Publications by authors named "Namkee G Choi"

126 Publications

Is cannabis use associated with prescription psychotropic and pain reliever medication and other substance use among individuals aged 50+ with mental illness?

Drug Alcohol Depend 2021 Aug 24;225:108842. Epub 2021 Jun 24.

Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78702, USA.

Background: Despite increasing rates of nonmedical and/or medical cannabis use in the 50+ age group, scant research exists on the associations between cannabis use and prescription medication use. In this study, we examined associations of use of prescription tranquilizers, sedatives, stimulants, and pain relievers, tobacco products, any/binge/heavy alcohol, and illicit drugs with cannabis use and use characteristics among U.S. adults aged 50+ years with past-year mental illness (n = 6454).

Methods: Data are from the 2015-2019 National Survey on Drug Use and Health (NSDUH). We used logistic regression models to examine associations of past-month use of each substance with (1) cannabis use among all those with past-year mental illness, and (2) cannabis use characteristics among cannabis users, controlling for severity of mental illness and sociodemographic and health characteristics.

Results: Of individuals aged 50+, 14.1 % had any past-year mental illness, and 9.7 % of those with mental illness, compared to 4.0 % of those without, reported past-month cannabis use. Compared to nonusers, cannabis users had higher odds of using each substance except antidepressants, with adjusted odds ratios ranging from 1.3 (sedatives) to 3.6 (illicit drugs). Compared to nonmedical cannabis users, medical users had 2-2.5 times higher likelihood of co-use of tranquilizers, sedatives, and prescription pain relievers but lower odds of binge and heavy alcohol use.

Conclusions: Cannabis users, especially medical cannabis users, are significantly more likely to use prescription psychotropic or pain medications. Healthcare professionals should assess for poly-substance use and potential adverse effects among older adults with mental illness.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108842DOI Listing
August 2021

Associations of cannabis use frequency and cannabis use disorder with receiving a substance use screen and healthcare professional discussion of substance use.

Am J Addict 2021 Jun 18. Epub 2021 Jun 18.

Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA.

Background And Objectives: Screening, brief intervention, and referral to treatment (SBIRT) can reduce substance use, but receipt of these services by those who use cannabis frequently and have cannabis use disorder (CUD) remains unexplored. We examined cannabis use frequency and CUD's associations with the odds of receiving a substance use screening and a healthcare professional discussion among those who used healthcare services.

Methods: Data came from the 2015-2019 National Survey on Drug Use and Health (N = 214,505 aged 18+). Among adults who used cannabis and attended healthcare settings in the past year (N = 36,374), multivariable logistic regression analysis was used to examine associations of cannabis use frequency and CUD with receiving a substance use screen and substance use discussion by a healthcare professional.

Results: Cannabis use frequency was associated with higher odds of receiving a screen (adjusted odds ratio [AOR] = 1.27, 95% confidence interval [CI] = 1.14-1.41 for 300+ days of use) and a discussion among those screened (AOR = 1.83, 95% CI = 1.60-2.09 for 300+ days of use). CUD was not associated with receiving a screen, but it was positively associated with receiving a discussion among those screened (AOR = 1.22, 95% CI = 1.08-1.39). Nonmedical users were less likely to have a discussion among those screened and not screened.

Discussion And Conclusions: Findings indicate disparities in screening and discussion of substance use with patients, especially between medical and nonmedical users.

Scientific Significance: Study findings provide novel insight into differences in the reach of SBIRT services among adult cannabis users.
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http://dx.doi.org/10.1111/ajad.13195DOI Listing
June 2021

One Year Impact on Social Connectedness for Homebound Older Adults: Randomized Controlled Trial of Tele-delivered Behavioral Activation Versus Tele-delivered Friendly Visits.

Am J Geriatr Psychiatry 2021 Aug 16;29(8):771-776. Epub 2021 May 16.

The University of Texas at Austin Steve Hicks School of Social Work (CNM, NGC).

Objectives: Lonely and socially isolated homebound older participants of a randomized trial comparing behavioral activation (BA) versus friendly visiting, both delivered by lay counselors using tele-videoconferencing, were reassessed at 1-year to determine whether benefits at 12 weeks were maintained over time.

Methods: The study reinterviewed 64/89 (71.9%) participants.

Results: The positive 12-week impact of tailored BA on 3 indicators of social connectedness (loneliness, social interaction and satisfactions with social support) was maintained, albeit to a lesser degree, over 1 year. The positive impact on depressive symptoms and disability was also maintained.

Conclusions: The intervention's potential reach and scalability are suggested by several factors: participants were recruited by home delivered meals programs during routine assessments; the intervention was brief and delivered by lay counselors; care delivery by tele-videoconferencing is increasingly common. The 1 year outcomes indicate that brief BA delivered by tele-video conferencing can have an enduring impact on social connectedness.
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http://dx.doi.org/10.1016/j.jagp.2021.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286332PMC
August 2021

One Year Impact on Social Connectedness for Homebound Older Adults: Randomized Controlled Trial of Tele-delivered Behavioral Activation Versus Tele-delivered Friendly Visits.

Am J Geriatr Psychiatry 2021 Aug 16;29(8):771-776. Epub 2021 May 16.

The University of Texas at Austin Steve Hicks School of Social Work (CNM, NGC).

Objectives: Lonely and socially isolated homebound older participants of a randomized trial comparing behavioral activation (BA) versus friendly visiting, both delivered by lay counselors using tele-videoconferencing, were reassessed at 1-year to determine whether benefits at 12 weeks were maintained over time.

Methods: The study reinterviewed 64/89 (71.9%) participants.

Results: The positive 12-week impact of tailored BA on 3 indicators of social connectedness (loneliness, social interaction and satisfactions with social support) was maintained, albeit to a lesser degree, over 1 year. The positive impact on depressive symptoms and disability was also maintained.

Conclusions: The intervention's potential reach and scalability are suggested by several factors: participants were recruited by home delivered meals programs during routine assessments; the intervention was brief and delivered by lay counselors; care delivery by tele-videoconferencing is increasingly common. The 1 year outcomes indicate that brief BA delivered by tele-video conferencing can have an enduring impact on social connectedness.
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http://dx.doi.org/10.1016/j.jagp.2021.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286332PMC
August 2021

Alcohol use disorder and treatment receipt among individuals aged 50 years and older: Other substance use and psychiatric correlates.

J Subst Abuse Treat 2021 Apr 29;131:108445. Epub 2021 Apr 29.

