I'M GEORGE KOOB, DIRECTOR OF
THE NATIONAL INSTITUTE ON
ALCOHOL AND ALCOHOLISM, I WOULD
LIKE TO WELCOME YOU TO THE
SEMINAR.
SO, OUR PRESENTERS TODAY ARE
DR. KATHERINE KEYES FROM
COLUMBIA UNIVERSITY, FOCUS ON
ALCOHOL USE AMONG OLDER ADULTS,
DR. SARA JO NIXON FROM
UNIVERSITY OF FLORIDA WHO WILL
PRESENT WHAT ARE THE IMPACTS OF
ALCOHOL USE IN OLDER ADULTS.
AND DR. CYNTHIA CAMPBELL FROM
KAISER PERMANENTE AND DR. DEREK
SATRE FROM UNIVERSITY OF
CALIFORNIA, SAN FRANCISCO AND
KAISER PERMANENTE, COVERING WHAT
CAN WE DO ABOUT IT.
I THINK MANY OF YOU KNOW AS THE
POPULATION OF OLDER ADULTS 65
AND ABOVE EXPANDS RAPIDLY, SO DO
THE RATES OF ALCOHOL USE AND
MISUSE AMONG PEOPLE WITHIN THIS
AGE GROUP.
THE BODY CHANGES AS WE AGE,
THESE CHANGES RENDER PEOPLE MORE
SUSCEPTIBLE TO SOME OF THE HARMS
THAT STEM FROM ALCOHOL MISUSE.
WHILE THE PERSONAL OF PEOPLE
AGES 65 AND OLDER WHO CONSUME
ALCOHOL EACH MONTH INCREASED BY
16% BETWEEN 2002 AND 2019, DUE
TO THE SIZE OF THE AGING BABY
BOOMER COHORT, THE ACTUAL NUMBER
OF DRINKERS IN THAT AGE GROUP
INCREASED 80% DURING THAT TIME.
THESE DATA HIGHLIGHT THE NEED
FOR EARLY INTERVENTION, A BROAD
DISCUSSION ON WHAT WE CAN DO TO
PREVENT FURTHER UPWARD TRENDS.
TODAY'S WEBINAR WILL DO JUST
THAT.
AND WILL ALSO PROVIDE AN
IMPORTANT UPDATE ON THE WAY NIAA
NIAAA CONTINUES TO SUPPORT THE
RESEARCH WITH ALCOHOL MISUSE AND
DELIVERY OF APPROACHES TO REDUCE
ALCOHOL MISUSE IN OLDER ADULTS.
I'M EXCITED TO LEARN AND LISTEN
IN ON WHAT WILL BE A ROBUST
DISCUSSION AT THE END.
FINALLY BEFORE I TURN IT OVER TO
THE SPEAKERS, A FEW HOUSEKEEPING
NOTES.
THIS MEETING IS BEING RECORDED,
WILL BE AVAILABLE ON THE NIH
VIDEOCAST WEB PAGE.
THERE WILL BE TIME ALLOTTED FOR
QUESTIONS AND ANSWERS AFTER THE
FORMAL PRESENTATION.
PLEASE SUBMIT YOUR QUESTIONS VIA
THE SUBMIT LIVE FEEDBACK BUTTON
LOCATED UNDER THE VIDEO WINDOW
ON THE VIDEOCAST PAGE.
I'LL REPEAT THAT.
PLEASE SUBMIT YOUR QUESTIONS VIA
THE SUBMIT LIVE FEEDBACK BUTTON
LOCATED UNDER THE VIDEO WINDOW
ON THE VIDEOCAST PAGE.
THANKS FOR JOINING US.
NOW I'LL TURN IT OVER TO
KATHERINE KEYES.
>> THANK YOU FOR THE
INTRODUCTION.
I'LL SHARE MY SCREEN.
CAN EVERYONE SEE THE SLIDES?
THERE WE GO.
CAN EVERYONE SEE THE SLIDES?
GREAT.
SO I'M GOING TO DO SOME KIND OF
10,000-FOOT VIEW STAGE SETTING
FOR THE DISCUSSION ON TRENDS IN
ALCOHOL USE AMONG OLDER ADULTS
AND TALK ABOUT EPIDEMIOLOGICAL
DATA WE HAVE ON WHAT THESE
TRENDS ARE.
SO FIRST WE KNOW THAT ESPECIALLY
LAST 15 YEARS ALCOHOL USE AMONG
OLDER ADULTS HAS BEEN
INCREASING.
THESE ARE DATA FROM THE NATIONAL
HOUSEHOLD SURVEY ON DRUG USE AND
HEALTH, AND THEY SHOW PERCENTAGE
OF PEOPLE AGE 50 OR HIGHER,
ENGAGED IN BINGE DRINKING IN THE
PATH MONTH.
2005 TO MID-PART OF THE LAST
DECADE, 2013-2014, THERE WAS A
RELATIVE INCREASE OF ABOUT 20%
INCREASES IN THE PROPORTION OF
PEOPLE OVER AGE 50 WHO ENGAGED
IN BINGE DRINKING IN THE PAST
MONTH.
FURTHERMORE, OTHER DATA FROM THE
SAME TIME PERIOD ALSO FROM THE
NATIONAL HOUSEHOLD SURVEY ON
DRUG USE AND HEALTH FOCUSED ON
POPULATION 60 ON MORE CONFIRMING
THESE TRENDS AMONG BOTH MEN AND
WOMEN, OVER AGE 60, THROUGH
ABOUT THE MID-POINT OF THE LAST
DECADE, THERE WERE DE DECLINES N
ABSTENTION THROUGH THE MID-POINT
OF THE LAST DECADE.
ANOTHER DATA SOURCE THAT ALSO
CONFIRMS THIS IS A META-ANALYSIS
DONE OF THE SIX NATIONALLY
REPRESENTATIVE DATASETS WE HAVE
IN THE UNITED STATES THAT
CONSISTENTLY MEASURE ALCOHOL USE
AND BINGE DRINKING.
AND SHOWN HERE IS THE META
ANALYZED ESTIMATE BY AGE.
YOUNG PEOPLE ARE MORE LIKELY TO
BINGE DRINK THAN OLDER PEOPLE,
BUT ACTUALLY THE FASTEST
INCREASES IN BINGE DRINKING,
META ANALYZED ACROSS SIX
DATASETS, WAS INDIVIDUALS AGED
65+, AMONG WHOM THERE WAS A 3.4%
INCREASE FROM 2000 TO 2015.
DATA SINCE 2015, WE'VE HAD A LOT
OF YEARS AND A PANDEMIC, THE
DATA WE HAVE ISN'T EXACTLY
COMPARABLE.
THESE ARE THE TRENDS IN THE
NATIONAL HOUSEHOLD SURVEY
THROUGH 2020, THESE BLACK DOTTED
LINES INDICATE BREAKS IN
MEASUREMENT OR DESIGN SO WE
CAN'T ACTUALLY COMPARE TRENDS
BEFORE AND AFTER THOSE BREAKS,
LEADING TO SOME AMBIGUITY IN OUR
UNDERSTANDING OF THE TOTAL TIME
TREND OVER THAT TIME PERIOD BUT
WHAT IS CLEAR IS BINGE DRINKING
HASN'T GONE DOWN.
INCREASES STARTING REALLY AROUND
THE 2000s AND HEADING UP
THROUGH THE MID-POINTS OF THE
PREVIOUS DECADE THROUGH
2014-2015 WE DON'T HAVE ANY
EVIDENCE FROM THE NATIONAL
HOUSEHOLD SURVEY ON DRUG USE AND
HEALTH THAT THOSE INCREASES HAVE
ABATED.
IF ANYTHING, INCREASES HAVE
REMAINED RELATIVELY STATIC, WITH
THE PAST YEAR -- PAST MONTH
ALCOHOL USE REMAINING RELATIVELY
STATIC OR EVEN INCREASING SINCE
THE PANDEMIC, AND FOR PAST MONTH
WE SAW THOSE INCREASES CONTINUE
ESPECIALLY AMONG MEN AFTER 2015
AND SOME EVIDENCE THEY MIGHT BE
DECREASING SLIGHTLY IN THE PAST
FEW YEARS BUT NOT TO THE
PRE-2000 LEVEL.
SO ALL OF THIS TOGETHER
INDICATES THAT WE REALLY DO HAVE
AN INCREASING BURDEN OF ALCOHOL
USE AMONG OLDER ADULTS.
AND I'D LIKE TO SPEAK FOR A FEW
MINUTES ABOUT WHY, WHY ARE WE
SEEING THESE INCREASES AMONG
OLDER ADULTS?
NOW, THIS GOES FROM THE
EPIDEMIOLOGICAL DATA WHERE WE
CAN OBSERVE TRENDS TO SOME
SPECULATION AND HYPOTHESIS
GENERATION, BUT I DO THINK THE
DATA CAN SPEAK TO SOME OF THE
REASONS WHY WE'RE SEEING THESE
TRENDS.
AND I SEPARATE THE POTENTIAL
UNDERLYING DRIVERS OF THE TRENDS
IN OLDER ADULT DRINKING INTO
SUPPLY AND DEMAND SIDE FACTORS.
SO I'LL START WITH DEMAND SIDE
FACTORS.
WHY ARE OLDER ADULTS WANTING TO
DRINK MORE?
ONE REASON IS NOT ONLY AS DR.
KOOB MENTIONED DO WE HAVE AN
INCREASING NUMBER OF OLDER
ADULTS LIFTING PAST 65 BUT ALSO
LIVING HEALTHIER.
SHOWN IS LIFE EXPECT YENS EXPE,
WE'VE HAD AN INCREASING LIFE
EXPECTANCY OCCURRING THROUGHOUT
THE LAST SEVERAL DECADES.
WE'VE EXPERIENCED LEVELING OFF
OF LIFE EXPECTANCY IN THE U.S.,
ESPECIALLY IN THE LAST FEW
YEARS, AS THE PANDEMIC HAS
RAGED, BUT COMPARED TO PRIOR
GENERATIONS AND PRIOR DECADES
PEOPLE ARE LIVING MUCH LONGER
THAN THEY WERE IN PREVIOUS
DECADES, AND THEY ARE ALSO
LIVING HEALTHIER LIVES.
WHY DOES THAT MATTER FOR BINGE
DRINKING?
WELL, EPIDEMIOLOGICAL DATA SHOWS
THAT ACTUALLY THE OLDER ADULTS
MOST LIKELY TO ENGAGE IN BINGE
DRINKING ARE THE HEALTHIEST.
PEOPLE WHO DON'T HAVE MAJOR
CONTRAINDICATIONS OF ALCOHOL USE
WITH MEDICATION AND OTHER
ILLNESSES TEND TO BE THOSE WHO
ENGAGE IN THE MOST EXCESSIVE
ALCOHOL USE.
SO FOR EXAMPLE, THESE ARE DATA
AMONG ADULTS OVER AGE 50 FROM
NATIONAL HOUSEHOLD SURVEY ON
DRUG USE AND HEALTH, AND THE
PEOPLE WHO ARE MOST LIKELY TO
BINGE DRINK, OVER 50 YEARS OLD,
WERE THOSE WITH NO CHRONIC
CONDITIONS.
AND EVEN THOSE WITH ONE CHRONIC
CONDITION.
HOWEVER, AMONG THOSE WITH TWO OR
THREE CHRONIC CONDITIONS, THOSE
ADULTS WERE LESS LIKELY TO BINGE
DRINK THAN OTHERS.
SO, AS THE PROPORTION OF PEOPLE
OVER AGE 50 AND OVER AGE 65 NOT
ONLY GROWS, BUT FOR WHICH
THERE'S NO CONTRAINDICATION TO
ALCOHOL USE, THAT MIGHT BE ONE
REASON WE'RE SEEING THESE
INCREASES.
ANOTHER FACTOR THAT COULD BE
CONTRIBUTING TO INCREASES AMONG
OLDER ADULTS IS STRESS.
ECONOMIC STRESS, ESPECIALLY
STRESS AROUND RETIREMENT AGE.
