Describe the economic burden of alcohol use and why it is problematic. Include at least three concepts covered in the reading

F

D a

B J a

N b

c

d

e

a

A R R A A

K A E O

1

o i ( c c ( c

o B

h 0

Drug and Alcohol Dependence 170 (2017) 198–207

Contents lists available at ScienceDirect

Drug and Alcohol Dependence

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g a l c d e p

ull length article

emographic trends of binge alcohol use and alcohol use disorders mong older adults in the United States, 2005–2014

enjamin H. Han a,b,∗, Alison A. Moore c, Scott Sherman a,d, Katherine M. Keyes e, oseph J. Palamar b,d

New York University School of Medicine, Department of Medicine, Division of Geriatric Medicine and Palliative Care, 550 First Avenue, BCD 615, New York, Y 10016, United States Center for Drug Use and HIV Research, New York University Rory College of Nursing, 433 First Avenue, 7th Floor, New York, NY 10010, United States University of California, San Diego, Department of Medicine, Division of Geriatrics, 9500 Gilman Drive, La Jolla, CA 92093, United States New York University Langone Medical Center, Department of Population Health, 550 First Avenue, New York, NY 10016, United States Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, United States

r t i c l e i n f o

rticle history: eceived 23 September 2016 eceived in revised form 2 November 2016 ccepted 3 November 2016 vailable online 12 December 2016

eywords: lcohol pidemiology lder adults

a b s t r a c t

Background: Alcohol use is common among older adults, and this population has unique risks with alcohol consumption in even lower amounts than younger persons. No recent studies have estimated trends in alcohol use including binge alcohol use and alcohol use disorders (AUD) among older adults. Methods: We examined alcohol use among adults age ≥50 in the National Survey on Drug Use and Health (NSDUH) from 2005 to 2014. Trends of self-reported past-month binge alcohol use and AUD were estimated. Logistic regression models were used to examine correlates of binge alcohol use and AUD. Results: The prevalence of both past-month binge alcohol use and AUD increased significantly among adults age ≥50 from 2005/2006 to 2013/2014, with a relative increase of 19.2% for binge drinking (linear trend p < 0.001) and a 23.3% relative increase for AUD (linear trend p = 0.035). While males had a higher prevalence of binge alcohol use and AUD compared to females, there were significant increases in both among females. In adjusted models of aggregated data, being Hispanic, male, and a smoker or illicit drug

user were associated with binge alcohol use, while being male, a smoker, an illicit drug user, or reporting past-year depression or mental health treatment were associated with AUD. Conclusions: Alcohol use among older adults is increasing in the US, including past-month binge alcohol use and AUD with increasing trends among females. Providers and policymakers need to be aware of these changes to address the increase of older adults with unhealthy drinking.

© 2016 Elsevier Ireland Ltd. All rights reserved.

. Introduction

Alcohol is the most commonly used psychoactive substance by lder adults (Moore et al., 2009), and the most common substance nvolved among older adults entering substance abuse treatment Arndt et al., 2011; Han et al., 2009). Older adults (typically ≥65) an have particular vulnerabilities to alcohol due to physiological

hanges in aging (Oslin, 2000), increasing chronic disease burden Moore et al., 2006), and medication use (Moore et al., 2007). This an place older adults at a higher risk for adverse outcomes from

∗ Corresponding author at: New York University School of Medicine, Department f Medicine, Division of Geriatric Medicine and Palliative Care, 550 First Avenue, CD 615, New York, NY 10016, United States.

E-mail address: [email protected] (B.H. Han).

ttp://dx.doi.org/10.1016/j.drugalcdep.2016.11.003 376-8716/© 2016 Elsevier Ireland Ltd. All rights reserved.

alcohol, and alcohol use can complicate the management of chronic disease (Moos et al., 2005). Higher quantities of alcohol use by older adults have been associated with functional impairments (Moore et al., 2003) and increased mortality risk (Holahan et al., 2014; Moore et al., 2007). This has led the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to lower recommended drinking thresholds for adults age 65 and older (NIAAA, 2016).

