Discussion Question

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 5.3 4.8 5.1 0.1 2.0 0.813 Female 1.3 1.6 1.9 1.7 2.4 1.1 84.6 0.001

Race/ethnicity Non-Hispanic White 3.0 3.2 3.4 3.3 3.8 0.8 26.7 0.013 Non-Hispanic African American 2.8 3.2 4.3 3.1 3.4 0.6 21.4 0.599 Hispanic 3.3 3.2 3.6 1.6 3.3 0.0 0.0 0.554 Non-Hispanic Asian 0.3 1.6 0.9 0.1 0.9 0.6 200.0 0.759 Other 6.3 1.5 4.8 7.8 7.4 1.1 17.5 0.140

Education <High School 2.5 2.5 3.3 3.2 3.3 0.8 32.0 0.096 High School 2.4 3.1 3.0 3.1 3.5 1.1 45.8 0.034 Some College 3.3 3.5 4.2 3.0 3.3 0.0 0.0 0.679 College or more 3.8 3.1 3.5 3.2 4.3 0.5 13.2 0.458

Total family income <$20,000 2.2 2.3 3.5 3.0 3.1 0.9 40.9 0.005 $20–$49,999 2.8 3.3 2.9 3.1 3.4 0.6 21.4 0.289 $50,000–$74,999 4.8 3.1 3.5 3.3 4.1 −0.7 −14.6 0.761 ≥$75,000 4.7 5.0 5.1 3.6 5.2 0.5 10.6 0.907

Marital status Married 2.5 3.1 3.0 2.9 3.5 1.0 40.0 0.019 Widowed 1.6 1.1 1.9 1.0 2.1 0.5 31.3 0.467 Divorced or separated 6.2 4.4 5.9 5.0 4.9 −1.3 −21.0 0.345 Never married 3.8 4.3 4.7 4.5 4.4 0.6 15.8 0.591

Tobacco use Past month use 6.2 7.0 6.7 6.9 7.5 1.3 21.0 0.173 Past year use 6.4 6.9 6.4 6.8 7.5 1.1 17.2 0.255

Illicit drug Past month use 13.7 18.2 17.8 17.3 18.2 4.5 32.8 0.372 Past year use 13.4 15.4 15.2 15.7 14.5 1.1 8.2 0.834

Overall health Excellent 2.3 3.3 2.5 2.4 3.9 1.6 69.6 0.142 Very Good 3.2 3.6 3.7 3.0 3.7 0.5 15.6 0.802 Good 3.0 2.9 3.6 2.8 3.3 0.3 10.0 0.647 Fair/Poor 3.2 2.4 3.7 4.6 4.0 0.8 25.0 0.005

Chronic diseasec

Multiple chronic conditions (≥2 chronic disease)

2.8 2.5 3.0 3.5 3.4 0.6 21.4 0.091

Mental health Past year major

depressive episode 6.1 6.6 6.9 7.2 6.7 0.6 9.8 0.650

Anxiety in past year 6.9 6.6 5.6 7.3 5.5 −1.4 −20.3 0.542 Received mental health

treatment in past year 5.5 6.2 6.9 7.2 6.1 0.6 10.9 0.478

e. se, He

a w t h f F a b

a Trend for each subsequent year from 2005 to 2006 as the comparison. b Alcohol use disorder defined on DSM IV criteria for alcohol abuse or dependenc c Chronic conditions include: Asthma, Bronchitis, Cirrhosis, Diabetes, Heart Disea

lcohol use disorders in bivariable models compared to those who ere married, but the difference was not significant when con-

rolled for covariates. Those who are widowers may be older and ave more comorbidities, highlighting the importance of adjusting

or such factors in analyses of drinking among older populations. urther, in bivariable models, fair/poor health was associated with

lower risk of binge drinking compared to those in excellent health, ut a higher risk of alcohol use disorder. When adjusted, those

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

reporting fair/poor health remained at lower risk for binge drinking, and no significant relationship remained for alcohol use disorder. It is well documented that chronic health problems are associ- ated with reducing and/or eliminating alcohol consumption among

older adults (Moos et al., 2005; Satre and Arean, 2005), and these results are generally consistent with those findings in that older adults with fair or poor health are less likely to engage in unhealthy drinking patterns (Geroldi et al., 1994; Hajat et al., 2004; Satre et al.,

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

Table 4 Multivariable logistic regression analysis of demographic, chronic disease, and substance use characteristics associated with past-month binge alcohol use for adults age ≥50-2005-2014.

