In the News
News and new developments around alcohol, medications, mental health, addictions, and older adults.
NEW YORK (Reuters Health) - Women in their 50s and beyond report physical and verbal abuse at a rate similar to that of younger women, a large U.S. study shows. At the outset, the study of nearly 92,000 women ages 50 to 79 found that 10,200 had been abused some time in the past year. Three years later, over 2,400 more women reported abuse, according to findings published in the April issue of the American Journal of Public Health.
The findings highlight the "serious health threat" that abuse poses to older women, the study's lead author, Dr. Charles P. Mouton of the University of Texas Health Science Center at San Antonio, told Reuters Health.
Mouton and his colleagues gathered their figures using data from the Women's Health Initiative, a national medical study of postmenopausal women. At the start of the study and again three years later, participants were asked whether a family member or friend had physically abused them in the past year. They were also asked about verbal abuse such as put-downs, severe criticism and threats.
Overall, 11 percent of women reported some form of abuse at the study's start, with 89 percent of them saying they'd been subjected to verbal abuse alone. Verbal abuse, Mouton said, can cause both physical and mental harm. Research has linked it to stress and depression, and people who suffer verbal abuse tend to report poorer physical and psychological health.
Among women in the study, those in their 50s were more likely to report abuse than older women were, and low income was associated with a higher risk of any type of abuse. Black women were nearly three times more likely than white women to say they'd been physically abused, but white women reported more verbal abuse. Although study participants were not asked to identify their abuser, Mouton said it's fair to assume that it was often a husband or partner.
According to the researchers, most studies on abuse have focused on younger women or on frail elderly adults, who are at risk of abuse by caregivers. The new findings, they say, show that healthy older women may suffer rates of abuse comparable to, or even higher, than those of younger women.
Mouton said he thinks doctors need to be more aware of the potential for abuse among their older female patients. He noted that he routinely screens such patients for abuse, although studies have not yet shown whether routine screening is effective in spotting and stopping abuse.
The news article on the study can be found at: www.nlm.nih.gov/medlineplus/news/fullstory_17210.html
The citation for the journal article is : Charles P. Mouton, Rebecca J. Rodabough, Susan L. D. Rovi, Julie L. Hunt, Melissa A. Talamantes, Robert G. Brzyski, and Sandra K. Burge, (April, 2004) Prevalence and 3-Year Incidence of Abuse Among Postmenopausal Women, Am J Public Health, 94: 605-612.
Program Helps Seniors Learn, Cope With HIV (June 4, 2004)
HIV among older adults is increasing. Misconceptions about the disease process, poor diagnoses and lack of knowledge are factors that have led to an increase in HIV cases among older adults. Seniors affected by HIV is highest in South Florida. Paul Spearing of Oakland Park, a program analyst with the Senior HIV Intervention Project reports, heterosexual women over 60 as the growing at risk group for HIV. The Broward County Health Department has responded by sponsoring The Senior HIV Intervention Project that offers information and resources to seniors over the age of 50.
Smoking ban called 'elder abuse' April 13, 2004
SUDBURY, Ont. (CP) A member of the Sudbury Elder Abuse Committee says
preventing residents of long-term care facilities from smoking in their "home" is a form of elder abuse.
BARRIERS TO ACCESS TO MENTAL HEALTH SERVICES FOR ETHNIC SENIORS: THE TORONTO STUDY
Joel Sadavoy, MD, FRCPC1, Rosemary Meier, MB, ChB, MSc, FRCPsych, FRCPC2, Amoy Yuk Mui Ong, MSW3, (Canadian Journal of Psychiatry 2004; 49:192-199)
Objective: To identify and describe barriers to access to mental health services encountered by ethno-racial seniors.
Conclusions: There is a clear need for more mental health workers from ethnic backgrounds, especially appropriately trained psychiatrists, and for upgrading the mental health service capacity of frontline agencies through training and core funding. Active community education programs are necessary to counter stigma and improve knowledge of mental disorders and available services. Mainstream services require acceptable and appropriate entry points. Mental health services need to be flexible enough to serve changing populations and to include services specific to ethnic groups, such as providing comprehensive care for seniors.
