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The article presents a study which examined and compared sociodemographic, physical, and mental health characteristics associated with cannabis use among middle-aged and older adults. Topics discussed include the use of cannabis to alleviate a variety of health conditions, sociodemographic, physical, and mental health characteristics by age group among the sample, and income and urbanicity associations with cannabis use by age group.

Background: Alcohol and drug use (substance use) is a risk factor for crash involvement. Objectives: To assess the association between substance use and crash injury severity among older adults and how the relationship differs by rurality/urbanicity. Methods: We pooled 2017–2021 cross-sectional data from the United States National Emergency Medical Service (EMS) Information System. We measured injury severity (low acuity, emergent, critical, and fatal) predicted by substance use, defined as self-reported or officer-reported alcohol and/or drug use. We controlled for age, sex, race/ethnicity, road user type, anatomical injured region, roadway crash, rurality/urbanicity, time of the day, and EMS response time. We performed a partial proportional ordinal logistic regression and reported the odds of worse injury outcomes (emergent, critical, and fatal injuries) compared to low acuity injuries, and the predicted probabilities by rurality/urbanicity. Results: Our sample consisted of 252,790 older adults (65 years and older) road users. Approximately 67%, 25%, 6%, and 1% sustained low acuity, emergent, critical, and fatal injuries, respectively. Substance use was reported in approximately 3% of the population, and this proportion did not significantly differ by rurality/urbanicity. After controlling for patient, crash, and injury characteristics, substance use was associated with 36% increased odds of worse injury severity. Compared to urban areas, the predicted probabilities of emergent, critical, and fatal injuries were higher in rural and suburban areas. Conclusion: Substance use is associated with worse older adult crash injury severity and the injury severity is higher in rural and suburban areas compared to urban areas. [ABSTRACT FROM AUTHOR]

Objectives This study investigates whether the year of arrival to the United States (U.S.) and birthplace relate to postmigration cognitive difficulties among foreign- and U.S.-born Arab Americans in later life. Methods We analyzed 19 years (2000–2019) of data from the American Community Survey Public Use Microdata Samples (weighted N = 393,501; ages ≥ 50 years). Cognitive difficulty was based on self-reported data, and weighted means, percentages, adjusted prevalence estimates, and adjusted odds ratio were calculated. Results Controlling only for demographics, foreign-born Arabs reported higher odds of cognitive difficulty compared to U.S.-born Arabs across all arrival cohorts (p <.001). After accounting for economic and integration factors, those who arrived between 1991 and 2000 had higher odds (odds ratio [OR] = 1.06, 95% confidence interval [CI] =1.00, 1.19, p <.01), while those who arrived after 2001 had lower odds (OR = 0.87, 95% CI = 0.78, 0.97, p <.001) of cognitive difficulty. Lacking English proficiency (OR = 1.90, 95% CI = 1.82, 1.98, p <.001) was related to higher odds, whereas not being a U.S. citizen was significantly associated with lower odds (OR = 0.89, 95% CI = 0.52, 0.94, p <.001) of cognitive difficulty. Yet, results varied by birthplace. Migrants born in Iraq consistently reported the highest odds of cognitive difficulty across all arrival cohorts. Discussion Migration history and birthplace may be important factors explaining cognitive disparities among the diverse group of Arab migrants and Arab Americans. Future research examining mechanisms underlying these associations and the impact of migration on cognitive health is needed to address cognitive disparities in migrants. [ABSTRACT FROM AUTHOR]

To examine associations between alcohol use and cognitive performance among older adults in Greece and the United States, and assess potential differences due to differing drinking practices in the two countries. Data came from Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) and National Alzheimer's Coordinating Center Uniform Dataset (NACC). We examined those aged 65–90 years at baseline who had no cognitive impairment and complete data for cognitive and alcohol use variables (N = 1110 from HELIAD; N = 2455 from NACC). We examined associations between current alcohol use and frequency of such use with cognitive performance on various cognitive tasks stratified by gender. In NACC, use of alcohol was associated with better cognitive performance. Men drinkers performed better than non-drinkers on Trail A (standardized mean 0.07 vs. −0.24, p<.001), Trail B (0.06 vs. −0.19, p=.001), and women drinkers performed better on Trail A (0.04 vs. −0.09, p=.016), Trail B (0.04 vs. −0.10, p=.005), verbal fluency (Animals: 0.05 vs. −0.13, p<.001; Vegetables: 0.04 vs. −0.09, p=.027), and MoCA (0.03 vs. −0.08, p=.039). In HELIAD, fewer differences were seen with only women drinkers exhibiting better performance than non-drinkers on the Boston Naming Task (0.11 vs. −0.05, p=.016). In general, more frequent drinkers performed better on cognitive tasks than less frequent drinkers, although this was only statistically significant in the NACC dataset. While drinking alcohol may be associated with better cognitive performance across both the US and Greece, more research is needed to assess the cultural factors that may modify this association. [ABSTRACT FROM AUTHOR]