Characteristic OR (95% CI) AOR (95% CI)

Year 2005–2006 1.00 1.00 2007–2008 1.11 (1.00, 1.22) 1.09 (0.98, 1.21) 2009–2010 1.15** (1.05, 1.26) 1.14* (1.03, 1.27) 2011–2012 1.15* (1.03, 1.28) 1.13* (1.01, 1.26) 2013–2014 1.23*** (1.12, 1.34) 1.22*** (1.10, 1.34)

Age group 50–64 1.00 1.00 ≥65 0.43*** (0.40, 0.47) 0.59*** (0.54, 0.64)

Sex Male 1.00 1.00 Female 0.31*** (0.29, 0.34) 0.37*** (0.34, 0.40)

Race/ethnicity Non-Hispanic White 1.00 1.00 Non-Hispanic African American 1.10 (0.99, 1.22) 1.05 (0.93, 1.19) Hispanic 1.07 (0.97, 1.18) 1.15* (1.03, 1.29) Non-Hispanic Asian 0.47*** (0.37, 0.60) 0.58*** (0.45, 0.75) Other 1.13 (0.94, 1.36) 1.01 (0.82, 1.23)

Education <High School 1.00 1.00 High School 1.26*** (1.14, 1.38) 1.20** (1.07, 1.34) Some College 1.17** (1.05, 1.30) 1.00 (0.89, 1.13) College or more 0.93 (0.84, 1.02) 0.76*** (0.66, 0.86)

Total family income <$20,000 1.00 1.00 $20–$49,999 1.35*** (1.27, 1.43) 1.16*** (1.08, 1.25) $50,000–$74,999 1.57*** (1.43, 1.73) 1.21** (1.08, 1.35) ≥$75,000 1.80*** (1.63, 1.99) 1.42*** (1.25, 1.60)

Marital status Married 1.00 1.00 Widowed 0.51*** (0.45, 0.57) 0.92 (0.81, 1.06) Divorced or separated 1.30*** (1.21, 1.41) 1.15** (1.05, 1.26) Never married 1.16* (1.04, 1.30) 0.97 (0.85, 1.11)

Tobacco use Past year use 3.19*** (2.98, 3.43) 2.28*** (2.11, 2.45)

Illicit drug use Past year use 3.82*** (3.49, 4.19) 2.45*** (2.21, 2.72)

Overall health Excellent 1.00 1.00 Very Good 1.14** (1.03, 1.25) 1.09 (0.98, 1.20) Good 1.06 (0.97, 1.15) 0.99 (0.90, 1.10) Fair/Poor 0.88* (0.79, 0.98) 0.83** (0.73, 0.93)

Chronic diseasea

Multiple chronic conditions (≥2 chronic disease) No 1.00 1.00 Yes 0.70*** (0.65, 0.74) 0.79*** (0.73, 0.84)

Mental health Past year major depressive episode 0.91 (0.81, 1.03) 0.92 (0.79, 1.07) Anxiety in past year 0.99 (0.88, 1.11) 1.03 (0.87, 1.22) Received mental health treatment in past year 0.96 (0.89, 1.05) 1.02 (0.90, 1.16)

a Chronic conditions include: Asthma, Bronchitis, Cirrhosis, Diabetes, Heart Disease, Hepatitis, High Blood Pressure, Lung Cancer, HIV/AIDS, Sleep Apnea, Stroke, Ulcers. AOR = adjusted odds ratio; CI = confidence interval.

2 o m a r h a a

* p < 0.05. ** p < 0.01.

*** p < 0.001.

007). However, such reductions may not apply to alcohol use dis- rders, which may be more chronic conditions requiring additional anagement in the presence of multiple health morbidities. We

lso note that these analyses raise important future directions of esearch. For example, bivariable analyses suggested that mental ealth problems and service utilization might also be increasing

cross time among older adults. The extent to which these trends re independent of trends in alcohol use or a consequence of such

trends is an important future direction, as mental health challenges are an important part of the care for older adults.

