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Improve health for Vermont's older adults

Vermonters are healthy

Vermonters are healthy

Vermonters are Healthy

Reduce alcohol and drug misuse in older Vermonters

Vermonters are healthy

% of adults age 65 and older who drink at a level of risk

23%2016

Story Behind the Curve

Last Updated: January 2017

Author: Vermont Department of Health, Division of Alcohol and Drug Abuse Programs


One fifth of Vermonters age 65 and older drink at a risky level. Alcohol is the most commonly abused psychoactive substance among all age groups including older adults. Adults 65+ may have unique risks associated with alcohol use. Older adults may have greater risks associated with alcohol use likely due to physiological changes during the aging process, including chronic diseases and increased medication use. These results raise public health concerns given a fifth of older adults report ‘fair/poor’ health. However, older adults report significantly fewer “poor mental health days” than other age groups. This population may be particularly vulnerable to the adverse effects of alcohol as it may impact the course of chronic disease or increase risks of injury at lower doses than younger adults. However, we note that “Older adults with cardiovascular disease (CVD) and diabetes are significantly less likely than those without these conditions to report binge and chronic drinking. Obese adults are also significantly less likely to report chronic drinking than those who are not obese. This suggests that those with these conditions may be hearing from their doctor, or other sources, that alcohol consumption should be limited due to their illness. Chronic and binge drinking did not vary significantly [by age] for any other chronic health conditions measured on the BRFSS.” (Alcohol Use Among Older Adults – Data Brief: 2014 BRFSS). Health providers should ensure that screening for unhealthy alcohol use is part of the regular medical care for this population.

We use the Behavioral Risk Factor Surveillance System survey data to look at alcohol use risk behaviors among adults age 65 and older. The data depict the percentage of at-risk drinking by this age group. At-risk drinking is defined as 3 or more drinks on one occasion for men and 2 or more drinks for women. This is an indicator of a health risk reported in the Health Rankings by the National Health Foundation.

Vermont rates of at-risk drinking among older adults is somewhat higher than US rates.

BRFSS, 2011-2015

* denotes Vermont proportion is statistically higher than U.S

For more information on alcohol use in older adults, please see this Health Department Data Brief, available here and the reference section below.


Partners
  • ADAP (Vermont Department of Health Division of Alcohol and Drug Abuse Programs)
  • AHS (Agency of Human Services) initiative to provide substance abuse screening for all its clients
  • Vermont SBIRT (Screening, Brief Intervention and Referral to Treatment) to provide training on alcohol use screening to medical providers and to elder care professionals
  • SASH (Support and Assistance at Home) and home health care providers participating in substance use screening
  • DMH Designated Agencies Elder Care Clinicians providing substance use screening for its clients
  • Area Agencies on Aging case managers participating in alcohol use screening of its clients
What Works
  • Education and prevention services to increase awareness of the prevalence and risk for harm of alcohol misuse among older adults, especially those taking medications that are reactive to alcohol
  • Early identification of problem substance use through evidence-based screening instruments
  • Vermont SBIRT program for medical providers to screen and provide education to their patients about potential problems with mixing prescription medications with alcohol
  • Training elder care professionals to screen for alcohol use problems
Strategy
  • Identify recommended screening tools and train elder care professionals as well as medical providers in the use of these screening tests
  • Partner with the ADAP prevention staff in developing educational materials for seniors and their caregivers
  • Screening tools have been identified, and these include the Short
    Michigan Alcohol Screening Test-geriatric version (S-MAST-G). Training in the use of these tools is being provided to elder care professionals. These trainings have all followed the SBIRT model for substance abuse screening training
  • ADAP prevention services has created a community presentation on substance misuse and abuse among older adults to be delivered in Vermont communities by the area Prevention Consultants. An education brochure on alcohol use and aging has also been created to be distributed widely to elder care and medical providers for use with their clients and patients. The brochure offers specific strategies to lower this risk.
  • Promote and participate in educational programs for substance abuse and elder care professionals about older adults with substance use problems
Notes on Methodology
  • The curve on the percentage of at-risk chronic drinking among older adults is calculated from a BRFSS data query. The data is calculated and reported by the Vermont BRFSS Coordinator. Chronic drinking for adults age 65 and older is defined as drinking more the sixty standard drinks per month for these older men and more than thirty drinks per month for these older women.
  • The target for improvement is for the Vermont percentage to decrease over time and be no greater than the US percentage for chronic drinking among this age group.
  • This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont were age adjusted. In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment visit /www.cdc.gov/nchs/data/statnt/statnt20.pdf.
  • Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.
References

  • Substance Abuse Among Older Adults, SAMHSA TIP 26, 2012
  • Substance Abuse and Mental Health Among Older Americans: The State of the Knowledge and Future Directions, Bartels, Blow, Brockmann, and Van Citters, 2005
  • Older Americans Behavioral Health Issue Brief 2: Alcohol Misuse and Abuse Prevention, SAMHSA and AoA, 2012
  • Older Americans Behavioral Health Issue 3: Screening and Preventive Brief Interventions for Alcohol and Psychoactive Medication Misuse/Abuse, SAMHSA and AoA, 2012
  • Evidence-Based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults, Blow, Bartels, Brockman and Van Citters, Older Americans Substance Abuse and Mental Health Technical Assistance Center
  • “Drinking Over the Lifespan”, Alcohol Research, vol. 38, no. 1
  • “Episodic Heavy Drinking and 20-Year Total Mortality Among Late-Life Moderate Drinkers”, Holahan, Schutte, Brennan, and Moos, American Clinical and Experimental Research, Vol. 2, no. 1, 2014
  • “The Epidemiology of At-Risk and Binge Drinking Among Middle-Aged and Elderly Community Adults: National Survey on Drug Use and Health”, Blazer and Wu,  American Journal of Psychiatry, 2009, 166:1162-1169
  • “The Alcohol-Related Problems Survey: Identifying Hazardous and Harmful Drinking in Older Primary Care Patients”, Fink, Morton, Beck, Hays, Spritzer, Oishi, and Moore, Journal of American Geriatric Society, 50:1717-1722, 2002
  • “Current Heavy Alcohol Consumption is Associated with Greater Cognitive Impairment in Older Adults”, Woods, et al, Alcoholism: Clinical and Experimental Research, Vol 2, no. 1, 2016
  • “Silent Epidemic: Seniors and Addiction”;  from US NEWS and World Report, 12/02/2015
  • Retirement and the Hidden Epidemic: the Complex Link Between Aging, Work Disengagement, and Substance Misuse-And What to do About It, Bamberger and Bacharach, 2014


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