Background: Recent literature suggests that the gap in prevalence of binge drinking between men and women is closing, but little is known about sex‐specific differences in trends and correlates of binge drinking among older Americans. Methods: A total of 18,794 adults, aged 65 years and older were surveyed in the 2015–2019 National Survey on Drug Use and Health. We estimated trends in prevalence of past‐month binge drinking (≥5 drinks on the same occasion for men and ≥4 drinks for women), stratified by sex. Correlates of binge drinking were estimated for men and women separately, focusing on demographic characteristics, chronic diseases, past‐month tobacco and cannabis use, depression, and emergency department use. Multivariable generalized linear models using Poisson and log link were used to examine associations stratified by sex. Results: Binge drinking among older men increased from 12.8% in 2015 to 15.7% in 2019 (p = 0.02) but remained stable among older women (7.6% to 7.3%, p = 0.97). In adjusted models, having a college degree was associated with higher risk of binge drinking among women (adjusted prevalence ratio [aPR] = 1.68, 95% CI: 1.13–2.50), but lower risk among men (aPR = 0.69, 95% CI: 0.56–0.85). Men who are separated or divorced were also at higher risk (aPR = 1.25, 95% CI: 1.05–1.50), but women were not. Both men and women reporting past‐month use of tobacco (men aPR = 1.87, 95% CI: 1.61–2.17, women aPR = 2.11, 95% CI: 1.71–2.60) and cannabis (men aPR = 2.05, 95% CI: 1.63–2.58, women aPR = 2.77, 95% CI 2.00–3.85) were at higher risk of binge drinking. Conclusions: Binge drinking has increased among older men whereas it has remained stable among older women in the United States. Interventions should consider that although tobacco and cannabis use is associated with an increased risk of binge drinking among both older men and women, demographic correlates tend to differ by sex. [ABSTRACT FROM AUTHOR]

Although subjective cognitive decline (SCD) may be an early risk marker of Alzheimer's Disease (AD), research on SCD among Hispanics/Latinos/as/x (henceforth Latinos/as) living in the U.S. is lacking. We investigated if the cross-sectional relationship of self-reported SCD with objective cognition varies as a function of ethnic background (Latinos/as versus Non-Hispanic Whites [NHWs]). Secondary analyses conducted solely within the Latino/a group investigated if informant reported SCD is associated with objective cognition and whether self-reported SCD is related to markers of brain health in a sub-sample of Latinos/as with available MRI data. Eighty-three participants (≥60 years of age) without dementia (35 Latinos/as; 48 NHWs) completed the Mattis Dementia Rating Scale (MDRS) and the Subjective Cognitive Decline-Questionnaire (SCD-Q). Additionally, 22 Latino/a informants completed the informant-version of the SCD-Q. Hierarchical regression models investigated if ethnicity moderates the association of MDRS and SCD-Q scores after adjusting for demographics and depressive symptoms. Correlational analyses within the Latino/a group investigated self- and informant-reported associations of SCD-Q scores with objective cognition, and associations of self-reported SCD-Q scores with medial temporal lobe volume and thickness. Latinos/as had lower education and MDRS scores than NHWs. Higher SCD-Q scores were associated with lower MDRS scores only in Latinos/as. Within the Latino/a group, self, but not informant reported SCD was related to objective cognition. Medium to large effect sizes were found whereby higher self-reported SCD was associated with lower entorhinal cortex thickness and left hippocampal volume in Latinos/as. The association of SCD and concurrent objectively measured global cognition varied by ethnic background and was only significant in Latinos/as. Self-reported SCD may be an indicator of cognitive and brain health in Latinos/as without dementia, prompting clinicians to monitor cognition. Future studies should explore if SCD predicts objective cognitive decline in diverse groups of Latinos/as living in the U.S. [ABSTRACT FROM AUTHOR]

Background: Alcohol use is common among older adults, and this population has unique risks with alcohol consumption in even lower amounts than younger persons. No recent studies have estimated trends in alcohol use including binge alcohol use and alcohol use disorders (AUD) among older adults.Methods: We examined alcohol use among adults age ≥50 in the National Survey on Drug Use and Health (NSDUH) from 2005 to 2014. Trends of self-reported past-month binge alcohol use and AUD were estimated. Logistic regression models were used to examine correlates of binge alcohol use and AUD.Results: The prevalence of both past-month binge alcohol use and AUD increased significantly among adults age ≥50 from 2005/2006 to 2013/2014, with a relative increase of 19.2% for binge drinking (linear trend p<0.001) and a 23.3% relative increase for AUD (linear trend p=0.035). While males had a higher prevalence of binge alcohol use and AUD compared to females, there were significant increases in both among females. In adjusted models of aggregated data, being Hispanic, male, and a smoker or illicit drug user were associated with binge alcohol use, while being male, a smoker, an illicit drug user, or reporting past-year depression or mental health treatment were associated with AUD.Conclusions: Alcohol use among older adults is increasing in the US, including past-month binge alcohol use and AUD with increasing trends among females. Providers and policymakers need to be aware of these changes to address the increase of older adults with unhealthy drinking. [ABSTRACT FROM AUTHOR]

Ten percent of older adults experience elder mistreatment, and it is much more common in older adults with dementia. It is associated with higher rates of psychological distress, hospitalization, and death and, in the United States, costs billions of dollars each year. Although elder mistreatment is relatively common and costly, it is estimated that fewer than 10% of instances of elder mistreatment are reported. Given these data, there is a great need for research on interventions to mitigate elder mistreatment and for a practical model or framework to use in approaching such interventions. Although many theories have been proposed, adapted, and applied to understand elder mistreatment, there has not been a simple, coherent framework of known risk factors of the victim, perpetrator, and environment that applies to all types of abuse. This article presents a new model to examine the multidimensional and complex relationships between risk factors. Theories of elder mistreatment, research on risk factors for elder mistreatment, and 10 years of experience of faculty and staff at an Elder Abuse Forensics Center who have investigated more than 1,000 cases of elder mistreatment inform this model. It is hoped that this model, the Abuse Intervention Model, will be used to study and intervene in elder mistreatment. [ABSTRACT FROM AUTHOR]