Steve Hicks School of Social Work, University of Texas at Austin, United States of America.

Objective: Alcohol use disorder (AUD) is increasing among U.S. individuals aged 50+. We examined associations of past-year AUD with other substance use and any mental illness (AMI) and associations of past-year AUD treatment receipt with other substance use, AMI, and mental health treatment receipt among those with AUD.

Methods: Data came from the 2015-2018 National Survey on Drug Use and Health (N = 35,229). We used multivariable logistic regression analysis to examine the research questions.

Results: In the 50+ age group, 58.7% of women and 66.9% of men reported past-year alcohol use and 2.0% of women and 4.9% of men had AUD. Those with any alcohol use problem (binge drinking, heavy drinking, or AUD) had higher odds of other substance use or use disorders; however, AMI was associated with higher odds of AUD only (AOR = 2.54, 95% CI = 2.15-3.00, AOR = 2.63, 95% CI = 1.98-3.50, and AOR = 3.13, 95% CI = 2.19-4.48, respectively, for mild, moderate, and serious mental illness). Only 7.9% of those with AUD received any alcohol treatment. AMI and mental health treatment were associated with higher odds of alcohol treatment receipt (AOR = 5.18, 95% CI = 2.13-12.55, AOR = 4.14, 95% CI = 1.51-11.30, and AOR = 2.91, 95% CI = 1.41-6.00, respectively, for moderate mental illness, serious mental illness, and mental health treatment receipt).

Conclusion: The findings show that fewer than one in 10 older adults with AUD received any alcohol treatment and suggest that individuals need education on alcohol harms and assistance in accessing alcohol treatment. Combined mental health and alcohol treatment at a single location may improve access and use.
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http://dx.doi.org/10.1016/j.jsat.2021.108445DOI Listing
April 2021

Comparing older nonmedical and medical cannabis users: health-related characteristics, cannabis use patterns, and cannabis sources.

Am J Drug Alcohol Abuse 2021 Apr 29:1-11. Epub 2021 Apr 29.

Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.

: US epidemiologic data show that nearly one in 10 individuals aged 50+ report past-year cannabis use, and nearly one in five users report medical use. However, research on older cannabis users, especially medical cannabis users, is scant.: We examined medical and nonmedical cannabis users aged 50+ on health-related characteristics, cannabis use patterns, and cannabis sources. Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else's, or use other means.: We used 2018 and 2019 National Survey on Drug Use and Health data (N = 17,685 aged 50+; male = 8,030; female = 9,655). Hypotheses were tested using logistic regression analysis.: The past-year cannabis use rate was 8.9%. Of past-year users, 18.5% reported medical use. Compared to nonmedical use, medical use was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR = 4.18, 95% CI = 2.53-6.89), high-frequency use (e.g., AOR = 2.56, 95% CI = 1.35-4.86 for 200-365 days), and purchase at a medical cannabis dispensary (AOR = 4.38, 95% CI = 2.47-7.76).: Medical and nonmedical users did not differ on physical and most behavioral health indicators. Most obtained cannabis from private/informal sources. Some medical users are likely to self-treat without healthcare professional consultation. Healthcare professionals should engage older adults in discussions of cannabis use and behavioral health needs.
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http://dx.doi.org/10.1080/00952990.2021.1908318DOI Listing
April 2021

Mental health treatment use among cannabis users aged 50+: Associations with cannabis use characteristics.

Drug Alcohol Depend 2021 Jun 10;223:108705. Epub 2021 Apr 10.

Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI, 96817, United States.

Background: This study examined associations of mental health treatment use and perceived treatment need with cannabis use characteristics (medical vs. nonmedical use, initiation age, use frequency, and cannabis use disorder) among past-year cannabis users aged 50+.

Methods: Data came from the 2015-2019 National Survey of Drug Use and Health (N = 44,007). After comparing past-year cannabis users with nonusers and nonmedical users with medical users on sociodemographic and health-related factors, the research questions were examined with logistic regression models.

Results: In addition to mental disorders, medical use, compared to nonmedical use, was associated with higher odds of psychotherapeutic prescription medication use (AOR = 1.47, 95 % CI = 1.07-2.01) and any mental health treatment (prescription medication, outpatient care and/or inpatient care) (AOR = 1.51, 95 % CI = 1.13-2.03). Compared to 1-29 days of use, nonmedical users who used on 100-199 days (AOR = 0.60, 95 % CI = 0.40-0.89) and medical users who used on 200-365 days users (AOR = 0.48, 95 % CI = 0.26-0.87) had lower odds of treatment receipt. Factors associated with increased odds of receiving treatment included discussion with a healthcare professional about drug use, higher education, and having health insurance. Other illicit drug use, chronic illnesses, and female gender were associated with higher odds of perceived treatment need, while having health insurance was associated with lower odds.

Conclusions: Some older adults may use medical cannabis as an adjunct to professional mental health treatment while others may use it as a substitute. Affordability and accessibility gaps followed by cultural and personal sense of stigma and self-sufficiency beliefs appear to be barriers to receiving professional care.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108705DOI Listing
June 2021

Reasons for refusing referrals and challenges to effectual engagement in tele-treatment for depression among low-income homebound older adults.

Aging Ment Health 2021 Apr 10:1-9. Epub 2021 Apr 10.

Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA.

To describe reasons for refusal to be referred to or enroll in a depression treatment study and post-enrollment challenges to treatment engagement and technology-related problems among low-income homebound individuals aged 50+ years with depression. Data came from a 3-arm randomized clinical trial that evaluated real-world effectiveness of lay counselor-delivered behavioral activation (BA) versus clinician-delivered problem-solving therapy (PST). Interventionists were embedded in a large home-delivered meals program and treatment sessions were videoconferenced; hence Tele-BA and Tele-PST. We described refusal reasons of those who refused initial case manager referrals ( = 279), telephone screening ( = 64), enrollment ( = 47), or post-enrollment baseline assessments ( = 18). We used inductive thematic analysis to explore challenges to effectual treatment engagement and tele-delivery-related problems among Tele-PST or Tele-BA participants ( = 183) from the interventionists' tele-session process recordings. More than a third of potentially eligible older adults refused their case managers' referral, and a quarter of those who accepted referral refused further screening or enrollment. Three quarters of those who refused reported no interest or need or declined to talk about depression. Others refused given their busy schedule with medical appointments and caregiving. Nearly 80% of Tele-BA or Tele-PST participants had some challenges to effectual engagement in treatment sessions due to environmental and health-related conditions and other life stressors including financial distress. Though many tele-sessions had connectivity and other technology-related problems, these did not affect depression outcomes. Mental health service providers for low-income older adults need to be aware of these challenges when adopting best practice strategies for them.
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http://dx.doi.org/10.1080/13607863.2021.1910789DOI Listing
April 2021

Cannabis use, use frequency, and use disorder in large metropolitan, small metropolitan, and nonmetropolitan areas.