To read this abstract go to: www.cpa-apc.org/publications/archives/cjp/2004/march/sadavoy.asp
MOOD DISORDERS AND PROBLEM GAMBLING: CAUSE, EFFECT OR CAUSE FOR CONCERN? A REVIEW OF THE LITERATURE
January 2004, By Neasa Martin
The purpose of this study was to review the current literature to understand the potential link between problem gambling and mood disorders. Findings from the review include evidence of a greater prevalence of mood disorders, as well as substance abuse and suicidal behaviour, among people with gambling problems. There is no clear consensus in the literature on whether mood disorders lead to problem gambling, worsen the gambling or occur as a result of the gambling.
The review identified a gap in the research on whether or not people with mood disorders have higher rates of problem gambling. The Mood Disorders Society proposes that research into whether mood disorders represent a risk factor for problem gambling be conducted in partnership with members of the mood disorders self-help community. To read this report go to: www.mooddisorderscanada.ca/findinghelp/gambling/report/
CALL FOR FEEDBACK ON BLUEPRINT FOR NATIONAL STRATEGY FOR SUICIDE PREVENTION
A blueprint for a national strategy on the prevention of suicide is now available on the website of the Canadian Association for Suicide Prevention, and its authors are asking for feedback. Begun in May of 2002, the blueprint's purpose is to guide the creation of a final, national strategy that will prompt action at all levels of government. The document includes guiding principles, goals and objectives of the strategy, and information on national strategies developed around the world.
Blueprint for a Strategy to Reduce Suicide and Its Impact, and questions the authors would like readers to answer about it, are available on the association's website at www.suicideprevention.ca
SOFT NETWORKS CLOSE THE GAP BETWEEN RESEARCH AND PRACTICE British Medical Journal, 2004;328 (15 May).
An informal email network may improve the knowledge for evidence based health care and encourage communication between specialties. Analysing the activity of CHAIN (Contact, Help, Advice and Information Network for Effective Health Care, an informal email network for people working in health care), Russell and colleagues (p 1174) found that members were able to improve cross-professional contact and share innovation, good practice, and research ideas. Soft networking enables knowledge for evidence based health care to be personalised and made meaningful through informal social interaction, say the authors, and skilled staff can encourage a strong culture of support and reciprocity. To read this article go to: http://bmj.bmjjournals.com/cgi/content/full/bmj;328/7449/1174
New Addiction Research Centre in British Columbia
Simon Fraser University News announced Nov. 27, 2003 the launch of a $10 million addiction research centre for British Columbia. It is a partnership of University of British Columbia, Simon Fraser University, University of Victoria, and University of Northern British Columbia.
The Centre’s mandate covers a range of addictions everything from substance abuse to problem gambling. Led by psychologist Bonnie Leadbeater of the University of Victoria, it will provide the first coordinated effort in addiction research in BC.
“Expertise will include researchers with backgrounds in the biomedical causes of addictions, the social dimensions of addictions, particularly related to youth and aboriginal health, and health service delivery to remote populations.”
The first year will see a special emphasis on the areas of fetal alcohol syndrome, addictions related to mental illness and the prevention of addiction among youth. The Centre’s advisory board is made up of university, community and government partners. Research units are being established at each of the partner universities.
Statistics on Gambling in Canada
Statistics Canada in March, 2003 produced a 5 page Fact Sheet on Gambling for their publication, Perspectives on Labour and Income. Statistics Canada — Catalogue no. 75-001-XIE. It looks at
-- provincial revenue and profit from gambling (e.g. the gambling profit in Alberta to the government was over $1 billion dollars in 2001).
-- who gambles (age, employment status, gender, income level);
-- who works in the industry.
The revenue for Canada from gambling has increased over 5 fold, from $2.7 billion in 1992 to almost $12 billion in 2002.
Click on the link for “gambling”.
Are Older Adults Often Getting the Wrong Drugs?
At least one in three Montreal-area seniors has been "improperly prescribed" medication by a general practitioner, a new study has found. The problems may be attributed to poor communication among doctors, patients and pharmacists.
