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Use of Medications, Alcohol, and Smoking in Elderly Japanese-American Men in Hawaii

Use of Medications, Alcohol, and Smoking in Elderly Japanese-American Men in Hawaii. A Report From the Honolulu-Asia Aging Study (HAAS) Lon White Pacific Health Research Institute and the Kuakini Medical Center. September 2004. Honolulu-Asia Aging Study.

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Use of Medications, Alcohol, and Smoking in Elderly Japanese-American Men in Hawaii

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  1. Use of Medications, Alcohol, and Smoking in Elderly Japanese-American Men in Hawaii A Report From the Honolulu-Asia Aging Study (HAAS) Lon White Pacific Health Research Institute and the Kuakini Medical Center. September 2004

  2. Honolulu-Asia Aging Study • An ongoing longitudinal study of older Japanese-American men, focused largely on pathogeneses of Alzheimer’s disease, Parkinson’s disease, related degenerative brain diseases, cerebrovascular disease, and brain aging.

  3. Honolulu-Asia Aging Studystaff and key collaborators • Honolulu: L White, H Petrovitch, GW Ross, K Masaki, R Abbott, J Hardman, J Uyehara-ock, J Nelson, and : clinic team, “A” team, histopathology, genetics, and administration. • NIA L Launer, R Peila, D Foley. • Kentucky Wm Markesbery, D Davis. • NIOSH/Morgantown J O’Callaghan, D Miller, C Burchfiel, D Sharp. • USCC Zarow, H Chui

  4. THE HONOLULU HEART PROGRAMSERIAL EXAMINATIONS EXAMS YEAR N Exam I 1965-68 8006 Exam II 1968-70 7498 Lipo I 1970-72 2780 Exam III 1971-74 6860 Lipo II 1975-78 2386 Lipo III 1980-82 1965 Mail Quest. 1988 4664

  5. HONOLULU-ASIA AGING STUDY EXAMINATION CYCLES exam YEAR age range N • HHP/HAAS 4 1991-93 71-93yr 3741 • HHP/HAAS 5 1994-96 74-95 2705 • HHP/HAAS 6 1997-99 77-98 1991 • HHP/HAAS 7 1999-00 79-100 1523 • HHP/HAAS 8 2001-03 81-103 1200 • HHP/HAAS 9 2004- 83+ ?

  6. How many prescription meds do these men take? • Based on data from the baseline HAAS exam, 1991-93. • Limited to 3413 men with normal cognitive functioning. • Based on examining bottles and pills, and on answers to questions.

  7. % of men using 0-7 different meds

  8. % of HAAS men aged 71-74according to # of meds used

  9. % of HAAS men aged 75-84according to # of meds used

  10. % of HAAS men aged 85-93according to # of meds used

  11. What were the most commonly prescribed meds? • For hypertension and/or cardiovascular disease (used by more than 50% of men) • Aspirin, NSAIDS, Tylenol • Meds for asthma, chronic lung disease • laxatives

  12. PERCENT of HAAS men using Psychoactive meds (1999, n=1383) • SSRI antidepressants 1.2 % • Other antidepressants 0.7 % • Ambien 0.4 % • Benzodiazepine 1.2 % • Other sedative 0.3 % • Neuroleptic 0.2 % • Trazodone 0.1% • total 4.2%

  13. Use of psychoactive meds • 3.9% of men used one • 0.4% (5/1375) used two • 2 used a benzodiazepine + a sedative • 1 used an SSRI antidepr + a tricyclic • 1 used an SSRI antidepr + another antidep. • 1 used an SSRI antidepr + benzodiazepine • Only 8 men were taking an opiate, and none were taking a second psychoactive med

  14. Is there evidence of abuse or overuse of prescription or OTC meds in the HAAS cohort? NO

  15. Is there evidence of excessive intake of alcohol, or of smoking? YES

  16. ACQUISITION OF INFORMATION • Alcohol – self report: frequency and size -- units of beer, saki, wine, and liquor; oz/mo of alcohol calculated 1965, ‘71, ‘87, and ’91 • Cigarettes – self report: ever/never/now cigs/day, with pack-years calc. 1965, ’71, ’87, and ‘91

  17. % of HAAS men in 7 strata of alcohol intake(N=3268; aged 71-93; 1991-93)