Recent epidemiological studies on alcohol use by middle-aged and older adults from the 2005 to 2007 National Survey on Drug Use and Health (NSDUH), estimated the prevalence of past-year alcohol use to be 51% for adults age ≥50, 56% for adults age 50–65, and 43% for adults age ≥65. The study also found the prevalence of alcohol

dependence to be 2.7% and alcohol abuse to be 3.4% for adults age ≥50 (Blazer and Wu, 2011). The prevalence of binge drinking for males was estimated to be 19.6% and for females it was estimated

ol Dep

t 2 n ( t e R a p [ d a 2

r c h i O a H d B

u s t a d o m s f

2

2

( n t A t e p v t t v – i t a p i 2 N

2

2 h W w

B.H. Han et al. / Drug and Alcoh

o be 6.3% (Blazer and Wu, 2009). Cross-sectional data from the 005 to 2006 National Health and Nutrition Examination Survey of on-institutionalized Americans estimated 14.5% of older drinkers age ≥50) consumed alcohol above the recommended limits by he NIAAA, and 11.7% reported past-year binge drinking (Wilson t al., 2014). A recent cross-sectional study of the 2010 Behavioral isk Factor Surveillance System found a lower prevalence of binge lcohol use among adults age 45–64 at 13.3% and for adults ≥65 revalence was estimated to be 3.8% (Centers for Disease Control CDC], 2012). However, it was noted that the frequency of binge rinking was highest among binge drinkers age ≥65 with an aver- ge of 5.5 episodes a month compared to all other age groups (CDC, 012).

Given the aging Baby Boomer generation, which has higher eported rates of substance use compared to any generation pre- eding it (Johnson and Gerstein, 2000; Kuerbis et al., 2014), we ypothesize that there have been increases in alcohol use, includ-

ng binge drinking and alcohol use disorders among older adults. ne study noted increases in the rates of alcohol-related hospital dmissions for older adults from 1993 to 2010 (Sacco et al., 2015). owever, no studies have examined recent trends or changes in emographic shifts for alcohol use among older adults as the Baby oomer generation continues to age.

Understanding demographic trends of alcohol use and alcohol se problems in older adults is vital for targeted public health creening and interventions. The aim of this study was to estimate he prevalence and to examine demographic trends of self-reported lcohol use – in particular binge alcohol use and alcohol use disor- ers among older adults, and to determine correlates of use among lder adults. To do this, we examined cross-sectional data from the ost recent ten years (2005–2014) of a nationally representative

ample of non-institutionalized individuals in the US – the NSDUH, ocusing on adults age 50 and older.

. Methods

.1. Study population

Data were utilized from the ten most recent cohorts 2005–2014) of NSDUH, an annual cross-sectional survey of on-institutionalized individuals in the 50 US states and the Dis- rict of Columbia (Substance Abuse and Mental Health Services dministration [SAMHSA], 2013). A different cross-section of par-

icipants is sampled each year and thus the years are independent of ach other. NSDUH is a nationally representative probability sam- le of individuals living in households and the sample was obtained ia four stages: Census tracts were first selected within each state, hen segments in each tract were selected, then dwelling, and hen respondents were selected for the sample each year. Sur- eys were administered via computer-assisted interviewing (CAI)

conducted by an interviewer and audio computer-assisted self- nterviewing (ACASI). Sampling weights were provided by NSDUH o address unit- and individual-level non-response. Weights were djusted to ensure that estimates are consistent with estimates rovided by the US Census Bureau. Additional information regard-

ng sampling and the survey can be found elsewhere (SAMHSA, 013). The weighted interview response rates for 2005–2014 SDUH ranged from 71.2–76.0%.

.2. Measures

.2.1. Alcohol use and binge alcohol use. Participants were asked ow long it has been since consuming their last alcoholic beverage. e utilized recoded variables derived from this question indicating hether alcohol was reportedly used within the last 12 months,

endence 170 (2017) 198–207 199

and within the last 30 days. They were also asked whether they have binged on alcohol within the last 30 days. Binge alcohol use was defined using SAMHSA’s definition as drinking five or more drinks on the same occasion, which is defined as consuming this many drinks at same time or within a couple hours of each other (SAMHSA, 2013).

2.2.2. Alcohol use disorders. Those reporting alcohol use within the last 12 months were asked additional questions to determine whether they met criteria for abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edi- tion (DSM-IV; American Psychiatric Association, 2000). Although a diagnostic interview was not conducted, these questions were utilized as a proxy. A respondent was defined as having alcohol abuse if they reported a positive response to ≥1 DSM-IV abuse cri- teria and defined as having alcohol dependence if they indicated a positive response to ≥3 DSM-IV dependence criteria. The variable used for past-year alcohol use disorder includes respondents diag- nosed with past-year alcohol abuse or alcohol dependence, which is consistent with SAMHSA NSDUH reports (SAMHSA, 2013).

