“Inflamm-Aging:” Alcohol Makes It Even Worse

Newswise. June 30, 2016 — The immune system in the elderly is dysfunctional and infections are more prevalent, more severe, and harder to defeat.

Drinking alcohol has a variety of damaging effects on the immune system and organs – like the gut, liver and lung – which can be worsened by pre-existing conditions as well as consumption of prescription and over-the-counter medications that aged individuals often take.

This presentation addresses how alcohol affects the elderly more dramatically, and also suppresses their ability to battle infections, like pneumonia, much more severely than it does younger individuals.

“Our laboratory has been studying inflammatory and immune responses in the aged for well over a decade,” said Brenda J. Curtis, Ph.D., a research assistant professor at the University of Colorado Denver.

“We know that even healthy elderly individuals have an elevated basal inflammatory state, known as ‘inflamm-aging.’ Advanced age alone is a risk factor for a poor prognosis after injury or infection. Adding alcohol to the fragile immune milieu of the aged reduces their ability to fight infections.”

“Our research suggests that alcohol intoxication perturbs the immune system of the aged both throughout the body and in local regions, like the lung,” added Elizabeth J. Kovacs, Ph.D., director of Burn Research
and professor in the department of surgery at the
University of Colorado Denver / Anschutz Medical Campus.

“We have shown that alcohol exposure makes macrophages less effective at clearing pathogens and releasing molecules important for recruiting other immune cells to the site of infection, and that this is worsened in the elderly.”

Innate immune cells control the immediate response to an infection, including neutrophils and macrophages, Curtis explained. These cells work together to find and eradicate infectious organisms.

However, drinking alcohol can impair innate immune function, thereby rendering the individual more susceptible to infections.

“This is due in part to direct effects of ethanol on innate immune cells,” said Curtis. “Even short-term exposure of macrophages to alcohol reduces their ability to migrate to a site of infection as well as their ability to destroy the pathogen.”

“In addition, the effects of alcohol on the elderly are more potent than they are in younger individuals in part because of the pro-inflammatory state of the aged,” noted Kovacs. “Aged individuals also have decreased lung function and cough strength, which further escalates the risk for developing pneumonia.”

Overdose Deaths from Common Sedatives Have Surged, New Study Finds

 Newswise, February 21, 2016--Headlines about America’s worsening drug epidemic have focused on deaths from opioids—heroin and prescription painkillers such as OxyContin.

But overdose deaths have also soared among the millions of Americans using benzodiazepine drugs, a class of sedatives that includes Xanax, Valium, and Klonopin, according to a study led by researchers at Albert Einstein College of Medicine, Montefiore Health System and the Perelman School of Medicine at University of Pennsylvania. Their findings appear online today in the American Journal of Public Health.

“We found that the death rate from overdoses involving benzodiazepines, also known as ‘benzos,’ has increased more than four-fold since 1996—a public health problem that has gone under the radar,” said lead author Marcus Bachhuber, M.D., MS., assistant professor of medicine at Einstein and attending physician, internal medicine at Montefiore. 

“Overdoses from benzodiazepines have increased at a much faster rate than prescriptions for the drugs, indicating that people have been taking them in a riskier way over time.”

An estimated 1 in 20 U.S. adults fills a benzodiazepine prescription during the course of a year. The drugs are prescribed for conditions including anxiety, mood disorders and insomnia.

In 2013, benzodiazepine overdoses accounted for 31 percent of the nearly 23,000 deaths from prescription drug overdoses in the U.S. But little was known about the national trends in benzodiazepine prescribing or in fatalities from the drugs. To find out, the researchers examined data for the years 1996-2013 from two sources:

•The Medical Expenditure Panel Survey. This federally sponsored survey includes a nationally representative sample of families and individuals who provide information about healthcare purchases including prescription drugs.