Drug Alcohol Depend 2021 04 16;221:108631. Epub 2021 Feb 16.

The University of Texas at Austin, Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, United States.

Background: Despite significant geographical heterogeneity of sociodemographic and clinical characteristics, little is known about potential differences in cannabis use behaviors in U.S. geographic areas. In this study, we examined cannabis use behaviors in large metropolitan, small metropolitan, and nonmetropolitan areas. We focused on interactions between geographic areas and health insurance status and medical cannabis laws (MCL).

Methods: Data came from the 2015-2018 National Survey on Drug Use and Health (NSDUH; N = 171,766 adults; N = 36,175 cannabis users). Weighted chi-squares tests of independence and multivariable Poisson regression models were used to examine study questions.

Results: Past-year use was highest in large metropolitan areas (16.08 %). Frequent use was highest among nonmetropolitan area users (48.67 %). Uninsured adults had a higher likelihood of past-year use (RRR = 1.21, 95 % CI = 1.14, 1.29) and frequent use (RRR = 1.27, 95 % CI = 1.14, 1.41), but a lower likelihood of cannabis use disorder (RRR = 0.77, 95 % CI = 0.66, 0.89). Uninsured adults in nonmetropolitan areas had a higher likelihood (RRR = 1.62, 95 % CI = 1.39, 1.88) of past-year use than insured nonmetropolitan area adults. MCL state residency was associated with a higher likelihood of frequent use among nonmetropolitan (RRR = 1.39, 95 % CI = 1.11, 1.74) and small metropolitan users (RRR = 1.30, 95 % CI = 1.15, 1.47). Cannabis use disorder likelihood did not vary by geographic area.

Conclusions: Lack of health insurance and MCL state residency are significant variables affecting cannabis use behaviors in small metropolitan and/or nonmetropolitan areas.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108631DOI Listing
April 2021

A Feasibility Study of Multi-Component Fall Prevention for Homebound Older Adults Facilitated by Lay Coaches and Using a Tablet-Based, Gamified Exercise Application.

J Appl Gerontol 2021 Feb 4:733464821991024. Epub 2021 Feb 4.

The University of Vermont, Burlington, USA.

Although homebound older adults face high risk for falls, they are unable to utilize community-based fall prevention programs due to their mobility limitations. In this article, we report a feasibility study of a four-session, multicomponent fall prevention program for low-income homebound older adults using pre, post, mixed-method design. The manualized program was delivered by lay coaches who were trained and supervised by a physical therapist. The program also used an iPad-based gamified strength and balance exercise app (called KOKU) that was operable without the need to connect to the internet. Participants ( = 28) in this study were highly receptive to the program and approved all components: psychoeducation, the KOKU app, home-safety checks, safe ambulation training, and medication review. The study showed that a brief, multi-component fall prevention program for homebound older adults is feasible and acceptable. Further research is needed to evaluate its effectiveness.
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http://dx.doi.org/10.1177/0733464821991024DOI Listing
February 2021

Sex differences in cannabis forms and exposure reasons in cannabis-related poison control center cases aged 50.

Clin Toxicol (Phila) 2021 Jan 21:1-15. Epub 2021 Jan 21.

Central Texas Poison Center, Temple, TX, USA.

Context/objectives: A significant proportion of individuals aged 50+ in the U.S. use cannabis for medical or recreational purposes, sometimes with adverse effects. Given differences in cannabis use among men and women, we examined sex differences in (1) cannabis forms used, (2) exposure reasons, and (3) medical outcomes in older-adult poison control center (PCC) cases.

Methods: Data came from the American Association of Poison Control Centers' National Poison Data System, 2009-2019. We focused on the 3633 cases aged 50+ in which plant and other non-synthetic cannabinoid cannabis forms were the only or primary substance. Logistic regression was used to examine associations of sex with cannabis forms. Multinomial logistic regression models were fit to examine associations of sex with exposure reasons (therapeutic errors/adverse reactions, intentional misuse/abuse, other) and medical outcomes (no-to-minimal, moderate, or major effects).

Results: Females constituted 57.4% of cases. In multivariable analyses, female cases had 1.20 (95% CI = 1.01-1.43) greater odds of involving cannabis forms other than plant forms and 1.93 greater odds (95% CI = 1.66-2.24) of therapeutic errors/adverse effects compared to intentional misuse/abuse. Older age and occurrence in recreational-cannabis-legal states were positively associated with other cannabis forms. Older age, recreational and/or medical cannabis-legal states, CBD, pharmaceuticals, concentrated extracts, and chronic exposure were associated with higher odds of therapeutic errors/adverse effects. Sex was not significantly associated with medical outcomes.

Conclusions: Female cases compose a large share of PCC cases aged 50+ and are associated with higher odds of involving cannabis forms other than plants and therapeutic errors/adverse reactions compared to intentional misuse/abuse.
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http://dx.doi.org/10.1080/15563650.2020.1869756DOI Listing
January 2021

Management site and level of health care for cannabis- and synthetic cannabinoid-related poison control center cases involving older adults, 2016-2019.

Drug Chem Toxicol 2021 Jan 7:1-9. Epub 2021 Jan 7.

Director, Central Texas Poison Center, Temple, TX, USA.