  18. % of HAAS men reporting high monthly alcohol intake, 1965 data

  19. % of HAAS men reporting high monthly alcohol intake, 1971 data

  20. % of HAAS men reporting high monthly alcohol intake, 1987 data

  21. % of HAAS men reporting high monthly alcohol intake, 1991 data

  22. % OF MEN RECEIVING ANTIDEPRESSANT MEDS ACCORDING TO LEVEL OF DEPRESSIVE SYMPTOMS

  23. Predictors and correlates of alcohol intake among HAAS men who reported any consumption • Older age (inverse p<0.0001) • Education (inverse p<0.0001) • HDL-cholesterol level (direct p<0.001) • Smoking (pack years, direct p<0.0001) • Depressive symptoms (direct p<.05) • # of persons available when lonely (inverse p<0.05) • # of children (direct p<0.01) • Widowed, divorced, or never married (p=0.004)

  24. Factors NOT significantly associated with alcohol intake among HAAS men who reported any consumption • obesity • Heart disease or stroke • Poor cognitive test scores • # of relatives seen /month • # of Rx meds

  25. Heavy alcohol drinking in elderly Japanese-American men • It does occur, and high intake is associated with specific risk factors. • The decrease with advanced age is modest. • The % of men consuming >60 ounces of alcohol / month remains at 1-4% even among men in their 80s.

  26. late-life heavy drinkers – 4 types • “new” late-life heavy drinker • “established” late-life heavy drinker • “recidivist” late-life heavy drinker • Life-long heavy drinker

  27. “NEW” late-life heavy drinker • < 10 oz /mo in 1965 • < 10 oz/mo in 1971 • < 10 oz/mo in 1987 • > 60 oz/mo in 1991

  28. “established” late-life heavy drinker • < 10 oz/mo in 1965 • < 10 oz/mo in 1971 • > 10 oz/mo in 1987 • > 60 oz/mo in 1991

  29. “recidivist” late-life heavy drinker • > 10 oz/mo in either 1965 or 1971 • < 10 oz/mo in 1987 • > 60 oz/mo in 1991

  30. WHO ARE THESE GUYS? WHY ARE THEY DRINKING SO MUCH? IS IT REALLY BAD FOR THEM?

  31. “lifelong” late-life heavy drinker • > 10 oz/mo in either 1965 or 1971 • > 10 oz/mo in 1987 • > 60 oz/mo in 1991

  32. late-life heavy drinkers – 4 types N % new late-life heavy drinker 88 3.9 established late-life heavy drinker 26 0.8 recidivist late-life heavy drinker 70 2.5 life-long heavy drinker 71 2.5

  33. new and established late-life heavy drinking -- risk factors • Depressive symptomatology (CES-D 11) • Widowed, divorced, or never married • Greater number of children

  34. Recidivist and life-long late life heavy drinkers – risk factors • Level and consistency of drinking during middle life • Lifetime smoking • High hdl-C

  35. Did late-life heavy drinking have a significant impact on survival? • “new” late-life heavy drinkers: NO • “established” late-life drinkers: N0 • “recidivist” late-life drinkers: YES OR 2.6 (1.45-4.63) for death within 10 yrs* • Life long drinkers: MARGINAL OR 1.5 (0.91-2.63) for death within 10 yrs* *controlling for age, heart disease, stroke, cognitive test score, smoking (packyears), midlife blood pressure, midlife and latelife BMI, midlife and late life cholesterol, diabetes/blood glucose, and HDL.

  36. Does late life alcohol intake cause dementia? • Only rarely. • In this cohort, late life EthOH intake is not a risk factor for cognitive test scores, or for decline, or for prevalent or incident dementia. • Also not associated with lesions of Alzheimer’s disease, Parkinson’s disease, or for aging-related atrophy.

  37. Heavy drinking in late life -- conclusions • It occurs often enough to be an important public health matter. • There appear to be definable subgroups having different pathogeneses, implying a need for different case-finding and intervention strategies.

  38. Heavy drinking and smoking in late life % smoking ------- never past current • New drinkers 12 81 7 • Established drinkers 8 77 15 • Recidivist drinkers 7 80 13 • Lifelong drinkers 16 67 17 • other and non-drinkers 40 54 6

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