•Multiple-cause-of-death data from the Centers for Disease Control and Prevention. The researchers extracted reports from physicians, medical examiners or coroners on all overdose deaths involving a benzodiazepine, including deaths also involving other medications, alcohol or illicit drugs.

Their analysis revealed that the number of adults purchasing a benzodiazepine prescription increased by 67 percent over the 18-year period, from 8.1 million prescriptions in 1996 to 13.5 million in 2013.

 For those obtaining benzodiazepine prescriptions, the average quantity filled during the year more than doubled between 1996 and 2013. Most crucially, the overdose death rate over the 18-year period increased from 0.58 deaths per 100,000 adults in 1996 to 3.14 deaths per 100,000 adults in 2013, a more than four-fold increase.

Overall, the rate of overdose deaths from benzodiazepines has leveled off since 2010. But for a few groups—adults aged 65 and over and for blacks and Hispanics—the rate of overdose deaths after 2010 continued to rise.

“The greater quantity of benzodiazepines prescribed to patients—more than doubling over the time period—suggests a higher daily dose or more days of treatment, either of which could increase the risk of fatal overdose,” said senior author Joanna Starrels, M.D., M.S., associate professor of medicine at Einstein and attending physician, internal medicine at Montefiore.

Dr. Starrels also offered two other possible reasons for the spike in benzodiazepine deaths. “People at high risk for fatal overdose may be obtaining diverted benzodiazepines [i.e., not from medical providers], and we know that combining benzodiazepines with alcohol or drugs—including opioid painkillers—can lead to fatal overdoses,” she said.

She noted that opioid prescribing has increased rapidly during most of the period covered in her study and that opioids are involved in 75 percent of overdose deaths involving benzodiazepines.

“An obvious way to improve benzodiazepine safety would be for people to reduce their use of these medicines,” said study co-author Chinazo Cunningham, M.D., M.S., professor of medicine and of family and social medicine at Einstein and associate chief of the division of general internal medicine at Einstein and Montefiore.

“But we should also be emphasizing the danger of fatal overdose from taking benzodiazepines concurrently with opioid painkillers or with alcohol.”

“This epidemic is almost entirely preventable, as the most common reason to use benzodiazepines is anxiety—which can be treated effectively and much more safely with talk therapy,” said Sean Hennessy, Pharm.D., Ph.D., professor of epidemiology at Penn’s Perelman School of Medicine and co-author of the study.

“Given the high prevalence of anxiety symptoms, we need a more constructive approach to the problem than popping pills.”

The study is titled “Increasing benzodiazepine prescription and overdose mortality in the United States, 1996-2013.” The research was supported by the National Institutes of Health (NIH K24DA036955, R25DA023021 and K23DA027719). The authors report no conflicts of interest.

NYU Study Finds Adults Aged 50-59 Now Largest Age Group in Opioid Treatment Programs

Notable shifts found in demographic background including gender and ethnicity among older adults

Newswise, December 1, 2015 — Recent years have seen a change in drug use patterns, especially for older adults, with an increase in their admission to substance abuse treatment and increased injection drug use among those over the age of 50. 

Yet, there has been little research regarding the epidemiology, health status, and functional impairments in the aging population of adults accessing opioid treatment.

Of the few studies on this population to date, most have been based off of a limited dataset that only accounts for treatment admissions, and therefore may not fully capture the utilization of substance abuse treatment over time. 

Furthermore the treatment episode dataset (TEDS), defines an older adult as aged over 50 or 55, and may not fully demonstrate how the population is aging.

Given the gaps in existing data, researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR), and NYU’s School of Medicine (NYUSoM) sought to elucidate age trends for opioid treatment programs, with an emphasis on older adults, in a new study published in the Journal of Substance Use & Misuse. 

The investigation focuses on such trends in New York City, as it has one of the largest methadone treatment systems in the U.S. and consistently provides access to treatment in the public system.

