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					    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

 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.
       Honolulu-Asia Aging Study
       staff 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.
   USC      C Zarow, H Chui
THE HONOLULU HEART PROGRAM
     SERIAL 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
HONOLULU HEART PROGRAM
 Began in 1965 with the examination of 8006 Japanese-American men
 Born 1900 through 1919.       Follow-up exams 1967-69, and 1971-74
 Extensive information collected related to heart disease, stroke, cancer.

HONOLULU ASIA AGING STUDY
 Began in 1991 with the examination of 3734 HHP cohort members
 Focus on dementia, cognitive impairment, and other aging-related brain
 Diseases. Followup exams 1994-96, 1997-98, 1999-00, 2001-current

ASSESSMENT S OF COGNITION / DEMENTIA
 Cognitive Abilities Screening Instrument (developed by E. Teng, et al).
 Range of 0-100, CASI 74 ~ MMSE 21; CASI 65 ~ MMSE 17-18.
 Standardized neurological exam, significant other history, and
 CERAD neurosych. Battery. DSMIII-R criteria for dementia,
 ADRDA-NINCDS criteria for AD, and California criteria for VsD.
       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+          ?
   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.
 % of men using 0-7 different meds

30

25

20

15

10

5

0
     none   1      2       3      4      5   6   7+

                number of Rx meds used
      % of HAAS men aged 71-74
     according to # of meds used
30


25


20


15


10


 5


 0
     none   1   2   3       4      5      6   7+

                    number of meds used
  % of HAAS men aged 75-84
 according to # of meds used
30

25

20

15

10

5

0
     none   1   2     3    4     5    6   7+

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

30

25

20

15

10

5

0
     none   1   2      3    4     5       6   7+
                    number of meds used
   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
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%
      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
 Is there evidence of abuse or
overuse of prescription or OTC
   meds in the HAAS cohort?

             NO
Is there evidence of excessive
       intake of alcohol,
         or of smoking?

            YES
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
% of HAAS men in 7 strata of alcohol
             intake
       (N=3268; aged 71-93; 1991-93)
70

60

50

40

30

20

10

0
     none   1 --19   20 --39   40 --59   60 --79   80 -- 99   >= 100

                     alcohol intake, ounces/ month
      % of HAAS men reporting high
     monthly alcohol intake, 1965 data

12


10
                                                        60+ oz
                                                        40-59 oz
8


6


4


2


0
     45-49   50-54   55-59   60-64   65-69   70-74   75-79   80-82   85+
      % of HAAS men reporting high
     monthly alcohol intake, 1971 data

12


10

                                                             60+ oz
8
                                                             40-59 oz

6


4


2


0
     45-49   50-54   55-59   60-64   65-69   70-74   75-79   80-82      85+
      % of HAAS men reporting high
     monthly alcohol intake, 1987 data
12


10
                      60+ oz

8                     40-59 oz

6


4


2


0
     45-49   50-54   55-59   60-64   65-69   70-74   75-79   80-82   85+

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

12


10
                     60+ oz
8
                     40-59 oz

6


4


2


0
     45-49   50-54   55-59    60-64   65-69   70-74   75-79   80-82   85+
% OF MEN RECEIVING ANTIDEPRESSANT
   MEDS ACCORDING TO LEVEL OF
       DEPRESSIVE SYMPTOMS
50
45
40
35
30
25
20
15
10
 5     1.5            1.3          2.5          2.9

 0
     0 TO 4        5 TO 8       9 TO 13        14+

              CES-D 11 (depression symptoms)
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)
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
   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.
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
“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
    “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
    “recidivist” late-life heavy
              drinker
      > 10 oz/mo in either 1965 or 1971


     < 10 oz/mo in 1987

      > 60 oz/mo in 1991
WHO ARE THESE GUYS?   WHY
ARE THEY DRINKING SO MUCH?
IS IT REALLY BAD FOR THEM?
    “lifelong” late-life heavy
             drinker
     > 10 oz/mo in either 1965 or 1971


     > 10 oz/mo in 1987

     > 60 oz/mo in 1991
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
new and established late-life
heavy drinking -- risk factors

 Depressive symptomatology (CES-D 11)
 Widowed, divorced, or never married
 Greater number of children
Recidivist and life-long late life
  heavy drinkers – risk factors
  Level and consistency of drinking during
   middle life
  Lifetime smoking
  High hdl-C
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.
    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.
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.
    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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posted:10/24/2011
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