Search

High rates of substance use disorders (SUDs) in persons age 50 and older are concerning. Those reentering the community in later life after incarceration are especially at risk. We determined if later-life prison release increases risk of SUD-related hospitalizations and ED visits in a national sample of veterans (N=7,671) released from prison between 2012 to 2014 and matched never-incarcerated controls (N=7,671). Later-life prison release was associated with increased risk of any SUD-related hospitalization/ED visit (2907.1 vs. 465.0 per 100,000/year; adjusted HR=2.67; 95% CI, 2.11-3.36) and 3-fold risk of hospitalizations/ED visits due to alcohol use disorder (1955.4.1 vs. 282.6 per 100,000/year; adjusted HR=3.04; 95% CI, 2.24-4.13) and drug use disorder (1586.1 vs. 252.0 per 100,000/year; adjusted HR=3.09; 95% CI, 2.23-4.30). Those reentering the community in later life after prison are at higher risk of experiencing SUD-related hospitalizations or ED visits. Prevention and intervention efforts targeting later-life prison-to-community care transitions are needed. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.

This session will provide information about adverse health outcomes, including suicide, suicide attempts and unintended death, that may be related to polysubstance use and polypharmacy in older adults, particularly older veterans. It will further provide information that will help support late-life suicide prevention and intervention efforts. Older veterans (age50 and older) have the highest number of lives lost to suicide, make up majority of the veteran population, and are highly likely to experience conditions (e.g., chronic pain, sleep disorders, musculoskeletal) associated with commonly prescribed medications that are potential markers for suicide risk (hereafter referred to as “high-risk” drug categories), including benzodiazepines, sedative-hypnotics, opioids, antidepressants, antipsychotics, and antiepileptics. The research presented in this session will highlight important patterns in high-risk drug prescribing and use and related outcomes in late life. The presentations will underscore various groups of older veterans that may be important to consider and, yet, neglected in the polysubstance and polypharmacy and suicide prevention conversation, including those who recently attempted suicide, veterans with late-life posttraumatic stress disorder (PTSD), and older veterans transitioning from prison to community. Drs. Maust and Morin will present findings on prescribing and use of high-risk medications in late life, including an overview of trends in polypharmacy and associations with suicide attempts. Drs. Byers and Barry will speak about older veterans with PTSD and those with a history of incarceration, with information on suicide, unintended death by overdose, and substance use disorder-related emergency department visits and hospitalizations, emphasizing importance of care transition models for prevention. Aging, Alcohol and Addictions Interest Group Sponsored Symposium.

Late-life veteran suicide is a public health concern, and may overlap with recent high-risk medication use. We identified use in the 6 months prior to attempt and assessed salient risk factors. 13,872 veterans aged 50 years and older that attempted suicide were compared with demographically-matched controls utilizing VHA healthcare in a similar time period. Medications potentially related to suicide risk were included. Other variables were psychiatric and medical diagnoses, fatality of attempt and means. Compared with controls, veterans who attempted were nearly 3 times more likely to have been prescribed benzodiazepines and opioids, even when controlling for other diagnoses. Those taking 3 or more high-risk medications were between 7 and 11 times more likely to attempt than controls, with a higher risk of death particularly by drug overdose. These findings begin to uncover the complex contribution of prescription medications and polypharmacy to late-life veteran suicide, with implications for prevention. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.

Very little is known about Alzheimer’s Disease and related dementias (AD/ADRD) and diseases (e.g., Parkinson’s/PD) in older adults returning to community from prison (“older reentry adults”). We utilized a national sample of older veterans to conduct the first study documenting the occurrence (prevalence/incidence) of AD/ADRD and related diseases in older reentry adults. We examined 28,235 reentry veterans who were aged 50 years and older at their most recent release date and Medicare beneficiaries, 2008 through December 31, 2017. AD/ADRD and related diseases were identified by ICD-9/10 codes in the electronic health record from Medicare and inpatient/outpatient Veterans Health Administration data. We examined distributions of AD/ADRD and related diseases across 4 age categories (sample %): 50-64 (55%), 65-74 (37%), 75-84 (7%), and 85+ (0.7%). Of the 28,235 veterans 50 years and older, 17% (n=4,725) had dementia (defined by AD/ADRD based on NIA criteria) or mild cognitive impairment (MCI) and 3% (n=794) had PD. Of those with dementia/MCI, 18% had AD and 26% MCI. Nearly 40% of dementia diagnoses occurred prior to/on most recent release date, and 40% of PD diagnoses occurred prior to/on most recent release date. Differences were significant across age groups (P