Increasing numbers of older adults use cannabis and cannabis-derived products that can have adverse effects. This study examined management site and level of healthcare services for older adult poison control center cases involving cannabis products. Using the American Association of Poison Control Centers' (PCC) National Poison Data System, 2016-2019, we extracted the 3109 cases aged 50+ for which cannabis was the only or primary substance. Multinomial logistic regression models were fit to examine associations between specific cannabis forms and management/care site (on site [mostly at home], at a healthcare facility [HCF], or no follow-up due to referral refusal or leaving against medical advice) and level of healthcare services for cases managed at a HCF. The results show that between 2016 and 2019, PCC cannabis cases involving older adults increased twofold, largely due to cases of cannabidiol, edibles, and concentrated extracts. Plant form and synthetic cannabinoid cases declined substantially. Compared to plant forms, synthetic cannabinoid cases had 4.22 (95% CI = 2.59-6.89) greater odds of being managed at, rather than outside, a HCF and 2.17 (1.42-3.31) greater odds of critical care unit admission. Although e-cigarette cases, compared to plant form cases, had lower odds of being managed at a HCF, HCF-managed e-cigarette cases had 3.43 greater odds (95% CI = 1.08-10.88) of critical care unit admission. Synthetic cannabinoid cases also had 1.86 (95% CI = 1.03-3.35) greater odds of no follow-up, and the presence of a secondary substance was also a significant factor. Stricter regulations for listing chemical ingredients and providing safety guidelines are needed for cannabis-derived products.
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http://dx.doi.org/10.1080/01480545.2020.1868494DOI Listing
January 2021

Characteristics of Mental Health and Substance Use Service Facilities for Older Adults: Findings from U.S. National Surveys.

Clin Gerontol 2020 Dec 27:1-13. Epub 2020 Dec 27.

Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA.

: To describe the characteristics of U.S. mental health and substance use service programs dedicated/tailored for older adults (age 65+).: Data came from the 2012 and 2019 National Mental Health Services Survey (N-MHSS) and the National Survey of Substance Abuse Treatment Services (N-SSATS). Using Pearson χ and Fisher's exact tests, we compared the numbers/proportions of older-adult programs in 2012 and 2019 and examined differences between facilities with or without an older-adult program in 2019.: From 2012 to 2019, the percent of all mental health and substance use service facilities for adults that had a dedicated/tailored program for older adults increased significantly, from 20.7% to 28.9% for mental health facilities and from 7.1% to 24.8% for substance use facilities, with 101 mental health facilities and 53 substance use facilities serving older adults exclusively in 2019. Compared to facilities without an older-adult program, higher percentages of facilities with such a program offered treatment for co-occurring mental and substance use disorders and supplemental health and social care services.: Given the rapidly aging society, more accessible and affordable programs dedicated/tailored for older adults are needed. To achieve this goal and better meet older adults' needs, more detailed data on facility characteristics are needed to build the knowledge base on improving the treatment environment.: Programs for older adults should be designed to meet the complex needs of those with mental health and/or substance use problems and incorporate innovative service delivery models that can improve older adults' access.
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http://dx.doi.org/10.1080/07317115.2020.1862381DOI Listing
December 2020

The reciprocal relationship between depression and disability in low-income homebound older adults following tele-depression treatment.

Int J Geriatr Psychiatry 2021 06 14;36(6):802-810. Epub 2020 Dec 14.

Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA.

Objectives: Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low-income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modality.

Methods: In a 3-arm randomized clinical trial, 277 low-income homebound individuals aged 50+ participated in behavioral activation tele-delivered by bachelor's-level lay counselors (Tele-BA), problem-solving therapy tele-delivered by licensed clinicians (Tele-PST), or telephone support calls (attention control). Depressive symptoms were assessed with the 24-item Hamilton Rating Scale for Depression and disability with the 12-item World Health Organization Disability Schedule 2.0. Along with mediation models, mediation was assessed controlling for autoregressive and contemporaneous effects.

Results: Mediation models showed evidence of postintervention disability and depression mediating each other in separate mediation models. In the cross-lagged model, in which autoregressive and contemporaneous effects were included, only the depression-to-disability path exhibited mediation. There was no evidence of difference between Tele-BA and Tele-PST. Although the temporal precedence of treatment conditions on the outcomes is apparent, we could not establish a temporal precedence between disability and depression as these two measures exhibited parallel improvement.

Conclusions: Brief depression treatments for low-income homebound older adults were effective in reducing both depression and disability among these disabled older adults. The importance of this study lies in the comparable effects of Tele-BA and Tele-PST. Lay-counselor model is a promising alternative to clinician-delivered psychotherapy for growing numbers of homebound older adults.
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http://dx.doi.org/10.1002/gps.5480DOI Listing
June 2021

Modifying Behavioral Activation to Reduce Social Isolation and Loneliness Among Older Adults.

Am J Geriatr Psychiatry 2021 Aug 5;29(8):761-770. Epub 2020 Sep 5.

Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health (RP, CJS, SMF, MLB), Lebanon, NH.

Objective: To describe our modification of Behavioral Activation to address social isolation and loneliness: Brief Behavioral Activation for Improving Social Connectedness. Our recent randomized clinical trial demonstrated the effectiveness of the intervention, compared to friendly visit, in alleviating loneliness, reducing depressive symptoms, and increasing social connectedness with lonely homebound older adults receiving home-delivered meals.

Methods: We modified Brief Behavioral Activation Treatment for Depression to address social isolation and loneliness by addressing each of its key elements: Psychoeducation; intervention rationale; exploration of life areas, values and activities; and activity monitoring and planning. The intervention consisted of six weekly sessions, up to 1 hour each. Interventionists were bachelor's-level individuals without formal clinical training who participated in an initial 1-day training as well as ongoing supervision by psychologists and social workers trained in BA throughout the study delivery period.

Results: We provide three case examples of participants enrolled in our study and describe how the intervention was applied to each of them.

Conclusions: Our preliminary research suggests that Behavioral Activation modified to address social connectedness in homebound older adults improves both social isolation and loneliness. This intervention has potential for scalability in programs that already serve homebound older adults. Further research is needed to solidify the clinical evidence base, replicate training and supervision procedures, and demonstrate the sustainability of Brief Behavioral Activation for Improving Social Connectedness for homebound and other older adults.
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http://dx.doi.org/10.1016/j.jagp.2020.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933361PMC
August 2021

Effect of Telehealth Treatment by Lay Counselors vs by Clinicians on Depressive Symptoms Among Older Adults Who Are Homebound: A Randomized Clinical Trial.

JAMA Netw Open 2020 08 3;3(8):e2015648. Epub 2020 Aug 3.

Baylor College of Medicine, Houston, Texas.

Importance: Older adults who are homebound and have low income have limited access to psychosocial treatments because of their homebound state and geriatric mental health workforce shortages.

Objective: To evaluate clinical effectiveness of a brief, aging service-integrated, videoconferenced behavioral activation (tele-BA) treatment delivered by lay counselors compared with videoconferenced problem-solving therapy (tele-PST) delivered by licensed clinicians and attention control (AC; telephone support calls).

