Alcohol Consumption, Life Context, and Coping Predict Mortality among Late-Middle-Aged Drinkers and Former Drinkers

This study examined mortality risk for individuals in four alcohol consumption categories and identified life context and coping factors that independently predicted mortality among late-middle-aged drinkers and former drinkers ( n = 1869). Compared with light drinkers, former drinkers (current abstainers) were at increased mortality risk; moderate drinkers were at decreased risk. Consistent with previous research on older samples, heavy drinkers were not at increased risk. Abstainers' increased risk was reduced in a model that controlled for life context and coping factors. Other independent predictors of mortality included reporting an illness stressor, stressor severity, less participation in activities with friends, greater use of resigned acceptance and alternative rewards coping, and less use of cognitive avoidance and emotional discharge coping. The findings support previous research on the alcohol-mortality relationship among older adults, and highlight the fact that abstainers' life stressors and avoidance coping responses may be more important predictors of their mortality than their abstention.     

Health Perception and Depressive Symptoms Among Older Korean Americans

Given the increasing recognition of racial/ethnic health disparities, the present study focused on older Korean Americans. Using data from 230 older Korean Americans in Florida (M age = 69.8, SD = 7.05), we assessed (a) how background variables (demographic information and acculturation), health constraints (chronic conditions and functional disability), and psychosocial factors (sense of mastery and filial satisfaction) were associated with health perception and depressive symptoms; and (b) whether health perception mediated the connections between health constraints and depressive symptoms. We observed positive perceptions of health and emotional states among individuals with higher levels of acculturation, fewer chronic conditions, less disability, and a greater sense of mastery. We also found that persons who were more satisfied with their relationships with adult children and who had more positive health perception were less depressed. Additionally, the findings supported a mediation model of health perception in the linkages between physical and mental health. Findings and implications are discussed here in a cultural context.     

Course and Severity of Substance Abuse Among Patients With Comorbid Major Depression

The authors assessed the course and severity of substance-related disorder (SRD) among patients with comorbid major depressive disorder (MDD) by means of both retrospective and concurrent data. A total of 642 patients were assessed. Data on course included lifetime use, age at first use, years of use, use in the last year, periods of abstinence, and current diagnosis. Data on severity included two measures of SRD-associated problems, substance abuse vs. dependence, self-help activities, and number of substances being abused. SRD-MDD patients tended to manifest lower levels of cannabis, opiate, and cocaine use, and more SRD-only patients were abusing three or more substances. Men with SRD-MDD demonstrated longer mean durations of abstinence compared with men with SRD-only, whereas SRD-MDD women demonstrated shorter mean durations of abstinence, compared with women with SRD-only. MDD-SRD patients showed slightly less substance abuse, but SRD severity was comparable with SRD-only patients.     

Three-Year Chemical Dependency and Mental Health Treatment Outcomes Among Adolescents: The Role of Continuing Care

Background: Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long‐term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This study examines the effect of the index CD and ongoing CD and psychiatric treatment episodes, 12‐step participation, and individual characteristics such as CD and mental health (MH) severity and gender, age, and ethnicity, on 3‐year CD and MH outcomes. Methods: Participants were 296 adolescents aged 13 to 18 seeking treatment at 4 CD programs of a nonprofit, managed care, integrated health system. We surveyed participants at intake, 1 year, and 3 years, and examined survey and administrative data, and CD and psychiatric utilization. Results: At 3 years, 29.7% of the sample reported total abstinence from both alcohol and drugs (excluding tobacco). Compared with girls, boys had only half the odds of being abstinent (OR = 0.46, p = 0.0204). Gender also predicted Externalizing severity at 3 years (coefficients 18.42 vs. 14.77, p < 0.01). CD treatment readmission in the second and third follow‐up years was related to abstinence at 3 years (OR = 0.24, p = 0.0066 and OR = 3.33, p = 0.0207, respectively). Abstinence at 1 year predicted abstinence at 3 years (OR = 4.11, p < 0.0001). Those who were abstinent at 1 year also had better MH outcomes (both lower Internalizing and Externalizing scores) than those who were not (11.75 vs. 15.55, p = 0.0012 and 15.13 vs. 18.06, p = 0.0179, respectively). Conclusions: A CD treatment episode resulting in good 1‐year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents.     

