Associations between Health Service Utilization and Age of Onset for Alcohol Use Disorder Among Older Adults

Background and Purpose: Age of onset for alcohol use disorders (AUD) is associated with both physical and mental health outcomes among adults, however research into the health effects of age of onset in older adulthood is sparse. The number of older adults with an alcohol use disorder (AUD) in the U.S. is expected to double between 2010 and 2050, likely increasing physical and mental health problems among this population. Older adults are most often screened for AUDs through medical services, but the relationship between AUD characteristics and medical service utilization is unclear. Therefore the purpose of this study is to examine the effect age of onset of 1^st AUD may have on medical service utilization among older adults.

Methods: Data are from the 2012-2013 National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III), a population-representative survey of United States adults aged 18 or older living in non-institutionalized settings. Our sample included respondents who were aged 55 and older and met DSM-5 diagnostic criteria for an AUD at any point in their life (N = 1,632). Participants reported the age at which their AUD symptoms first appeared, past-year alcohol consumption (number of drinks per drinking day), as well as many sociodemographic and clinical factors (age, gender, race/ethnicity, annual household income, lifetime DSM-5 mental health/substance use diagnoses, presence of chronic health conditions, etc.). In terms of physical health service utilization, participants reported the number of overnight hospital stays in the past year, number of times received any medical care in the past year and number of injuries that required any medical attention in past year. Multivariate negative binomial regression models examined whether age of onset for AUD was significantly associated with past year physical health service utilization, when controlling for additional factors associated with physical health.

Results: About 44% of older adults reported 1^st AUD onset between ages 18 and 20, 41% between ages 21 and 29, and 14% after age 30. Multivariate models showed that controlling for sociodemographic and clinical factors, older adults with 1^st AUD onset after 30 years reported fewer past year overnight hospital stays, fewer past year receipt of any medical care, and fewer past year injuries that required any medical care, compared to older adults with 1^st AUD onset between age 18 and 20.

Conclusions and Implications: A majority of older adults experience 1^st AUD onset between ages 18 and 20. Also, AUD onset after age 30 is associated with lower rates of past-year medical service utilization among older adults. Future research is necessary to establish whether these lower rates are due to lower AUD problem severity, or recency in AUD problem persistence. However, social work practice implications from these findings highlight the need to implement screening and referral services for AUD outside of medical care settings in which social workers participate, given that older adults with later onset AUD are some of the most least likely to access medical service settings.