Design, Setting, And Participants: This 3-group randomized clinical trial using a randomization prior to consent approach included individuals aged 50 years or older who were homebound and had 24-item Hamilton Depression Rating Scale (HAMD) scores of 15 or greater between February 15, 2016, and April 15, 2019. Tele-BA and tele-PST participants received 5 weekly treatment sessions. Assessments were performed at baseline and 12, 24, and 36 weeks after baseline. Intention-to-treat statistical analyses were performed from January 1, 2020, to February 15, 2020.

Interventions: Tele-BA participants were taught 5 steps for reinforcing healthy behaviors to improve mood, physical functioning, and social engagement. Tele-PST participants were taught a 7-step approach for problem solving coping skills.

Main Outcomes And Measures: The primary outcome was the 24-item HAMD scores. Response (ie, ≥50% reduction in HAMD) and remission (ie, HAMD <10) rates and effect sizes for clinically meaningful differences were examined. Secondary outcomes were disability, social engagement and activity frequency, and satisfaction with participation in social roles.

Results: A total of 277 participants were enrolled, including 193 (69.7%) women, 83 (30.0%) who were Black, 81 (29.2%) who were Hispanic, and 255 (92.1%) with income of $35 000 or less. The mean (SD) age was 67.5 (8.9) years. Among these, 90 participants were randomized to tele-BA, 93 participants were randomized to tele-PST, and 94 participants were randomized to the AC. Compared with participants in the AC group, participants in the tele-BA and tele-PST groups had significantly higher response and remission rates and medium to large effect sizes (tele-BA: raw growth modeling analysis d = 0.62 [95% CI, 0.35 to 0.89]; P < .001; tele-PST: raw growth modeling analysis d = 1.00 [95% CI, 0.73 to 1.26]; P < .001) for HAMD scores. While tele-PST was significantly more effective than tele-BA for reducing HAMD scores (t258 = -2.79; P = .006), there was no difference between tele-BA and tele-PST on secondary outcomes.

Conclusions And Relevance: In this randomized clinical trial, participants who received tele-BA by lay counselors achieved statistically and clinically meaningful changes in depressive symptoms. Given shortages of licensed mental health clinicians, tele- and lay counselor-delivered services may help improve access to evidence-based depression treatment for large numbers of underserved older adults.

Trial Registration: ClinicalTrials.gov Identifier: NCT02600754.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.15648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489833PMC
August 2020

Cannabis and synthetic cannabinoid poison control center cases among adults aged 50+, 2009-2019.

Clin Toxicol (Phila) 2021 Apr 25;59(4):334-342. Epub 2020 Aug 25.

Central Texas Poison Center, Temple, TX, USA.

Objectives: Older (aged 50+) cannabis users are growing in numbers, but research on poison control center (PCC) cases has not focused on them. In this study, we examined: (1) changing trends in cannabis forms reported in PCC cases; (2) demographic and clinical factors associated with different cannabis forms; and (3) associations between cannabis forms and medical outcomes.

Methods: We used the American Association of Poison Control Centers' National Poison Data System (NPDS), January 1, 2009-December 31, 2019, to examine the 5201 cases aged 50+ in which cannabis was the only or primary substance. Following descriptive analyses, multinomial logistic regression was fit to examine associations of three cannabis forms (dried/undried plant, other preparations, and synthetic cannabinoids/e-cigarettes for cannabis delivery) with cases' demographic and clinical characteristics, and binary logistic regression was fit to examine associations of medical outcomes (major/potentially major vs. nonmajor) with cannabis forms.

Results: Cannabis-related cases involving older adults increased 18-fold (from 61 to 1074) between 2009 and 2019. Compared to plant forms, other preparations had 51.24 times greater odds of appearing in 2018-2019 than in 2009-2011 (95% CI = 27.74-94.67), and synthetic cannabinoids/e-cigarettes had 2.19 times greater odds of appearing in 2014-2015 (95% CI = 1.64-2.93) but lower odds of appearing in 2016-2017 (RRR = 0.67, 95% CI = 0.50-0.89). Other preparations were positively associated with older age, adverse reactions, and suicide attempts but negatively associated with medical cannabis legal states. Synthetic cannabinoids/e-cigarettes were positively associated with being male, intentional misuse/abuse, and chronic use. Compared to plant forms, major medical outcomes/death were less likely among those who used other preparations (OR = 0.75, 95% CI = 0.56-0.99) but more likely among those who used synthetic cannabinoids/e-cigarettes (OR = 2.07, 95% CI = 1.60-2.66).

Conclusions: Although PCC cannabis cases involving older adults are relatively few, cases of other cannabis preparations than plant forms increased rapidly in recent years while cases of synthetic cannabinoids decreased. The rate of major medical outcomes also appears to be high.
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http://dx.doi.org/10.1080/15563650.2020.1806296DOI Listing
April 2021

Cannabis and synthetic cannabinoid poison control center cases among adults aged 50+, 2009-2019.

Clin Toxicol (Phila) 2021 Apr 25;59(4):334-342. Epub 2020 Aug 25.

Central Texas Poison Center, Temple, TX, USA.

Objectives: Older (aged 50+) cannabis users are growing in numbers, but research on poison control center (PCC) cases has not focused on them. In this study, we examined: (1) changing trends in cannabis forms reported in PCC cases; (2) demographic and clinical factors associated with different cannabis forms; and (3) associations between cannabis forms and medical outcomes.

Methods: We used the American Association of Poison Control Centers' National Poison Data System (NPDS), January 1, 2009-December 31, 2019, to examine the 5201 cases aged 50+ in which cannabis was the only or primary substance. Following descriptive analyses, multinomial logistic regression was fit to examine associations of three cannabis forms (dried/undried plant, other preparations, and synthetic cannabinoids/e-cigarettes for cannabis delivery) with cases' demographic and clinical characteristics, and binary logistic regression was fit to examine associations of medical outcomes (major/potentially major vs. nonmajor) with cannabis forms.

