Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

Holton, Alice; Keeney, Cora; Ryan, Benedict K.; Cousins, Gráinne

doi:10.1136/bmjopen-2019-035212

Cited by 17 publications

(10 citation statements)

References 35 publications

(44 reference statements)

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“…The persistent and pernicious stigma associated with mental health and substance use problems may often contribute to older adults denying or minimizing the full scope of their substance use (Choi & DiNitto, 2013). Research also suggests that older adults may be particularly vulnerable to the health effects of unhealthy alcohol use (Mewton et al, 2020), including dangerous medication interactions (Holton et al, 2020), falls (Shakya et al, 2020), and exacerbation of chronic conditions (Moore et al, 2006;Zhou et al, 2016). In addition, studies show that older adults, especially the "baby boomer" generation, frequently drink above recommended limits and considerably more than previous older generations in the United States, and have higher rates of comorbidities (Barry & Blow, 2016).…”

Section: Patient Characteristicsmentioning

confidence: 99%

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

Felicia

Parthasarathy

et al. 2021

Alcoholism Clin & Exp Res

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Background: Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors. Methods: This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017. Results:We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/ insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions.Conclusions: These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.

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Section: Patient Characteristicsmentioning

confidence: 99%

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

Felicia

Parthasarathy

et al. 2021

Alcoholism Clin & Exp Res

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“…There are many hazards associated with medication used by older adults and one of them is how alcohol interacts with prescription medication. This might be explained by age-related changes in the absorption, distribution, and metabolism of alcohol and medicine which may alter the effects of medication [7,18].…”

Section: Introductionmentioning

confidence: 99%

Validation of the AUDIT and AUDIT-C for Hazardous Drinking in Community-Dwelling Older Adults

Gils

Franck

Dierckx

et al. 2021

IJERPH

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Background: One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. Method: A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. Results: Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. Conclusion: The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender.

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“…Physiological tolerance of alcohol decreases with age (4,5). Older adults often have long-term conditions that may be exacerbated by drinking, or take medications that interact harmfully with alcohol (6,7). Most older people living in higher income countries use alcohol.…”

Section: Main Text Introductionmentioning

confidence: 99%

“… 4 , 5 Older adults often have long-term conditions that may be exacerbated by drinking, or take medications that interact harmfully with alcohol. 6 , 7 Most older people living in higher-income countries use alcohol. Up to 45% of older drinkers consume alcohol at hazardous levels, where their intake puts them at risk of physical, psychological, or social harm.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting primary care practitioners’ alcohol-related discussions with older adults: a qualitative study

et al. 2021

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Background: Risk of harm from drinking is heightened in later life, due to age-related sensitivities to alcohol. Primary care services have a key role in supporting older people to make healthier decisions about alcohol. Aim: To examine primary care practitioners’ perceptions of factors that promote and challenge their work to support older people in alcohol risk-reduction. Design and Setting: Qualitative study consisting of semi-structured interviews and focus groups with primary care practitioners in Northern England. Method: Thirty-five practitioners (general practitioners, practice/district nurses, pharmacists, dentists, social care practitioners, domiciliary carers) participated in eight interviews and five focus groups. Data were analysed thematically, applying principles of constant comparison. Results: Practitioners highlighted particular sensitivities amongst older people to discussing alcohol, and reservations about older people’s resistance to making changes in old age; given drinking practices could be established, and promote socialisation and emotional wellbeing in later life. Age-related health issues increased older people’s contact with practitioners; but management of older people’s long-term conditions was prioritised over discussion of alcohol. Dedicated time to address alcohol in routine consultations with older people, and training in alcohol intervention facilitated practitioners; particularly pharmacists and practice nurses. Conclusion: There are clear opportunities to support older people in primary care to make healthier decisions about alcohol. Dedicated time to address alcohol, training in identification of alcohol-related risks, particularly those associated with old age; and tailored interventions for older people, feasible to implement in practice settings, would support primary care practitioners to address older people’s alcohol use.

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Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross-sectional study

Cited by 17 publications

References 35 publications

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

Validation of the AUDIT and AUDIT-C for Hazardous Drinking in Community-Dwelling Older Adults

Factors affecting primary care practitioners’ alcohol-related discussions with older adults: a qualitative study

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