Little is known about late-life posttraumatic stress disorder (PTSD) and risk of suicide and apparent accidental death by overdose. We studied 488,044 older veterans (50 and older) with PTSD and propensity-matched comparison group without PTSD (n=488,044), seen in VA 2012-2013 followed to 12/31/2016. There were 5,693 non-fatal and fatal suicide attempts for those with PTSD and 4,310 for those without PTSD (approximately 20% fatal for each group). Those with PTSD had nearly 2-fold increased risk of any attempt [HR=1.55 (95% CI=1.49-1.62)]. While results specific to death by suicide were non-significant, impact of PTSD on method of death (e.g., drug overdose, firearms, hanging) was significant only for drug overdose [HR=1.58 (95% CI=1.22-2.03)]. Intentional and unintentional death by narcotics and such drugs as non-opioid analgesics and autonomic nervous system drugs were most highly associated with late-life PTSD. This study provides important implications for late-life suicide prevention related to PTSD and cause-specific drugs. Part of a symposium sponsored by the Aging, Alcohol and Addictions Interest Group.

Occurrence of new mental health (MH) disorders in patients with dementia is neglected, with next to nothing known. We examined association between dementia diagnosis and risk of new psychiatric disorders and suicide, and MH services use. We merged four national databases from US Department of Veterans Affairs. Sample included 2,529,181 patients (≥50 years) in fiscal years (FY) 2012-2013 with no MH disorders. Dementia, psychiatric disorders (mood, anxiety, substance), suicidal behavior (ideation, plan, attempt, death by suicide) were identified by ICD-9/10 codes and national suicide databases. Hazard ratios (HR) were estimated using Cox proportional hazard models, with time-to-event defined as age at first diagnosis of MH disorder during FY 2014-2016. Analyses adjusted for medical/sociodemographic factors. Compared to those without dementia, dementia patients showed roughly 2-fold increased risk of new mood (HR: 2.19, 95% Wald CI: 2.15-2.24, p

The number of middle/older-age persons reentering the community following incarceration is growing exponentially, yet little is known about suicide-related outcomes (attempts and deaths) in this population. We conducted a retrospective cohort study (2012–2014) of Veterans age ≥50 who were Medicare enrollees to compare rates of death by suicide, drug overdose, and other accidental injuries and rates of suicide attempt between those reentering the community in later life (N=7,671) and a matched group of non-incarcerated controls (N=7,671). We linked the Department of Veterans Affairs National Patient Care Database and Suicide Data Repository, and used linked Medicare data to identify reentry status. We determined rates of each outcome (per 100,000/year) in the reentry and control groups and used competing risk proportional hazards models adjusted for medical conditions, psychiatric illness, homelessness, and traumatic brain injury to compare their risks. Suicide rates were 30.4 and 17.4 in the reentry and control groups, respectively (HR 2.40; 95%CI 0.51–11.24). Those released from prison also had significantly higher rates of death by drug overdose (121.7 vs. 43.5; HR 3.45; 95%CI 1.37–8.73) and other accidental injury (126.0 vs. 39.1; HR 3.13; 95%CI 1.28–7.69), and increased risk of suicide attempt (599.7 vs. 134.7; HR 3.42; 95%CI 2.22–5.26). Individuals released from incarceration in later life are at considerably higher risk of suicidal behavior and death by drug overdose and accidental injuries as compared with non-incarcerated persons. This study offers benchmark data regarding these mortality outcomes and suicide risk in a growing high-risk population, with implications for targeting prevention and intervention.

Little is known about whether specific mental health issues are more prevalent in certain dementia subtypes. This study examined psychiatric disorders and suicidal behavior among older veterans with different dementia subtypes. The sample included 4,951,919 older veterans (≥50 years) who used Veterans Health Administration healthcare services. Data were from the National Patient Care Database and National Suicide Prevention and Application Network for fiscal years 2012–2013. International Classification of Diseases, 9th Edition codes were used to identify psychiatric diagnoses and dementia subtypes, and Pearson’s chi-square tests were used to determine prevalence of mental health conditions among dementia subtypes. Among older veterans, 0.03% were diagnosed with frontotemporal, 0.52% with vascular, 0.66% with Alzheimer’s, 0.08% with Lewy body, 0.30% with senile, and 3.45% with not otherwise specified dementia. Older veterans with any dementia had higher prevalence of mood and anxiety disorders and suicidal behavior than those without dementia (p