Results: Cannabis-related cases involving older adults increased 18-fold (from 61 to 1074) between 2009 and 2019. Compared to plant forms, other preparations had 51.24 times greater odds of appearing in 2018-2019 than in 2009-2011 (95% CI = 27.74-94.67), and synthetic cannabinoids/e-cigarettes had 2.19 times greater odds of appearing in 2014-2015 (95% CI = 1.64-2.93) but lower odds of appearing in 2016-2017 (RRR = 0.67, 95% CI = 0.50-0.89). Other preparations were positively associated with older age, adverse reactions, and suicide attempts but negatively associated with medical cannabis legal states. Synthetic cannabinoids/e-cigarettes were positively associated with being male, intentional misuse/abuse, and chronic use. Compared to plant forms, major medical outcomes/death were less likely among those who used other preparations (OR = 0.75, 95% CI = 0.56-0.99) but more likely among those who used synthetic cannabinoids/e-cigarettes (OR = 2.07, 95% CI = 1.60-2.66).

Conclusions: Although PCC cannabis cases involving older adults are relatively few, cases of other cannabis preparations than plant forms increased rapidly in recent years while cases of synthetic cannabinoids decreased. The rate of major medical outcomes also appears to be high.
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April 2021

Health Care Utilization Among Adults With CKD and Psychological Distress.

Kidney Med 2019 Jul-Aug;1(4):162-170. Epub 2019 Jul 13.

Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.

Rationale & Objective: Despite extensive research on health care access for individuals with chronic kidney disease (CKD), there is little research on the relationship between health care access barriers and psychological distress.

Study Design: An observational study based on the publicly available 2013 to 2017 US National Health Interview Survey data.

Setting & Participants: 3,923 respondents 18 years or older who self-reported a diagnosis of CKD in the preceding 12 months.

Predictors And Outcomes: Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Barriers to health care access included lack of health insurance coverage, lack of a usual source of health care, and financial barriers to accessing/obtaining health care, including medical specialist services, prescription drugs, mental health counseling, and dental care.

Analytical Approach: Multinomial logistic regression with 3 levels of K6 scores (no distress, mild to moderate distress, and serious distress) as the dependent variable.

Results: 15% of respondents reported mild to moderate and 11% reported serious psychological distress. Compared with those with no distress, those with mild to moderate and serious distress were younger but less likely to have worked in the preceding year, had more chronic medical conditions, and visited an emergency department more frequently. Multivariable regression models show that each financial barrier to health care access (likely due to lack of health insurance) was significantly associated with mild to moderate and serious distress.

Limitations: CKD diagnosis was self-reported and CKD stage was unknown. Because this is a cross-sectional study, associations cannot be assumed to imply causal relationships.

Conclusions: Access to sick and preventive/routine care should be improved. People with CKD should be assessed for psychological distress, treated as needed, and offered case management and social services to help them navigate the health care system and alleviate personal stressors.
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http://dx.doi.org/10.1016/j.xkme.2019.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380337PMC
July 2019

Acceptability and effects of tele-delivered behavioral activation for depression in low-income homebound older adults: in their own words.

Aging Ment Health 2020 Jul 22:1-8. Epub 2020 Jul 22.

Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. Debakey VA Medical Center, VA South Central Mental Illness Research, Education and Clinical Center, & Baylor College of Medicine, Houston, TX, USA.

Objectives: To examine experiences and perspectives of low-income homebound older adults ( = 90) who participated in tele-delivered behavioral activation (Tele-BA) treatment for depression by bachelor's-level lay counselors.

Methods: We used the 11-item Treatment Evaluation Inventory (TEI) to measure participants' acceptability of Tele-BA. We used inductive thematic analysis to explore participants' Tele-BA session goals and activities and unsolicited and solicited comments about their Tele-BA experience.

Results: Participant's TEI score averaged 70 out of maximum possible 77. The most frequently chosen Tele-BA goals were to improve self-care management of physical and mental health, engage in self-enrichment/self-enjoyment, improve living environment and daily routine, and to increase social connectedness. The themes that emerged from participants' comments about Tele-BA were: (1) benefits of psychoeducation; (2) importance of and gratitude for working with a counselor; (3) benefits of activity planning; (4) understanding of behavior and mood connection; (5) positive effects of increased activity on health and self-enjoyment; (6) sense of being productive and useful from accomplishing goals; (7) hope for the future; and (8) pride in tele-treatment.

Conclusion: Participants' comments show that Tele-BA aimed at reinforcing healthy behaviors that improve both physical functioning and mood is well aligned with these older adults' perception of what treatment should be. The findings also provide support for lay counselors' clinical capacity. Given geriatric mental health workforce shortages, lay counselors may be able to effectively supplement existing professional mental health service systems.
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http://dx.doi.org/10.1080/13607863.2020.1783516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7855933PMC
July 2020

Internet and Health Information Technology Use and Psychological Distress Among Older Adults With Self-Reported Vision Impairment: Case-Control Study.

J Med Internet Res 2020 06 3;22(6):e17294. Epub 2020 Jun 3.

Department of Emergency Medicine, Brown University, Providence, RI, United States.

Background: The number of older adults with vision impairment (VI) is growing. As health care services increasingly call for patients to use technology, it is important to examine internet/health information technology (HIT) use among older adults with VI.

Objective: This study aimed to examine (1) the rates of internet/HIT use among older adults with VI compared with a matched sample of their peers without VI, (2) associations of VI with internet/HIT use, and (3) association of HIT use with psychological distress, assessed with the Kessler-6 screen.

Methods: Data were obtained from the 2013 to 2018 US National Health Interview Survey. Older adults (aged ≥65 years) with self-reported VI were matched with older adults without VI, in a 1:1 ratio, based on age, sex, number of chronic medical conditions, and functional limitations (N=2866). Descriptive statistics and multivariable logistic regression models, with sociodemographic factors, health conditions, health insurance type, and health care service use as covariates, were used to examine the research questions.

Results: In total, 3.28% of older adults (compared with 0.84% of those aged 18-64 years) reported VI, and 25.7% of them were aged ≥85 years. Those with VI were significantly more socioeconomically disadvantaged than those without VI and less likely to use the internet (adjusted odds ratio [aOR] 0.64, 95% CI0.49-0.83) and HIT (aOR 0.74, 95% CI 0.56-0.97). However, among internet users, VI was not associated with HIT use. HIT use was associated with lower odds of mild/moderate or serious psychological distress (aOR 0.62, 95% CI 0.43-0.90), whereas VI was associated with greater odds of mild/moderate or serious distress (aOR 1.84, 95% CI 1.36-2.49). Health care provider contacts were also associated with higher odds of internet or HIT use.