This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the prevalence and sociodemographic and health-related correlates of substance use, including alcohol, tobacco, and nonmedical drug use, in adults aged 65 and older. DESIGN: Cross-sectional, retrospective survey of a population-based sample, the 2001/02 National Epidemiologic Survey on Alcohol and Related Conditions. SETTING: United States. PARTICIPANTS: Eight thousand two hundred five U.S. adults aged 65 and older. MEASUREMENTS: Prevalence of lifetime and previous-12-month alcohol, tobacco, and nonmedical drug use and associations between substance use and sociodemographic and health-related factors. RESULTS: Almost 80% of older adults had used any of the three substances over their lifetimes, and more than 50% reported such use over the previous 12 months. Alcohol was the most commonly used substance over the lifetime (74%) and in the previous 12 months (45%), followed by tobacco (52% lifetime; 14% previous 12 months); far fewer reported nonmedical use of drugs (5% lifetime; 1% previous 12 months). In general, being younger, male, and divorced or separated were factors consistently associated with use of any of the three substances. CONCLUSION: Most older adults had used substances over their lifetimes and in the previous 12 months. Alcohol is the substance of choice for this age group, followed by tobacco; few report nonmedical drug use. [ABSTRACT FROM AUTHOR]

This article discusses the engagement of reconsideration on the contextual understanding in the clitoral-vaginal dichotomy of Marie Bonaparte in the U.S. The author reflects on the act of Bonaparte of relocating her clitoris that was a projection of anxiety where visualizing the passion for frigidity. He mention that clitoral-vaginal dichotomy is considered repressive model, which the relocation of Bonaparte's clitoris is part of behavioral anxiety that affects gender differentiation, pronatalism and women's social power.

OBJECTIVES: To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey). DESIGN: Longitudinal analysis of a national probability sample–based cohort study. SETTING: Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971–1974, and the NHANES Epidemiologic Followup Survey, 1992. PARTICIPANTS: Four thousand six hundred ninety-one adults aged 60 and older who provided data on alcohol use. MEASUREMENTS: The prevalence of at-risk drinking in older adults in the United States and the 20-year all-cause mortality risk associated with it. At-risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method. RESULTS: The prevalence of at-risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at-risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2–3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at-risk drinking was associated with higher mortality rates than not-at-risk drinking (hazard ratio=1.20, 95% confidence interval=1.01–1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at-risk drinking was associated with greater mortality rates. CONCLUSION: In this first, large population-based study of older adults examining the mortality risks of alcohol use and comorbidity, at-risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks. [ABSTRACT FROM AUTHOR]

Aims To estimate age, period, cohort and other demographic influences on heavy alcohol consumption and trajectories of heavy drinking in American adults. Design Prospective cohort of 14 127 participants, aged 25–74 years at baseline. Generalized estimating equations to model longitudinal change in the probability of heavy drinking and its association with demographic factors. Setting National, population-based sample of non-institutionalized civilians. Measurements Heavy alcohol consumption (usual number of drinks per occasion ≥ five for men; ≥ four for women) at baseline (1971–74) and three follow-ups until 1992. Findings Heavy alcohol consumption declined with increasing age (age effect) and tracked national average consumption (period effect). There was no cohort effect. Higher probability of heavy drinking was associated with male gender (relative risk: RR = 2.4), being not married (RR = 1.4), having less than high school education (RR = 1.7), having annual income below the median (RR = 1.5), not living in the South-east (RR = 1.7), and smoking (RR = 3.4). Getting married and quitting smoking during the study were each associated with reduction in heavy drinking (RR = 0.55 and 0.61, respectively). Slower age-related decline in the probability of heavy drinking was seen in men ( P < 0.0001), married individuals ( P = 0.03), and smokers ( P = 0.05). Conclusions Demographic predictors of trends in heavy drinking are different from those for trends in average alcohol consumption. The likelihood of heavy drinking declined more slowly with increasing age in men and smokers, suggesting that the negative health effects of alcohol in older ages may be greatest in these groups. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the (1) prevalence of at-risk drinking and participation in health-related behaviors and practices and (2) associations of at-risk drinking with other health-related behaviors and practices among older persons completing a health-risk appraisal for the elderly (HRA-E). DESIGN: Cross-sectional study using data from a self-administered, mailed survey sample. SETTINGS: Persons from three organizations were surveyed: (1) the American Association of Retired Persons; and (2) a large medical group and (3) a community-based senior health center in southern California. PARTICIPANTS: 1,889 persons age 55 years and older. MEASUREMENTS: The HRA-E included items on health characteristics, drinking behaviors (including amount of alcohol use and two alcoholism screening measures: the CAGE (Cut down, Annoyed, Guilty, Eye opener) and Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G), and participation in selected health-related behaviors and practices. Social drinkers were defined as those who drank fewer than 14 drinks weekly and screened negative on the CAGE (defined as two or more “no” responses) and SMAST-G. Hazardous drinkers drank fewer than 14 drinks weekly and screened negative. Harmful drinkers drank fewer than 14 drinks weekly and screened positive. Possible at-risk drinkers drank 14 or more drinks weekly and screened positive. Least squares regression models were used to assess the effects of hazardous, harmful, and possible at-risk drinking on each of the health-related practices and behaviors. We also conducted these analyses using three other definitions of social, possible at-risk, hazardous, and harmful drinking. RESULTS: Of all respondents, 40% were social drinkers, 3% were harmful drinkers, 2% were hazardous drinkers, and 11% were possible at-risk drinkers. Hazardous, harmful, and possible at-risk drinkers commonly reported driving after drinking or being driven by someone who had been drinking (67%, 76%, and 64% respectively). Harmful and possible at-risk drinkers were more likely than social drinkers to smoke and were less likely to use seatbelts regularly. These findings were observed regardless of how the drinking groups were defined. CONCLUSION: All groups of at-risk drinkers more commonly engaged in selected adverse health-related behaviors and practices than did social drinkers. [ABSTRACT FROM AUTHOR]