Predictors of Preventive Health Care Use Among Middle-aged and Older Adults in Mexico: The Role of Religion

Research has shown that religion is associated with a wide range of health behaviors among adults of all ages. Although there is strong support for religion’s influence on behaviors such as drinking and smoking, less is known about the possible relationship between religion and the use of preventive health services. This relationship may be particularly important in Mexico, a country with high levels of religiousness and low levels of preventive service utilization. The current study uses a nationally representative sample of middle-aged and older adults in Mexico (n = 9,890) to test the association between three facets of religion and three preventive services aimed at detecting chronic conditions or underlying risk factors. The findings show that religious salience is significantly related to the use of blood pressure and cholesterol screenings, even after controlling for a variety of social, demographic, and health-related factors. In addition, attending religious services and participating in religious activities are both positively associated with blood pressure and diabetes screening. This type of research adds to our knowledge of the determinants of preventive service utilization, as well as to the burgeoning literature on religion and health. Furthermore, because the vast majority of research in this field takes place in more developed and Westernized countries, such as the US and Western Europe, analyzing this relationship in a sample of older Mexicans is critical for providing the field with a more comparative orientation.     

Computerized Screening of Substance Abuse Problems in a Primary Care Setting: Older vs. Younger Adults

The purpose of the current study was to examine differences in responses of older adults (age 55 and above) and younger adults (ages 18 to 54) to the Drug Abuse Problem Assessment for Primary Care (DAPA‐PC), a computerized drug and alcohol abuse screening instrument developed for primary care settings. Data were collected from a diverse population of 327 adults presenting for care at The George Washington University Medical Faculty Associates clinic in downtown Washington, DC. Results indicated that rates of drug and alcohol abuse were similar in both groups. However, older adults were less likely than younger adults to perceive their drug use as problematic. This finding has serious implications for older adults, who tend to be underrepresented in treatment programs. There is a need for screening seniors and identifying those who may be at risk for substance abuse problems. Differences in responses to alcohol and drug assessments by age should be taken into consideration when designing screening instruments. The results of this study suggest that the DAPA‐PC would provide a useful instrument for screening older adults in a primary care setting.     

Predictors of Mortality in Home-Dwelling Patients with Cardiovascular Disease Aged 75 and Older

OBJECTIVES: To compare the predictive value of biomarkers commonly measured in older patients with cardiovascular disease (CVD) with an indicator of cognitive function.
DESIGN: Prospective cohort study.
SETTING: Helsinki, Finland.
PARTICIPANTS: Three hundred ninety-eight home-dwelling older persons (261 women, mean age 80) with stable CVD and without a diagnosis of clinical dementia.
MEASUREMENTS: Simple laboratory and clinical measurements (including the Mini Mental State Examination (MMSE, maximum score 30 points) and New York Heart Association (NYHA) classification) were used to predict mortality. A MMSE score between 18 and 24 points was considered to indicate cognitive impairment.
RESULTS: At baseline, median MMSE score was 27 (interquartile range 25–28), with 59 individuals having a score below 24 points. During a mean follow-up of 6.0 years, 129 participants died. In the fully adjusted Cox proportional hazards model, low MMSE score was the strongest predictor of mortality, with a relative hazard of 2.38 (95% confidence interval=1.52–3.74; P <.001). Of the various clinical and laboratory variables, only creatinine, C-reactive protein, and history of congestive heart failure were significant independent predictors, whereas conventional risk factors were not.
CONCLUSION: Only a few clinical variables independently predicted 6-year mortality in older home-living patients with CVD. The strongest predictor was impaired cognitive function assessed using MMSE.     

Predictors of In-hospital Mortality Among Patients Presenting with Variceal Gastrointestinal Bleeding

Background/Aim:

The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2) to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding.

Patients and Methods:

This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20.

Results:

Cirrhosis accounted for 308 (97.16%) subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84%) completing the tally. Sixty-three (19.87%) subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000), Child-Pugh Class (P = 0.002), altered sensorium (P = 0.037), rebleeding within 24 h of admission (P = 0.000), low hemoglobin level (P = 0.023), and serum bilirubin (P = 0.002).

Conclusion:

Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.     

Predictors of Flexibility in Social Identity Among People Entering a Therapeutic Community for Substance Abuse

One of the key aspects of recovery from substance dependence is making a transition from a social network supportive of substance use to one that supports recovery. This study assessed this transition in social identity in an adult therapeutic community (TC) at baseline and 2 weeks into treatment. Where residents increased identification with the TC, and reduced social identification with using groups, retention in treatment improved. As retention is a proxy measure of positive outcomes, this pilot suggests that facilitating residents' positive identification with the community in the first weeks of treatment may be central to retaining residents and improving treatment outcomes.     