4.1. Limitations

The NSDUH relies on self-report and therefore is subject to social-desirability bias and recall bias; although the survey attempts to limit the former via audio computer-assisted self- interviewing (SAMHSA, 2013). Second, because NSDUH samples

B.H. Han et al. / Drug and Alcohol Dependence 170 (2017) 198–207 205

Table 5 Multivariable logistic regression analysis of demographic, chronic disease, and substance use characteristics associated with past-year alcohol use disorder for adults age ≥50-2005-2014.

Characteristic OR (95% CI) AOR (95% CI)

Year 2005–2006 1.00 1.00 2007–2008 1.03 (0.84, 1.28) 0.97 (0.78, 1.21) 2009–2010 1.17 (0.94, 1.44) 1.08 (0.86, 1.36) 2011–2012 1.05 (0.88, 1.26) 0.93 (0.77, 1.13) 2013–2014 1.23* (1.03, 1.47) 1.08 (0.89, 1.30)

Age group 50–64 1.00 1.00 ≥65 0.38*** (0.33, 0.44) 0.63*** (0.53, 0.74)

Sex Male 1.00 1.00 Female 0.35 (0.30, 0.40) 0.39 (0.33, 0.45)

Race/ethnicity Non-Hispanic White 1.00 1.00 Non-Hispanic African American 1.00 (0.82, 1.23) 1.01 (0.81, 1.26) Hispanic 0.88 (0.70, 1.10) 1.03 (0.81, 1.32) Non-Hispanic Asian 0.22*** (0.12, 0.40) 0.27*** (0.14, 0.52) Other 1.78*** (1.34, 2.35) 1.46* (1.08, 1.98)

Education <High School 1.00 1.00 High School 1.03 (0.87, 1.23) 1.04 (0.85, 1.27) Some College 1.17 (0.97, 1.41) 1.10 (0.88, 1.37) College or more 1.23* (1.03, 1.46) 1.19 (0.94, 1.49)

Total family income <$20,000 1.00 1.00 $20–$49,999 1.10 (0.98, 1.25) 1.06 (0.92, 1.22) $50,000–$74,999 1.34** (1.11, 1.61) 1.07 (0.86, 1.34) ≥$75,000 1.70*** (1.44, 2.01) 1.32 (1.06, 1.63)

Marital status Married 1.00 1.00 Widowed 0.51 (0.40, 0.64) 0.92 (0.71, 1.19) Divorced or separated 1.78 (1.57, 2.03) 1.38*** (1.20, 1.59) Never married 1.48 (1.25, 1.75) 1.07 (0.88, 1.28)

Tobacco use Past year use 3.25*** (2.91, 3.64) 2.02*** (1.80, 2.26)

Illicit drug use Past year use 6.71 (5.85, 7.70) 3.70 (3.21, 4.25)

Overall health Excellent 1.00 1.00 Very Good 1.21* (1.01, 1.45) 1.14 (0.94, 1.39) Good 1.08 (0.90, 1.31) 1.03 (0.84, 1.26) Fair/Poor 1.26** (1.07, 1.48) 1.03 (0.84, 1.28)

Chronic diseasea

Multiple chronic conditions (≥2 chronic disease) No 1.00 1.00 Yes 0.91 (0.81, 1.03) 0.91 (0.79, 1.05)

Mental health Past year major depressive episode 2.33*** (1.98, 2.74) 1.31* (1.07, 1.61) Anxiety in past year 2.09*** (1.75, 2.49) 1.03 (0.80, 1.31) Received mental health treatment in past year 2.40*** (2.10, 2.73) 1.95*** (1.62, 2.35)

a Chronic conditions include: Asthma, Bronchitis, Cirrhosis, Diabetes, Heart Disease, Hepatitis, High Blood Pressure, Lung Cancer, HIV/AIDS, Sleep Apnea, Stroke, Ulcers. AOR = adjusted odds ratio; CI = confidence interval.

t a t t f t h a c

* p < 0.05. ** p < 0.01.