Background: Despite concerns about increasing trends in depression over the past two decades, little is known about recent trends in depression and mental health (MH) treatment among older adults and whether these trends differ by demographic characteristics.Methods: We examined data from a US representative sample of noninstitutionalized adults aged ≥65 from the 2010-2019 National Survey on Drug Use and Health (N = 31,502). We estimated trends in the prevalence of past-year major depressive episode (MDE) overall and by demographic characteristics. We also estimated trends in MH treatment among those with past-year MDE.Results: From 2010/11 to 2018/19, the estimated prevalence of past-year MDE among older adults increased from 2.0 % (95 % CI: 1.6-2.6) to 3.2 % (95 % CI: 2.7 to 3.7), a 60.0 % increase (p = 0.013). Increases were detected among men (p = 0.038), White individuals (p = 0.018), those who are widowed (p = 0.003), those with an annual household income of <$20,000 (p = 0.020) or $20,000-$49,000 (p = 0.016), and those with some college degree (p = 0.014). Among those with MDE, there were no significant changes detected in any form of past-year MH treatment.Limitations: NSDUH does not assess individuals who are institutionalized, incarcerated, or experiencing homelessness, and thus the prevalence of MDE may be underestimated.Conclusions: Although the estimated prevalence of depression is increasing among older adults, there has not been a proportional increase in MH treatment among those with depression. These findings call for urgent expansion of treatment services and training of MH professionals with expertise in older adults to meet the needs of this growing, vulnerable population. [ABSTRACT FROM AUTHOR]

Reports on a conference on cell death in New Hampshire, scheduled in July 1998. Topics to be discussed; Speakers; Event organizers.

Background: While the number of older adults who engage in unhealthy drinking is increasing, few studies have examined the role of online alcohol screening and intervention tools for this population. The objective of this study was to describe characteristics of drinking behaviors among older adults who visited an alcohol screening and intervention website, and compare them to younger adults.Methods: We analyzed the responses of visitors to Alcoholscreening.org in 2013 (n=94,221). The prevalence of unhealthy alcohol use, behavioral change characteristics, and barriers to changing drinking were reported by age group (ages 21-49, 50-65, 66-80). Logistic regression models were used to identify characteristics associated with receiving a plan to either help cut back or quit drinking.Results: Of the entire study sample, 83% of respondents reported unhealthy drinking (exceeding daily or weekly recommended limits) with 84% among 21-49year olds, 79% among 50-65year olds, and 85% among adults over 65. Older adults reported fewer negative aspects of drinking, lower importance to change, highest confidence and fewer barriers to change, compared to younger adults. In the adjusted model, females (AOR=1.45, p<0.001) and older adults (AOR=1.55, p<0.002) were more likely to receive a plan to change drinking behaviors.Discussion: An online screening and intervention tool identified many older adults with unhealthy alcohol use behaviors and most were receptive to change. Web-based screening and interventions for alcohol use have the potential to be widely used among older adults. [ABSTRACT FROM AUTHOR]

The study examined the prevalence and correlates of substance use disorders and treatment utilization among lifetime MDMA users. Secondary analyses were conducted on data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of adults in the United States. Lifetime MDMA use was assessed, and MDMA users (n = 562) were compared to a matched sample of non-MDMA users. Substance use diagnoses were made using the AUDADIS -- DSM-IV, and data on treatment utilization were collected. MDMA use was significantly related to lifetime and past-year substance use disorders as well as treatment utilization in bivariate analyses. Multivariate analysis, however, showed that MDMA use was not related to lifetime substance use diagnosis or to treatment utilization. MDMA use still had the strongest association with past-year substance use disorders. Screening for substance use disorders and nicotine dependence may be warranted among adults who report lifetime MDMA use to help identify treatment needs and provide proper referrals. [ABSTRACT FROM AUTHOR]

Abstract: This study examines gender differences in the association of lifetime mental and substance use disorders among individuals with opioid use disorders in the United States. The sample (N =578) is from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is a representative household survey. Bivariate analyses and logistic regression modeling were conducted. About 70% of the sample had a lifetime non-substance use Axis I disorder; women were about twice as likely as men to have either a mood or anxiety disorder. About half of the sample had a personality disorder, with women more likely to have paranoid disorder and men more likely to have antisocial personality disorder. Individuals with a lifetime mental disorder were about three times more likely than others to be dependent on other substances, independent of gender. The study demonstrated an inverse relationship between lifetime mental and other substance use disorders, with women having significantly higher odds for several of the mental disorders and men having greater odds of other substance use disorders. [Copyright &y& Elsevier]