The study by Robyn Tamblyn, A. Huang, R. Perrault et al., was published in September 16, 2003 in the Canadian Medical Association Journal. The study was looking at whether receiving computerized decision-making support (CDS) could help improve prescribing practice among physicians.
The Research: As first step to the study, the researchers reviewed the prescriptions for 12,560 Montreal seniors in 1997. They linked patient medical records to their prescription records. Often patients would see more than one physician for prescriptions and go to more than one pharmacy to get them filled. Over time, a patient's list of medications would grow, but the physicians and pharmacists did not communicate with one another to make sure there weren't any unforeseen duplications or adverse interactions. "Physicians had incomplete information on what drugs were being prescribed," Tamblyn explained.
The researchers found that more than 30 per cent of the patients had at least one "inappropriate" prescription. Among the most frequent prescribing practices that could lead to problems for patients:
Medication errors are a growing problem across North America and believed to be the sixth leading cause of death in the United States. Up to 10 per cent of older adults end up in the hospital because of prescribing practices/ adverse medication interactions.
Stage 2: The McGill researchers decided to set up a computerized network for 107 physicians that linked their patient files with the provincial drug-insurance board. The physicians were divided into a “computerized” group linking prescriptions and records, and a control group to see if the computerized network might improve prescribing practices and reduce errors.
During the study the number of new potentially inappropriate prescriptions per 1000 visits was significantly lower (18%) in the computerized data group than in the control group. Most of this reduction involved duplicate prescriptions (e.g. study physician and another physician both prescribing same/ similar drug) and drug interactions caused by prescriptions written by the study physician.
Future Steps: The McGill researchers are now testing a more advanced version of the computerized prescription drug network. Under the new system, 30 GPs and 31 pharmacists have access to medication lists of patients, and the information is updated daily. That differs from the Pharmanet program in British Columbia, in which only pharmacists can exchange information.
The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care, Robyn Tamblyn, Allen Huang, Robert Perreault, André Jacques, Denis Roy, James Hanley, Peter McLeod, and Réjean Lap, Canadian Medical Association Journal, September 16 2003, Volume 169, Issue 6, Online: http://www.cmaj.ca/content/vol169/issue6/index.shtml
Comment: Although the study is interesting, people may want to question statements suggesting that prescribing anti-depressants and sedatives to older patients is inappropriate. In some cases, it is the specific drug used that is more likely to increase the risk of adverse effects than the type of drug. In the study, the authors are clear it is a specific type of anti-depressant (TCA's) they are referring to, but that information gets lost in the news reports.
Drugs in the News: How well do Canadian newspapers report the good, the bad and the ugly of new prescription drugs?" (April, 2003)
Collectively, Canadians spend $15 billion per year on pharmaceuticals – and almost every day there are media stories about new medicines. A Centre for Policy Alternatives' study titled “Drugs in the News" assessed whether Canadians can rely on daily newspapers to provide people with balanced, accurate information about new drugs.
The study examined the quality of new drug information provided through 193 news reports in 24 Canadian newspapers. The researchers focussed on five prescription drugs launched in Canada during the last five years that had received a high degree of media attention (Celebrex® (celecoxib) for symptoms of arthritis; Lipitor® (atovastatin), a cholesterol-lowering drug; Evista® (raloxifene), for post-menopausal osteoporosis; Tamiflu® (oseltamivir), for influenza; and Aricept® (donepezil), to treat Alzheimer’s disease).
The researchers found the media reporting is often poor and may promote unrealistic expectations regarding the benefits of drugs.
Benefits were most often identified in the first quarter of the article and were often overstated, while harms were usually identified in the third quarter of the article. Contraindications – those conditions under which it is not safe to take the drugs – were mentioned in only 4% of the articles. Only about one in six articles mentioned non-drug treatment options, such as exercise or diet.
Source: Cassels, A., Hughes,M., Cole, C. et al. (April, 2003) “Drugs in the News: How well do Canadian newspapers report the good, the bad and the ugly of new prescription drugs?" http://www.policyalternatives.ca/
Comment: The study raises a number of interesting issues that may be equally applicable to media coverage of alcohol and health-- including the reports that have surfaced this year on alcohol and heart health, alcohol and dementia, alcohol and macular degeneration etc.
