Substance misuse in older people

Rao, Rahul; Roche, Ann

doi:10.1136/bmj.j3885

Cited by 79 publications

(40 citation statements)

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“…In an earlier Norwegian study of older homedwelling people, the proportion of persons who had a problematic relation to alcohol and a long-term use of psychotropic drugs increased with age (Støver et al, 2012). Older people are more vulnerable to alcohol and psychotropic drug use (Ramchandani et al, 2015;Rao et al, 2015), and this elevated use can be a risk to their mental and physical health, potentially causing hospitalisation. To prevent or reduce elevated use of alcohol and psychotropic drugs in older people, this type of use needs to be detected, and the awareness of elevated and risky use should be enhanced among all healthcare personnel.…”

Section: Discussionmentioning

confidence: 99%

“…Throughout the present study, we will use the term psychotropic drugs to refer to prescribed psychotropic drugs. Both the ageing process (altered metabolism and volume of distribution) and general health (physical and mental) can interact with alcohol consumption and intake of psychotropic drugs, leading to poorer health and impaired function in activities of daily life (Blow & Barry, 2012;Rao, Crome, Crome, Ramakrishnan, & Iliffe, 2015).…”

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confidence: 99%

“…The use can be non-specific, and the role of substance use in the treatment of physical conditions is frequently overlooked (Rao et al, 2015). In addition, Hobden, Bryant, Sanson-Fisher, Oldmeadow, and Carey (2016) note that identification by general practitioners (GPs) of the shared context between depression and alcohol is low.…”

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confidence: 99%

“…In addition, Hobden, Bryant, Sanson-Fisher, Oldmeadow, and Carey (2016) note that identification by general practitioners (GPs) of the shared context between depression and alcohol is low. This is unfortunate because late-onset elevated substance use is more likely to have a better treatment prognosis than early-onset misuse (Moy, Crome, Crome, & Fisher, 2011;O'Connell, Chin, Cunningham, & Lawlor, 2003;Rao et al, 2015).…”

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confidence: 99%

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Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway

Johannesen

Engedal

Larsen

et al. 2017

Nordic Studies on Alcohol and Drugs

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Background: Although alcohol and prescribed psychotropic drug use has increased among older people, the usefulness of information provided about these substances in patients’ referrals to departments of old-age psychiatry (OAPsy) is unknown. Aims: To examine whether patients’ self-reported elevated use of alcohol and prescribed psychotropic drugs corresponds with information provided in the referrals to OAPsy departments and to explore the factors associated with elevated self-reported use of these substances. Methods: We recorded the information provided in referrals about the elevated use of alcohol and psychotropic drugs in a sample of 206 patients (69 men) from 12 OAPsy departments. The Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) helped to assess self-reported use. We also collected demographic data, as well as information about cognitive functioning and symptoms of anxiety and depression. Results: Seventy-three patients (35%) scored above the cut-off for alcohol use for women/men (AUDIT ≥ 3/4) or psychotropic drugs (DUDIT ≥ 6/8), if not both. Twenty patients (10%) reported an elevated use of both alcohol and psychotropic drugs, and the referrals for eight (40%) and ten (50%) of them, respectively, included information about this use. There was a significant association between self-reported use of alcohol above the cut-off and information about elevated use in the referrals. However, no such association was found between information in the referrals and self-reported use of prescribed psychotropic drugs. Elevated alcohol use was associated with more years of education, while elevated use of psychotropic drugs was associated with younger age and severe symptoms of anxiety and depression. Conclusion: The information reported in referrals about the elevated use of alcohol and psychotropic drugs demonstrated a trend in associations with self-reported use. However, the risk factors for elevated use of alcohol and psychotropic drugs in the elderly need to be examined further.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway

Johannesen

Engedal

Larsen

et al. 2017

Nordic Studies on Alcohol and Drugs

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“…Although hazardous alcohol use is declining in the younger age groups, this is not the case in the over fifties [1]. Particularly worrying is the increasing proportion of women drinking in later life, driven by life events including bereavement, changes in personal circumstances and retirement [2]. Therefore, not only is it important for screening and treatment of alcohol misuse in the community, it is crucial to focus on the older population.…”

Section: Introductionmentioning

confidence: 99%

The Enhanced Liver Fibrosis test is associated with liver-related outcomes in postmenopausal women with risk factors for liver disease

et al. 2020

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Background: Chronic liver disease (CLD) is usually asymptomatic but earlier detection is critical to permit lifesaving interventions for those at risk due to high alcohol consumption and increased body mass index (BMI). The aim of this study was to estimate the association between the Enhanced Liver Fibrosis (ELF) test and liver-related events (LRE) and its performance in predicting LRE in postmenopausal women with risk factors in a nested case-control study within the United Kingdom Trial of Ovarian Cancer Screening (UKCTOCS).Methods: In a cohort of 95,126 we performed a case-control study measuring ELF in blinded samples from 173 participants with self-reported high alcohol use and / or BMI ≥25 kg/m 2 comprising all 58 cases who developed LRE and 115 controls matched for age, alcohol and BMI who did not develop LRE during median follow-up of 8.5 years.Results: Using Cox regression at an ELF threshold of 10.51 hazard ratios (HR) for LRE were 4.88 (95% confidence interval (CI) 2.37-10.03) (unadjusted model) and 4.62 (95% CI 2.12-10.08) (adjusted for deprivation and self-reported hypertension, heart disease, hypercholesterolaemia and diabetes). At a threshold of 9.8 HR for LRE were 2.21 (95% CI 1.22-3.97) (unadjusted model) and 2.18 (95% CI 1.19-4.01) (adjusted). ELF was evaluated as a time dependent variable by generating time-dependent Cox models; HRs at an ELF threshold of 10.51 were 1.94 (95% CI 1.10-3.39) (unadjusted) and 2.05 (95% CI 1.16-3.64) (adjusted) and at a threshold of 9.8 HRs were 1.85 (95% CI 1.09-3.15) (unadjusted) and 1.80 (95% CI 1.04-3.13) (adjusted). Area under the receiver operating characteristic curve for recruitment ELF predicting LRE was 0.58 (95% CI 0.49-0.68), and for second subsequent ELF 0.61 (95% CI 0.52-0.71). Conclusion:This study demonstrates the association between ELF and CLD in postmenopausal women with risk factors for liver disease, creating the opportunity to intervene to reduce liver-related mortality and morbidity. Although larger studies are required, these results demonstrate the potential of ELF as a prognostic tool in health checks in primary care.(Continued on next page)

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