Introduction: Older adults living with Alzheimer's disease and related dementias (ADRD) who are then diagnosed with cancer are an understudied population. While the role of cognitive impairment during and after cancer treatment have been well-studied, less is understood about patients who are living with ADRD and then develop cancer. The purpose of this study is to contribute evidence about our understanding of this vulnerable population., Materials and Methods: This was a retrospective cohort study of a linked, representative family of databases of cancer registries and Medicare administrative claims that make up the SEER-Medicare database. Older adults ages 68 and older with a first primary cancer type: breast, cervical, colorectal, lung, oral, or prostate were eligible for inclusion (N = 337,932). Prevalence estimates of ADRD across cancer types and a 5% non-cancer comparison sample were compared by patient factors., Results: The overall prevalence of patients who had an ADRD diagnosis anytime in the three years prior to their cancer diagnosis was 5.6%. Patients with ADRD were more likely to be female, older (over age 75), a racial/ethnic minority, single, with multiple chronic conditions, and a tumor diagnosed early (stage I) or were unstaged. Black patients with colorectal and oral cancer had the highest and second highest prevalence of ADRD compared to White patients (13.46% vs 7.95% and 12.64% vs 7.82% respectively, p < .0001). We observed the highest prevalence of ADRD among Black patients for breast (11.85%), cervical (11.98%), lung (8.41%), prostate (4.83), and the 5% sample (9.50%, p > .0001)., Discussion: The higher prevalence of ADRD among Black and Latine older adults with cancer not only aligns with the trend observed in our non-cancer comparison sample, but also, these findings demonstrate the compounded risk experienced by minoritized older adults over the life course. The greater than expected prevalence of patients with ADRD who go on to develop cancer demonstrates better assessment of cognition is urgently needed. Accurate identification of these vulnerable populations is critical to improve assessment, care coordination, and address inequities in screening and treatment planning., Competing Interests: Declaration of Competing Interest Nothing to declare., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Functional limitations and physical disabilities associated with aging and chronic disease are major concerns for human societies and expeditious development of function-promoting therapies is a public health priority., Methods: Expert panel discussion., Results: The remarkable success of Operation Warp Speed for the rapid development of COVID-19 vaccines, COVID-19 therapeutics, and of oncology drug development programs over the past decade have taught us that complex public health problems such as the development of function-promoting therapies will require collaboration among many stakeholders, including academic investigators, the National Institutes of Health, professional societies, patients and patient advocacy organizations, the pharmaceutical and biotechnology industry, and the U.S. Food and Drug Administration., Conclusions: There was agreement that the success of well designed, adequately powered clinical trials will require careful definitions of indication/s, study population, and patient-important endpoints that can be reliably measured using validated instruments, commensurate resource allocation, and versatile organizational structures such as those used in Operation Warp Speed., (Published by Oxford University Press on behalf of The Gerontological Society of America 2023.)

Background: The use of cannabis among older adults is increasing in the United States. While cannabis use has been suggested to help alleviate chronic symptoms experienced by older adults, its potential adverse effects may lead to unintended consequences, including increased acute healthcare utilization related to its use. The objective of this study was to examine trends in cannabis-related emergency department (ED) visits in California., Methods: Using data from the Department of Healthcare Access and Information, we conducted a trend analysis of cannabis-related ED visits from all acute care hospitals in California from 2005 to 2019. For each calendar year, we determined the cannabis-related ED visit rate per 100,000 ED visits for adults aged ≥65 utilizing primary or secondary diagnosis codes. We estimated the absolute and relative changes in overall cannabis-related visit rates during the study period and by subgroup, including age (65-74, 75-84, ≥85), race/ethnicity, sex, payer/insurance, Charlson comorbidity index score, and cannabis-related diagnosis code., Results: The cannabis-related ED visit rate increased significantly for adults aged ≥65 and all subgroups (p < 0.001). The overall rate increased from 20.7 per 100,000 visits in 2005 to 395.0 per 100,000 ED visits in 2019, a 1804% relative increase. By race/ethnicity, older Black adults had the highest ED visit rate in 2019 and the largest absolute increase while older males had a higher ED visit rate in 2019 and a greater absolute increase than older women. Older adults with a higher Charlson score had a higher ED visit rate in 2019 and a larger absolute increase during the study period., Conclusion: Cannabis-related ED visits are increasing among older adults in California and are an adverse effect of cannabis use. Asking about cannabis use and providing education about its use should be a part of routine medical care for older adults., (© 2023 The American Geriatrics Society.)