YOU KNOW, WE REALLY STARTED TO
SEE INCREASES IN OLDER ADULT
DRINKING RIGHT AROUND THE TIME
OF THE 2008-2009 RECESSION,
THAT'S WHEN WE STARTED TO SEE
RISES IN PEOPLE OVER 50 AND OVER
65 AT PRECIPICE OF ECONOMIC
YEARS FOR WHICH ECONOMIC
RECESSION WOULD BE PARTICULARLY
DELETERIOUS TO THEIR LONG-TERM
NET WORTH, THAT'S THE GROUP
WHERE WE STARTED TO SEE REALLY
STRONG INCREASES IN BINGE
DRINKING.
DATA FROM CASE AND DEATON SHOWS
AS MEEDIAN HOUSEHOLD INCOME
DECLEANED WE'VE SEEN MORTALITY
RATES DECLINE FOR PEOPLE 50 TO
54 AS WELL AS PEOPLE AGE 60 TO
69.
WE'VE SEEN DECLINES IN HOUSEHOLD
INCOME, FOR THOSE GROUPS, AND AT
THE SAME TIME INCREASES IN
MORTALITY.
ECONOMIC FACTORS COULD BE
CORRECTING TO INCREASES.
ANOTHER FACTOR IS CO-OCCURRING
SUBSTANCE USE, IN THE SAME AGE
GROUPS OVER THE SAME TIME PERIOD
WE'VE SEEN YEAR-OVER-YEAR
INCREASES IN CANNABIS USE EVEN
AMONG INDIVIDUALS OVER 65, DATA
FROM THE NATIONAL HOUSEHOLD
SURVEY SHOWING TRENDS IN
CANNABIS USE FROM 2013 TO 2022,
ALTHOUGH PEOPLE AGE 65 AND OLDER
HAVE THE LOWEST RATES OF OVERALL
CANNABIS USE WE CAN SEE THEIR
RATES HAVE BEEN INCREASING JUST
AS MUCH AS PEOPLE IN OTHER AGE
GROUPS AS WELL.
SO WE HAVE A CO-OCCURRING FACTOR
THAT'S ASSOCIATED WITH INCREASES
IN ALCOHOL USE, THAT'S ALSO
INCREASING OVER THE SAME TIME.
FINALLY, THOSE ARE THE DEMAND
SIDE FACTORS BUT THERE'S ALSO
SUPPLY SIDE FACTORS THAT MAY BE
CONTRIBUTING TO OLDER ADULT
DRINKING.
SHOWN HERE IS THE PER CAPITA
PERCENTAGE CHANGE IN PER CAPITA
CONSUMPTION FROM 1977 TO 2018 IN
THE UNITED STATES BY BEVERAGE
TYPE.
WE CAN SEE OVERALL, THE BEVERAGE
THAT HAS BEEN INCREASING THE
MOST IN PER CAPITA CONSUMPTION
SINCE THE EARLY PART OF THE
2000s WHEN WE STARTED TO SEE
THIS INCREASE IN OLDER ADULT
DRINKING IS WINE.
WE ALSO KNOW OVER THE LAST TWO
DECADES, THINGS LIKE ALCOHOL
TAXES AND PRICE HAVE NOT KEPT UP
WITH BROADER ECONOMIC FACTORS
SUCH AS INFLATION, WHICH
FUNCTIONALLY LOWERS THE COST OF
ALCOHOL USE FOR EVERYONE.
WE HAVE THE MARKETING AND
ADVERTISING OF ALCOHOL AND
BRANDING OF PRODUCTS TO
ILLUSTRATE ALCOHOL USE MIGHT BE
PART OF A LUXURY LIFESTYLE, PART
OF A CARE-FREE RETIREMENT, AS
WELL AS THE PRICE GOING
FUNCTIONALLY DOWN OVER TIME,
THESE MAY INDICATE A SUPPLY SIDE
DRIVER OVER TIME IN THE ALCOHOL
MARKET ITSELF.
OLDER ADULTS ARE LIVING LONGER
AND HEALTHIER HAVE STAMINA TO
ENGAGE IN HEAVY CONSUMPTION IT
IS EXPENSE FOR THE -- IT IS
CONSEQUENTIAL THE DATA FROM THE
STUDIES THAT WERE FIRST
CONDUCTED IN 2001, 2002, AGAIN
IN 2012-2013, INDICATE INCREASES
IN THE PREVALENCE FOR ALL AGE
GROUPS BUT ESPECIALLY OVER 65
COMPARED TO LOWER RELATIVE
INCREASES IN OTHER AGE GROUPS.
THESE ARE DATA PUBLISHED SEVERAL
YEARS AGO SHOWING BIRTH COHORT
EFFECTS IN CAUSES OF DEATH, SOME
OF WHICH ARE RELATED TO ALCOHOL
USE.
SO EACH OF THESE LINES IS A
PARTICULAR BIRTH COHORT AS THEY
MOVE THROUGH THE LIFE COURSE,
AND WHAT YOU CAN SEE IS IN THIS
50 TO 60 YEAR AGE RANGE DOWN
HERE THERE'S NOT THAT MUCH TREND
IN THE OVERALL MORTALITY RATES,
IT'S WHERE YOU SEE PEOPLE BORN
19 ^50, 1955, 1960, THOSE
ENTERING OLDER AGE GROUPS NOW
WHERE WE STARTED TO SEE
ACCELERATION IN DEATHS RELATED
TO DRUGS, ALCOHOL USE AND
SUICIDE.
I WOULD POINT YOU PARTICULARLY
TO ALCOHOL-RELATED LIVER
DISEASES, AGAIN OLDER COHORTS NO
TREND.
ONCE YOU SEE PEOPLE BORN 1950,
1955, 1960 WE'RE SEEING
ACCELERATION EVEN AT YOUNGER
AGES, PEOPLE IN THEIR EARLY
50s.
THIS FIGURE SHOWS THE AVERAGE
ANNUAL CHANGE IN THE RATE OF
ALCOHOL-ASSOCIATINGED MORTALITY
FROM 1999 TO 2017.
I WOULD POINT YOUR ATTENTION TO
THESE TWO LINES HERE FOR AGE 55
TO 64 AND 65 TO 74, MEN AND
WOMEN, WE'VE SEEN INCREASES IN
ALCOHOL-RELATED MORTALITY, EVEN
ACUTE CAUSES OF ALCOHOL-RELATED
MORTALITY WHERE AMONG PEOPLE AGE
65 TO 74 THERE'S BEEN AN AVERAGE
ANNUAL CHANGE OF 5% FOR THE
PROPORTION OF PEOPLE DYING OF
ACUTE ALCOHOL-RELATED CAUSE, AND
INCREASES OVER TIME FOR BOTH AGE
GROUPS AMONG PEOPLE DYING OF
CHRONIC ALCOHOL-RELATED CAUSES.
THESE DATA END IN 2017.
WE KNOW THE PANDEMIC ONLY
ACCELERATED THE
ALCOHOL-ASSOCIATED MORTALITY
WE'VE SEEN IN PREVIOUS YEARS AS
WELL.
THESE DATA ARE NOT STRATIFIED BY
AGE BUT JUST SHOW THE REAL
ACCELERATION OF MONTHLY
ALCOHOL-RELATED DEATHS IN THE
U.S. POPULATION, DURING THE
COVID PANDEMIC, WE REALLY SAW
THIS ACCELERATION DURING THE
FIRST U.S. ISSUES OF STATE --
STATE AT-HOME ORDERS.
DATA PUBLISHED JUST SEVERAL
MONTHS AGO FROM THE CDC
CONFIRMED THESE TRENDS HAVE
STABILIZED, EVEN IN MORE RECENT
TIMES.
AND IMPORTANTLY, BY AGE, HERE IS
THE TREND IN DEATHS FROM
EXCESSIVE ALCOHOL USE BY AGE
GROUP FOR 2016-2017, 2018- 2019
AND THE PANDEMIC PERIOD.
FOR THESE AGES AMONG MALES AND
FEMALES, NOT ONLY ARE
ALCOHOL-RELATED DEATHS
INCREASING BUT THEY REALLY
ACCELERATED DURING THE PANDEMIC
PERIOD.
SO IN CONCLUSION I THINK WHAT WE
KNOW FROM THE EPIDEMIOLOGICAL
DATA IS THAT ALCOHOL CONSUMPTION
IS INCREASING IN THE U.S.,
INCLUDING AMONG ALL ADULTS BUT
ALSO EXTENDING TO PEOPLE IN
THOSE OLDER AGE GROUPS AS WELL.
THE REASONS UNDERLYING THESE
INCREASES ARE MULTI-FACTORIAL.
I THINK THEY STEM FROM BOTH
SUPPLY AND DEMAND FACTORS,
SUGGESTING THAT OUR PUBLIC
HEALTH RESPONSE SHOULD BE
ATTUNED TO BOTH OF THOSE DRIVERS
OF ALCOHOL CONSUMPTION AND
RELATED HEALTH PROBLEMS.
BUT WHAT'S DEFINITELY TRUE FROM
THE EPIDEMIOLOGICAL DATA IS
THERE ARE SERIOUS CONSEQUENCES
OF THESE INCREASES TO HUMAN
LIFE, INCLUDING INCREASES IN
ALCOHOL USE DISORDER, ALSO
ALCOHOL-RELATED DEATHS.
I'D LIKE TO THANK NIAAA FOR
GIVING ME THE OPPORTUNITY TO
SPEAK TODAY AND THANK THE
FUNDING I'VE RECEIVED FROM NIAAA
AND LOOK FORWARD TO ADDITIONAL
PRESENTERS AND DISCUSSION.
THANK YOU SO MUCH.
I WOULD LIKE THE TURN THE MIC,
SO TO SPEAK, TO SARA JO NIXON,
UNIVERSITY OF FLORIDA, FOR THE
NEXT PRESENTATION.
>> CAN YOU ALL SEE THE CORRECT
SLIDES?
PERHAPS NOT.
>> NOT QUITE IN PRESENTER MODE
YET.
>> OKAY, THANK YOU.
AND LET ME GET THIS IN THE RIGHT
PLACE HERE.
NOW CAN YOU -- NO, I CAN'T.
>> YES, IT'S GOOD.
>> ALL RIGHT, GREAT.
THANK YOU VERY MUCH.
ALL RIGHT.
NOW YOU CAN, RIGHT?
YOU'RE SEEING THE CORRECT --
>> IT FLIPPED BACK.
>> ALL RIGHT.
LET'S GO WITH THIS.
NOW YOU CAN THOUGH.
>> YES.
>> ALL RIGHT.
THANK YOU.
SO, FIRST OF ALL THANK YOU TO
NIAAA FOR FOCUSING ON THIS
REALLY IMPORTANT TOPIC, AND
THANK YOU ALSO TO THE ORGANIZERS
FOR INVITING ME TO BE PART OF
THIS.
AS YOU SAW IN DR. KEYES'
PRESENTATION THESE RATES ARE
ALARMING, AND THEY SORT OF
REMIND US THAT WHEN WE LOOK AT
THE EFFECTS OF ALCOHOL IN OLDER
POPULATIONS WE COULD LOOK AT
ALMOST ANYTHING, ANY DISEASE
STATE, ANY ORGAN CONDITION, ET
CETERA, ET CETERA.
WE DON'T HAVE THAT KIND OF TIME
TODAY.
SO TODAY I'M GOING TO FOCUS ON
THE NEUROBIOBEHAVIORAL IMPACT OF
ALCOHOL USE IN OLDER ADULTS.
MOST OF MY TALK WON'T BE ABOUT
ALCOHOL USE DISORDER, PER SE,
BUT I WANT TO START WITH IT IN
ORDER TO SET THE CONTEXT FOR
WHAT WE'D LIKE TO TALK ABOUT.
THE LARGE LITERATURE AND IN FACT
DSM-V RECOGNIZES THAT THERE ARE
RESIDUAL COGNITIVE CONSEQUENCES
TO THE CHRONIC EXCESSIVE USE OF
ALCOHOL, SUGGESTING 30 TO 40% OF
INDIVIDUALS WHO MEET CRITERIA
FOR AUD WHO ALSO DEMONSTRATE
CLINICALLY SIGNIFICANT COGNITIVE
IMPAIRMENT, AND OTHER STUDIES,
THE EMPIRICAL STUDIES DONE IN
THE FIELD WHERE INDIVIDUALS WITH
ALCOHOL USE DISORDER ARE
COMPARED WITH COMMUNITY CONTROLS
AGE AND EDUCATION MATCHED SO
THERE'S A SIGNIFICANT
ALCOHOL-RELATED IMPAIRMENT 50 TO
80% OF THOSE INDIVIDUALS.
