Substance use disorder among older adults in the United States in 2020

Aims   This study aimed to project the number of people aged 50 years or older with substance use disorder (alcohol/illicit drug dependence or abuse) in the United States in 2020.
Design   Logistic regression models were applied to estimate parameters predicting past-year substance use disorder using the 2002–06 National Survey on Drug Use and Health data. We applied these parameters to the projected US 2020 population to estimate the number of adults aged 50 or older with substance use disorder in 2020.
Setting   Non-institutionalized US residences.
Participants   Representative sample of the US civilian, non-institutionalized population.
Measurements   Substance use disorder is classified based on criteria in the Diagnostic and Statistical Manual of Mental Disorders , 4th edition.
Findings   Due to the large population size and high substance use rate of the baby-boom cohort, the number of adults aged 50 or older with substance use disorder is projected to double from 2.8 million (annual average) in 2002–06 to 5.7 million in 2020. Increases are projected for all examined gender, race/ethnicity and age groups.
Conclusions   Our estimates provide critical information for policymakers to allocate resources and develop prevention and treatment approaches to address future needs of the US older adult population with substance use disorder.     

Olfactory dysfunction and cognition among older adults in the United States

Background

In this work we assess the association between olfactory dysfunction and cognition in a nationally representative sample of older adults in the United States.

Methods

Participants aged ≥60 years (n = 1236) from the 2013–2014 National Health and Nutritional Examination Survey underwent both olfactory and cognitive testing. Olfaction was assessed by both objective test (8‐odor Pocket Smell Test: smell impairment defined as score ≤2) and self‐report. Cognitive assessment consisted of the Digit Symbol Substitution Test (DSST), the Animal Fluency Test, and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Regression models were used to examine the association between olfaction and cognition while adjusting for demographics, cardiovascular factors, and associated medical history.

Results

The prevalence of smell impairment in US older adults was 18.0% (95% confidence interval [CI], 14.0‐22.0%) and 22.0% (95% CI, 18.5‐25.6%) based on objective smell test and self‐report, respectively. In a multivariate model adjusted for relevant factors, low smell test scores were consistently associated with low scores on cognitive assessments, with a DSST score difference of ?1.5 (95% CI, ?2.2 to ?0.8), Animal Fluency Test score difference of ?0.4 (95% CI, ?0.7 to ?0.1), and CERAD Word List score difference of ?0.4 (95% CI, ?0.6 to ?0.2) per 1‐point decrease in smell test score. There was no association between self‐reported smell impairment and cognition.

Conclusion

Objectively measured olfactory dysfunction is independently associated with cognitive impairment. These findings are consistent with previous studies and suggest the utility of objective olfactory tests as an indicator for cognitive impairment as compared with self‐reported olfactory dysfunction, which is an uncertain indicator.

     

Predictors of colorectal cancer screening participation in the United States

OBJECTIVE: Our aim was to identify predictors of colorectal cancer screening in the United States and subgroups with particularly low rates of screening. METHODS: The responses to a telephone-administered questionnaire of a nationally representative sample of 61,068 persons aged >/=50 yr were analyzed. Current screening was defined as either sigmoidoscopy/colonoscopy in the preceding 5 years or fecal occult blood testing (FOBT) in the preceding year, or both. RESULTS: Overall, current colorectal cancer screening was reported by 43.4% (sigmoidoscopy/colonoscopy by 22.8%, FOBT by 9.9%, and both by 10.7%). The lowest rates of screening were reported by the following subgroups: those aged 50-54 yr (31.2%), Hispanics (31.2%), Asian/Pacific Islanders (34.8%), those with education less than the ninth grade (34.4%), no health care coverage (20.4%), or coverage by Medicaid (29.2%), those who had no routine doctor's visit in the last year (20.3%), and every-day smokers (32.1%). The most important modifiable predictors of current colorectal cancer screening were health care coverage (OR = 1.7, 95% CI = 1.5-1.9) and a routine doctor's visit in the last year (OR = 3.5, 95% CI = 3.2-3.8). FOBT was more common in women than in men (OR = 1.8, 95% CI = 1.6-2.0); sigmoidoscopy/colonoscopy was more common in Hispanics (OR = 1.4, 95% CI = 1.1-1.7) and Asian/Pacific Islanders (OR = 2.4, 95% = CI 1.5-3.9) relative to whites, in persons without routine doctor's visits in the preceding year (OR = 3.3, 95% CI = 2.8-4), and in persons with poor self-reported health (OR = 1.3, 95% CI = 1.2-1.5). CONCLUSIONS: Interventions should be developed to improve screening for the subgroups who reported the lowest screening rates. Such interventions may incorporate individual screening strategy preferences.     