Background/objectives: Use of cannabis is increasing in a variety of populations in the United States; however, few investigations about how and for what reasons cannabis is used in older populations exist., Design: Anonymous survey., Setting: Geriatrics clinic., Participants: A total of 568 adults 65 years and older., Intervention: Not applicable., Measurements: Survey assessing characteristics of cannabis use., Results: Approximately 15% (N = 83) of survey responders reported using cannabis within the past 3 years. Half (53%) reported using cannabis regularly on a daily or weekly basis, and reported using cannabidiol-only products (46%). The majority (78%) used cannabis for medical purposes only, with the most common targeted conditions/symptoms being pain/arthritis (73%), sleep disturbance (29%), anxiety (24%), and depression (17%). Just over three-quarters reported cannabis "somewhat" or "extremely" helpful in managing one of these conditions, with few adverse effects. Just over half obtained cannabis via a dispensary, and lotions (35%), tinctures (35%), and smoking (30%) were the most common administration forms. Most indicated family members (94%) knew about their cannabis use, about half reported their friends knew, and 41% reported their healthcare provider knowing. Sixty-one percent used cannabis for the first time as older adults (aged ≥61 years), and these users overall engaged in less risky use patterns (e.g., more likely to use for medical purposes, less likely to consume via smoking)., Conclusion: Most older adults in the sample initiated cannabis use after the age of 60 years and used it primarily for medical purposes to treat pain, sleep disturbance, anxiety, and/or depression. Cannabis use by older adults is likely to increase due to medical need, favorable legalization, and attitudes., (© 2020 The American Geriatrics Society.)

Objectives: Binge drinking is a risk factor for a range of harms. This study estimates the national prevalence of binge drinking and adds to our understanding of correlates of binge drinking among older adults in the United States., Design: Cross-sectional analysis., Setting/participants: A total of 10 927 adults, aged 65 years or older, from the 2015 to 2017 administrations of the US National Survey on Drug Use and Health., Measurements: We estimated the prevalence of past-month binge alcohol use (five or more drinks on the same occasion for men and four or more drinks on the same occasion for women). Characteristics of past-month binge drinkers, including demographics, substance use, serious mental illness, mental health treatment utilization, chronic disease, and emergency department (ED) use, were compared to participants who reported past-month alcohol use without binge drinking. Comparisons were made using χ 2 tests. We then used multivariable generalized linear models using Poisson and log link to examine the association between covariates and binge drinking among all past-month alcohol users aged 65 years or older., Results: Of 10 927 respondents, 10.6% (95% CI = 9.9%-11.2%) were estimated to be current binge drinkers. Binge drinkers were more likely to be male, have a higher prevalence of current tobacco and/or cannabis use, and have a lower prevalence of two or more chronic diseases compared to nonbinge drinkers. In multivariable analysis, among past-month alcohol users, the prevalence of binge drinking was higher among non-Hispanic African Americans than whites (adjusted prevalence ratio [aPR] = 1.44; 95% CI = 1.16-1.80), tobacco users (aPR = 1.52; 95% CI = 1.33-1.74), cannabis users (aPR = 1.41; 95% CI = 1.11-1.80), and those who visited the ED in the past year (aPR = 1.16; 95% CI = 1.00-1.33)., Conclusion: Over a tenth of older adults in the United States are estimated to be current binge drinkers. Results confirm the importance of screening for binge drinking behaviors among older adults to minimize harms. J Am Geriatr Soc 67:2139-2144, 2019., (© 2019 The American Geriatrics Society.)

Objectives: This study compared the association between social networks and alcohol consumption among middle-aged (MA) and older adults (OA) to better understand the nature of the relationship between those two factors among OA and MA., Method: We examined Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Current drinkers aged over 50 were subdivided into two age groups: MA (50-64, n = 5214) and OA (65 and older, n = 3070). Each age group was stratified into drinking levels (low-risk vs. at-risk) based on alcohol consumption. The size and diversity of social networks were measured. Logistic regression models were used to examine age differences in the association between the social networks (size and diversity) and the probability of at-risk drinking among two age groups., Results: A significant association between the social networks diversity and lower odds of at-risk drinking was found among MA and OA. However, the relationship between the diversity of social networks and the likelihood of at-risk drinking was weaker for OA than for MA. The association between social networks size and at-risk drinking was not significant among MA and OA., Conclusion: The current study suggests that the association between social networks diversity and alcohol use among OA differs from the association among MA, and few social networks were associated with alcohol use among OA. In the future, research should consider an in-depth exploration of the nature of social networks and alcohol consumption by using longitudinal designs and advanced methods of exploring drinking networks.

We explored the effect of older partner's age and age difference between partners on condomless sex among men who have sex with men (MSM). We analyzed dyads (n = 1720) from participants (n = 969) in the Sexual Acquisition Transmission of HIV Cooperative Agreement Program. We used modified Poisson regression to model the probability of a sexual encounter's being condomless as a function of older partner's age and age difference between partners adjusting for HIV status, substance use, race/ethnicity, and partner type. We found an interaction between older partner's age and age difference (p < 0.05). Condomless sex decreased with increasing age of the older partner when the age difference was 5-9 years (p = 0.004) or ≥10 years (p = 0.04), but not when <5 years. Condomless sex was less likely among older MSM when there was ≥5 years age difference between partners than <5 years difference. Both age and age discordance affect the likelihood of a sexual encounter between MSM being condomless.