The study, “Demographic Trends of Adults in New York City Opioid Treatment Programs- An Aging Population,” used data collected by New York State's Office of Alcoholism and Substance Abuse Services (OASAS). OASAS provides more detailed information on the treatment population than what is available nationally through the TEDS dataset, allowing the NYU researchers to characterize basic demographic, self-reported other substance use, and self-reported physical impairments.

“Most notably,” says Benjamin Han, MD, MPH, an instructor at NYUSoM and the study’s principle investigator, “we found a pronounced age trend in those utilizing opioid treatment programs from 1996 to 2012, with adults aged 50 and older becoming the majority treatment population.”

Specifically, individuals aged 50-59 which made up 7.8% (N= 2,892) of the total patient population in 1996, accounted for 35.9% (N= 12,301) of the population in 2012. Patients aged 60-69, also saw a dramatic increase in numbers, originally constituting 1.5% of patients (N= 558) to 12.0% of patients (N= 4,099).

“These increases are especially striking, considering there was about a 7.6% decrease in the total patient population over that period of time, and suggests that we are facing a never before seen epidemic of older adults with substance use disorders and increasing numbers of older adults in substance abuse treatment. 

Unfortunately there is a lack of knowledge about the burden of chronic diseases and geriatric conditions or the cognitive and physical function of this growing population” says Dr. Han.

During the same period, those age 40 and below, who in 1996 accounted for 56.2% of patients (N= 20,804), were a fraction of that in 2012, responsible for 20.5% of total patients (N= 7,035).

There were also notable shifts with regards to race and ethnicity. During this period older adults over the age of 60 were increasingly white, with a 10.3% increase in representation, while there was a 13.8% decrease in the percentage of black patients. 

There was a small increase in the Hispanic constituency from 35.0% in 1996 to 38.8% in 2012. These trends, however, were different for those aged 50-59. In this age group there were smaller decreases in both the white (3.5%) and black (5.9%) populations, and a larger increase in Hispanic patients (9.2%). 

However, when looking at all age groups during this period, the overall white population remained steady (-0.4%), with a slight decrease in black patients (3.5%) and a slight increase in Hispanic patients (3.4%).

Researchers believe the increase in older adults utilizing opioid treatment programs is likely to continue into the next decade. Further studies are required to better understand the specific and unique health needs of this growing population from a geriatric perspective. 

More research is also need to understand how other substance use can complicate care and how to address the changing ethnic and racial demographics of this population in New York City.

Researcher Affiliations: Benjamin H. Han, MD, MPH1*; Soteri Polydorou, MD2; Rosie Ferris, MPH1; Caroline Blaum, MD, MS1; Stephen Ross, MD2; Jennifer McNeely, MD, MS3.
1 NYU School of Medicine, Department of Medicine, Division of Geriatrics.
2 NYU School of Medicine, Division of Alcoholism and Substance Abuse
3 NYU School of Medicine, Department of Population Health and the Department of
Medicine.

Declaration of Interest: Gail Dorn, MS1 and Dawn Lambert-Wacey, MA1 provided the aggregated dataset used in this study, and assisted in the editing of the article.

1NYS Office of Alcoholism and Substance Abuse Services
Division of Outcome Management and System Information
1450 Western Ave, Albany, NY 12203-3526

About CDUHR
The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit www.cduhr.org

About NYU Langone Medical Center
NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation’s premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals—Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center’s dedicated inpatient orthopaedic hospital; and Hassenfeld Children’s Hospital, a comprehensive pediatric hospital supporting a full array of children’s health services across the Medical Center—plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center’s tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to www.NYULMC.org

About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master’s Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nursing.nyu.edu/ 

A Significant Number of Adults Can't Identify Signs of Substance Abuse in Seniors

According to a New National Survey by Harris Poll on behalf of Caron Treatment Centers Poll finds majority of adults age 35-50 (51%) report substance abuse is not a growing problem among seniors (age 60+); Yet nearly 1 in 3 (31%) say their aging parent has engaged in problematic behaviors 

WERNERSVILLE, Pa., Sept. 24, 2015 /PRNewswire-USNewswire/ -- Many American adults aren't involved with their parent's health issues or knowledgeable when it comes to symptoms of substance use disorders (SUDs), according to findings from a new national survey by Caron Treatment Centers, a leading not-for-profit provider of addiction treatment and behavioral healthcare.

