Research Symposium 2014 Dr Andy Towers, Massey University
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
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)
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?
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
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
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
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
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
AUDIT-C vs. by gender Men Women 70% 60% 50% 40% 30% 20% 10% AUDIT-c 0% Non-hazardous Hazardous Harmful
AUDIT-C vs. by gender Men Women 70% 60% 50% 40% 30% 20% 10% AUDIT-c 0% Non-hazardous Hazardous Harmful
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
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
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%
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%
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%
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%
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%
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%
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%
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
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
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
Research Symposium 2014 Thank you