THAT'S NOT CLINICAL IMPAIRMENT
BUT CERTAINLY IMPORTANT WHEN YOU
CONSIDER THE FACT THIS
COMPARISON IS THOSE WITH AUD AND
COMMUNITY GROUPS WHO ARE IN THE
SAME SOCIAL CIRCLES AND IN
COMPETING FOR THE SAME JOBS.
AND THESE IMPAIRMENTS CAN BE
OBTAINED EVEN IN THE ABSENCE OF
CONFOUNDING CO-MORBIDITIES.
BUT THAT DOESN'T DEAL WITH AGE.
AND FOR A DECADE THERE'S BEEN
CONCERN ABOUT HOW THIS STATE OF
AUD INTERSECTS WITH AGE, AND
ACROSS THIS TIME THERE HAVE BEEN
SORT OF TWO GENERAL HYPOTHESES
ABOUT HOW THIS HAPPENS.
EVEN IN HEALTHY AGING AS YOU SEE
IN THE DARK LINES, THERE ARE
CHANGES ACROSS TIME.
OFTENTIMES EARLY ON THESE ARE
COMPENSATED FOR BY VARIOUS KINDS
OF COMPENSATORY MECHANISMS, OR
COGNITIVE RESERVE, BUT OVER TIME
THERE'S CHANGE.
THE TWO HYPOTHESES ARE ALCOHOL
IMPACTS COGNITIVE AGING OR
INTERSECTS WITH COGNITIVE AGING
IN A MORE ADDITIVE WAY AND THAT
IS THAT AS YOU AGE, THERE ARE
EFFECTS OF ALCOHOL BUT PARALLEL
TO THAT IN HEALTHY AGING ACROSS
THE LIFESPAN.
THE ALTERNATIVE IS ACCELERATED
AGING HYPOTHESIS, IN WHICH YOU
CAN SEE THAT AS AGE INCREASES,
DIFFERENCE BETWEEN HEALTHY AGING
AND THAT EXPERIENCED BY
INDIVIDUALS USING ALCOHOL IN
CHRONIC EXCESSIVE PATTERNS
BECOMES LARGER.
THERE ARE DATA FOR BOTH.
MOST OF THE DATA, HOWEVER,
SUPPORT THE IDEA OF ACCELERATED
AGING HYPOTHESIS.
I WANT TO PROVIDE A SLIDE
ILLUSTRATING THIS BECAUSE WE'LL
RETURN TO THE CONCEPT HOW DO
THESE FACTORS INTERSECT AT THE
END OF THE PRESENTATION.
THESE ARE DATA THAT ARE MODIFIED
FROM A RECENT PRESENTATION OR
PAPER WHERE WE SHOW THE INCREASE
IN AGE AND DECREASE IN
FRONTAL -- WELL, REALLY
INCREASES PARTICULARLY IN THOSE
INDIVIDUALS WHO HAVE AUD.
BLACK LINE ARE CONTROLS, RED
LINE ARE INDIVIDUALS WITH
ALCOHOL USE DISORDER.
WE ADDED A VERTICAL LINE TO DRAW
YOUR ATTENTION TO HOW THESE
BEGAN TO DIFFERENTIATE.
PART OF THE BEAUTIES OF THIS
PARTICULAR STUDY ARE THE FACT
THAT MANY STUDIES OF THE EFFECT
OF AGE AND AUD ARE
CROSS-SECTIONAL, SO THEY
COMPARED, YOU KNOW, DIFFERENT
PEOPLE AT DIFFERENT AGES RATHER
THAN LONGITUDINALLY AND IN THIS
DATABASE THEY HAVE BEEN ABLE TO
DO BOTH.
SO THAT YOU ALSO SEE
LONGITUDINAL ASSESSMENTS WITH
THESE CONNECTED LINES AND CAN
FOLLOW THOSE PATTERNS AS WELL AS
CROSS-SECTIONAL CHANGES AS A
FUNCTION OF AGE.
BUT AS WE ALSO SAW, ALTHOUGH THE
RATES OF PROBLEM AND HAZARDOUS
DRINKING ARE INCREASING AT
ALARMING RATE AMONG OLDER
ADULTS, THE MAJORITY OF OLDER
ADULTS DO NOT DEVELOP CHANGE
SIGNIFICANTLY THEIR DRINKING
PATTERNS.
THEY ARE SORT OF MAINTAINED MORE
OR LESS, ALTHOUGH I'LL SHOW SOME
ON THAT AS WELL, OVER THIS OVER
THE LIFESPAN.
WHAT DOES THAT MEAN?
WE HEAR A LOT OF ATTENTION ABOUT
IS ALCOHOL GOOD OR BAD OR WHAT
ARE THE CUTOFFS, WHAT'S GOOD AND
BAD, AND WE BEGAN TO ANSWER THAT
QUESTION OR TRY TO BY
CONSIDERING ONE VERY GENERAL
FINDING, AND THAT IS MODERATE
DRINKING OR SOCIAL DRINKING
LIFESTYLES ARE PUNCTUATED BY
ACUTE DRINKING BOUTS.
THAT DREW OUR ATTENTION TO THE
FACT THAT IF YOU LOOK AT THE
KINDS OF CHANGES THAT WE SEE
WITH COGNITIVE DEFICITS, OR
COGNITIVE AGING, AND THOSE
ASSOCIATED WITH ACUTE ALCOHOL
EFFECTS, YOU SEE A GREAT DEAL OF
OVERLAP.
AND WE ASK, MIGHT SOCIALLY
RELEVANT ALCOHOL DOSES, THAT IS
THOSE THAT ARE RELEVANT TO THE
DAILY LIVES OF OLDER ADULTS,
THAT IS THOSE CONSISTENT WITH
SOCIAL DRINKING LIFESTYLES,
ACUTELY COMPROMISED VULNERABLE
PROCESSES IN OLDER DRINKERS.
THAT IS COULD THERE BE AN
AGE-RELATED VULNERABILITY SUCH
THAT THESE WERE DIFFERENTIALLY
COMPROMISED GIVEN IMPORTANCE OF
THESE KINDS OF PROCESSES, IN
EVERYDAY LIFE THAT SEEM TO BE OF
PARTICULAR RELEVANCE IN OVERALL
WELL-BEING WITH AGE.
WE HAD THE OPPORTUNITY TO
CONDUCT A SERIES OF STUDIES
WHICH WE LOOKED AT
NEUROCOGNITIVE PROCESSES RANGING
FROM FOUNDATIONAL AND VISUAL
ATTENTION THROUGH WORKING
MEMORY, AND THEN UP TO THOSE
KINDS OF TASKS LIKE DRIVING.
ONE OF THE FIRST I WANT TO TALK
ABOUT WHAT THE ALCOHOL DOSES
WERE, WE DID NOT DOSE
INDIVIDUALS GIVEN THE -- WITH
THE IDEA OF GIVING THE SAME
NUMBER OF DRINKS PER PERSON.
RATHER WHAT WE DID WAS TARGET A
PEAK BRAC CONSISTENT WITH A
NIGHT OUT ON THE TOWN WHERE HAD
YOU A DRINK BEFORE DINNER AND
THEN YOU HAD A DRINK AFTER
DINNER AND THEN YOU DROVE HOME
CONTEXT.
SO WE IN THE FIRST STUDY USED
PLACEBO DOSE AND THEN ONE THAT
WOULD BRING VRACs TO .04.
AT PEAK LEVELS, WE ALSO LOOKED
AT PERFORMANCE ON THE POSENER
COVERT VISUAL ATTENTION TASK.
DATA ON LEFT ARE P3 AMPLITUDES
CONTRASTED FOR THE OLDER AND
YOUNGER GROUPS AND THOSE WHO HAD
PLACEBO VERSUS THOSE WHO
RECEIVED THIS REALLY
RELATIVELY -- WELL, VERY LOW
DOSE OF ALCOHOL.
YOU CAN SEE IT ISN'T REALLY THE
ALCOHOL -- THE AGE MAIN EFFECT
THAT WE'RE INTERESTED IN.
WE'RE INTERESTED IN THE
INTERACTION.
WE FOUND THAT THOSE INDIVIDUALS
WHO WERE YOUNGER, THAT IS 25 TO
35 IN THIS PARTICULAR STUDY,
EXHIBITED A HIGHER AMPLITUDE FOR
THE P3 UNDER THE ALCOHOL
CONDITIONS THAN UNDER THE
PLACEBO.
ON THE OTHER HAND, WHEN WE
LOOKED AT THE OLDER INDIVIDUALS
AND IN THIS PARTICULAR STUDY
THESE OLDER INDIVIDUALS WERE
ACTUALLY RELATIVELY YOUNG, 55 TO
70.
WE FIND NOT ONLY THE OVER ALL
REDUCTION THAT WE EXPECTED BUT
ALSO AN INVERSION, OR A
DIVERGENT RESPONSE, TO THE
NEURODYNAMICS UNDERLYING
RESPONSE TO THE PRESENTATION OF
THE ACTUAL PERFORMANCE, DURING
THE PRESENTATION OF THE RESPONSE
LOOKING AT ELECTROPHYSIOLOGY.
THIS WAS, WE FELT, A GOOD START,
PARTICULARLY SINCE IT WAS AT
SUCH A VERY LOW ALCOHOL DOSE.
FROM THERE, WE MOVED TO LOOKING
AT WORKING MEMORY, USING A
REMEMBER-IGNORE TASK,
INDIVIDUALS ARE SHOWN THESE GRAY
FACES AND/OR SCENES, AND IN SOME
CONDITIONS THEY ARE TOLD PLEASE
REMEMBER THE FACES AND IN OTHERS
THEY ARE TOLD TO IGNORE THE
FACE.
THEY GET A SERIES OF IMAGES,
THERE'S A DELAY, THERE'S A
RESPONSE.
WE WERE ABLE THEREBY TO LOOK AT
ACCURACY OF RESPONSE BUT ALSO
NEURAL OSCILLATIONS DURING THIS
VERY IMPORTANT DELAY PHASE, WHEN
AN INDIVIDUAL HAS TO ENGAGE
WORKING MEMORY MAINTENANCE
PROCESSES.
AND HERE'S WHAT WE FOUND.
WE FOUND THAT AT THE PLACEBO,
THE POSTERIOR ALPHA POWER, THAT
IS SORT OF SUPPOSED TO REFLECT A
GATING MECHANISM, A WAY IN WHICH
INFORMATION -- IT'S AN
INDICATION THAT INFORMATION IS
BEING PROTECTED FROM
DISTRACTION, AND IT IS GENERALLY
OBSERVED BY COLLECTION OF SCALP
ACTIVITY, OF THE ALPHA
WAVELENGTH, AND WE FOUND
PLACEBO, THERE WAS NO
DIFFERENCE.
HOWEVER, ONCE YOU ADMINISTERED
ALCOHOL AND HERE WE USE TWO
DOSES, AGAIN THE LOW DOSE THAT
WE HAD USED IN OUR VERY INITIAL
WORK AND THEN WE USED A SLIGHTLY
HIGHER DOSE TO PERHAPS BETTER
REPRESENT THE TYPICAL DRINKING
CONTEXT.
AND, AGAIN, WHAT WE FOUND WAS
DIVERGING RESPONSES.
THE YOUNGER ADULTS SHOWED
GREATER ALPHA POWER UNDER
ALCOHOL CONDITIONS, WHICH WE
WOULD EXPECT THAT..
THEY ARE ENGAGING PROCESSES TO
PROTECT INFORMATION, WITH
ADMINISTRATION OF ALCOHOL THAT'S
INCREASED.
IN CONTRAST, THE OLDER ADULTS
SHOWED A DECREASE, WHICH
INCREASED VO 65 BUT NOT
EQUIVALENT TO YOUNGER ADULTS,
DID NOT DIFFER AT PLACEBO.
NOW WE HAVE DIVERGENT RESPONSES
IN TWO MEASURES, UNDERLYING
NEURAL ACTIVITY, BOTH P3 WHICH
IS SUPPOSED TO REFLECT A CONTEXT
RELEVANCE AND MEMORY UPDATING
KIND OF PROCESS, AND THE PAP,
SUPPOSEDLY REFLECTING A KIND OF
ATTENTIONAL INHIBITION AND
PROTECTION OF INFORMATION.