Racial and ethnic colorectal cancer patterns affect the cost-effectiveness of colorectal cancer screening in the United States

BACKGROUND & AIMS: Colorectal cancer screening beginning at age 50 is recommended for all Americans considered at "average" risk for the development of colorectal cancer. METHODS: We used 1988-1995 California Cancer Registry data to compare the cost-effectiveness of two 35-year colorectal cancer screening interventions among Asians, blacks, Latinos, and Whites. RESULTS: Average annual age-specific colorectal cancer incidence rates were highest in blacks and lowest in Latinos. Screening beginning at age 50 was most cost-effective in blacks and least cost-effective in Latinos (measured as dollars spent per year of life saved), using annual fecal occult blood testing (FOBT) combined with flexible sigmoidoscopy every 5 years and using colonoscopy every 10 years. A 35-year screening program beginning in blacks at age 42, whites at age 44, or Asians at age 46 was more cost-effective than screening Latinos beginning at age 50. CONCLUSIONS: Colorectal cancer screening programs beginning at age 50, using either FOBT and flexible sigmoidoscopy or colonoscopy in each racial or ethnic group, are within the $40,000-$60,000 per year of life saved upper cost limit considered acceptable for preventive strategies. Screening is most cost-effective in blacks because of high age-specific colorectal cancer incidence rates.     

Mortality associated with illegal drug use among adults in the United States

Objectives: To examine all-cause and cause-specific mortality over a 15-year follow-up period in relation to at-baseline reported lifetime use of illegal drugs from five classes (marijuana, cocaine, heroin, hallucinogens, and inhalants) among adults in the United States (US) household population. Methods: The study involved 20,983 sample adults who responded to the 1991 National Health Interview Survey Drug and Alcohol Use supplemental questionnaire and also met the eligibility criteria for mortality follow-up. Cox proportional hazards models were estimated to examine the relationships. Results: Adults who at baseline reported lifetime heroin use were at significantly higher risk of all-cause death over the follow-up period (hazard rate ratio or HR?=?2.02; 95% confidence interval or CI 1.26–3.23), compared with those who did not report using drugs from any of the five classes, even after adjusting for age, sex, race, education, marital status, cigarette smoking status, and alcohol use status. Those who at baseline reported lifetime cocaine (no heroin) use had a significantly higher rate of death associated with human immunodeficiency virus diseases over the follow-up period than nonusers of drugs from any of the five classes. Several limitations of the analysis are discussed. Conclusions: Further research is needed to understand and track the elevated mortality associated with illegal drug use and the correlates of drug-poisoning deaths.     