Purpose: Most malignancies are diagnosed in older adults who are potentially susceptible to aging-related health conditions; however, the manifestation of geriatric syndromes during surgical cancer treatment is not well quantified. Accordingly, we sought to assess the prevalence and ramifications of geriatric events during major surgery for cancer., Patients and Methods: Using Nationwide Inpatient Sample data from 2009 to 2011, we examined hospital admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes., Results: Within a weighted sample of 939,150 patients, we identified at least one event in 9.2% of patients. Geriatric events were most common among patients age ≥ 75 years, with a Charlson comorbidity score ≥ 2, and who were undergoing surgery for cancer of the bladder, ovary, colon and/or rectum, pancreas, or stomach (P < .001). Adjusting for patient and hospital characteristics, those patients who experienced a geriatric event had a greater likelihood of concurrent complications (odds ratio [OR], 3.73; 95% CI, 3.55 to 3.92), prolonged hospitalization (OR, 5.47; 95% CI, 5.16 to 5.80), incurring high cost (OR, 4.97; 95% CI, 4.58 to 5.39), inpatient mortality (OR, 3.22; 95% CI, 2.94 to 3.53), and a discharge disposition other than home (OR, 3.64; 95% CI, 3.46 to 3.84)., Conclusion: Many older patients who receive cancer-directed surgery experience a geriatric event, particularly those who undergo major abdominal surgery. These events are linked to operative morbidity, prolonged hospitalization, and more expensive health care. As our population ages, efforts focused on addressing conditions and complications that are more common in older adults will be essential to delivering high-quality cancer care., (© 2016 by American Society of Clinical Oncology.)

Objective: This aim of this study was to characterize trends in alcohol-related hospital admissions among middle-aged and older adults from 1993 to 2010 in relation to age, gender, race, and cohort membership., Method: This study utilized repeated cross-sectional data from the Nationwide Inpatient Sample. Using alcohol-related classified admissions, yearly rates and longitudinal trends of alcohol-related inpatient hospitalizations based on age, period, birth cohort, gender, and race were estimated., Results: Among those aged 45 and older, admissions rose from an estimated 610,634 to more than 1,134,876, and rates of any alcohol-related diagnosis also increased from 1993 to 2010. Rates for men were consistently higher than women, and rates for Blacks were higher than Whites. Age was associated with decreasing rates, but post-World War II cohorts displayed higher rates over time., Discussion: Rates of alcohol-related admissions are increasing among adults above age 45, which may be a function of cohort effects. Training the health care workforce is crucial to respond to this trend., (© The Author(s) 2015.)

Objective: To examine associations of alcohol and tobacco use disorders and psychiatric conditions among older U.S. adults., Methods: Sample was individuals aged at least 65 years (N = 8,205) who participated in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. Measurements included lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol use disorders (AUDs), tobacco use disorders (TUDs), and psychiatric conditions., Results: Among older adults, prevalence of lifetime and past 12-month AUDs were 16.1% and 1.5% and lifetime and past 12-month TUDs were 8.7% and 4.0%, respectively. Lifetime TUD was associated with increased odds of both lifetime (odds ratio [OR]: 4.17; 95% confidence interval [CI]: 3.30-5.26) and past 12-month (OR: 2.52; 95% CI: 1.50-4.24) AUDs, and lifetime AUD was associated with increased odds of both lifetime (OR: 4.13; 95% CI: 3.28-5.210 and past 12-month (OR: 3.51; 95% CI: 2.47-4.96) TUDs. Any lifetime mood, anxiety, or personality disorder among older adults was associated with increased odds of lifetime AUD and TUD, any lifetime mood disorder was associated with increased odds of past 12-month AUD and TUD, and any personality disorder was associated with past 12-month TUD., Conclusion: There is a strong association between AUD and TUD among older U.S. adults as well as associations between AUD and TUD with mood, anxiety, and personality disorders. Understanding the psychiatric conditions associated with AUDs and TUDs, especially past 12-month use disorders involving alcohol or tobacco, will enable healthcare providers to target screening and be more aware of symptoms and signs of potential AUDs and TUDs among those at higher risk., (Published by Elsevier Inc.)

Objectives: To examine the prevalence, sociodemographic, and health-related correlates of substance use disorders, including alcohol, tobacco, and nonmedical drug use among adults aged 65 years and older., Design: The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a cross-sectional survey of a population-based sample., Setting: The United States., Participants: Eight thousand two hundred five adults aged 65 years and older., Measurements: Prevalence of lifetime and past 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, determined alcohol, tobacco, and nonmedical drug use disorders., Results: Prevalence of any substance use disorder was 21.1% during the lifetime and 5.4% in the past 12 months. Lifetime and past 12-month alcohol use disorders were 16.1% and 1.5%; tobacco use disorders were 8.7% and 4.0%; and nonmedical drug use disorders were 0.6% and 0.2%, respectively. Younger age was associated with greater odds of any lifetime or past 12-month substance use disorders. Men and those who were divorced or separated had greater odds of both lifetime alcohol and tobacco use disorders. Very good or excellent self-rated health was associated with lower odds of lifetime and past 12-month tobacco use disorders. Younger age and being divorced or separated were associated with greater odds of lifetime nonmedical drug use disorder., Conclusions: More than one in five older adults ever had a substance use disorder, and more than 1 in 20 had a disorder in the past 12 months, primarily involving alcohol or tobacco. Older adults have increased comorbidities and use of medications, which can increase risks associated with substance use.