2.2.3. Demographics and health-related variables. We examined age (age 50–64 and ≥65, which were derived from predefined cate- gories), gender, race (i.e., white non-Hispanic, black non-Hispanic, Hispanic, other race), educational attainment (i.e., <high school, high school, some college, college or more), annual total fam- ily income (i.e., <$20,000; $20,000–$49,999; $50,000–$74,999; $75,000+), and marital status (i.e., married, widowed, divorced or separated, never married).

Participants were asked to rate their general health and response options for perceived health were “excellent”, “very good”, “good”, “fair”, and “poor”. They were also asked if they had ever been informed by a doctor or other medical professional that they have had the following 12 chronic diseases: asthma, bronchitis, cirrhosis of the liver, diabetes, heart disease, hepatitis, hypertension (high blood pressure), lung cancer, HIV/AIDS, sleep apnea, stroke, and ulcers. We computed a sum variable and recoded this into a binary variable indicating multiple self-reported chronic conditions (2 or more vs. 0–1 chronic conditions). This cutoff was chosen because multimorbidity is commonly defined as the co- occurrence of two or more chronic conditions (Tinetti et al., 2012). With regard to mental health, participants were asked whether they had experienced a depressive episode or anxiety within the past year. They were also asked if they had received mental health treatment within the past year.

Past 12-month and past 30-day tobacco use were queried and tobacco was defined as cigarettes, chewing tobacco, snuff, cigars, and pipe tobacco. Likewise, participants were asked about 12- month and 30-day use of a variety of illicit drugs (e.g., marijuana, cocaine) and we utilized two indicator variables indicating whether use of any was reported.

2.3. Statistical analyses

These analyses focused on participants age 50 and older, who represented about 9.2%–16.2% of the full NSDUH sample each year. Since some outcomes of interest (e.g., heavy 30-day alcohol use, alcohol abuse/dependence) were relatively rare, similar to previ- ous analyses (Hasin et al., 2015; Jones et al., 2015), we aggregated years into pairs to increase power to detect trends over time. Specif- ically, we collapsed years into 2005–2006, 2007–2008, 2009–2010, 2011–2012, and 2013–2014.

We first calculated descriptive statistics to estimate the weighted prevalence of self-reported past-year alcohol use of pat- terns across cohorts, as well as the prevalence of alcohol use patterns separately for each category of each covariate. We then cal-

200 B.H. Han et al. / Drug and Alcohol Dependence 170 (2017) 198–207

Table 1 Sample characteristics across cohorts for adults age 50 and older, % – United States 2005–2014.

Characteristic 2005–2006 2007–2008 2009–2010 2011–2012 2013–2014 Combined Years (n = 10,953) (n = 10,676) (n = 11,233) (n = 13,076) (n = 15,302) (n = 61,240)

Alcohol use prevalence Alcohol use in past year* 60.0 60.3 61.4 62.1 63.0 61.4 Alcohol use in past month* 47.1 47.4 48.0 49.0 49.9 48.4 Binge alcohol use past 30 days** 12.5 13.6 14.1 14.0 14.9 13.9 Alcohol use disorder past year*** 3.0 3.1 3.5 3.1 3.7 3.3

Age group 50–64 58.9 59.5 59.4 59.6 58.1 59.1 ≥65 41.1 40.5 40.6 40.4 41.9 40.9

Sex Male 46.1 46.2 46.4 46.8 46.6 46.4 Female 53.9 53.8 53.6 53.2 53.4 53.6

Race/ethnicity Non-Hispanic White 77.9 77.1 76.5 75.4 74.1 76.1 Non-Hispanic African American 9.6 9.7 9.8 10.0 10.3 9.9 Hispanic 7.8 8.1 8.4 8.9 9.7 8.6 Non-Hispanic Asian 3.0 3.3 3.6 3.5 3.8 3.5 Other 1.8 1.8 1.7 2.2 2.1 1.9

Education <High School 18.1 17.5 16.3 14.5 13.9 16.0 High School 32.4 32.8 32.4 31.9 31.2 32.1 Some College 21.9 22.2 22.5 23.4 24.5 23.0 College or more 27.6 27.5 28.9 30.2 30.4 29.0

