Concomitant alcohol and alcohol-interactive medication use by older New Zealanders : investigating the prevalence, and potential associations with health, healthcare utilization, and depression : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand
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2021
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Massey University
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Background: Older adults are more vulnerable to the adverse effects of alcohol-medication interactions (AMIs) than younger populations, and are more likely to use medications capable of causing an AMI when used with alcohol (alcohol-interactive (AI) medications). Survey findings from the United States (US) and Europe indicate many older adults use alcohol and AI-medications concomitantly. However, the prevalence of this issue in New Zealand is currently unknown, and few observational studies have explored the impact of concomitant alcohol and AI-medication use (concomitant alcohol/AI-medication use) on health outcomes in community samples. Research exploring motivating factors underlying alcohol use by AI-medication users indicates having awareness of AMI risks often motivates reduced alcohol consumption. There is also evidence that depression may increase the likelihood of concomitant alcohol/AI-medication use, particularly when alcohol is used to ‘self-medicate’ depressive symptoms. However, the moderating effects of depression on alcohol use by AI-medication users have not been directly assessed in a large community sample.
Design and Methods: Two studies were conducted, both involved secondary analysis of existing survey data and national pharmaceutical claims data. Samples were drawn from a representative sampling frame of older adults living in New Zealand. The first study (study 1) analysed data from a survey of adults aged 54-70 years, and the second study (study 2) analysed data from an augmented sample aged 49-83 years. The prevalence of concomitant alcohol/AI-medication use was explored in both study samples overall, and in subsamples of participants aged ≥65 years. Study 1 investigated the potential impact of concomitant alcohol/AI-medication use on general physical health and healthcare utilization. Study 2 assessed the potential relationships between alcohol use, AI-medication use, and depression. An evidence-based protocol was developed to inform methods of classifying AI-medications and measuring AI-medication use among survey participants using pharmaceutical dispensing records. Relationships between variables of interest were assessed using a series of hierarchical regression models and Chi-squared tests.
Results: Alcohol and AI-medications were used concomitantly by approximately one-in-four participants aged 54-70 years, one-in-three participants aged 49-83 years, and two-in-five participants aged 65-83 years. Concomitant alcohol/AI-medication use was not significantly associated with physical health or healthcare utilization, although these non-significant findings may reflect limitations of the outcome measures used in the present research. Alcohol use was negatively associated with AI-medication use, with stronger associations being observed for medications associated with more severe AMIs. These findings are consistent with research and theory indicating AMI awareness may lead to reduced alcohol consumption by AI-medication users. Depression did not influence the relationship between AI-medication use and alcohol use.
Conclusions: The present research findings indicate many New Zealand older adults are at risk of AMI. Providing relevant health warnings may help reduce the potential for AMI-related harm, although additional intervention may be needed for many older adults. Future research in this area should include longitudinal health outcome measures that are specific to the effects of AMI, and measures that assess drinking motives directly. The two studies presented in the present thesis were the first to explore the prevalence of concomitant alcohol/AI-medication use by older adults in New Zealand, which is a major contribution of this project overall. Another important contribution was the development of an evidence-based framework for measuring AI-medication use among survey participants.
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Older people, Alcohol use, Drug use, Psychology, Drug interactions, New Zealand