*** p < 0.001.

he civilian, non-institutionalized population, it does not include ctive members on the military, homeless, incarcerated, or insti- utionalized adults who may have different alcohol use patterns han those surveyed. Third, the survey is cross-sectional and dif- erent participants were sampled each year of the study period; herefore, this study cannot establish causality. In addition, mental

ealth may simultaneously be a cause, consequence, or correlate of lcohol use, and the cross-sectional nature of the NSDUH survey reates difficulties in teasing apart directionality of the associa-

tions. However, we recomputed models with and without mental health covariates and results did not change any associations of other covariates. Nonetheless, results of associations between men- tal health and substance use should not be interpreted with causal directions of effect implied. Finally, we utilized variables based on SAMHSA’s definition for binge drinking as drinking 5 or more alco-

hol drinks on the same occasion for at least 1 day in the previous 30 days (SAMHSA, 2013). The NIAAA and the CDC, however, utilize a different cutoff for binge drinking, defined as a pattern of drinking

2 ol Dep

t m 2 a a o ( b t

4

d o o w s h f u n r p

C

C

c d m i h S c c m a

R

N t K A D t p t a t f a i f

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

hat brings blood alcohol concentration to 0.08 g/dL, or 5 drinks for en and 4 drinks for women in roughly a two-hour period (NIAAA,

004). The NIAAA also recommends lower thresholds for adults 65 nd older: no more than 4 drinks on any given day for both men nd women (NIAAA, 2016). Since our analysis used the higher cut- ff for the binge drinking criteria for women and for older adults ≥65), our study is likely to have underestimated the prevalence for inge drinking among women and older adults compared to using he NIAAA cut offs.

.2. Conclusion

This study is among the first to examine recent trends and emographic changes in binge alcohol use and alcohol use dis- rders among older adults in the US, and supports projections f large increases in older adults with substance use disorders ho will need treatment (Han et al., 2009). Our findings demon-

trate that alcohol use, binge alcohol use, and alcohol use disorders ave continued to increase among older adults, particularly among

emales. We also found a significant increase in binge alcohol se among older adults with multiple chronic conditions. These ational trends in alcohol use among these groups present distinct isks and challenges, and suggest the importance of screening these opulations for binge alcohol use and alcohol use disorders.

onflict of interest

No conflict declared.

ontributors

All authors are responsible for this reported research. B. Han onceptualized and designed the study, helped interpret results, rafted the initial manuscript, and revised the manuscript. J. Pala- ar designed the study, conducted the statistical analyses, helped

nterpret results, and critically reviewed the manuscript. A. Moore elped interpret results and critically reviewed the manuscript. . Sherman helped conceptualize the study, interpret results, and ritically reviewed the manuscript. K. Keyes assisted with statisti- al analyses, helped interpret results, and critically reviewed the anuscript. All authors edited and approved the final manuscript

s submitted.

ole of the funding source

This research was funded by several grants through the ational Institutes of Health: NYU CTSA grant 1KL2 TR001446 from

he National Center for Advancing Translational Sciences (Han), 24AA15957 from the National Institute on Alcohol Abuse and lcoholism (Moore), K01 DA-038800 from the National Institute on rug Abuse (Palamar), and 1K24DA038345 from the National Insti-

ute on Drug Abuse (Sherman). The National Institutes of Health rovided financial support for the project and the preparation of he manuscript but did not have a role in the design of the study, the nalysis of the data, the writing of the manuscript, nor the decision o submit the present research. The Inter-university Consortium

or Political and Social Research and National Survey on Drug Use nd Health (NSDUH) principal investigators had no role in analysis, nterpretation of results, or in the decision to submit the manuscript or publication.

endence 170 (2017) 198–207

Acknowledgments

The authors would like to thank the Inter-university Consortium for Political and Social Research for providing access to these data (http://www.icpsr.umich.edu/icpsrweb/landing.jsp).

References

American Psychiatric Association, 2000. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychiatric Association, Washington, DC, Text revision.

Arndt, S., Clayton, R., Schultz, S.K., 2011. Trends in substance abuse treatment 1998–2008: increasing older adult first-time admissions for illicit drugs. Am. J. Geriatr. Psychiatry 19, 704–711, http://dx.doi.org/10.1097/JGP. 0b013e31820d942b.

Blazer, D.G., Wu, L., 2009. The epidemiology of at risk and binge drinking among middle-aged and elderly community adults: national survey on drug use and health. Am. J. Psychiatry 166, 1162–1169.

Blazer, D.G., Wu, L.T., 2011. The epidemiology of alcohol use disorders and subthreshold dependence in a middle-aged and elderly community sample. Am. J. Geriatr. Psychiatry 19, 685–694, http://dx.doi.org/10.1097/JGP. 0b013e3182006a96.