Background: Alcohol screening and brief intervention for unhealthy alcohol use has not been consistently delivered in primary care as part of preventive healthcare., Objective: To explore whether telephone-based intervention delivered by a health educator is efficacious in reducing at-risk drinking among older adults in primary care settings., Design: Secondary analyses of data from a randomized controlled trial., Participants: Subjects randomized to the intervention arm of the trial (n = 310)., Interventions: Personalized risk reports, advice from physicians, booklet about alcohol and aging, and up to three telephone calls from a health educator. All interventions were completed before the three-month follow-up., Measurements: Risk outcomes (at-risk or not at-risk) at 3 and 12 months after enrollment., Main Results: In univariate analyses, compared to those who remained at risk, those who achieved not at-risk outcome at 3 months were more likely to be women, Hispanic or non-white, have lower levels of education, consume less alcohol, drink less frequently, and have lower baseline number of risks. In mixed-effects logistic regression models, completing all three health educator calls increased the odds of achieving not at-risk outcome compared to not completing any calls at 3 months (OR 5.31; 95% CI 1.92-14.7; p = 0.001), but not at 12 months (OR 2.01; 95% CI 0.71-5.67; p = 0.18)., Conclusions: Telephone-based intervention delivered by a health educator was moderately efficacious in reducing at-risk drinking at 3 months after enrollment among older adults receiving a multi-faceted intervention in primary care settings; however, the effect was not sustained at 12 months.

Objectives: To describe differences between older at-risk drinkers, as determined using the Comorbidity Alcohol Risk Evaluation Tool, who reduced drinking and those who did not after an initial intervention and to determine factors associated with early reductions in drinking., Design: Secondary analyses of data from a randomized controlled trial., Setting: Seven primary care sites., Participants: Subjects randomized to the intervention group who completed the first health educator call approximately 2 weeks after enrollment (n=239)., Intervention: Personalized risk reports, booklets on alcohol-associated risks, and advice from physicians, followed by a health educator call., Measurments: Reductions in number of alcoholic drinks., Results: Thirty-nine percent of the sample had reduced drinking within 2 weeks of receiving the initial intervention. According to the final multiple logistic regression model, those who were concerned about alcohol-related risks (odds ratio (OR)=2.03, 95% confidence interval (CI)=1.01-4.07), read through the educational booklet (OR=2.97, 95% CI=1.48-5.95), or perceived that their physicians discussed risks and advised changing drinking behaviors (OR=4.1, 95% CI=2.02-8.32) had greater odds of reducing drinking by the first health educator call., Conclusion: Concern about risks, reading educational material, and perception of physicians providing advice to reduce drinking were associated with early reductions in alcohol use in older at-risk drinkers. Understanding these factors will enable development of better intervention strategies to reduce unhealthy alcohol use.

Objective: Most individuals with alcohol or other substance use disorders do not seek help for these problems. This study examined the factors associated with perceptions of need for help and receipt of help among individuals with alcohol or other substance dependence disorders in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)., Methods: The 2001-2002 NESARC surveyed a representative sample of the noninstitutionalized population in the United States. Individuals with a past-year substance dependence diagnosis (N=1,602) were classified into one of three groups: received help in the past year (14.7%), perceived a need for help but did not receive it (8.5%), or perceived no need and received no help (76.8%). Multinomial logistic regression with population weights was used to examine the influence of predisposing, enabling, and need-related factors on help seeking in the past year., Results: Factors that increased the receipt of help included older age, drug dependence (versus alcohol dependence only), longer time since the onset of dependence, co-occurring mood disorder, and more problems associated with substance use. Nonwhites were about twice as likely as whites (odds ratio=2.2) to perceive a need for help but not receive it. Similarly, more problems associated with substance use increased the odds of both receiving help and perceiving a need for help but not receiving it. None of the enabling characteristics were associated with help seeking or perceived need, after analyses controlled for predisposing and need-related factors., Conclusions: Increasing the recognition of problems associated with substance dependence, particularly alcohol, may facilitate help seeking, although barriers persist in regard to age and race-ethnicity.

Objective: This study examined rates of remission from substance-use disorders based on type of disorder (abuse vs dependence), type of substance (alcohol vs other drug), and polysubstance involvement (alcohol or drug vs alcohol and drug)., Method: Participants in the National Epidemiologic Survey on Alcohol and Related Conditions were included if they met criteria for a prior-to-past-year alcohol- and/ or drug-use disorder (N = 12,297). Odds ratios were computed to examine differences in the rate of remission as of the past year., Results: Individuals with a prior-to-past-year diagnosis of abuse were more likely to be remitted, compared with those with a diagnosis of dependence. Individuals with both prior-to-past-year alcohol- and drug-use disorders were less likely to be remitted, compared with those with only an alcohol- or drug-use disorder. No differences were observed in remission rates comparing individuals with a prior-to-past-year alcohol-use disorder with those with a drug-use disorder., Conclusions: The findings support prior research in suggesting a worse prognosis for individuals with a diagnosis of dependence and problematic use of both alcohol and drugs. In contrast with results from treatment samples, these general population data indicate that alcohol-use and drug-use disorders have a similar prognosis.

Objectives: We examined demographic predictors of longitudinal patterns in alcohol consumption., Methods: We used mixed-effects models to describe individual alcohol consumption and change in consumption with age, as well as the associations between consumption and birth year, national alcohol consumption, and demographic factors, among 14 105 adults from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study., Results: Alcohol consumption declined with increasing age, and individual consumption mirrored national consumption. Higher consumption was associated with male gender, being White, being married, having a higher educational level, having a higher income, being employed, and being a smoker. Faster age-related decline in consumption was associated with earlier cohorts, being male, being married, having a lower educational level, and being a smoker., Conclusions: Compared with alcohol consumption among earlier cohorts, that among recent cohorts declined more slowly with increasing age, suggesting that negative health effects of alcohol could increase in the future.