Infectious disease hospitalizations among older adults in the United States from 1990 through 2002

BACKGROUND: To understand conditions associated with substantial morbidity among older adults (aged > or = 65 years), we describe hospitalization rates and trends for overall infectious disease (ID) and for specific ID groups among older adults in the United States from January 1, 1990, through December 31, 2002. METHODS: The National Hospital Discharge Survey was used to generate hospitalization estimates from 1990 through 2002 for the US population of older adults. By using a comprehensive list of International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with IDs, we identified and analyzed hospitalizations associated with specific ID and ID-related categories. RESULTS: There were approximately 21.4 million (SE, 636 000) ID hospitalizations among older adults from 1990 through 2002, and between 1990 through 1992 and 2000 through 2002, the ID hospitalization rate increased 13% from 449.4 to 507.9 hospitalizations per 10 000 older adults (P = .01). This increase was caused in part by the increasing relative contributions of patients aged 75 through 84 years and 85 years or older to the older adult ID hospitalization rate. Almost half of ID hospitalizations (46% [SE, 0.7%]) and ID-related hospital deaths (48% [SE, 1.6%]) among older adults were associated with lower respiratory tract infections from 2000 through 2002. CONCLUSIONS: The hospitalization rate for IDs increased slightly among the older adult US population during the 13-year study and was associated with the aging of the older adult population. The reduction of ID hospitalization rates among older adults could help attenuate the anticipated increase in the number of hospitalizations among older adults and should be a high priority given the projected population growth among older adults in the United States.     

Prostate-specific antigen screening for prostate cancer in older men in the United States of America

Prostate cancer, like many diseases, is more common in older men. Although an estimated 1 in 7 men will be diagnosed with it, the majority of these men will not die from prostate cancer. The latent nature of this disease, the use of screening with prostate-specific antigen (PSA) testing and the greater risk of dying from causes other than prostate cancer contribute to this disparity. As the US population continues to age, prostate cancer screening and disease management presents an increasingly important public health issue. We discuss the current PSA screening recommendations and practices in the USA and the benefits and harms of screening older populations.     

Self-efficacy and participation in physical and social activity among older adults in Spain and the United States

PURPOSE: We explored Bandura's self-efficacy theory as applied to older adult (aged 63-92) participation in physical and social activity in a cross-cultural study. DESIGN AND METHODS: Older adults in Spain (n = 53) and the United States (n = 55) completed questions regarding self-efficacy, outcome expectancy, and participation in physical and social activities. RESULTS: Self-efficacy significantly predicted both physical and social activity in both Spain and the United States. Outcome expectancy did not significantly predict either activity, nor did education, gender, or overall health. Modified and new self-efficacy measures proved reliable in both samples. IMPLICATIONS: This study enhances understanding of how self-efficacy motivates participation in physical activity, as noted in previous studies, as well as provides a new understanding of what motivates participation in social activities. The high reliability of the new measures used in this study provides evidence for further use of these measures in other contexts. It is important to note that this study further supports the use of Bandura's theory of self-efficacy for cross-cultural applications.     

Primary care experience among older adults in the United States: a retrospective cross-sectional study

BackgroundWhile the importance of primary care becomes more imminent for older adults to manage multi-morbidities, the perception of primary care among this group is not well examined.AimTo evaluate the primary care experience among older adults in the United States (US).MethodsWe conducted a retrospective cross-sectional study examining four domains of primary care: first contact, longitudinality, comprehensiveness, and coordination. Using survey responses from Medical Expenditure Panel Survey (MEPS), we used propensity score matching method to compare the percentage of geriatric (≥65 years old) and non-geriatric (< 65 years old) who answered favorably to questions that supported each domain from 2014 to 2016. Using multivariate regression, we also assessed the impact of each domain on various demographic and perceived need for care features of older adults.ResultsA total of 12,982 surveys were analyzed for geriatric, compared to 62,694 surveys for non-geriatric. Overall, older adults answered more favorably than younger adults for all four domains. However, uninsured older adults, Black older adults and older adults with limitation in activities, cognitive impairments, and multiple comorbidities were more likely to have difficulties in accessing their usual source of care (USC). Additionally, Black, Hispanic, and Asian older adults and cognitively impaired adults perceived less contribution in their own treatment management.ConclusionOlder adults in the US generally experience good quality of primary care, compared to younger adults. However, establishing and maintaining access (first contact) and being involved in disease management (coordination) were perceived as poor by several cohorts of older adults.