Total family income <$20,000 41.8 38.6 38.9 38.5 36.7 38.8 $20–$49,999 35.8 36.6 36.3 35.1 35.7 35.9 $50,000–$74,999 11.2 13.4 12.1 12.4 12.6 12.4 ≥$75,000 11.2 11.4 12.8 14.0 15.0 13.0

Marital status Married 64.1 63.7 62.8 62.3 61.7 62.8 Widowed 15.3 13.9 13.7 12.9 12.6 13.6 Divorced or separated 15.4 16.0 17.0 18.2 18.8 17.2 Never married 5.3 6.4 6.5 6.6 7.0 6.4

Tobacco use Past month use 21.2 21.2 20.4 20.1 19.5 20.4 Past year use 24.0 24.0 23.2 22.7 22.3 23.2

Illicit drug use Past month use 2.5 2.7 3.5 3.9 4.7 3.5 Past year use 4.2 5.0 5.9 6.4 7.7 5.9

Overall health Excellent 17.4 17.1 17.0 17.4 17.6 17.3 Very Good 31.0 31.4 32.7 32.5 32.1 32.0 Good 31.4 30.2 30.2 30.4 30.2 30.5 Fair/Poor 20.1 21.4 20.1 19.6 20.0 20.2

Chronic diseasea

Multiple chronic conditions (≥2 chronic disease)

26.4 27.0 27.4 27.6 28.1 27.3

Mental health Past year major depressive episode 6.8 7.0 7.0 7.4 8.1 7.3 Anxiety in past year 3.9 4.3 4.6 4.6 5.6 4.6 Received mental health

treatment in past year 12.3 13.3 13.3 14.1 15.3 13.7

* p < 0.001 for trend for each subsequent year from 2005 to 2006 as the comparison. ** p < 0.001 for trend for each subsequent year from 2005 to 2006 as the comparison. Binge drinking defined as five or more drinks on the same occasion.

*** on. Al se, He

c 2 r p l a

d

p = 0.035 for trend for each subsequent year from 2005 to 2006 as the comparis a Chronic conditions include: Asthma, Bronchitis, Cirrhosis, Diabetes, Heart Disea

ulated the absolute change over time by subtracting prevalence in 013–2014 from prevalence in 2005–2006. We also calculated the elative change over time by dividing prevalence in 2013–2014 by revalence in 2005–2006. We then estimated whether there was a

inear association between binge drinking and alcohol use disorder nd time within each category of each covariate.

We aggregated data from all years into a single cross-section to etermine whether covariates were related to the two outcomes

cohol use disorder defined on DSM IV criteria for alcohol abuse or dependence. patitis, High Blood Pressure, Lung Cancer, HIV/AIDS, Sleep Apnea, Stroke, Ulcers.

of interest – binge drinking and alcohol use disorder. Using binary logistic regression we first estimated odds of each covariate sepa- rately, which produced unadjusted odds ratios (ORs). We then fit all covariates simultaneously (including indicators for year) using

multiple logistic regression. The adjusted ORs (AORs) represent the odds of each category with all else in the model being equal.

We weighted all analyses to account for the complex survey design. Since our analyses utilized data from 10 cohorts, we divided

B.H. Han et al. / Drug and Alcohol Dependence 170 (2017) 198–207 201

Table 2 Prevalence Estimates for self-reported past-month binge alcohol use by demographic, chronic disease, and substance use characteristics for adults age 50 and older, United States 2005–2014.

Characteristic 2005–2006 2007–2008 2009–2010 2011–2012 2013–2014 % Absolute Change from 2005–2006 to 2013–2014

% Relative Change from 2005–2006 to 2013–2014

p-valuea

(n = 10,953) (n = 10,676) (n = 11,233) (n = 13,076) (n = 15,302)

Prevalence past month binge alcoholb

12.5 13.6 14.1 14.0 14.9 2.4 19.2 <0.001

Age group 50–64 15.5 17.6 17.5 17.9 19.1 3.6 23.2 <0.001 ≥65 8.1 7.7 9.0 8.3 9.0 0.9 11.1 0.174

Sex Male 19.6 21.2 21.3 21.0 21.5 1.9 9.7 0.146 Female 6.3 7.1 7.8 7.9 9.1 2.8 44.4 <0.001