WHEN WE LOOKED AT THE BEHAVIOR,
WE ALSO FOUND SOME INTERESTING
DATA.
WE WERE PARTICULARLY INTERESTED
IN THE EFFECTS OF ALCOHOL ON THE
CAPACITY TO IGNORE
IRRELEVANTANCY, AFTER LOOKING AT
THE DATA FOR PERFORMANCE IN
INDIVIDUALS WITH AUD, FINDING
THAT VERY OFTEN THE DEFICIT
RESIDED IN INABILITY TO IGNORE
RELEVANCY, RATHER THAN JUST
ABILITY TO ATTEND TO THAT WHICH
WAS RELEVANT.
SO, IN THIS PARTICULAR SLIDE,
WHAT I'M SHOWING YOU IS THE
CORRECT REJECTION EFFICIENCY FOR
FACES.
THAT IS DID THEY APPROPRIATELY
IDENTIFY FACES AS BEING NOVEL,
THAT IS NOT HAVING BEEN SHOWN
BEFORE, DURING THAT
DECISION-MAKING PROCESS, AND WE
USE EFFICIENCY WHERE WE HAVE
PERCENT ACCURATE OVER MEAN
REACTION TIME.
UNDER PLACEBO WHEN USING THIS
EFFICIENCY RATIO WE INDEED SEE
SOME INDICATION OF AN AGE
DIFFERENCE, AND WE SEE THAT
OLDER MEN AT THE PLACEBO ARE
PERFORMING MORE POORLY, ALTHOUGH
THESE ARE NOT SIGNIFICANT
DIFFERENCES.
AS WE ADMINISTER ALCOHOL, AGAIN,
THE PATTERN CHANGES.
I WANT YOU TO PAY PARTICULAR
ATTENTION TO THIS TRIANGLE,
THESE ARE THE OLDER WOMEN, AND
IN THIS PARTICULAR STUDY THE AGE
RANGE WAS AGAIN TO AGE 70, BUT
BEGAN AT ABOUT -- ACTUALLY 60 TO
75, I'M SORRY, AND WE SEE THAT
THE OLDER WOMEN SHOW A GREATER
PROBLEM WITH THEIR ABILITY TO
SEPARATE THAT WHICH THEY HAVE
SEEN BEFORE VERSUS THAT WHICH
THEY HAVE NOT, THEY ARE
CONFUSING THOSE MORE THAN THE
YOUNGER WOMEN WHO DO
PARTICULARLY BETTER.
SO NOW WE HAVE AN AGE BY SEX
INTERACTION, AND ALCOHOL.
SO THE HIGHER THE DOSE, THE MORE
POORLY THE OLDER WOMEN
PERFORMED, AND THE BETTER THE
YOUNGER WOMEN PERFORMED.
AGAIN, DIVERGING RESPONSES AS A
RESULT OF AGE AND ALCOHOL.
THIS MAKES US THINK ABOUT -- -
THIS IS NOT GOING TO BE A SIMPLE
QUESTION TO ANSWER.
IT ISN'T JUST THAT YOU GET
WORSE.
IT ISN'T JUST THAT THE NEURAL
DYNAMICS CHANGE, BUT THEY CHANGE
IN DIVERGING TIMES OF
CONDITIONS, SO THAT SOMETIMES WE
HAVE PERFORMANCE THAT IS
AFFECTED, OTHER TIMES WE MAY
HAVE NEURAL DYNAMICS THAT ARE
AFFECTED WITHOUT CHANGES, IN THE
BEHAVIOR.
SORT OF THE COMPLICATED PROCESS
BY WHICH AGE AND ACUTE ALCOHOL
INTERACT.
WE THEN HAD THE OPPORTUNITY TO
LOOK AT DRIVING SCENARIOS.
AND IN THIS WE HAVE SEVERAL
DRIVING CONDITIONS.
THE FIRST ONE, THIS IS ACTUALLY
A PICTURE OF THE METROPOLIS,
STICKY DRIVE, ONE IN WHICH THEY
SIMPLY HAD TO STAY ON THE ROAD
BASICALLY.
THAT IS, IT'S A PRECISION DRIVE,
THEY ARE SUPPOSED TO ADHERE TO
THE SPEED LIMIT, STAY ON THE
ROAD, AND THERE ARE NO STIMULI
THAT SHOULD BE DISTRACTING.
HOWEVER, WHAT WE FOUND EVEN
UNDER THOSE CONDITIONS WERE AN
INTERACTION OF AGE AND ALCOHOL.
AND IF YOU LOOK ONLY AT THE GRAY
ONES, WE CAN DISCUSS THE OTHERS
LATER, BUT IF YOU LOOK AT THE
GRAY BARS HERE YOU'LL SEE THIS
IS THAT MODERATE DOSE,
INDIVIDUALS WHO RECEIVED THE
.065 OR TARGETED PEAK, .06 5,
AND OLDER ADULTS THE STEERING
RATE HAS TO DO WITH HOW MUCH
THEY MOVE THE STEERING WHEEL.
THEY MOVED THE STEERING WHEEL.
WE MIGHT CALL IT JERKY, IF YOU
EVER RIDE WITH ANYBODY THAT
DRIVES LIKE THAT YOU CERTAINLY
CALL IT JERKY.
AND THEN WE LOOKED AT THE
STANDARD DEVIATION FOR SPEED,
AND THAT MEANING THE KIND OF
VARIABILITY, HOW MUCH DO THEY
SPEED UP AND SLOW DOWN, WITH
THIS SUSTAIN CONSTANT SPEED, AND
HERE AGAIN IF YOU LOOK AT THE
065 GROUP YOU'LL SEE THEY DIFFER
SIGNIFICANTLY FROM THE YOUNGER
GROUP, BY THE WAY IN NONE OF
THESE WERE DIFFERENCES AMONG THE
YOUNGER PARTICIPANTS AFFECTED BY
THE ALCOHOL DOSE.
AND WITH THE OLDER OF COURSE
THEY WERE WITH THE 065 SHOWING
DRAMATIC CHANGE.
SO THAT'S THE PRECISION.
AND THAT TO ME IS KIND OF SCARY
FOR SURE.
BUT WE ALSO LOOKED AT RESPONSE
TO RELEVANT VERSUS IRRELEVANT
DISTRACTERS, IN THESE VARIOUS
SCENARIOS.
WE LOOKED AT THE SORT OF COUNTRY
DRIVE, SMALL TOWN, AND THEN THE
METROPOLIS.
AND THE METROPOLIS DATA WERE
PARTICULARLY INTERESTING.
THIS IS THE DEGREE TO WHICH THEY
DECELERATED, WHEN THEY WERE
CONFRONTED WITH WHAT WAS
IRRELEVANT HAVEN'T DISTRACTER.
FOR INSTANCE A PERSON WALKING
DOWN THE SIDEWALK AND WALKING
THEIR DOG.
OR SOMEBODY WITH A CHILD WALKING
DOWN THE STREET.
BUT NOT CROSSING IN FRONT OF
THEM.
A CONDITION WHICH THEY WOULD
NEED TO MAKE NO CHANGE IN THEIR
CURRENT DRIVING.
AND YET WHAT WE FOUND WAS YES
YES,
INDEED THERE WAS AN AGE
DIFFERENCE, BUT IT WAS GREATLY
INCREASED UNDER ALCOHOL
CONDITIONS.
IN OTHER WORDS, THEY WERE
SLOWING DOWN IN THE MIDDLE OF
THE STREET, EVEN WHEN THERE WAS
NOTHING GOING ON AROUND THEM,
THAT WOULD REQUIRE THAT KIND OF
RESPONSE.
THIS HAS REAL WORLD FUNCTIONAL
IMPACT WHEN YOU ARE THINKING
ABOUT DRIVING HOME AFTER HAVING
DINNER AND A DRINK.
NOW, WHAT ABOUT NEURAL ACTIVITY?
LET'S RETURN TO THAT POSTERIOR
ALPHA POWER THAT I TALKED ABOUT
A WHILE AGO IN THE CONTEXT OF
WORKING MEMORY MAINTENANCE
PROCESSES.
HERE WE'RE LOOKING AT IT AS THEY
ARE DRIVING.
AND WHAT WE CAN SAY IS, YES,
AGAIN.
YES AGAIN WE GET DIVERGING
RESPONSES, AND DURING THE
DRIVING YOU WOULD EXPECT THAT
INDIVIDUALS ARE NOT TRYING TO
NECESSARILY HARBOR INFORMATION
AND PROTECT IT.
IN FACT, DRIVING IS AN ENGAGING
TASK.
YOU NEED TO BE AWARE OF THINGS
THAT ARE GOING ON AROUND YOU.
AND YOU WOULD EXPECT THAT
PERHAPS THE YOUNGER ONES WITH
ALCOHOL GIVEN PRIOR EXPERIENCE
WOULD BE ABLE TO CONSTRAIN THAT
AND PAY ATTENTION TO WHAT THEY
ARE DOING WHEREAS OLDER DRINKERS
DID NOT.
SO, OPPOSITE EFFECTS WHETHER
YOU'RE TALKING ABOUT THE NEURAL
DYNAMICS OF PAYING ATTENTION TO
THE WORLD OR BEING ABLE TO
INHIBIT AND PROTECT INFORMATION,
WHETHER OR NOT YOU RESPOND
APPROPRIATELY TO IRRELEVANT
STIMULI, WHICH CAN RESULT IN YOU
SLAMMING ON THE BRAKES IN THE
MIDDLE OF THE STREET, OR INDEED
WORKING MEMORY AND INTENTIONAL
PROCESSES.
MOST OFTEN AT THIS POINT PEOPLE
SAY, WELL, YEAH, BUT THAT'S DUE
TO, WELL, AGE DIFFERENCES OR SEX
DIFFERENCES OR DOSE AND THE FACT
THAT THESE ARE ALL THE FUNCTION
OF DIFFERENCES IN
PHARMACOKINETICS, AND THEY ARE
NOT.
WHEN YOU TARGET A PARTICULAR
BRAC RATHER THAN GIVING EVERYONE
THE SAME DOSE, SAME NUMBER OF
DRINKS, YOU CAN DISENTANGLE
THOSE THINGS AND IT'S NOT ABOUT
PHARMACOKINETICS.
IT IS ABOUT A RATHER UNIQUE
AGE-RELATED VULNERABILITY TO
EFFECTS OF ALCOHOL EVEN AT DOSES
VERY CONSISTENT WITH DRINKING
PATTERNS IN OLDER ADULTS.
SO, KNOWING THAT, WE BEGAN TO
REALLY CONCLUDE THAT THESE ACUTE
DOSES DO CARRY RISK, AND THEY
CARRY RISK BECAUSE OF DIRECT
EFFECT OF ALCOHOL, ALSO BECAUSE
OF POTENTIAL SECONDARY OR
INDIRECT EFFECTS OF ALCOHOL.
BUT THAT'S NOT THE ONLY
QUESTION.
IMPORTANTLY, WE'RE ALL CONCERNED
ABOUT OUR COGNITIVE INTEGRITY
AND STABILITY ACROSS OUR ADULT
LIFESPAN, AND I'VE BEEN TALKING
LARGELY ABOUT ACUTE EFFECT.
WELL, THE MORE STRAIGHTFORWARD
QUESTION IS PERHAPS HOW DOES
CONTINUED DRINKING AMONG OLDER
ADULTS IMPACT AGE-RELATED
COGNITIVE DECLINE?
I STARTED WITH THIS IDEA WHEN WE
WERE TALKING ABOUT ALCOHOL USE
DISORDER.
WHAT HAPPENS WHEN WE LOOK AT THE
LITERATURE ON THE IMPACT OF
ALCOHOL ON COGNITIVE DECLINE AND
IMPAIRMENT, AND THE ANSWER IS IT
DEPENDS.
SOME STUDIES SUGGEST THERE'S NO
HARM IF NOT BENEFIT FOR HAVING
AS MANY AS THREE DRINKS A DAY,
AND FOUR FOR MEN REALLY DO NOT,
WHILE OTHERS SAY THERE'S NO
LEVEL OF DRINKING THAT LENDS
BENEFIT, AND THAT EVEN WITH LOW
LEVELS THERE IS ADDED RISK OF
COGNITIVE DECLINE OR COGNITIVE
IMPAIRMENT.