The online survey, commissioned by Caron and conducted by Harris Poll among more than 1,000 U.S. adults age 35-50 with a living parent, step-parent, or parent-in-law aged 60+ who they regularly contact (at least once a month), reveals alarming misperceptions about their parents' behavior and the consequences of drinking alcohol and taking prescription medication.

The survey demonstrates a disconnect between how involved adults say they are in their parent's healthcare and the steps they take to support their parent's wellness. It also shows the majority of adults (51%) don't think substance abuse is a growing problem among seniors; however, according to the National Council on Alcoholism and Drug Dependence (NCADD), alcohol and prescription drug problems among adults age 60+ are one of the fastest growing health issues in America.

Furthermore, the NCADD states adults age 65+ take more prescribed and over-the-counter medications than any other age group in the U.S. Misuse is prevalent among seniors not only because doctors prescribe more medications with greater frequency, but also because an individual's body becomes more susceptible to the effects of alcohol/drugs with age. Additionally, many don't realize combining alcohol and prescription medication can cause health complications and even death.

"We're in the midst of an epidemic regarding seniors and substance use disorders," said Dr. Joseph Garbely, M.D., Medical Director at Caron.

"Tragically, the majority of seniors who struggle with SUDs and related issues don't get the help they need and their health declines rapidly. It's critical that adults with aging parents understand the signs and symptoms of SUDs and are empowered with tools to talk to their parents, and in some cases their parent's doctors, about these issues."

Adults Believe They Could Spot Signs of Substance Abuse In Their Parents But Poll Shows Many Could Not Identify Major Symptoms 

Experts say nearly 2.8 million Americans age 50+ meet the criteria for SUD which is expected to nearly double (5.7 million) by 2020, according to the National Institutes of Health (NIH).

Nearly one-third of adults (32%) surveyed by Harris Poll said it's uncommon for people to start abusing alcohol and/or drugs after turning 60. In reality, many seniors experience problems with alcohol abuse after age 60. A Mayo Clinic study found at least 41% of adults age 65+ said their issues started after turning 60.

In early 2015, Caron developed a senior program after observing the specialized needs of the population.

Experts at Caron with extensive experience working with seniors created the personalized treatment approach to encompass several factors including low motivation, lifestyle changes, and unique triggers like retirement, death of a spouse, limitations to mobility, isolation, and the development of a chronic illness. Additionally, there are often significant co-occurring issues that must be treated in order to help seniors achieve recovery.

Experts at Caron say it's critical to start a dialogue with aging parents about their overall mental wellbeing – including their growing vulnerability to substance abuse and behavioral health issues. Although four in five adults (84%) said they'd be able to recognize symptoms of substance abuse in their parent, a significant amount didn't identify the following as signs:

• Anxiety (54%)
• Sleeping problems (46%)
• Failing to keep up with medical appointments/treatments (43%)
• Depressed mood (38%)
• Recurring accidents/injuries/falls (37%)
• Confusion/disorientation (36%)
• 12% were unsure of the signs

Adults Lack Awareness of Dangers of Drinking Alcohol While Taking Prescription Medication; Trust Doctors to Discuss Abuse

Caron's survey revealed confusion around the potentially deadly combination of alcohol and prescription medication:

• One in ten adults (10%) admitted uncertainty about what substances their parent uses
• 11% said their parent consumed alcohol while taking prescription medication at age 60+
• About 2 in 5 (37%) said it's okay for seniors to have one glass of wine/beer while taking prescription medication
•  

The survey also showed nearly nine in 10 adults (87%) trust their parent's doctor would discuss the proper use, side-effects, storage, and disposal of prescription medications before prescribing. Additionally, the majority of adults (83%) said they trust the people who manage their parent's health to identify substance abuse signs; however, only 18% of providers discuss storage/disposal of drugs and over 40% of primary care doctors report difficulty discussing potential drug abuse with patients, according to the American College of Physician Medicine (ACPM). Safe storage and disposal is also important to understand because of a rising trend in individuals taking medication from others' medicine cabinets.