Race/ethnicity Non-Hispanic White 12.1 13.7 14.3 14.3 14.8 2.7 22.3 <0.001 Non-Hispanic African American 14.5 14.2 14.6 15.9 15.6 1.1 7.6 0.344 Hispanic 14.8 14.3 15.0 11.9 17.2 2.4 16.2 0.446 Non-Hispanic Asian 6.7 8.6 4.5 6.6 8.9 2.2 32.8 0.655 Other 16.6 9.8 15.1 19.7 14.5 −2.1 −12.7 0.377

Education <High School 11.8 12.3 12.4 13.1 14.6 2.8 23.7 0.064 High School 13.1 15.2 15.4 15.9 17.8 4.7 35.9 <0.001 Some College 13.5 14.4 15.4 14.7 14.9 1.4 10.4 0.329 College or more 11.4 11.8 12.5 12.1 12.0 0.6 5.3 0.540

Total family income <$20,000 9.9 10.1 11.9 11.0 12.4 2.5 25.3 0.004 $20–$49,999 13.7 14.9 14.1 14.7 14.5 0.8 5.8 0.473 $50,000–$74,999 15.0 15.9 17.1 17.7 15.9 0.9 6.0 0.400 ≥$75,000 15.4 18.5 17.9 17.6 20.9 5.5 35.7 0.009

Marital status Married 12.3 14.6 14.1 14.3 14.6 2.3 18.7 0.010 Widowed 6.9 6.8 8.0 7.8 8.7 1.8 26.1 0.058 Divorced or separated 18.0 15.2 18.8 16.6 18.6 0.6 3.3 0.292 Never married 14.4 14.4 13.9 17.4 18.3 3.9 27.1 0.020

Tobacco use Past month use 24.7 26.6 27.8 26.5 27.2 2.5 10.1 0.175 Past year use 24.4 26.9 26.9 25.8 27.6 3.2 13.1 0.085

Illicit drug use Past month use 35.7 35.0 40.0 41.8 35.6 −0.1 −0.3 0.786 Past year use 34.6 34.0 37.7 37.4 33.2 −1.4 −4.1 0.797

Overall health Excellent 11.8 13.7 13.9 13.3 14.3 2.5 21.2 0.166 Very Good 12.8 15.1 15.2 15.8 15.9 3.1 24.2 0.003 Good 14.0 13.7 14.3 13.4 14.8 0.8 5.7 0.541 Fair/Poor 10.1 11.2 12.0 12.9 13.7 3.6 35.6 <0.001

Chronic diseasec

Multiple chronic conditions (≥2 chronic disease)

9.9 10.5 10.1 11.8 11.8 1.9 19.2 0.010

Mental health Past year major depressive episode 9.5 13.9 12.9 14.7 12.6 3.1 32.6 0.161 Anxiety in past year 8.9 15.1 14.9 15.6 13.2 4.3 48.3 0.182 Received mental health

treatment in past year 9.7 13.9 13.8 14.6 14.5 4.8 49.5 0.003

a Trend for each subsequent year from 2005 to 2006 as the comparison.

se, He

t S a a ( a L

b Binge drinking defined as five or more drinks on the same occasion. c Chronic conditions include: Asthma, Bronchitis, Cirrhosis, Diabetes, Heart Disea

he weights by 10 to obtain nationally representative estimates. tata SE 13 (StataCorp, College Station, TX, 2013) was used for all nalyses, and survey (“svy”) commands were utilized to provide ccurate standard errors using Taylor series estimation methods

Heeringa et al., 2010). Secondary analysis of this publically avail- ble data was exempt for review by the New York University angone Medical Center Institutional Review Board.

patitis, High Blood Pressure, Lung Cancer, HIV/AIDS, Sleep Apnea, Stroke, Ulcers.

3. Results

Sample characteristics and alcohol use across cohorts are pre- sented in Table 1. Tests for trends suggest that between 2005/2006

and 2013/2014, there were significant increases in prevalence of past-year alcohol use (from 60.0% to 63.0%, p < 0.001) and past- month alcohol use (from 47.1% to 49.9%, p < 0.001). The prevalence of past-month binge alcohol use among adults age 50 and older sig-

2 ol Dep

n 1 l f

a ( l 6 l w a r m t

n o h ( b a e T f

m a s n > t o p o C f 0

m R p h o d I w h

4

t c p d 2 a T t

h r a t

02 B.H. Han et al. / Drug and Alcoh

ificantly increased from 2005/2006 to 2013/2014 from 12.5% to 4.9% (p < 0.001), representing a 19.2% relative increase. The preva-

ence of past-year alcohol use disorder also significantly increased rom 3.0% to 3.7% (p = 0.035).