Blow, F.C., Barry, K.L., 2002. Use and misuse of alcohol among older women. Alcohol Res. Health 26, 308–315.

Breslow, R.A., Dong, C., White, A., 2015. Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010. Alcohol. Clin Exp. Res. 39, 371–379.

Centers for Disease Control, 2012. Vital Signs: Binge Drinking Prevalence, Frequency, and Intensity Among Adults—U.S., 2010. MMWR 61, 14–19.

Centers for Disease Control, 2015. Fact Sheets – Binge Drinking, Available from: http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm (Accessed 09.01.16).

Choi, N.G., DiNitto, D.M., Marti, C.N., Choi, B.Y., 2016. Sociodemographic characteristics and health status of lifetime abstainers, ex-drinkers, bingers, and nonbingers among baby boomers and older adults. Subst. Use Misus 51, 637–648, http://dx.doi.org/10.3109/10826084.2015.1133645.

Cigolle, C.T., Langa, K.M., Kabeto, M.U., Tian, Z., Blaum, C.S., 2007. Geriatric conditions and disability: the health and retirement study. Ann. Intern. Med. 147, 156–164.

Geroldi, C., Rozzini, R., Frisoni, G.B., Trabucchi, M., 1994. Assessment of alcohol consumption and alcoholism in the elderly. Alcohol 11, 513–516.

Hajat, S., Haines, A., Bulpitt, C., Fletcher, A., 2004. Patterns and determinants of alcohol consumption in people aged 75 years and older: results from the MRC trial of assessment and management of older people in the community. Age Ageing 33, 170–177.

Hamajima, N., Hirose, K., Tajima, K., Rohan, T., Calle, E.E., Heath Jr., C.W., Collaborative Group on Hormonal Factors in Breast Cancer, 2002. Alcohol, tobacco and breast cancer-collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br. J. Cancer 87, 1234–1245, http://dx.doi. org/10.1038/sj.bjc.6600596.

Han, B., Gfroerer, J., Colliver, J.D., Penne, M.A., 2009. Substance use disorder among older adults in the United States in 2020. Addiction 104, 88–96.

Hasin, D.S., Saha, T.D., Kerridge, B.T., Goldstein, R.B., Chou, S.P., Zhang, H., Jung, J., Pickering, R.P., Ruan, W.J., Smith, S.M., Huang, B., Grant, B.F., 2015. Prevalence of marijuana use disorders in the United States between 2001 and 2002 and 2012–2013. JAMA Psychiatry 72, 1235–1242.

Heeringa, S., West, B.T., Berglund, P.A., 2010. Applied Survey Data Analysis. Chapman & Hall/CRC, Boca Raton, FL.

Hohmann, A.A., 1989. Gender bias in prescribing in primary care. Med. Care 27, 478–490.

Holahan, C.J., Schutte, K.K., Brennan, P.L., Holahan, C.K., Moos, R.H., 2014. Episodic heavy drinking and 20-year total mortality among late-life moderate drinkers. Alcohol. Clin. Exp. Res. 38, 1432–1438, http://dx.doi.org/10.1111/acer.12381.

Johnson, R.A., Gerstein, D.R., 2000. Age, period, and cohort effects in marijuana and alcohol incidence: United States females and males, 1961–1990. Subst. Use Misuse 35, 925–948.

Jones, C.M., Logan, J., Gladden, R.M., Bohm, M.K., 2015. Vital signs: demographic and substance use trends among heroin users—United States, 2002–2013. MMWR 64, 719–725.

Kuerbis, A., Sacco, P., Blazer, D.G., Moore, A.A., 2014. Substance abuse among older adults. Clin. Geriatr. Med. 30, 629–654, http://dx.doi.org/10.1016/j.cger.2014. 04.008.

Mamdani, M., Herrmann, N., Austin, P., 1999. Prevalence of antidepressant use among older people: population-based observations. J. Am. Geriatr. Soc. 47, 1350–1353.

Merrick, E.L., Horgan, C.M., Hodgkin, D., Garnick, D.W., Houghton, S.F., Pana, L.,

Saitz, R., Blow, F.C., 2008. Unhealthy drinking patterns in older adults: prevalence and associated characteristics. J. Am. Geriatr. Soc. 56, 214–223.