Can Drinking Help Smokers?
RED WINE COUNTERACTS SMOKING: STUDY
Source: The Age
Drinking red wine while having a cigarette can counteract the harmful effects smoking has on the arteries, a study presented at an international cardiology conference has shown.
Previous research has shown that smoking just one cigarette can cause significant dysfunction of the arteries lasting up to an hour. But a Greek study presented at the European Society of Cardiology in Vienna found having two glasses of red while smoking one cigarette counteracted the immediate effects on the blood vessels.
Releasing the finding, John Lekakis of Alexandra Hospital in Athens said it could be the starting point for developing medicines that protected nicotine addicts from the harmful effects of their habit. "Our findings showed that two 250ml glasses of red wine suspend the harmful effect of one cigarette and leads us to further investigate constituents of red wine that could reverse arterial dysfunction caused by smoking," he said.
But Professor Andrew Tonkin, director of health, medical and scientific affairs at the National Heart Foundation of Australia, said the emphasis should be on helping people quit rather than protecting smokers against themselves. "At the Foundation we don't believe there's any safe level of smoking," he told AAP.
"It's extremely important as one of the preventative factors of heart disease and we need to be helping people stop rather than giving them medicine.
Comment:It will be interesting to see whether this study is likely to get a lot of airplay/ media attention. Obviously it is important to check out the research, and see if the findings can be replicated.
Memory and Aging
If you are looking for an interesting overview of memory and aging, check out Baycrest Centre for Geriatric Care's interactive memory site : http://partners.senecac.on.ca/baycrest/
It talks about types of memory and changes with normal aging; as well as about cognitive disorders. It uses quizzes, audio vignettes, and a short audio-visual presentation on cognitive disorders (with transcript).
Prevention and Education Issues
Source: Masters, J. (May - June 2003). Moderate Alcohol Consumption and Unappreciated Risk for Alcohol-Related Harm among Ethnically Diverse, Urban-Dwelling Elders, Geriatric Nursing, Vol.24, 144-161.
This survey looked at how older adults defined "moderate alcohol consumption" and how they have interpreted media reports of the health benefits of moderate alcohol consumption. The results showed that many older adults define moderate alcohol use at levels above (American) Federal guidelines. While anywhere for one quarter to a third of those surveyed felt 1 drink a day was "moderate", the rest defined it differently. 15% of the entire sample of 107 adults aged 50 to 87 felt that drinking 3-4 drinks a day was "moderate", and 26% felt that 2 drinks a day was "moderate".
Whites (20%) and Blacks (19%) were more likely than Latinos (10%) to view drinking 3-4 drinks / day as moderate. Younger adults (those aged 50 to 59) were more likely than older adults (aged 60-87) to view 3-4 drinks a day as moderate.
A notable number of older adults agreed with the statement that moderate alcohol use is good for health. 56% of those surveyed were aware of media reports on alcohol and health; and of this group, 81% felt that the health benefits applied to everyone. Mind you, 57% of the group also acknowledged that alcohol could be harmful to health.
The researcher states that the disparity between older adults’ definition of moderate drinking and Federal guidelines for low-risk drinking may contribute to the under- recognition of problem drinking by nurses and other health care providers and this can place older adults at an unappreciated level of risk for alcohol-related harm.
With Education, Treatment Professionals Can Change Their Attitudes about Harm Reduction
Source: Goddard, P. (2003) Changing attitudes towards harm reduction among treatment professionals: a report from the American Midwest, International Journal of Drug Policy 14 (2003) 257–260
This study looked at whether using educational presentation on harm reduction could be effective in changing the attitudes of drug and alcohol treatment professionals working in the Midwest region of the United States. One hundred and thirty seven treatment professionals with an average of approximately 10 years of drug or alcohol treatment experience attended a 2-hour educational presentation about harm reduction.
The researchers assessed participants’ attitudes towards harm reduction immediately before and after the presentation. They also looked at the participants’ treatment philosophy allegiance. Results indicated that attitudes towards harm reduction were significantly more favourable after the presentation than before, even among professionals who were using an Alcoholics Anonymous/12-Step treatment approach.