With regard to past-month binge alcohol use (Table 2), middle- ged adults (age 50–64) reported a significant increase over time a 23.2% relative increase, p < 0.001). Females had a significantly arge increase in the prevalence of past-month binge drinking from .3% to 9.1% (a 44.4% relative increase, p < 0.001). Likewise, preva-

ence in past-month binge drinking significantly increased among hite participants, those earning <$20,000 or ≥$75,000, those with

high school education, those who were married or never mar- ied, respondents who reported very good or fair/poor health, had ultiple chronic conditions, and those who received mental health

reatment in the past year. As shown in Table 3, older adults (age ≥65) experienced a sig-

ificant increase in prevalence of past-year alcohol use disorders ver time (a 40.0% relative increase, p = 0.014). Female participants ad a large significant increase in past-year alcohol use disorders an 84.6% relative increase, p = 0.001) with males remaining sta- le. Prevalence of alcohol use disorder also significantly increased mong white participants, those with a high school diploma, those arning less than $20,000 per year, and those who were married. here was also an increase among those reporting that they are of air or poor health.

Table 4 shows results from the multivariable logistic regression odel with past-month binge drinking as the outcome vari-

ble. Results from the adjusted model suggest that more recent tudy participants, younger participants, males, Hispanics (versus on-Hispanic whites), those reporting higher household incomes $20,000, those who reported being divorced or separated, and hose reporting past year use of tobacco or illicit drug had higher dds of reporting past-month binge drinking. History of multi- le chronic conditions was associated with significantly lower dds of reporting past-month binge drinking (AOR = 0.79; 95% I: 0.73–0.84; p < 0.001) along with participants who reported air or poor health status (versus excellent) (AOR = 0.83; 95% CI: .73–0.93; p = 0.003).

Table 5 reports results from the multivariable logistic regression odel with past-year alcohol use disorder as the outcome variable.

esults from the adjusted model show that younger (age 50–64) articipants (versus older; ≥65), males (versus females), higher ousehold income ≥$75,000, those who reported being divorced r separated (vs. married) and past year use of tobacco or illicit rug had higher odds of reporting past-year alcohol use disorders.

n addition, past-year major depressive episode and respondents ho received mental health treatment in the past year also had igher odds of alcohol use disorders.

. Discussion

The prevalence of alcohol use among older adults is increasing in he US; however, little is known about recent trends, demographic hanges, and correlates of use. We found a significant increase in revalence of past-month binge drinking and past-year alcohol use isorders in the US among older adults from a ten year period from 005/2006 through 2013/2014, with large relative increases in AUD mong adults age ≥65 and binge drinking among adults age 50–64. he results in this study indicate some demographic changes in rends of unhealthy alcohol use.

Our study found that among females, binge drinking and alco-

ol use disorders increased greatly during the study period. With egard to binge drinking, we also detected significant increases mong older non-Hispanic whites, but by 2013/2014 Hispanics had he highest prevalence for binge drinking relative to other races.

endence 170 (2017) 198–207

Those reporting household incomes ≥$75,000 also had significant increases and the highest binge drinking prevalence by 2013/2014 compared to other household incomes. Regarding alcohol use disorders, there were significant increases among non-Hispanic whites and household incomes <$20,000. The significant demo- graphic correlates of binge alcohol use and alcohol use disorders determined in this study including younger age, being male or not married, tobacco use, and illicit drug use, are similar to results of previous studies (Blazer and Wu, 2009, 2011; Choi et al., 2016; Moore et al., 2009). Our findings of high prevalence rates and cor- relates of Hispanic ethnicity with binge drinking corroborate with previous studies (Merrick et al., 2008), although we found no sig- nificant trends during the study period for this population.