Cardiovascular and All-Cause Mortality Risk by Coronary Artery Calcium Scores and Percentiles Among Older Adult Males and Females

BackgroundCoronary calcium is a marker of coronary atherosclerosis and established predictor of cardiovascular risk in general populations; however, there are limited studies examining its prognostic value among older adults (≥75 years) and even less regarding its utility in older males compared with females. Accordingly, we sought to examine the prognostic significance of both absolute and percentile coronary calcium scores among older adults.MethodsThe multicenter Coronary Artery Calcium Consortium consists of 66,636 asymptomatic patients without cardiovascular disease. Participants ages ≥75 were included in this study and stratified by sex. Multivariable Cox regression models were constructed to assess cardiovascular and all-cause mortality risk by Agatston coronary calcium scores and percentiles.ResultsAmong 2,474 asymptomatic patients (mean age 79 years, 10.4-year follow-up), prevalence of coronary artery calcium was 92%. For both sexes, but in females more so than males, higher coronary calcium score and percentiles were associated with increased cardiovascular and all-cause mortality risk. Those at the lowest coronary calcium categories (0-9 and <25 percentile) had significantly lower risk of cardiovascular and all-cause mortality relative to the rest of the population. Multivariable analyses of traditional cardiovascular risk factors and coronary artery calcium variables revealed that age and coronary calcium were the strongest independent predictors for adverse outcomes.ConclusionsBoth coronary artery calcium scores and percentiles are strongly predictive of cardiovascular and all-cause mortality among older adults, with greater risk-stratification among females than males. Both low coronary artery calcium scores 0-9 and <25th percentile define relatively low risk older adults.     

Depression, Substance Abuse and Other Contextual Predictors of Adherence to Antiretroviral Therapy (ART) Among Haitians

Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti’s resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.     

Outcomes and Predictors of Mortality Among Cardiac Intensive Care Unit Patients With Heart Failure

BackgroundLittle is known regarding the causes of critical illness and determinants of prognosis of patients with heart failure (HF) admitted to the modern cardiac intensive care unit (CICU). We sought to describe the epidemiology and outcomes of patients with HF admitted to the contemporary CICU.Methods and ResultsRetrospective cohort analysis of Mayo Clinic CICU patients admitted with HF from 2007 to 2018 who had left ventricular ejection fraction (LVEF) data. HF with reduced LVEF (HFrEF) was defined as a LVEF of less than 50%, and HF with preserved LVEF (HFpEF) as a LVEF of 50% or greater. In-hospital mortality was analyzed using multivariable logistic regression. Survival to 1 year was analyzed using a Kaplan–Meier analysis. We included 4012 patients, including 67.8% with HFrEF and 32.2% with HFpEF. Patients with HFrEF and HFpEF were comparable and had equivalent severity of illness. Critical care therapies were used in 59.4%, with a slight preponderance in patients with HFrEF. In-hospital mortality occurred in 12.5% of patients and was similar in HFrEF vs HFpEF. Shock and cardiac arrest were the strongest predictors of adjusted in-hospital mortality, followed by Braden skin score and serum chloride level; patients with HFrEF and HFpEF had similar adjusted mortality rates. The 1-year survival after hospital discharge was 74.5% and was slightly lower for patients with HFpEF. All-cause rehospitalization occurred in 36.6%, and 52.8% of hospital survivors died or were readmitted within 1 year.ConclusionsCICU patients with HF have a substantial burden of critical illness, high use of critical care therapies, and poor outcomes regardless of LVEF. This finding emphasizes the potential unmet care needs in this cohort.Lay summaryPatients with heart failure who require admission to the cardiac intensive care unit have high severity of illness and are at significant risk of death during and after hospitalization. These patients often require specialized critical care therapies to treat manifestations of critical illness. Patients who are admitted with cardiac arrest or shock, including those who require mechanical ventilation or vasopressors, are at particularly high risk of death. Patients’ left ventricular ejection fraction is not strongly associated with the risk of death when accounting for other major predictors including frailty and laboratory abnormalities.     

High mortality of older patients admitted to hospital from care homes and insight into potential interventions to reduce hospital admissions from care homes: the Norfolk experience

There is a high mortality rate in patients admitted to hospitals acutely from care homes. In a retrospective case analysis study of 3772 older people admitted to the Department of Medicine for the Elderly between January and June 2005, 340 (9.0%) were from care homes, and 93 (27.3%) of the residents died during the index admission. Nearly 40% of these deaths occurred within 24 h of admission indicating a high level of less appropriate admissions. Investigating eight nursing homes which admitted the highest number of patients from one primary care trust revealed that the most cited reasons for admission were the lack of advance care plans, access to General Practitioners (GPs) out of hours, as well as general access to palliative care and specialist nurses, and poor communication between patient, relatives, GPs, hospitals and care home staff. Our findings provide some useful insight into the factors that need to be addressed to avoid unnecessary or inappropriate admissions from care homes for better end of life care in aging societies.