Research Symposium Dr Andy Towers, Massey University

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1 Research Symposium 2014 Dr Andy Towers, Massey University

2 Identifying the prevalence of hazardous drinking in older adults & flags for primary care workers Counties Manukau AOD Provider Collaborative Research Symposium Thursday 19 June 2014 University of Auckland

3 Alcohol & older adults Older adults & alcohol Historically: Drink more frequently but lower volume Currently: Age-related drinking decline is disappearing Physiology, ageing and alcohol Higher physiological sensitivity Higher risk of alcohol-related mental health conditions More co-morbid health conditions & medication use More deaths due to unintentional injuries (e.g., falls)

4 Alcohol screening in older adults Primary healthcare screening Older adults less likely to be screened Screening practices not adequately screening health risk: A. Risk ignores existing alcohol-related chronic health conditions B. Risk ignores co-occurring use of alcohol-interacting medications C. Risk ignores frailty Many older drinkers who are at risk remain undetected AUDIT-C vs. for older adult screening Compare AUDIT-C with Alcohol-Related Problem Survey () What are the primary reasons for any differences between these screens?

5 The data collection NZLSA 2012 Postal Survey & Face-to-face interviews AUDIT-C data drawn from 2012 postal survey responses Alcohol-Related Problems Survey () in 2012 face-to-face interviews Developed at UCLA using Expert Advisory Panel 2002 Trialled in New Zealand Longitudinal Study of Ageing (NZLSA) 2012

6 The Alcohol-Relation Problems Survey () Medical & psychiatric conditions Drink driving Symptoms of disease Symptoms of abuse & dependence Alcohol- Related Problems Survey () Smoking Quantity & frequency of drinking Alcoholinteracting medication use Physical functioning

7 Demographics Sample (N = 655: age = 66; sd = 7.5) 22% 53% Gender 47% Ethnicity 75% 31% Work 63% Men Women NZ-Euro Maori Other Working Retired Other Partnered Separated Widowed Single 11% 10% 4% Marital status 75% 66% 9% Living standard 25% Hardship Comfortable Good

8 The AUDIT-C & the 86% of the entire sample were drinkers AUDIT-C 42% hazardous (>=4) 6% harmful (>=8) 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% AUDIT-C Non-hazardous Hazardous Harmful

9 The AUDIT-C & the 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 86% of the entire sample were drinkers AUDIT-C 42% hazardous (>=4) 6% harmful (>=8) 18% hazardous 37% harmful AUDIT-C Non-hazardous Hazardous Harmful

10 AUDIT-C vs. by gender Men Women 70% 60% 50% 40% 30% 20% 10% AUDIT-c 0% Non-hazardous Hazardous Harmful

11 AUDIT-C vs. by gender Men Women 70% 60% 50% 40% 30% 20% 10% AUDIT-c 0% Non-hazardous Hazardous Harmful

12 AUDIT-C vs. by gender Men Women 70% AUDIT-c 70% AUDIT-c 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% Non-hazardous Hazardous Harmful 0% Non-hazardous Hazardous Harmful

13 AUDIT-C vs. by gender Men Women 70% AUDIT-c 70% AUDIT-c 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% Non-hazardous Hazardous Harmful 0% Non-hazardous Hazardous Harmful

14 Impact of alcohol-related conditions on screening The addition of alcohol-related health conditions should increase risk AUDIT-C No conditions (33%) 1 condition (38%) 2 conditions (21%) 3 or more conditions (9%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

15 Impact of specific alcohol-related conditions High-blood pressure (47%) Gout (12%) Osteoporosis (12%) Mental health problems (10%) Diabetes (9% AUDIT-C Congestive heart failure (6%) Breast cancer (4%) Cirrhosis/liver (2%) Gastritis (2%) Colorectal cancer (2%) Memory disorder (2%) Ulcer (1%) Throat/mouth cancer (<1%) Hepatitis (<1%) Pancreatitis (<1%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

16 Impact of medication use on screening The addition of alcohol-related health conditions should increase risk AUDIT-C No medications (33%) 1 medication (25%) 2 medications (17%) 3 or more medications (25%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

17 Impact of specific medications on screening Blood pressure (37%) Arthritis & pain (19%) Nitrates/heart (13%) Anticoagulants (11%) Anti-depressant (10%) AUDIT-C Sedatives (7%) Diabetes (5%) Anti-psychotic/anxiety (4%) Bladder (4%) Muscle relaxants (4%) Narcotic (3%) Seizure (1%) Antihistamine (sedating) (1%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

18 Impact of health problems on screening The addition of health problems (e.g., falls, vomiting) should increase risk AUDIT-C No problems (10%) 1 problem (17%) 2 problems (17%) 3 or more problems (56%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

19 Impact of specific health problems on screening Sleeping (69%) Memory (42%) Heartburn (34%) Feeling depressed (27%) Diarrhoea (26%) Nervousness (26%) Tripping/bumping (25%) Bladder control (25%) Stomach pains (21%) Nausea (15%) AUDIT-C Falling (12%) Vomiting (9%) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

20 Primary health care: Past year doctors visits AUDIT-C None: 4% 1 visit: 18% 2 visits: 23% 3-5 visits: 46% 6 or more visits: 9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

21 Primary health care: Ever been told to cut down / Doctors visits Yes (past year) Yes (not in past year) No Yes (in past year) 3% Yes (not in past year) 4% No 93% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No visits 1 visit 2 visits 3-5 visits 6 or more visits Times they have visited the doctor in the past year

22 0% 0% 5% 4% 2% 5% 3% 4% 2% 2% 100% 90% 93% 93% 97% Primary health care: Ever been told to cut down / Doctors visits Yes (past year) Yes (not in past year) No Yes (in past year) 3% Yes (not in past year) 4% No 93% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No visits 1 visit 2 visits 3-5 visits 6 or more visits Times they have visited the doctor in the past year

23 Conclusions Older adults drinking in New Zealand Heavy drinking despite chronic conditions, meds & health problems Non-hazardous misnomer; conditions, meds & health problems increase risk 96% saw GP in past 12 months; 9% 6 times Only 7% ever told to reduce drinking GP is key point of medical contact; 1 st contact is the key Gender Chronic conditions Medications Health problems GP visits Men much more likely to drink hazardously & harmfully Multipleconditions Multiplemedications 3 or more problems Multiple yearly visits Liver/pancreasrelated CNS depressants Falls/vomiting

24 Research Symposium 2014 Thank you

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