Aging is marked by physiological changes that can place older adults at higher risk for impaired function, chronic disease, increased medication use, and geriatric conditions (e.g., falls and cognitive impairment) (Cigolle et al., 2007). While there is evi- dence that moderate alcohol use may be associated with decreases in morbidity and mortality among older adults (Kuerbis et al., 2014; Oslin, 2000; Thun et al., 1997), older adults with multiple chronic conditions are often particularly vulnerable to the negative effects of alcohol, especially when consuming alcohol in amounts exceed- ing NIAAA recommended drinking limits (Moore et al., 2006). In addition, there is a high prevalence among older adults who are prescribed medications that interact with alcohol (Breslow et al., 2015), which can lead to harmful effects (Moore et al., 2007). Binge alcohol use in particular may increase the risk for unin- tentional injuries (such as falls) and negatively impact chronic disease and chronic disease management (including cardiovascular disease) among older adults (CDC, 2015; NIAAA, 2000). There- fore, results from this study may raise concern given significant increases in binge alcohol use from 2005/2006 to 2013/2014 among older adults with self-reported “fair/poor” health, and increases among adults with multiple chronic diseases. Recommendations have been suggested to lower recommended drinking limits based on comorbidities for older adults (Moore et al., 2006), which will become more important as the trend of increased binge alcohol use among older adults with multimorbidity may continue.

While the findings in this study continue to show that older males are more likely to drink at potentially unhealthy levels, the large increases among older females who reported binge drinking or were diagnosed with alcohol use disorders is alarming. Older females are at particular risk for experiencing adverse effects asso- ciated with alcohol use given the larger impact of physiological changes in lean body mass compared to males as well as unique social and psychological factors (Blow and Barry, 2002), and expe- rience the adverse effects of alcohol at lower amounts (Wilson et al., 2014). In addition, compared to males, older females are more likely to be prescribed psychotherapeutic medications (Hohmann, 1989; Mamdani et al., 1999) that can lead to severe adverse reactions when taken concomitantly with alcohol (NIAAA, 2015). A distinc- tive risk for female alcohol consumption has been associated with increased risk for some breast cancers (Hamajima et al., 2002; Zhang et al., 2007). Since older females generally drink less than males, they are less likely to be screened for or seek help for alco- hol use problems (Blow and Barry, 2002). Our findings of a large increase in both binge alcohol use and alcohol use disorders among older females over the past ten years indicates an emerging pub- lic health problem. Health care providers need to be aware of this increasing trend of unhealthy alcohol use among older females, and ensure that screening for unhealthy alcohol use is part of regular medical care for this population.

For some demographic and health-related characteristics, results differed between bivariable and multivariable models, and between binge drinking and alcohol use disorders. For example, widowhood was associated with lower risks of binge drinking and

B.H. Han et al. / Drug and Alcohol Dependence 170 (2017) 198–207 203

Table 3 Prevalence Estimates for self-reported past-year alcohol use disorder by demographic, chronic disease, and substance use characteristics for adults age 50 and older, United States 2005–2014.

Characteristic 2005–2006 2007–2008 2009–2010 2011–2012 2013–2014 % Absolute Change from 2005–2006 to 2013–2014

% Relative Change from 2005–2006 to 2013–2014

p-valuea

(n = 10,953) (n = 10,676) (n = 11,233) (n = 13,076) (n = 15,302)

Prevalence past-year alcohol use disorderb

3.0 3.1 3.5 3.1 3.7 0.7 23.3 0.035

Age group 50–64 4.0 4.4 4.5 4.0 4.8 0.8 20.0 0.265 ≥65 1.5 1.1 1.9 1.8 2.1 0.6 40.0 0.014

Sex Male 5.0 4.7 5

Who We Are

We are a professional custom writing website. If you have searched a question and bumped into our website just know you are in the right place to get help in your coursework.

Do you handle any type of coursework?

Yes. We have posted over our previous orders to display our experience. Since we have done this question before, we can also do it for you. To make sure we do it perfectly, please fill our Order Form. Filling the order form correctly will assist our team in referencing, specifications and future communication.

Is it hard to Place an Order?

1. Click on the “Place order tab at the top menu or “Order Now” icon at the bottom and a new page will appear with an order form to be filled.

2. Fill in your paper’s requirements in the "PAPER INFORMATION" section and click “PRICE CALCULATION” at the bottom to calculate your order price.

3. Fill in your paper’s academic level, deadline and the required number of pages from the drop-down menus.

4. Click “FINAL STEP” to enter your registration details and get an account with us for record keeping and then, click on “PROCEED TO CHECKOUT” at the bottom of the page.

5. From there, the payment sections will show, follow the guided payment process and your order will be available for our writing team to work on it.

Need help with this assignment?

Order it here claim 25% discount

Discount Code: SAVE25