being among older adults [135], those experiencing late onset deafness showing significantly lower well-being [136]. How older adults manage end-of-life medical decision making has been linked to their personal and affiliative beliefs, rather than to a lack of autonomy [137]. …”

Section: Scientific Advances On Psychological Well-beingmentioning

confidence: 99%

Psychological Well-Being Revisited: Advances in the Science and Practice of Eudaimonia

Ryff

2013

Psychother Psychosom

2,018

1,506

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This article reviews research and interventions that have grown up around a model of psychological well-being generated more than two decades ago to address neglected aspects of positive functioning such as purposeful engagement in life, realization of personal talents and capacities, and enlightened self-knowledge. The conceptual origins of this formulation are revisited and scientific products emerging from 6 thematic areas are examined: (1) how well-being changes across adult development and later life; (2) what are the personality correlates of well-being; (3) how well-being is linked with experiences in family life; (4) how well-being relates to work and other community activities; (5) what are the connections between well-being and health, including biological risk factors, and (6) via clinical and intervention studies, how psychological well-being can be promoted for ever-greater segments of society. Together, these topics illustrate flourishing interest across diverse scientific disciplines in understanding adults as striving, meaning-making, proactive organisms who are actively negotiating the challenges of life. A take-home message is that increasing evidence supports the health protective features of psychological well-being in reducing risk for disease and promoting length of life. A recurrent and increasingly important theme is resilience - the capacity to maintain or regain well-being in the face of adversity. Implications for future research and practice are considered.

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Older Adults’ Inpatient and Emergency Department Utilization for Ambulatory-Care-Sensitive Conditions: Relationship With Alcohol Consumption

Cited by 17 publications

References 49 publications

Hospital Outcomes in Major Depression Among Older Adults: Differences by Alcohol Comorbidity

Hospital Outcomes in Major Depression Among Older Adults: Differences by Alcohol Comorbidity

Associations of Mental Health and Substance Use Disorders With Presenting Problems and Outcomes in Older Adults’ Emergency Department Visits

Psychological Well-Being Revisited: Advances in the Science and Practice of Eudaimonia

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