WHY?
WELL, IF YOU LOOK AT THE STUDY
YOU FIND THE EXISTING LITERATURE
HAS A LOT OF DIFFERENCES,
STUDIES VARY GREATLY IN TERMS OF
OPERATIONAL DEFINITIONS AND
COMPARISON GROUPS.
FOR INSTANCE, SOMETIMES
ABSTAINERS ARE INCLUDED AS A
CONTROL GROUP, AND IN THAT CASE
WHAT DO YOU HAVE?
YOU HAVE SICK QUITTERS, OR DO
YOU HAVE INDIVIDUALS LIFELONG
ABSTAINERS, IN SOME CASES
MODERATE VERSUS HEAVY IS A
LITTLE HARD TO DIFFERENTIATE,
AND AGAIN VERY OFTEN STUDIES OF
CROSS-SECTIONAL VERSUS
LONGITUDINAL.
THAT'S NOT ALWAYS THE CASE,
THERE ARE SOME VERY NICE
LONGITUDINAL ASSESSMENTS BUT
VERY OFTEN THEN THE ASSESSMENT
OF DRINKING IS NOT NECESSARILY
TAKEN IN CLOSE PROXIMITY WITH
THE ONGOING ASSESSMENTS AND
PATTERNS HAVE CHANGED.
SO, WE HAD THE OPPORTUNITY AGAIN
WITH SUPPORT FROM NIAAA TO TRY
TO --
>> SARA, YOU'RE RUNNING A LITTLE
LATE HERE.
>> OKAY.
LET ME GET TO THE VERY END THEN.
SO THE MOST IMPORTANT PART IS
THIS.
QFI AND WORKING MEMORY, QUANTITY
FREQUENCY INDEX AND WORKING
MEMORY, IN BASELINE, IN
INDIVIDUALS 65 TO 80 THERE'S A
NEGATIVE CORRELATION, IT'S
SMALL, NOT QUITE SIGNIFICANT,
THIS IS ONLY AT BASELINE.
BEFORE WE LOOK OVER TIME, AND WE
LOOKED AT ISOLATION.
THERE'S BEEN LOTS OF CONCERN,
WHAT DO WE FIND?
MEN ARE AFFECTED BY BEING
ISOLATED BY DRINKING LESS,
WHEREAS IT'S NOT IMPACTFUL FOR
WOMEN.
AND WHAT ABOUT STABILITY?
LOOK AT INDIVIDUALS ACROSS TIME,
YOU CAN SEE THERE'S A GREAT DEAL
OF DIFFERENCES, THESE ARE
COLLECTED EVERY FOUR MONTHS IN
THE COURSE OF THIS STUDY.
WE'LL HAVE TO LOOK AT THAT
IMPACT.
AND THEN AS WE LOOK AT THE
OVERALL PANEL WE CAN SEE WE'RE
GOING TO UNDERSTAND THIS, WE
HAVE TO LOOK AT VERY MANY
DOMAINS.
AND THAT CAN HAPPEN ONLY WITH
REALLY SYSTEMATIC AND LONG-TERM
STUDY.
WE THINK PART IS WE'VE NOT
EFFECTIVELY DEALT WITH
VULNERABILITY AND DIFFERENTIAL
VULNERABILITY IN THESE SAMPLES,
AND THAT WE SHOULD BE ABLE TO
SEPARATE RESILIENCE, MODERATE
DRINKERS, AND VULNERABLE BY
PAYING MORE ATTENTION TO THE
INTERSECTION OF ACUTE EFFECTS
AND CHRONIC PATTERNS OF USE.
COULDN'T BE DONE WITHOUT ALL OF
THESE PEOPLE, AND I APOLOGIZE
FOR GOING OVER.
CAN YOU TELL I LOVE THIS STUFF?
AND THANK YOU VERY MUCH.
>> NOW WE'RE GOING TO PASS THE
BATON TO CYNTHIA CAMPBELL.
CYNTHIA?
>> GREAT.
THANK YOU SO MUCH.
CAN YOU SEE WHAT I'M SHARING?
>> YES, BUT YOU NEED TO MOVE TO
PRESENTER MODE.
YES, THERE YOU GO.
>> DEREK AND I WILL TALK AFTER
THOSE TWO GREAT PRESENTATIONS
SETTING UP THE QUESTION WHAT CAN
WE DO ABOUT IT AND WE'RE
APPRECIATIVE OF THE OPPORTUNITY
TO SPEAK WITH YOU TODAY AND
THANK NIAAA FOR THEIR SUPPORT.
SO OUR OVERALL MESSAGE IS REALLY
TODAY THAT TREATMENT FOR OLDER
ADULTS FOR ADDICTION IS
EFFECTIVE, IT WORKS, BUT THEY
FACE UNIQUE CHALLENGES TO ACCESS
AND ENGAGEMENT.
WE REALLY WANT TO ADDRESS OLDER
ADULTS AND PROBLEMATIC DRINKING
THROUGH A RANGE OF CARE SETTINGS
AND PROVIDERS WITH AN OPEN DOOR
POLICY.
WE WANT TO MEET PATIENTS, OLDER
ADULTS WHERE THEY ARE AND
WHEREVER THEY PRESENT.
DEREK WILL TALK ABOUT SPECIALTY
ADDICTION TREATMENT AND EVIDENCE
THERE AND I'LL TALK MORE ABOUT
IDENTIFYING PATIENTS AND
TREATMENT ADAPTATIONS.
>> THANKS, CYNTHIA.
HERE I WANTED TO GIVE AN
OVERVIEW OF A COUPLE STUDIES
LOOKING AT HOW OLDER ADULTS ARE
DIFFERENT FROM YOUNGER ADULTS IN
SPECIALTY ADDICTION TREATMENT.
SO EVEN THOUGH WE KNOW THERE ARE
ACCESS BARRIERS AS CYNTHIA
MENTIONED, WE HAVE LOOKED AT
WHAT ARE OLDER PATIENTS LIKE
ONCE THEY GET TO ADDICTION
TREATMENT AND HOW DO THEY DO.
THIS IS A SUMMARY OF DATA FROM
STUDIES CONDUCTED IN KAISER
PERMANENTE NORTHERN CALIFORNIA
IN LARGE OUTPATIENT DAY
TREATMENT PROGRAMS.
AND WE LOOKED AT DIFFERENCES
BETWEEN ADULTS AGES 55 AND OVER
VERSUS YOUNGER IN TERMS OF
CLINICAL CHARACTERISTICS, AND
HOW THEY DID IN CARE.
SO, BROADLY WHAT WE FOUND WAS
THAT OLDER PATIENTS WERE LESS
LIKELY THAN YOUNGER ADULTS TO
MEET ALCOHOL USE DISORDER
CRITERIA YET THEY WERE STILL IN
TREATMENT SO THIS GOES TO AN
ISSUE ABOUT DIFFERENCES IN
VALIDITY OF DIAGNOSES ACROSS AGE
GROUP DIFFERENCES, SO THEY MAY
BE LESS LIKELY TO MEET
DEPENDENCE CRITERIA BUT STILL
NEEDED CARE.
LESS LIKELY TO REPORT SUBSTANCE
USE OTHER THAN ALCOHOL, THEY
ALSO HAD LOWER PSYCHIATRIC
SEVERITY, THEY HAD GREATER
MEDICAL CO-MORBIDITIES, AND MORE
LIKELY TO REPORT ABSTINENCE AS
TREATMENT GOAL, SO I SHOULD SAY
ALSO THAT IN MOST SPECIALTY CARE
TREATMENT SET ALSO INCLUDING
OURS OLDER ADULTS WERE THE
MINORITY IN TREATMENT BUT THE
WAY TREATMENT IS TYPICALLY
STRUCTURED PEOPLE GET TOGETHER
IN THE SAME PROGRAMS SO THIS IS
A SNAPSHOT OF CLINICAL
DIFFERENCES.
AND THEN IF YOU GO TO THE NEXT
SLIDE, WE ALSO LOOKED AT
DIFFERENCES IN TREATMENT
PARTICIPATION AND RETENTION, AND
THESE DATA REALLY SHOWED A
POSITIVE INDICATOR IN TERMS OF
TREATMENT PROGNOSIS FOR OLDER
ADULTS, SO SPECIFICALLY WE FOUND
THAT AGAIN THOSE OLDER ADULTS 55
AND OLDER HAD LONGER RETENTION
AND CARE, THERE WERE SOME SOCIAL
NETWORK DIFFERENCES FOR SUPPORT,
LESS LIKELY TO CONTINUE IN
CERTAIN FORMS OF AFTERCARE, SUCH
AS A.A.
SOCIAL NETWORK DIFFERENCES,
SMALLER SOCIAL NETWORKS, A
NORMAL AGE-RELATED TREND.
MORE LIKELY TO BE MARRIED.
BUT THEY ALSO WERE LESS LIKELY
TO HAVE ANYONE ACTIVELY
ENCOURAGE THEIR SUBSTANCE USE.
HIGHER RATES OF ABSTINENCE
ESPECIALLY OLDER WOMEN, AND THEY
ALSO HAD GREATER REDUCTION IN
HEAVY EPISODIC DRINKING AMONG
ADULTS NOT ABSTINENT SO REALLY A
POSITIVE TREATMENT PICTURE.
IF YOU GO TO THE NEXT SLIDE,
WANTED TO THROW THIS IN AS
REALLY HELPFUL TREATMENT
RESOURCE.
SO THIS IS THE SAMHSA TREATMENT
PROTOCOL TREATING SUBSTANCE USE
DISORDER IN OLDER ADULTS,
SPECIALTY CARE, THIS WOULD BE A
GOOD PLACE TO THROW IT IN BUT IT
DOES ADDRESS INTERVENTION
STRATEGIES ACROSS THE RANGE OF
SETTINGS.
SO THIS IS A CONSENSUS PANEL
THAT WAS LED BY FRED LOWE AND I
ALSO PARTICIPATED ON THIS PANEL.
IT WAS UPDATED A FEW YEARS AGO
IN 2020 AND THIS IS FREELY
AVAILABLE ONLINE AND I WANTED TO
HIGHLIGHT THIS AS A USEFUL
RESOURCE.
I'LL HAND IT BACK OVER TO
CYNTHIA TO TALK ABOUT TREATMENT
ACCESS ISSUES AND INTERVENTIONS
AND A RANGE OF SETTINGS.
>> THANK YOU.
I'LL GO QUICKLY.
I WANT TO HAVE TIME FOR
QUESTIONS.
BEAR WITH ME.
WE'VE HEARD FROM DEREK HOW
TREATMENT WORKS FOR OLDER ADULTS
BUT KNOW THAT MOST OLDER ADULTS
WHO NEED TREATMENT DO NOT
RECEIVE IT.
SO THIS FIGURE SHOWS ON THE LEFT
PERCENTAGE IN THE LAST YEAR WHO
NEEDED SUBSTANCE USE TREATMENT,
11% OF OLDER ADULTS, AND THIS
FIGURE ON THE RIGHT, PIE SHOWS
AMONG THOSE ABOUT 3 5% WHO
NEEDED TREATMENT RECEIVED IT,
STILL A GAP THAT WE NEED TO
ADDRESS.
AND THIS IS BASED ON 2022 DATA
FROM NATIONAL SURVEY ON DRUG USE
AND HEALTH.
AND BEYOND THAT WHEN TALKING
ABOUT PATIENTS IN SPECIALTY
TREATMENT, THOSE ARE PATIENTS
WITH ALCOHOL USE DISORDER SO
THIS IS THE PYRAMID YOU MAY BE
FAMILIAR WITH, PATIENTS WITH AUD
ARE AT THE TOP.
A SMALL PERCENTAGE RELATIVE TO
THE REST.
THOSE ARE PATIENTS APPROPRIATE
FOR SPECIALTY TREATMENT, BUT
THERE ARE LARGE GROUPS IN THE
MIDDLE HERE SO HIGH RISK
DRINKING, MODERATE, LOW-RISK
DRINKING.
THOSE PATIENTS CAN STILL BENEFIT
FROM CARE, AND OLDER ADULTS ARE
PARTICULARLY AT RISK EVEN AT
LOWER LEVELS OF DRINKING AS
WE'VE HEARD FROM THE PREVIOUS
TWO PRESENTERS.