The researchers conclude that despite the predominance of abstinence-focused approaches in the US, the study demonstrated that professionals’ attitudes may be altered following education about harm reduction approaches and they suggest this education may be a necessary step in making harm reduction approaches more available to Americans with drug and alcohol problems.
U.S. Treatment for Older Adults Needs to Triple?
According to a study released by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the North Carolina-based Research Triangle Institute, the need for substance abuse treatment among older Americans is expected to nearly triple in 2020 as baby-boomers (those born 1946 to 1964) head into later years and bring their alcohol and drug use tendencies.
The study, Substance Abuse Treatment Need Among Older Adults in 2020: The Impact of the Aging Baby-Boom Cohort, published in the journal Drug and Alcohol Dependence reported that the number of adults ages 50 and over who will need treatment for an alcohol or drug abuse problem will grow to 4.4 million in 2020, compared to 1.7 million in 2001.
Researchers used data from SAMHSA’s National Household Survey on Drug Abuse. According to researchers, this projection is due to a 50 % increase in the number of older adults and a 70 % increase in the rate of treatment need among older adults. They found that the increasing rate of treatment need in the age 50+ group reflects an increase in problems associated with the use of illicit drugs and nonmedical use of prescription drugs.
SAMHSA (www.samhsa.gov) also has a new report on older adults entitled "Substance Abuse by Older Adults: Estimates of the Future Impact on the Treatment System". That report can be found at www.samhsa.gov/oas/aging/toc.htm
Source: Gfroerer, J., Penne, M., Pemberton, M. & Folsom, R. (2003). Substance abuse treatment need among older adults in 2020: the impact of the aging baby-boom cohort, Drug and Alcohol Dependence, 69, 127-135.
July 21, 2003
Depression can be debilitating for anyone, but it can be especially bad for older adults, who have a six-times higher rate of successful suicides. Most anti-depressants can take weeks or even months to kick in, in older adults, but an old drug (Ritalin) is now showing some promise in this area. To read more go to:
Note: Only a small sample of patients at present. Will need more research to find out if placebo effect or not.
“OLDER ALCOHOLICS FACE GREATER SUICIDE RISK”
Study finds association amplified with age
MONDAY, July 14 (HealthDayNews) – As alcoholics age, they face an increased risk of suicide. So says a study in the July issue of Alcoholism: Clinical and Experimental Research.
The study found middle-age and older alcoholics have a greater suicide risk than young alcoholic adults. Alcoholism is a common disorder and is also a potent risk factor for suicide. This was the first study of a sample of adults across the age spectrum that explicitly focused on factors that increase the risk for suicide and medically serious suicide attempts associated with alcohol dependence," study author Kenneth R. Conner, an assistant professor at the University of Rochester Medical Center, says in a news release.
For more information please go to: http://www.healthscout.com/template.asp?page=newsdetail&ap=1&id=514096
HOSPITAL RX FOR ALCOHOLICS: HAIR OF THE DOG
Teaching facilities serve liquor to prevent or treat DTs
TUESDAY, February 4, 2003 (HealthDayNews) Severe alcoholics who are treated at American hospitals are getting a surprising message from their doctors: Drink up!
In a study released today, researchers found that an astounding 38 percent of teaching hospitals surveyed keep patients supplied with beer, wine and liquor to prevent or treat alcohol withdrawal syndrome, a condition that afflicts people who drink steadily all day.
For more information please go to: http://www.healthscout.com/template.asp?page=newsdetail&ap=1&id=511617
Comment: I have known of some Canadian doctors who “prescribe” alcohol to a patient to avoid alcohol withdrawal while in hospital, but to the best of my knowledge it does not happen often.
Sometimes a community nurse may recommend to a person with a heavy alcohol problem who is waiting to go for a day or two to a detoxification centre to not just stop drinking while they are waiting, but to continue having a drink. The purpose is to avoid the early onset of withdrawal symptoms in an unmonitored setting. But that is different than keeping a person on alcohol while in the hospital.
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