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Recurrent risk of hospitalization among older persons with problematic alcohol use: a multiple failure‐time analysis with a discontinuous risk model
Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School on Aging and Health (SWEAH), Faculty of Medicine, Lund University, Sweden.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
Oregon Health and Science UniversityPortland State University, School of Public Health, Portland, OR, USA.ORCID iD: 0000-0001-9014-2894
Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, Colorado, USA.ORCID iD: 0000-0002-3529-2512
2022 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 117, no 9, p. 2415-2430Article in journal (Refereed) Published
Abstract [en]

Background and Aims: Older persons with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all-cause, alcohol, polydrug and psychiatric-related repeated hospitalizations among older persons with problematic alcohol use.

Design: A linked register-based cohort study with discontinuous multiple-failure (time-to-repeated-event) data. Hospitalization and mortality were considered as failure.

Setting: Sweden, March 2003-November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish Cause of Death Register.

Participants: 50 years and older (n= 1741; 28% women), with one or more alcohol problem days in the 30 days before an ASI assessment.

Measurements: Five mutually exclusive latent classes of problematic alcohol use, identified with eleven ASI items, were the independent variables: “Late Onset with Fewer Consequence (LO:FC; reference group)”; “Early Onset/Prevalent Multi-Dimensional problems (EO:MD)”; “Late Onset with co-occurring Anxiety and Depression (LO:AD)”; “Early Onset with co-occurring Psychiatric Problems (EO:PP)”; and “Early Onset with major Alcohol Problem (EO:AP)”. Covariates included sociodemographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization, and/or mortality due to: (a) all-cause, (b) alcohol-related disorders and diseases (c) polydrug use (d) other psychiatric disorders.

Findings: During the study period, 73.2% were hospitalized at least once, 57.3% were alcohol-related, 8.5% polydrug use and 18.5% psychiatric-related diagnoses. Compared with LO:FC, EO:PP had higher risk for all-cause (adjusted hazard ratio [aHR]= 1.27, 95% confidence interval [CI]= 1.02—1.59) and alcohol-related (aHR= 1.34, 95% CI= 1.02—1.75) hospitalizations. Adjusted risks for polydrug-related hospitalization were 2.55, 95%CI= 1.04—6.27 for EO:MD and 2.62, 95%CI= 1.07—6.40 for EO:PP. Adjusted risk for psychiatric-related hospitalization was higher for LO:AD (aHR= 1.78, 95%CI= 1.16—2.73 and EO:PP (aHR= 2.03, 95%CI= 1.22—3.38).

Conclusions: Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older persons with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022. Vol. 117, no 9, p. 2415-2430
Keywords [en]
hospital readmission, substance use disorder, mental health disorder, longitudinal study, dual diagnoses, aged, addiction care, addiction services, at-risk drinking, at-risk alcohol consumption
National Category
Psychiatry Social Work
Research subject
Psychiatry; Social Medicine
Identifiers
URN: urn:nbn:se:umu:diva-194237DOI: 10.1111/add.15907ISI: 000792509600001PubMedID: 35470927Scopus ID: 2-s2.0-85129627252OAI: oai:DiVA.org:umu-194237DiVA, id: diva2:1654720
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
The Royal Swedish Academy of Sciences, SO2021-0027Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-07213Swedish Research Council, 2013‐08755Available from: 2022-04-28 Created: 2022-04-28 Last updated: 2023-02-27Bibliographically 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, MojganLundgren, Lena M.

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