SO WE REALLY WANT TO TRY TO
REACH THESE GROUPS AS WELL.
SO, EVEN THOUGH MOST OLDER
ADULTS HAVE LOWER SEVERITY HOW
DO WE REACH THIS MIDDLE GROUP
AND HELP THEM?
IMPORTANT TOOL IS SCREENING
BRIEF INTERVENTION AND REFERRAL
TO TREATMENT, SBIRT.
UNITED STATES TASK FORCE
RECOMMENDS SCREENING FOR
UNHEALTHY ALCOHOL USE IN PRIMARY
CARE IN ADULTS FOLLOWED BY BRIEF
INTERVENTION.
YOU CAN SEE THE CRITERIA ON THE
SLIDE.
THERE IS A FAIR AMOUNT OF
EVIDENCE THIS IS EFFECTIVE.
JUST VERY BRIEFLY SBIRT FOR
THOSE WHO AREN'T FAMILIAR THE
FIRST STEP IS SCREENING OR
ASSESSING RISKY ALCOHOL USE WITH
STANDARDIZED ASSESSMENT TOOL TO
IDENTIFY APPROPRIATE LEVEL OF
CARE AND THERE ARE SEVERAL TOOLS
USED WITH OLDER ADULTS.
THIS IS FOLLOWED BY BRIEF
INTERVENTION SEMI STRUCTURED
CONVERSATION FOCUSED ON
INCREASING SUBSTANCE USE
AWARENESS AND USING MOTIVATION
CHANGE, 10 TO 15 MINUTES, AND
MORE SEVERE PATIENTS ARE THEN
REFERRED FOR SERVICES IDEALLY
WITH A WARM HANDOFF.
IT'S IMPORTANT SCREENING FOR
OLDER ADULTS IS UNIVERSAL AND
POPULATION BASED.
AND THAT IT'S DONE ANNUALLY FOR
THOSE OVER 60, THE
RECOMMENDATION FROM THE EXPERT
PANEL FROM SAMHSA, AND DONE AT
MAJOR LIFE TRANSITIONS TRIGGERS
FOR PROBLEM THE FOR BRIDGING. ,
FREQUENT FALLS, CHALLENGES WITH
DAILY ACTIVITY IS ANOTHER GOOD
TIME TO BE SCREENING FOR
PROBLEMATIC ALCOHOL USE.
SCREENING BRIEF INTERVENTION IS
EFFECTIVE, ALCOHOL PROBLEMS WITH
OFTEN OVERLOOKED AND
UNDERTREATED IN OLDER ADULTS.
STACY STERLING HAS BEEN LEADING
WORK IN OUR TEAM FOUND AT OLDER
ADULT LESS LIKELY TO BE SCREENED
AND RECEIVE INTERVENTION, OLDER
WOMEN LESS LIKELY THAN OLDER
MEN, WE ALSO SEE VARIATION BY
RACE AT LOWER RATES OF BI AMONG
BLACK PATIENTS AND FOUND IN
OTHER STUDIES AS WELL.
WE CURRENTLY HAVE A STUDY
EXAMINING DISPARITIES AMONG
AGING WOMEN, CARE DELIVERY,
BECAUSE IDENTIFYING SUBGROUP
DIFFERENCES IN DISPARITIES IS SO
IMPORTANT.
SO WE THINK BROADLY ABOUT WHO
CAN IDENTIFY PATIENTS AND WHERE.
WE KNOW OLDER ADULTS HAVE
CONTACT WITH HEALTH SYSTEM,
DIFFERENT TYPES OF PROVIDERS, SO
THAT PRESENTS A RANGE OF
OPPORTUNITY TO IDENTIFY AND
INTERVENE WITH OLDER ADULTS,
DONE NOT JUST IN PRIMARY CARE
BUT DIFFERENT SETTINGS,
EMERGENCY DEPARTMENT, URGENT
CARE, YOU CAN SEE DIFFERENT
PROVIDERS LISTED HERE.
IN-HOME PROVIDERS CAN BE KEY
BECAUSE THEY ARE IN THE HOME, IN
THE ENVIRONMENT AND CAN SEE
THINGS THAT WE CAN'T ALWAYS SEE
IN THE HEALTH SYSTEM OTHERWISE.
AND COMMUNITY PROVIDERS ARE ALSO
VERY IMPORTANT, FAITH BASED,
PEER SUPPORT, SENIOR CENTERS, SO
REALLY CONNECTING WITH OLDER
ADULTS WHEREVER THEY ARE
PRESENTING.
THIS SLIDE IS FULL BUT IN ORDER
TO UNDERSTAND HOW WE CAN ADAPT
TREATMENT TO BETTER ENGAGE OLDER
ADULTS WE HAVE TO UNDERSTAND
WHAT THE BARRIERS ARE SO I'LL
HIGHLIGHT A FEW.
OFTEN OLDER ADULTS DO NOT
RECOGNIZE THEY HAVE A PROBLEM.
THEY HAVE BEEN DRINKING LIKE
THIS FOR YEARS SO IT FEELS
NORMAL TO THEM.
THEY DON'T REALIZE THEY ARE MORE
VULNERABLE AS THEY AGE TO THE
NEGATIVE CONSEQUENCES.
THEY CAN BE SOCIALLY ISOLATED,
MAY NOT HAVE A PARTNER ANYMORE
OR FAMILY THAT LIVES CLOSE BY,
SO THEY DON'T HAVE THE SUPPORTS
TO HELP THEM RECOGNIZE THE
PROBLEMS, ENCOURAGE THEM TO GET
TO TREATMENT.
THEY MAY ALSO HAVE AN ATTITUDE
OF WHY BOTHER, I DON'T HAVE MUCH
LONGER, I WANT TO KEEP DRINKING.
ON THE PROVIDER SIDE, IT'S A
YOUNGER PERSON'S PROBLEM,
ORDINARY ADULTS DON'T HAVE THESE
PROBLEMS, HARD TO DISTINGUISH
FROM OTHER MENTAL HEALTH
CHALLENGES FROM COGNITIVE
DECLINE, AND OLDER PEOPLE DON'T
HAVE THE SAME ACTIVITIES THAT
YOUNGER ADULTS THAT CAN HELP
IDENTIFY PROBLEMS, THEY ARE NOT
ACTIVE WORKFORCE, DON'T HAVE TE
SAME RESPONSIBILITIES, AN
ATTITUDE WE SHOULD JUST LET THEM
DO WHAT THEY WANT, THEY DON'T
HAVE A LOT OF TIME LEFT, AGEISM,
BECAUSE WE WOULDN'T APPROACH
YOUNGER ADULTS THE SAME WAY.
HOW CAN WE ENGAGE ACROSS THE
CONTINUUM, AGE SENSITIVE CARE
COMES IN.
THERE MAY BE OPPORTUNITIES TO
PROVIDE AGE-SPECIFIC ADDICTION
TREATMENT, SO FOR EXAMPLE
AGE-SPECIFIC GROUPS, BUT THAT
ISN'T AS COMMON, HARDER TO
SUPPORT, MAY NOT BE THE NUMBERS,
TREATMENT PROGRAMS TO SUPPORT
THAT.
BUT WE CAN STRIVE TO MAKE CARE
AGE SENSITIVE SO ADAPTING
EXISTING SERVICES TO ACCOMMODATE
OLDER ADULT NEEDS.
IN THE INTEREST OF TIME THESE
ARE ALL AVAILABLE ON THE SAMHSA
TIP, A FANTASTIC RESOURCE,
TREATMENT NEEDS TO BE SUPPORTED,
NOT CONFRONTATIONAL, HARM
REDUCTION AND NOT ABSTINENCE,
USING SHARED DECISION MAKING,
TREATMENT CAN BE ADAPTED TO THE
LEVEL OF SPECIFIC AND COGNITIVE
FUNCTIONING OF THE OLDER ADULT
SO ADDRESSING DIFFICULTIES THAT
OLDER ADULTS HAVE MIGHT INCLUDE
SHORTER SESSIONS, SLOWER PACE,
REPEATING INFORMATION, PROVIDING
INFORMATION IN MULTIPLE FORMATS
NOT JUST VERBAL BUT PRINT.
WE KNOW THERE'S A LOT OF CONCERN
ABOUT DIGITAL DIVIDE BUT THERE'S
EVIDENCE OLDER ADULTS ACCEPT
TELEHEALTH AND FIND IT VALUABLE.
SO FOR PATIENTS WITH LESS
MOBILITY, WHO LACK
TRANSPORTATION, ARE NOT DRIVING,
THIS IS WHERE TELEHEALTH COULD
BE A VERY USEFUL TOOL.
AND WE NEED CONTENT THAT
ADDRESSES ISOLATION, LONELINESS,
GRIEF.
SO THESE ARE JUST KEY THINGS
THAT DRIVE PROBLEMATIC DRINKING
IN OLDER ADULTS, SO HOW CAN WE
DEVELOP IMPROVED COPING OF
SOCIAL SKILLS IN THIS
POPULATION?
THAT COULD BE STRENGTHENING
SOCIAL CONNECTIONS WITH
NON-DRINKING FRIENDS, JOINING
MUTUAL HEALTH GROUPS, STRENGTHEN
CONNECTIONS THEY DO HAVE.
IT'S REALLY IMPORTANT TO INVOLVE
FAMILY AND CAREGIVERS, EDUCATING
THEM, ENCOURAGING THEIR
INVOLVEMENT, TRAINING STAFF TO
BE AGE SENSITIVE.
MEDICATIONS ARE AN OPTION WITH
MONITORING FOR THIS GROUP,
PARTICULARLY WITH MEDICATION
INTERACTIONS WE KNOW OLDER
ADULTS ARE TAKING MULTIPLE
MEDICATIONS, SO THAT HAS TO BE
REVIEWED PERIODICALLY.
AND WE WANT TO TAILOR TREATMENT
FOR DIVERSITY.
OLDER ADULTS ARE A HETEROGENEOUS
POPULATION, WE WANT TO BE
SENSITIVE TO GENDER DIVERSITY,
DIFFERENCES
AND CULTURAL DIFFERENCES AS
WELL.
A LOT CAN BE DONE TO IDENTIFY IN
A HOLISTIC WAY, THERE'S A LOT OF
ROOM FOR IMPROVEMENT, WE WANT TO
REACH OLDER ADULTS WHERE THEY
ARE, WE TALKED ABOUT THE HEALTH
SYSTEM TODAY, BUT THERE'S A LOT
OF OPPORTUNITY IN THE COMMUNITY
AND REACHING PATIENTS, FOR
EXAMPLE, IN SENIOR CENTERS AND
FOCUSING ON PREVENTION AS WELL.
AND THEN A MESSAGE THAT HAS BEEN
MEANINGFUL AND STRUCK ME IS WHEN
I'VE HEARD FRED BLOWE, AN
EXPERT, TALK ABOUT HOW IT'S
NEVER TOO LATE FOR OLDER ADULTS,
WE SHOULDN'T GIVE UP ON TRYING
TO ADDRESS ALCOHOL PROBLEMS
BECAUSE WE CAN IMPROVE QUALITY
OF LIFE AND EXTEND THEIR LIFE.
I THANK THE COLLABORATORS ON THE
TEAM AS WELL AS END WITH
ADDITIONAL RESOURCES FOR PEOPLE
INTERESTED, AND I'LL TURN IT
BACK TO DR. KOOB FOR QUESTIONS
AND ANSWERS.
THANK YOU.
>> THANK YOU VERY MUCH, ALL FOUR
OF YOU SPEAKERS FOR EXCELLENT
TALKS.
I LEARNED A GOOD BIT TODAY
MYSELF.
WE HAVE A QUESTION FROM PAT, I'M
ASSUMING FOR DEREK OR CYNTHIA.
WHAT APPROACH HAS BEEN GIVEN TO
PROVIDING SENIOR SERVICES SUCH
AS COMMUNITY HOUSING WHICH WOULD
ADDRESS LONELINESS, LACK OF
COMMUNITY, AND ACTIVITY
AVAILABILITY, INCREASED ACCESS
TO CARE AND AFTER-CARE, ET
CETERA, DO YOU WANT TO TAKE A
SHOT AT THAT?
