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Background. This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared. Methods. This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version. Results. Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weeny consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study. Conclusions. Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC. Key Words: Alcohol--At-risk drinking--Problem drinkers.

Background. Confounding of depression with somatic illness and anxiety, a problem in any age group, may be especially troublesome in frail older persons. This paper examined this problem in a factor analytic study of the structure of depressive symptomatology, identifying affective and somatic symptom clusters and relating those clusters to health and functional variables cross-sectionally and prospectively over a l-year interval. Methods. The factor structure of a DSM-IV symptom checklist was examined among 1,245 elderly long-term care residents. Regression analyses examined the association of resulting factors with cognition, functional disability, self- and physician-rated health, and pain at baseline and a year later. One-year mortality was also examined. Results. Factor analysis revealed three unique symptom clusters: depressed mood, somatic symptoms, and psychic anxiety. Depressed mood and somatic symptoms were associated cross-sectionally with all functional health variables, but psychic anxiety was associated only with pain. Longitudinally, depressed mood was the only independent predictor of decline in cognition, functional ability, physician-rated health, and mortality; the last effect, however, did not withstand control for baseline health and functioning. Somatic symptoms at baseline predicted decrement in self-rated health a year later. Effects varied as a function of cognitive status. Conclusions. These data suggest that concerns about the confounding role of somatic symptoms in the association of depression with physical health are unfounded. Although somatic symptoms of depression and anxiety were associated with health and functional status cross-sectionally, depressed mood was by far the stronger predictor of health declines over time.

Ratings on a 10-item affect checklist yielding composite positive affect and negative affect scores were made daily for 30 days by older people in residential care: 19 were diagnosed as having major depression, 21 had minor depression, and 37 were without psychiatric diagnosis ('normal'). Mean levels of positive affect were highest in normal people and least in those with major depression; negative affect was lowest in normal ones and highest in those with a major depression. Variability was least among those with major depression in positive affect and among normal people in negative affect, while residents with minor depression showed some tendency, although inconsistent, toward greater day-to-day variability in positive affect. Patterns of invariance were such that those with major depression tended to be consistently lacking in positive affect but were variable in negative affect; normal people showed variability in positive affect but a relatively unvarying lack of negative affect. Clinical major depression was thus characterized less by 'pervasive' depressive affect than by anhedonia.

The incidence of depression among nondepressed residents in a nursing home and a congregate apartment as well as the patterns of stability and change among depressed residents were studied for one year. About 15.7% of 868 respondents displayed possible major depression while 16.5% displayed minor depression on admission to the study. About 6.6% of 448 respondents with minor or no depression were detected a year later. More than 40% of those initially detected to have major depression showed no remission after one year. More than 50% of those with minor depression showed no depression after one year but 16.2% showed signs of major depression.

Many studies have found a relationship between complaints of chronic pain and depression, although the nature of this relationship is not clearly understood. Most studies have focused on younger patients with specific types of pain, but the elderly often complain of more generalized pain. It has been suggested that these complaints are in some cases symptoms of an underlying depression. A recent study showed that pain and depression were related in elderly populations as in younger populations, although specifics of the relationship were unclear. This study examined the relationship between pain and depression in the elderly. It measured pain intensity and localization, depression, and health and functional capacity in 598 elderly subjects aged 61 to 99 years. Results showed that subjects who were found to be depressed experienced greater pain intensities and reported a higher number of localized pain complaints. The number of subjects reporting localized pain in 12 areas increased as depression level increased, for all areas except headaches and joint pain. When health factors were figured in, pain was found to be significantly associated with functional disability and health, although depression remained a significant factor. The results show that, as is found in younger subjects, pain and depression are linked in the elderly. The exact mechanism of this relationship is still unclear, but it appears that depression may increase sensitivity to pain caused by an existing physical problem. (Consumer Summary produced by Reliance Medical Information, Inc.)