Conclusions: Compared with their matched age peers without VI, older adults with VI are less likely to use HIT because they are less likely to use the internet. Socioeconomically disadvantaged older adults experiencing a digital divide need help to access information and communication technologies through a fee waiver or subsidy to cover internet equipment and subscription and ensure continuous connectivity. Older adults with VI who do not know how to use the internet/HIT but want to learn should be provided instruction, with special attention to accessibility features and adaptive devices. Older adults with a low income also need better access to preventive eye care and treatment of VI as well as other health care services.
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http://dx.doi.org/10.2196/17294DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301257PMC
June 2020

Prescription Pain Reliever Use and Misuse among Cannabis Users Aged 50+ Years.

Clin Gerontol 2021 Jan-Feb;44(1):53-65. Epub 2020 May 6.

Department of Emergency Medicine, Brown University Warren Alpert Medical School , Providence, RI, USA.

: To examine rates and correlates of dual cannabis and prescription pain reliever (PPNR) use and misuse among U.S. individuals aged 50+ who reported past-year cannabis use. : Using the 2015-2018 National Survey of Drug Use and Health, we examined cannabis nonuse/use and PPNR nonuse/use/misuse among all 35,229 respondents, and then focused on 2,632 past-year cannabis users to examine the risk of PPNR use but no misuse and the risk of PPNR misuse, compared to PPNR nonuse. : More than one-half of older cannabis users used PPNR in the past year. Multinomial logistic regression results show that the risks of PPNR use/no misuse and PPNR misuse were higher among those who had more chronic medical conditions and a major depressive episode. The risk of PPNR use/no misuse was also associated with high frequency and medical cannabis use. The risk of PPNR misuse was also associated with younger cannabis initiation age and cannabis and other illicit drug use disorders. : Correlates of dual cannabis and PPNR use/misuse among older adults are poor physical and mental health problems and problematic cannabis use. : Older adults with cannabis and PPNR misuse need access to evidence-based treatment, including medication-assisted treatment when needed.
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http://dx.doi.org/10.1080/07317115.2020.1757540DOI Listing
May 2020

Predictors of CNS-Active Medication Use and Polypharmacy Among Homebound Older Adults With Depression.

Psychiatr Serv 2020 08 28;71(8):847-850. Epub 2020 Apr 28.

Steve Hicks School of Social Work, University of Texas at Austin, Austin (Choi, Marti); Behavioral Health and Implementation Program, U.S. Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston (Kunik); Department of Psychiatry, Baylor College of Medicine, Houston (Kunik).

Objective: The authors assessed central nervous system (CNS) polypharmacy among low-income, racially diverse homebound older adults with depression (N=277) and its associations with the participants' ratings of depressive symptoms and pain.

Methods: CNS-active and other psychotropic and analgesic medications intake was collected from patients' medication containers. Depressive symptoms were assessed with the 24-item Hamilton Depression Rating Scale, and pain intensity was measured on an 11-point numerical rating scale. Covariates were disability (World Health Organization Disability Assessment Schedule 2.0) and perceived social support (Multidimensional Scale of Perceived Social Support).

Results: Of the patients, 16% engaged in CNS polypharmacy, taking three or more CNS-active medications. Of these, 69%, 69%, and 89% were using selective serotonin reuptake inhibitors, benzodiazepines, and opioids, respectively. Higher pain intensity ratings were associated with CNS polypharmacy. Benzodiazepine users were more likely than nonusers to use opioids.

Conclusions: Medication reviews and improved access to evidence-based psychotherapeutic treatments are needed for these older individuals with depression.
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http://dx.doi.org/10.1176/appi.ps.201900551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528951PMC
August 2020

Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50-64.

Int J Environ Res Public Health 2020 04 15;17(8). Epub 2020 Apr 15.

Brown University Warren Alpert Medical School, Department of Emergency Medicine, Providence, RI 02903, USA.

Lack of health insurance (HI) is a particular problem for near-older Americans aged 50-64 because they tend to have more chronic health conditions than younger age groups and are at increased risk of disability; however, little recent research has focused on HI coverage and healthcare access among this age group. Using the U.S. National Health Interview Survey data for the years 2013 to 2018, we compared HI coverage and healthcare access between the 50-64 and 65+ age groups. Using logistic regression analysis, we then examined the sociodemographic and health characteristics of past-year healthcare access of near-older Americans without HI to those with private HI or public HI (Medicare without Medicaid, Medicaid without Medicare, Medicare and Medicaid, and VA/military HI). We estimated the odds of healthcare access among those without HI compared to those with private or public HI. Near-older Americans without HI were at least seven times more likely to have postponed or foregone needed healthcare due to costs, and only 15% to 23% as likely to have had contact with any healthcare professional in the preceding 12 months. Expanding HI to near-older adults would increase healthcare access and likely result in reduced morbidity and mortality and higher quality of life for them.
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http://dx.doi.org/10.3390/ijerph17082711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215278PMC
April 2020

Measuring Social Engagement among Low-Income, Depressed Homebound Older Adults: Validation of the Social Engagement and Activities Questionnaire.

Clin Gerontol 2020 Apr 15:1-14. Epub 2020 Apr 15.

Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas, USA.

: To investigate the psychometric properties of the 10-item Social Engagement and Activities Questionnaire (SEAQ) to assess social-group, interpersonal interaction, and solitary activities among low-income, depressed homebound older adults (n = 269).: We used principal component analysis (PCA) to evaluate the underlying dimensions of the 10-item full SEAQ and a 6-item abbreviated item set. We assessed evidence of validity for the SEAQ by examining relationships between the SEAQ and older adults' clinical characteristics: perceived social support, disability, and depressive symptoms.: PCA results showed two components: (1) a general social-group activities engagement component; and (2) a low level of socialization (i.e., strong negative coefficients on the recreational activities and self-enrichment/educational activities and a negative coefficient for interpersonal interaction activities). The general social-group activities engagement component in both the full and abbreviated SEAQ were significantly positively correlated with the full and abbreviated SEAQ and perceived social support, providing evidence for convergent validity, and they were significantly negatively correlated with disability and depressive symptoms, providing evidence for discriminant validity.: The present study provides evidence of validity for the use of the SEAQ to assess social engagement and activities among low-income, depressed homebound older adults.: The SEAQ may be used in future studies measuring changes in social engagement and activities in these older adults.
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http://dx.doi.org/10.1080/07317115.2020.1753275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566275PMC
April 2020

Older-Adult Marijuana Users in Substance Use Treatment: Characteristics Associated with Treatment Completion.