>> THERE'S A DESPERATE NEED FOR
HOUSING, I KNOW IN THE SAN
FRANCISCO BAY AREA THERE'S AN
URGENT NEED, AND NATIONWIDE
THERE'S HUGE DEMAND THAT CAN
ADDRESS THESE ISSUES.
THERE'S AN ISSUE IN A LOT OF
SENIOR HOUSING SITUATIONS, WHERE
HAPPY HOUR AND DRINKING CAN BE
PROBLEMATIC IN FOCUS, SO IT CAN
CUT BOTH WAYS.
IT'S CRITICAL TO ADDRESS
LONELINESS ISSUES, KEEP AN EYE
THAT ALCOHOL ISN'T BEING
PROMOTED TOO HEAVILY AS AN
ACTIVITY.
>> YEAH.
>> ANOTHER QUESTION, FOR DR.
KEYES, DO YOU KNOW WHETHER OLDER
ADULTS HAVE INCREASED THEIR
DRINKING OVER TIME OR DOES THIS
BIRTH COHORT HAVE HIGHER LEVELS
OF DRINKING THAN PREVIOUS BIRTH
COHORTS?
>> THANK YOU FOR THE QUESTION.
THAT'S A GREAT QUESTION.
ESPECIALLY FOR THESE COHORTS NOW
AGING INTO 50s AND 60s THEY
HAD DID HAVE HIGHER LEVELS IN
YOUNG ADULTHOOD BUT ARE ALSO
ACCELERATING LEVELS OF DRINKING
COMPARED TO THOSE OLDER ADULTS
IN PREVIOUS COHORTS MORE
RAPIDLY.
SO, BOTH HIGHER LEVEL OF
CONSUMPTION COMPARED TO PREVIOUS
COHORTS THAT FROM WHICH WE --
BASED ON THE BEST AVAILABLE
DATA, WHICH IS IMPERFECT, AND
THERE IS A FASTER ACCELERATION
IN OLDER ADULTHOOD AS WELL.
>> I'LL ASK A QUESTION OF SARA
JO.
JUST TO BE FAIR TO GET EVERYBODY
A QUESTION.
BUT ALSO BECAUSE THIS IS ONE OF
THE BIG QUESTIONS OF COURSE.
SO, BRIEFLY, SARA JO, BECAUSE
THIS IS A LONG ANSWER, WHAT
ABOUT ALZHEIMER'S DISEASE AND
ALCOHOL, GIVEN THE COGNITIVE
ISSUES THAT YOU RAISED IN YOUR
TALK?
>> YEAH, THANKS FOR ASKING THAT.
YOU KNOW, THAT'S TRICKIER THAN
IT SHOULD BE.
AND THERE'S SO MANY INTERFACES,
WE HAVE TO ALSO SUBTRACT OUT OR
ACCOUNT FOR DIFFERENCES IN
IMPAIRMENT VERSUS DECLINE.
SO, WHEN WE JUST LOOK AT GROUP
DIFFERENCES, WE'RE LOOKING AT
IMPAIRMENT, AND WE SEE
IMPAIRMENT WITH CHRONIC ALCOHOL,
AND IT'S LARGER AND OLDER
ADULTS, BUT IS THAT ACTUALLY
DEMENTIA?
AND WE HAVE TO HAVE LONGITUDINAL
STUDIES TO BE ABLE TO
EFFECTIVELY ANSWER THAT.
THERE ARE PROBABLY A GROUP OF
VULNERABLE DRINKERS WHO, OVER
TIME, IN THAT INTERFACE, ARE AT
INCREASED RISK DUE TO GENETICS
AND PERHAPS AND THEN THE
INTERACTION OF THE ALCOHOL AND
COGNITIVE AGING EFFECTS COME
TOGETHER TO PLACE THEM INDEED AT
INCREASED RISK FOR THAT KIND OF
DEMENTIA OUTCOME.
>> GREAT.
THANK YOU.
I THINK THAT'S A GREAT SUMMARY
OF WHERE WE'RE AT RIGHT NOW.
AND IT IS AN ABIDING QUESTION.
ANOTHER QUESTION FROM THE
WEBINAR, FROM ALLISON MOORE, FOR
DR. CAMPBELL.
HOW ABOUT ONLINE OR OTHER
VIRTUAL MEANS OF ADDRESSING
UNHEALTHY DRINKING IN OLDER
ADULTS?
I SKIPPED A QUESTION THAT I'LL
COME BACK TO.
>> YEAH, I THINK THAT COULD BE A
REALLY USEFUL TOOL.
IT'S NOT GOING TO WORK FOR
EVERYONE BUT WE'RE SEEING
EVIDENCE THAT FOR SOME OLDER
ADULTS THAT CAN WORK AND CAN
HELP ADDRESS SOME OF THE
LONELINESS.
I THINK IT'S SOMETHING THAT, YOU
KNOW, MAYBE THAT COULD BE PART
OF PRACTICE, YOU KNOW, WHEN
YOU'RE -- OLDER ADULTS COULD
PRACTICE WITH THE TECHNOLOGY, I
THINK THERE'S BEEN EVIDENCE
AROUND TEXT MESSAGING AND OTHER
STUDIES THAT SHOW THAT IT CAN
WORK FOR SOME PEOPLE, SO
PARTICULARLY AFTER THE COVID
PANDEMIC PEOPLE ARE MORE USED TO
IT, AND EVEN IN OUR OWN HEALTH
SYSTEM NOT JUST BEHAVIORAL
HEALTH WE'RE SEEING OLDER ADULTS
USE TELEHEALTH AT HIGHER RATES.
I DON'T KNOW IF THERE'S ANYTHING
YOU WANT TO ADD, DEREK.
>> I WOULD AGREE COMPLETELY.
EXCEPT MAYBE TO ADD BECAUSE OF
ISSUES LIKE MOBILITY OR CONCERN
ABOUT NOT JUST GETTING COVID BUT
GETTING THE FLU OR A COLD THAT
SOMETIMES PEOPLE PREFER THIS
MODALITY THAN A BIG GROUP
SETTING LIKE A.A. OR SELF-HELP
GROUPS AS WELL AS OF COURSE
MEETING WITH PROVIDERS AND IT
LOOKS LIKE REIMBURSEMENT FOR
TELEHEALTH IS GOING TO BE
EXTENDED FOR QUITE SOME TIME SO
THAT'S GREAT.
>> I SKIPPED THIS QUESTION,
TRACY.
IS THERE A MENTAL HEALTH
PSYCHOLOGICAL REASON FOR
INCREASE IN ALCOHOL CON CONSUM,
NOT JUST MID-CLASS
STRESS/RETIREMENT, MAYBE
KATHERINE?
>> THIS REMAINS AN OPEN
HYPOTHESIS, CERTAINLY CASE AND
DEATON HAVE MADE THE CASE FOR
DEPTHS OF DESPAIR INCREASING IN
THIS AGE GROUP OVERALL COMBINES
SUICIDE AND MENTAL
HEALTH-RELATED MORTALITY RATES
INCLUDING DRUG OVERDOSE WITH
ALCOHOL-RELATED CAUSES AS WELL
SO THERE'S THIS HYPOTHESIS THAT
INCREASES IN ALCOHOL-RELATED
CONSEQUENCES ARE WRAPPED UP IN
THESE OTHER SO-CALLED DEPTHS OF
DESPAIR.
WE HAVE META ANALYZED DEPRESSION
AVAILABLE DATA NATIONALLY IN THE
U.S. FROM ACROSS ALL AGE GROUPS
AND CERTAINLY WHEN YOU LOOK NOT
JUST AT MORTALITY-RELATED MENTAL
HEALTH BUT UNDERLYING STUDIES OF
MENTAL HEALTH CONDITIONS LIKE
DEPRESSIVE SYMPTOMS, THERE WE
SEE REALLY MOST OF THE ACTION IN
TERMS OF COHORT EFFECT, YOUNG
PEOPLE.
THERE HAVE BEEN EXTRAORDINARY
INCREASES IN MENTAL HEALTH
PROBLEMS AMONG ADOLESCENTS AND
YOUNG ADULTS, WE'RE NOT SEEING
THAT AS MUCH IN OLDER ADULTS.
THE DATA I'VE LOOKED AT, BEYOND
DEPTHS OF DESPAIR NARRATIVE,
DOES NOT SUPPORT MENTAL HEALTH
BEING THE UNDERLYING DRIVER OF
THE INCREASES IN OLDER ADULTS
BUT CERTAINLY I THINK OF COURSE
A COMPONENT OF INCREASED RATES
OF DRINKING IN THAT AGE GROUP AS
WELL.
>> THANK YOU.
A QUESTION FROM ANDRE, FOR SARA
JO NIXON.
CAN EXCESSIVE/OVERCAUTIOUS
BRAKING DURING DRIVE, ALCOHOL,
AFFECT OVERCAUTIOUS BRAKING
DURING DRIVING IN OLDER ADULTS,
SOUNDS LIKE YOU WERE BEHIND
SOMEBODY WHO WAS DOING THAT.
>> BESIDES BEING TERRIBLY
ANNOYING, INDEED, THAT SORT OF
OVERLY CAUTIOUS APPROACH TO
DRIVING LIKELY IS A COMPENSATORY
MECHANISM FOR THE IDEA THAT IF I
DON'T SLOW DOWN FAST ENOUGH OR I
NEED TO WATCH WHAT'S HAPPENING
AROUND ME OR I'LL MISS IT, COULD
CERTAINLY BE A PART.
SO THEY THINK IT'S ADAPTIVE
UNLESS YOU'RE BEHIND THEM; AND
THEN YOU SWEAR IT'S NOT ADAPTIVE
AT ALL.
>> AND THEN A QUESTION FROM
MARILYN WHITE CAMPBELL.
GREAT TALK.
I THINK THIS IS FOR YOU, OR FOR
EVERYBODY.
THANK YOU ALL.
WHAT ARE THE RATES OF COGNITIVE
IMPAIRMENT OR ALCOHOL-RELATED
DEMENTIA IN OLDER ADULTS AND CAN
YOU COMMENT ON REVERSIBILITY IN
THIS AGE GROUP WITH ABSTINENCE?
I GUESS EITHER SARA JO OR
KATHERINE KEYS OR ANY ONE OF YOU
MIGHT WANT TO COMMENT ON THAT.
>> OR MAYBE NONE OF US.
THIS IS REALLY A TOUGH ISSUE TO
BE ABLE TO ADDRESS.
AND HOW MUCH OF THE EFFECT IS
REALLY AN ALCOHOL-RELATED
DEFICIT RATHER THAN TRUE
DEMENTIA, HOW DO YOU FOLLOW THAT
OVER TIME?
HOW DO OTHER RISK FACTORS IMPACT
THE OUTCOMES ON THAT?
IT'S TERRIBLY IMPORTANT THAT WE
KNOW THAT BUT WE ARE GOING TO
HAVE SYSTEMATIC LONGITUDINAL
STUDIES TO BE ABLE TO ANSWER IT.
>> YEAH, I WOULD ECHO, TRENDS
DON'T NECESSARILY LINE UP WITH
TRENDS IN ALCOHOL USE AS WELL
BUT ALCOHOL USE CAUSED
CONSEQUENCE, WE KNOW THERE'S A
CRITICAL ROLE FOR ALCOHOL USE IN
COGNITIVE IMPAIRMENT AND
COGNITIVE DECLINE SO I THINK
THAT'S WHERE A LOT OF US ARE
PUTTING EFFORT.
>> FROM ACHIEVEMENT PERSPECTIVE
I WANT TO COMMENT SOMETIMES WHAT
I'VE HEARD FROM PROVIDERS IS
THAT A PATIENT WILL SHOW UP AT A
MEMORY CLINIC AND THEY WON'T
ACCEPT THEM BECAUSE THEY ARE
DRINKING AND PRESENTS A TRICKY
CLINICAL ISSUE WHERE YOU DON'T
WANT TO POSTPONE THAT CARE,
RIGHT?
BUT THE MEMORY CLINIC IS LIKE,
WELL, THEY THINK IT'S THE
ALCOHOL AND WANT TO TEASE THAT
OUT.
IT'S A HARD TOPIC.