"Most doctors are well intentioned, but unfortunately we cannot rely on them alone to manage their patient's care," said David Rotenberg, Chief Clinical Officer at Caron.

"A typical patient in our senior program has been prescribed medication from multiple doctors. The doctors may not know this and may not think to ask the patient. Additionally, doctors sometimes fail to discuss proper use or potential side effects of prescribed medications or to emphasize the dangers of alcohol. We are expanding our work with the medical community to better educate doctors about substance use disorders. However, it's also critical that communities and families are educated and can raise awareness."

Nearly One Third of Adults Have Observed Instances of Risky Behavior among Parents Including Drinking and Driving

While many adults may not be able to recognize signs of substance abuse, almost one third (31%) reported their parent has engaged in behavior while age 60+ that may be cause for concern. Specifically:

• 13% of adults said their parent has drunk 3+ drinks at one time
• 11% said their parent has driven after drinking
• 10% said their parent has taken multiple prescriptions or OTC medications at once

Adults are likelier to say their father has engaged in risky behavior, drinking while taking prescription medications (14% vs. 7%) or drinking and driving (15% vs. 8%), compared to their mother.

Adults Report Limited Involvement in Parents' Healthcare, Many Do Not Play Active Role in Care

Over 2 in 5 adults (44%) said they don't talk to their parent about their health and fewer take an active role in their parents' healthcare:

• 18% check to ensure their parent is taking their medications
• 17% accompany their parent to doctor visits
• 14% pick up/refill medications for their parent
• 3% received/are receiving formal training to provide care for their parent

Awareness Needed to Address Seniors and Substance Abuse

It's important adults are aware of the substance abuse dangers among seniors and can help make informed decisions to keep themselves and their parents safe. While many doctors play a role in trying to manage these issues, the earlier adults identify their parent may have a problem, the better chance for a successful recovery.

Experts caution not to wait for a parent to experience an extreme consequence before taking action. To this effect, Caron has been educating physicians and retirement home staff, training them to better understand the signs/symptoms of substance abuse and prevention strategies.

In 2016, Caron will break ground on its $15 million Carole and Ray Neag Medical Center which will support treatment for seniors.

For more information and to learn more about seniors and substance abuse visit www.caron.org or follow us on Twitter: @CaronTreatment.

About Caron Treatment Centers

With nearly 60 years in the field, Caron Treatment Centers provides lifesaving addiction and behavioral healthcare treatment in Wernersville, Pennsylvania and at Caron Ocean Drive and Caron Renaissance in Palm Beach County, Florida. Caron's regional offices in Atlanta, Boston, New York City, Philadelphia and Washington, DC offer community and recovery support. Caron has the most extensive continuum of care including adolescents, young adults, adults and seniors. Caron's treatment is customized to meet the needs of individuals and families – with highly trained teams prepared to address co-occurring disorders. Caron offers an innovative approach to ongoing recovery care for its alumni and their families.

Methodology
This survey was conducted online within the U.S. by Harris Poll on behalf of Caron Treatment Centers betweenJune 18-26, 2015 among 1,007 U.S. adults ages 35-50 who have a living parent, step-parent, or parent-in-law aged 60+ who they regularly contact (once a month or more often). Figures for age, sex, race/ethnicity, education, region and household income were weighted, where necessary, to bring them into line with their actual proportions in the population. Propensity score weighting was used to adjust for respondents' propensity to be online.