Moore, A.A., Endo, J.O., Carter, M.K., 2003. Is there a functional relationship between excessive drinking and functional impairment in older persons? J. Am. Geriatr. Soc. 51, 44–49.

ol Dep

M

M

M

M

N

N

N

N

O

S

National Health and Nutrition Examination Survey (NHANES). J. Gen. Intern. Med. 29, 312–319.

Zhang, S.M., Lee, I.M., Manson, J.E., Cook, N.R., Willett, W.C., Buring, J.E., 2007.

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

oore, A.A., Giuli, L., Gould, R., Hu, P., Zhou, K., Reuben, D., Greendale, G., Karlamangla, A., 2006. Alcohol use, comorbidity, and mortality. J. Am. Geriatr. Soc. 54, 757–762.

oore, A.A., Whiteman, E.J., Ward, K.T., 2007. Risks of combined alcohol-medication use in older adults. Am. J. Geriatr. Pharmacother. 5, 64–74.

oore, A.A., Karno, M.P., Grella, C.E., Lin, J.C., Warda, U., Liao, D.H., Hu, P., 2009. Alcohol, tobacco, and nonmedical drug use in older U.S. Adults: data from the 2001/02 national epidemiologic survey of alcohol and related conditions. J. Am. Geriatr. Soc. 57, 2275–2281.

oos, R.H., Brennan, P.L., Schutte, K.K., Moos, B.S., 2005. Older adults’ health and changes in late-life drinking patterns. Aging Ment. Health 9, 49–59.

ational Institute of Alcohol Abuse and Alcoholism, 2000. Tenth Special Report To The U.S. Congress On Alcohol And Health. National Institute of Health, Bethesda, MD.

ational Institute of Alcohol Abuse and Alcoholism, 2004. NIAAA Council Approves Definition Of Binge Drinking. NIAAA Newsletter, pp. 3, Available from: http:// pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter Number3. pdf (Accessed 09.01.16).

ational Institute of Alcohol Abuse and Alcoholism, 2015. Alcohol: A Women’s Health Issue. NIAAA, Bethesda, MD, Available from: http://pubs.niaaa.nih.gov/ publications/brochurewomen/women.htm (Accessed 09.01.16).

ational Institute of Alcohol Abuse and Alcoholism, 2016. Older Adults. NIAAA, Bethesda, MD, Available from: https://www.niaaa.nih.gov/alcohol-health/

special-populations-co-occurring-disorders/older-adults (Accessed 09.01.16).

slin, D.W., 2000. Alcohol use in late life: disability and comorbidity. J. Geriatr. Psychiatry Neurol. 13, 134–140.

ubstance Abuse and Mental Health Services Administration (SAMHSA), 2013. Results From The 2012 National Survey On Drug Use And Health: Summary Of

endence 170 (2017) 198–207 207

National Findings. NSDUH Series H-46, HHS Publication No. (SMA) 13–4795. Rockville, MD. (Accessed 09.01.16).

Sacco, P., Unick, G.J., Kuerbis, A., Koru, A.G., Moore, A.A., 2015. Alcohol-related diagnoses in hospital admissions for all causes among middle-aged and older adults: trends and cohort differences from 1993 to 2010. J. Aging Health 27, 1358–1374.

Satre, D.D., Arean, P.A., 2005. Effects of gender, ethnicity, and medical illness on drinking cessation in older primary care patients. J. Aging Health 17, 70–84.

Satre, D.D., Gordon, N.P., Weisner, C., 2007. Alcohol consumption, medical conditions, and health behavior in older adults. Am. J. Health Behav. 31, 238–248.

StataCorp, 2013. Stata Statistical Software: Release13.0. StataCorp, College Station, TX.

Thun, M.J., Peto, R., Lopez, A.D., Monaco, J.H., Henley, S.J., Health, C.W., Doll, R., 1997. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N. Engl. J. Med. 337, 1705–1714.

Tinetti, M.E., Fried, T.R., Boyd, C.M., 2012. Designing health care for the most common chronic condition—multimorbidity. JAMA 307, 2493–2494.

Wilson, S.R., Knowles, S.B., Huang, Q., Fink, A., 2014. The prevalence of harmful and hazardous alcohol consumption in older U.S. adults: data from the 2005–2008

Alcohol consumption and breast cancer risk in the Women’s Health Study. Am. J. Epidemiol. 165, 667–676.