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A Multidimensional Latent Class Analysis of Harmful Alcohol Use Among Older Adults: Subtypes Within the Swedish Addiction Severity Index Registry
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).ORCID iD: 0000-0002-4378-6803
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).ORCID iD: 0000-0001-8296-5313
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0003-3452-3953
Umeå University, Faculty of Social Sciences, Department of Social Work. The Cross-National Behavioral Health Laboratory; Graduate School of Social Work, University of Denver, Denver, Colorado.
2020 (English)In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 14, no 4, p. e89-e99Article in journal (Refereed) Published
Abstract [en]

Objectives: The present study aimed to identify multidimensional typologies of harmful alcohol use based on the Swedish Addiction Severity Index (ASI) assessment data on individuals aged 50 years and above.

Methods: Latent class analysis examined 11 indicators from ASI data on 1747 individuals (men = 1255, women = 492) who reported they were troubled by alcohol problem at least one day in the past 30 days before their assessment. The discriminative validity of the classes was assessed by comparing other measures of individual characteristics and problem severity of other ASI dimensions.

Results: Five subtypes of harmful alcohol use were identified. Two classes with alcohol problems varying in psychosocial functioning, age composition and ages of onset of both regular and heavy drinking. Two with psychiatric comorbidity but varying in violence, criminality, gender composition and ages of onset of regular and heavy drinking. One with high prevalence of concurrent use of other substances, psychiatric, legal, and employment problems.

Conclusions: The analysis identified, in a national sample, heterogeneous risk groups of older adults with harmful alcohol use. These findings suggest a need for healthcare providers to assess older adults not only for their substance use but also for associated problems and needs. Given these findings, the Addiction Severity Index is a valuable assessment tool for older adults with harmful alcohol use.

Place, publisher, year, edition, pages
Wolters Kluwer, 2020. Vol. 14, no 4, p. e89-e99
Keywords [en]
addiction severity index, harmful alcohol use, older adults, register-based study, subtypes
National Category
Substance Abuse Psychiatry Social Work Public Health, Global Health, Social Medicine and Epidemiology
Research subject
medical behavioral science
Identifiers
URN: urn:nbn:se:umu:diva-168621DOI: 10.1097/ADM.0000000000000636ISI: 000619442100017PubMedID: 32097236Scopus ID: 2-s2.0-85089202504OAI: oai:DiVA.org:umu-168621DiVA, id: diva2:1411289
Projects
Substance Use Disorder Among Older Adults: typologies, pathways and health outcomesSTANCE
Part of project
STANCE ? Program: Studying social services, treatment and other interventions for Alcohol and Narcotics and resulting health outcomes ? A Collaborative longitudinal research program , Forte, Swedish Research Council for Health, Working Life and Welfare
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07213
Note

Acknowledgement: The first author (WBJ) was also awarded grant from the Kempe Foundation to cover tuition fees for methodological courses relevant to this study.

Available from: 2020-03-03 Created: 2020-03-03 Last updated: 2023-09-05Bibliographically approved
In thesis
1. Alcohol and aging: a multimethod study on heterogeneity and multidimensionality
Open this publication in new window or tab >>Alcohol and aging: a multimethod study on heterogeneity and multidimensionality
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Alkohol och åldrande : en multimetodstudie om heterogenitet och multidimensionalitet
Abstract [en]

Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite grow­ing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experi­ences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addic­tion services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol prob­lems and recovery.

Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related out­comes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons re­cruited from a specialist outpatient clinic for alcohol treatment. 

Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which re­spected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).

Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incor­porating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by consider­ing their heterogeneity in treatment goals, biopsychosocial functioning, and available re­sources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an inte­grated and person-centered care across the continuum. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 98
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 100
Keywords
older adults, substance use disorder, alcohol use disorder, comorbidity, recovery, alcohol treatment, aging, healthy aging, integrated care, person-centered care, biopsychosocial model, register-based, longitudinal, latent class
National Category
Substance Abuse Gerontology, specialising in Medical and Health Sciences Social Work
Research subject
medical behavioral science; health services research; health services research; Psychiatry
Identifiers
urn:nbn:se:umu:diva-205174 (URN)978-91-8070-010-8 (ISBN)978-91-8070-009-2 (ISBN)
Public defence
2023-03-24, Hörsal UB.A.220 (Lindellhallen 2), Umeå, 13:00 (English)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07213The Royal Swedish Academy of Sciences, SO2021-0027The Kempe Foundations
Available from: 2023-03-03 Created: 2023-02-25 Last updated: 2023-02-27Bibliographically approved

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Jemberie, Wossenseged BirhanePadyab, MojganSnellman, FredrikLundgren, Lena

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