Trajectories of Concurrent Alcohol and Medication Use Among Community-Dwelling Older Adults

Objectives:

Research suggests that the concurrent use of alcohol and medications can lead to a number of health problems for older adults, who take more medication than any other age group (Pringle, Ahern, Heller, Gold, & Brown, 2005). Despite older adults' increased risk of alcohol-medication interaction there has been limited research focused on the patterns and correlates of simultaneous alcohol and medication use in older adults. This study examined trajectories of concurrent use among community-dwelling older adults by gender, race and age and the impact of health status on group membership.

Methods:

Data from the Cardiovascular Health Study (CHS), a population-based longitudinal study of older adults, were analyzed for this study. The CHS cohort consists of 5,888 participants ages 65 and older. The mean age of respondents is 72 and roughly 15% of the sample is African American. Participants completed face-to-face and telephone interviews along with clinical examinations. Concurrent use was calculated using weekly alcohol consumption and total number of alcohol-interactive medications currently being taken. The SAS Proc Traj procedure was used to conduct group-based logit modeling. The Bayesian Information Criterion (BIC) was used for model selection.

Results:

A model with four groups represented the best fit. Each of the four groups are characterized by their own distinct patterns of concurrent use. For group 1, concurrent use increased over the course of the study. The second trajectory is fairly flat and is comprised of individuals with a stable pattern of no to low use over the course of the study. The third group is characterized by moderately high levels of use in the initial waves of the study followed by a gradual steady decrease in concurrent use over time. The final group is indicative of high-stable rates of concurrent use over time. Using the no to low use group as the comparison group, gender was a significant predictor of group membership. Males had a higher probability of group membership in the high use group. Race did not predict membership in the increasing use group yet, being White increase the probability of group membership in the high use group and the decreasing use group with significant coefficients of 0.81 and 0.61, respectively. Age is only significant for determining membership in the increasing use group. Individuals with fair-poor health are less likely to be in the increasing use group; self-reported health was not significantly related to membership in any other group. Individuals with a diagnosis of depression are significantly more likely to be in the no to low use group.

Implications:

This research provides a preliminary understanding of factors that help target older adults who are at risk for concurrent use. The results demonstrate that men and Whites are at increased risk for prolonged concurrent alcohol and medication use. These findings indicate a significant need for social work and health care professionals to educate older adults about the dangers of concurrent use. Additionally, health campaigns focused on the promotion of safer use of alcohol and medications by older adults are needed.