>> WHILE YOU'RE SPEAKING,
CYNTHIA, THE NEXT QUESTION IS
CAN WE MITIGATE THE WAY
AGE-RELATED COGNITIVE DECLINE E
ACTS AS A BARRIER TO NAVIGATING
TREATMENT AND TREATMENT
CONDITIONS, SORT OF ALMOST
ANSWERED THAT.
BUT IT'S IN THE REVERSE WAY.
SO HOW DO WE MITIGATE
AGE-RELATED COGNITIVE ACT AS A
BARRIER TO NAVIGATING ACCESS TO
TREATMENT AND TREATMENT OPTIONS?
>> YEAH, I MEAN, I WISH I HAD A
GREAT ANSWER TO THAT.
I THINK IT CAN BE A BARRIER, AND
THERE'S THIS MOVEMENT TOWARDS
MORE AGE-FRIENDLY HEALTH
SYSTEMS.
AND I THINK SORT OF TRAINING
PROVIDERS TO REALLY BE AWARE AND
RECOGNIZE WHAT ARE AGE-FRIENDLY
APPROACHES AND NOT PUTTING UP
BARRIERS IS CRITICAL.
IT'S NOT FAST, OF COURSE.
BUT I THINK IT'S REALLY
IMPORTANT SO THAT WHEREVER YOU
ARE IN THE HEALTH SYSTEM, NOT
JUST ADDICTION TREATMENT, YOU'RE
AWARE OF THESE ISSUES.
I DON'T KNOW IF DEREK HAS
ANYTHING.
>> MAYBE JUST TO ADD THERE HAS
BEEN A TREND IN OUR SYSTEM AND
SOME OTHERS ABOUT INTEGRATED
BEHAVIORAL HEALTH SERVICES AND
PRIMARY CARE, SO HAVING MASTER'S
LEVEL CLINICIANS, SOCIAL
WORKERS, COUNSELORS, INTEGRATED
INTO PRIMARY CARE THAT CAN
ADDRESS, WOULD BE WELL PLACED TO
ADDRESS THIS AS WELL AS OTHER
COMORBID MENTAL HEALTH ISSUES.
PEOPLE MAY NOT BE APPROPRIATE OR
WILLING TO GO TO SPECIALTY
ADDICTION TREATMENT.
>> THAT QUESTION IS FROM HANNAH.
ONE MORE, THANK YOU FOR STUDYING
AND SHARING THIS IMPORTANT
TOPIC.
FOR ALL OF YOU.
DID YOU LOOK AT THE POSSIBLE
RELATIONSHIPS WITH EARLY ONSET
OF DRINKING, UNDER-AGE DRINKING
FOR INSTANCE?
>> ANYBODY WANT TO TAKE THAT
ONE?
>> WE'VE LOOKED AT THAT TO SOME
EXTENT BY LOOKING AT AGE OF
ONSET OF LIKE REGULAR DRINKING.
AND WE ARE NOT, IN THIS GROUP OF
COMMUNITY DRINKERS, FINDING THE
KINDS OF RELATIONSHIPS THAT YOU
SOMETIMES FIND IN POPULATIONS
WITH ALCOHOL USE DISORDER.
THERE DOES SEEM TO BE AN
AGE-RELATED VULNERABILITY
SOMEWHAT DIFFERENT THAN A FACTOR
OF CHRONICITY OR AGE OF INITIAL
USE IN THESE DRINKERS.
>> ONE COMMENT FOR UNDERAGE
DRINKING, WHAT'S INTERESTING,
THE COHORTS NOW IN THEIR 50's
AND 60s, OLDER ADULTS, THEY
ARE FROM HEAVY DRINKING UNDERAGE
COHORTS.
WHEN WE LOOK AT COHORTS WITH
HIGHEST RATES OF BINGE DRINKING,
COHORTS THAT WERE TEENAGERS IN
THE LATE '70s AND EARLY
'80s, ONE THING THAT'S
INTERESTING FROM THE
EPIDEMIOLOGICAL DATA SINCE THAT
TIME UNDERAGE DRINKING HAS
DECLINED THROUGHOUT THE '90s,
2000s, YOU KNOW, AGE 18
DRINKING IS GOING DOWN QUITE
RAPIDLY.
AT THE SAME TIME WE IN
EPIDEMIOLOGY, IN ALCOHOL
EPIDEMIOLOGY, CALL THE REVERSAL.
AS UNDERAGE DRINKING DECLINED,
THERE'S BEEN AN ACCELERATION OF
DRINKING IN TRANSITION TO
ADULTHOOD, EVEN THOUGH TEENAGERS
ARE DRINKING LESS THAN EVER,
THEY ARE EXITING THE TRANSITION
TO ADULTHOOD AGE BAN WITH
ACCELERATING RATES COMPARED TO
PREVIOUS COHORTS, IT'S A
FASCINATING TOPIC CHANGE OF AGE
DISTRIBUTION OF ALCOHOL USE AND
PROBLEMS RELATED TO ALCOHOL USE
THAT WILL IMPLICATIONS FOR ALL
AREAS WE TOUCHED ON TODAY IN THE
COMING DECADES.
>> YEAH, THANK YOU.
AND THEN WE HAVE A QUESTION FROM
MARY CARTO.
I READ A BOOK, SPIRIT-LED
SOBRIETY, BY PAULETTE KINEG,
THROUGH A COMBINATION OF RELYING
ON FAITH AND LEARNING SCIENCE
BEHIND AUD, NEURAL PLASTICITY IS
THE PROCESS.
WHAT ARE YOUR THOUGHTS ABOUT
SPIRITUALITY AND SCIENCE
COMBINING?
>> THIS IS AN IMPORTANT TREND IN
THE ADDICTION TREATMENT THAT
PEOPLE ARE INTEGRATING,
EDUCATION, SCIENCE-BASED
BEHAVIORAL INTERVENTIONS, AS
WELL AS AUD MEDICATIONS, BUT
THEN ALSO BEING OPEN TO
SPIRITUAL-BASED TOOLS INCLUDING
MINDFULNESS, BEING INVOLVED IN
A.A., AND WHATEVER THAT MEANS TO
PEOPLE INDIVIDUALLY.
SO DEFINITELY SEEING IT AS
COMPLEMENTARY TO UNDERSTAND THE
PROCESS OF AUD AS WELL AS FULL
RANGE OF BEHAVIORAL AND
SPIRITUAL TOOLS PEOPLE CAN USE.
>> AND ONE FROM JUDY HAHN.
BARRIERS TO DETERMINING WHAT IS
COGNITIVE DECLINE VERSUS ALCOHOL
USE, HOW ABOUT THE ROLE OF
ALCOHOL BIOMARKERS?
MAYBE SARA JO, YOU'VE BEEN
WORKING IN THIS DOMAIN.
>> WELL, I WOULD SAY JUDY, THOSE
ARE GREAT QUESTIONS ABOUT HOW TO
ABSOLUTELY DO THAT, SEPARATING
THOSE OUT.
AND WE NEED TO HAVE VERY GOOD
MEASURES.
I THINK ALCOHOL BIOMARKERS ARE A
WAY OF TRACKING ACTUAL USE
RATHER THAN REPORTED USE OVER
TIME.
WE DO FIND THERE'S RELATIVELY
STABLE DRINKING PATTERNS THAT
THAT DOESN'T MEAN THEY DON'T
INTERACT WITH OTHER FACTORS,
THAT PLACE INDIVIDUALS AT
INCREASED RISK FOR DECLINE,
REGARDLESS OF ALCOHOL USE, SO
THOSE THINGS COME TOGETHER.
WE WILL NEED EXACTLY THIS KIND
OF SYSTEMATIC KIND OF THING
YOU'RE TALKING ABOUT FROM
BIOMARKERS AND OTHER WAYS OF
MEASURING USE AND MAYBE EMA,
OTHER WAYS OF TRACKING THESE
FACTORS, ALL AT THE SAME TIME.
WE'LL HAVE TO GET CREATIVE HOW
WE WANT TO DO THAT, TO ANSWER
THAT QUESTION.
>> AND THEN FINAL QUESTION FROM
EDIE SULLIVAN, WHO DID SOME OF
THE WORK THAT SARA JO SHOWED IN
THAT SLIDE.
EDIE'S QUESTION IS, WITH
LONGITUDINAL COGNITIVE AND MOTOR
STUDY OF REDUCING DRINKING IN
OLDER PEOPLE WE MIGHT OBSERVE
REVERSAL OF DECLINE IN THEY DO
NOT ALSO HAVE IRREVERSIBLE
NON-AUD DEMENTIA.
IS THERE ANY EFFORT TO EDUCATE
MEMORY DISORDER CAREGIVERS TO
INCLUDE FOLKS WITH AUD, HELP
THEM REDUCE DRINKING, WHICH
COULD REVEAL WHO HAS AUD-RELATED
DECLINE VERSUS NON-AUD-RELATED
DECLINE?
AND SO I'M GOING TO GO FIRST TO
DEREK AND CYNTHIA TO SEE WHAT
YOU GUYS THINK.
>> I WOULD SAY THIS IS A
CRITICAL DISTINCTION, PROVIDERS
DO NEED TO BE AWARE OF, THAT
THEY ARE DIFFERENT FACTORS THAT
INFLUENCE, THAT CAUSE DEMENTIA,
SOME MAY ARE MORE REVERSIBLE
THAN OTHERS.
AND TO BE DEFINITELY AWARE OF
THE POTENTIAL FOR IMPROVEMENT
WITH ABSTINENCE, BUT THEN
PERHAPS ALSO TO BE AWARE THERE
COULD BE ADDITIONAL PROCESSES
GOING ON.
>> YEAH, I THINK IT GOES BACK TO
THE TRAINING OF PROVIDERS,
DIFFERENT TYPES OF PROVIDERS,
ABOUT HOW TO BE AWARE AND
IDENTIFY PROBLEMS AND IT CAN BE
HARD BUT I THINK THERE'S A LOT
OF WORK THAT COULD BE DONE
STILL.
BY DIFFERENT TYPES OF PROVIDERS.
>> I'LL MAKE A FINAL COMMENT,
THIS HAS BEEN EXCELLENT, THE
DISCUSSION IN PARTICULAR,
BECAUSE IT BROUGHT OUT A LOT OF
THINGS WE COULDN'T COVER BUT
BROUGHT OUT OVERARCHING THEMES
WE PICKED UP ON NIAAA,
CONSIDERING ALCOHOL A VITAL SIGN
FOR ALL HEALTH CARE PROVIDERS IS
ONE.
IT'S A WINDOW ON MEDICAL
CONDITIONS.
WE'VE TALKED A GREAT DEAL TODAY
ABOUT IT, THE WINDOW ON
COGNITIVE ISSUES.
BUT THERE'S ALSO THE ISSUE OF
INTEGRATED CARE, WORKING WITH
LIVER DOCS AT NIAAA, ACTUALLY
VERY ACTIVELY RIGHT NOW ABOUT
INTEGRATED CARE, BUT AS YOU
POINT OUT COULD BE GENERALIZED
TO INTEGRATED CARE OF ANY
DISORDER THAT IS EXACERBATED BY
ALCOHOL AND VICE VERSA.
TRACKING KATHERINE IS DOING,
WORKING OUT WHERE ARE
VULNERABILITIES, HAVE PICKED UP
ON THIS ISSUE THAT, YES, WE'VE
SEEN A 20-YEAR DECLINE IN
UNDERAGE DRINKING BUT WE'RE ALSO
SEEING A SHIFT NOW TO THIS
OLDER, YOU KNOW, YOUNGER ADULT
AGE GROUP THAT'S DRINKING A LOT
AND WHAT DOES THAT BODE FOR WHEN
THEY MOVE INTO THEIR 60s AND
SO ON AND SO FORTH.
I THINK EVERYBODY OUT THERE, YOU
CAN SEE THIS IS A TOPIC WE
TOUCHED ON TODAY THAT ACTUALLY
GENERALIZES TO A LOT OF
CHALLENGES THAT NIAAA FACES IN
OUR MISSION.
I THINK I'M GOING TO USE THAT AS
A SEGUE TO SAY GOOD-BYE TO
EVERYBODY, AND THANK AGAIN OUR
SPEAKERS AND ALL THE
PARTICIPANTS WHO GAVE US SOME
REALLY, REALLY EXCELLENT
QUESTIONS.
THANKS, EVERYBODY.
>> THANK YOU.
>> THANKS SO MUCH.