J Psychoactive Drugs 2020 Jul-Aug;52(3):218-227. Epub 2020 Apr 7.

University of Texas at Austin Steve Hicks School of Social Work , Austin, TX, USA.

More older adults are using marijuana and receiving substance use treatment. We used the 2015-2017 Treatment Episode Data Set-Discharges (TEDS-D) to identify characteristics associated with treatment discharge among those aged 50+ whose admission involved marijuana use. Among these discharges ( = 130,287), 7.0% had been admitted for marijuana use only and 93.0% for polysubstance use (13.0% marijuana-primary, 57.7% marijuana-secondary, and 22.3% marijuana-tertiary), and the overall treatment completion rate was 45%. Using logistic regression, we examined associations of detoxification, residential rehabilitation, and outpatient treatment completion with type of marijuana and other substance involvement. Compared to marijuana-only cases, marijuana-tertiary cases had higher odds of completing detoxification (AOR = 1.54, 95% CI = 1.16-2.03), marijuana-secondary cases had higher odds of completing residential rehabilitation (AOR = 1.19, CI = 1.01-1.40), and all polysubstance cases had lower odds of completing outpatient treatment. Of the polysubstance cases, treatment completion odds were higher for those with alcohol problems but lower for those with other illicit drug problems. Previous treatment, referral source, psychiatric problems, first age of marijuana use, and racial/ethnic minority status were significant factors in treatment completion. Better strategies are needed to promote treatment retention and completion among older adults admitted for marijuana use problems, especially those who also have other illicit drug problems.
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http://dx.doi.org/10.1080/02791072.2020.1745966DOI Listing
April 2020

Improving Social Connectedness for Homebound Older Adults: Randomized Controlled Trial of Tele-Delivered Behavioral Activation Versus Tele-Delivered Friendly Visits.

Am J Geriatr Psychiatry 2020 07 2;28(7):698-708. Epub 2020 Mar 2.

Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Health (RP, CJS, MLB), Hanover, NH.

Objective: To test the acceptability and effectiveness of a lay-coach-facilitated, videoconferenced, short-term behavioral activation (Tele-BA) intervention for improving social connectedness among homebound older adults.

Methods: We employed a two-site, participant-randomized controlled trial with 89 older adults (averaging 74 years old) who were recipients of, and initially screened by, home-delivered meals programs. All participants reported loneliness; many reported being socially isolated and/or dissatisfaction with social support. Participants received five weekly videoconference sessions of either Tele-BA or Tele-FV (friendly visits; active control). Three primary outcomes were social interaction (Duke Social Support Index [DSSI] Social Interaction Subscale), subjective loneliness (PROMIS Social Isolation Scale), and DSSI Satisfaction with Social Support Subscale. Depression severity (PHQ-9) and disability (WHODAS 2.0) were secondary outcomes. Mixed-effects regression models were fit to evaluate outcomes at 6- and 12-weeks follow-up.

Results: Compared to Tele-FV participants, Tele-BA participants had greater increase in social interaction (t [81] = 2.42, p = 0.018) and satisfaction with social support (t [82] = 2.00, p = 0.049) and decrease in loneliness (t [81] = -3.08, p = 0.003), depression (t [82] = -3.46, p = 0.001), and disability (t [81] = -2.29, p = 0.025).

Conclusion: A short-term, lay-coach-facilitated Tele-BA is a promising intervention for the growing numbers of homebound older adults lacking social connectedness. The intervention holds promise for scalability in programs that already serve homebound older adults. More research is needed to solidify the clinical evidence base, cost-effectiveness and sustainability of Tele-BA delivered by lay coaches for homebound and other older adults.
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http://dx.doi.org/10.1016/j.jagp.2020.02.008DOI Listing
July 2020

Marijuana use/nonuse among those aged 50+: comparisons of use-to-nonuse, initiation/reinitiation, and continued use over 24 months.

Aging Ment Health 2021 06 2;25(6):1134-1142. Epub 2020 Mar 2.

University of Texas at Austin Steve Hicks School of Social Work, Austin, TX, USA.

Objectives: To examine: (1) correlates of use-to-nonuse (use 13-24 months ago, but no past-year use), initiation/reinitiation (no use 13-24 months ago, but past-year use), and continued use over a 24-month period; and (2) associations of past-year marijuana use disorder with use/nonuse among older adults.

Method: The 2015-2017 National Survey on Drug Use and Health provided data ( = 26,322 aged 50+). We used multinomial and binary logistic regression analyses to compare users-to-nonusers and initiators/reinitiators to continued users ( = 2304).

Results: In the 50-64 age group, 2.1% were users-to-nonusers, 2.2% initiators/reinitiators, and 7.2% continued users. In the 65+ age group, the corresponding percentages were 0.7%, 0.7%, and 2.4%. Residence in states with medical marijuana laws, nicotine dependence, and other illicit drug use were associated with a lower likelihood of use-to-nonuse than continued use. Alcohol use disorder was associated with a higher likelihood of initiation/reinitiation. Parole/probation status was associated with higher likelihood of use-to-nonuse. Moderate/great marijuana risk perceptions were associated with a higher likelihood of both use-to-nonuse and initiation/reinitiation. The odds of marijuana use disorder did not differ between continued users and initiators/reinitiators or between medical and recreational users.

Conclusion: Most older users continued using over 24 months. Substantial numbers had marijuana and other substance use problems that require treatment.
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http://dx.doi.org/10.1080/13607863.2020.1732292DOI Listing
June 2021

Felt Age Among Racial/Ethnic Minority Older Adults Attending a Senior Center.

J Appl Gerontol 2021 04 8;40(4):395-403. Epub 2020 Feb 8.

The University of Texas at Austin, USA.

Research shows that felt age among older adults is a good proxy for their current and future physical and mental health. Using both quantitative and qualitative interview data, we examined correlates of and self-reported reasons for felt age among 102 low-socioeconomic status (SES), non-Hispanic Black and Hispanic older adults who were members of a senior activity center. Fewer activities of daily living (ADL)/instrumental activities of daily living (IADL) impairments, more positive affect, and higher self-efficacy were associated with higher odds of feeling younger, while financial stress was associated with lower odds. The most common self-reported reasons for younger felt age were staying active, followed by good health, positive attitudes, exercise/dancing, independence, interpersonal/intimate relationships, faith/spirituality, volunteering, family, driving/traveling, and being of sound mind. Poor health, lack of energy, and limited ability to engage in activities were self-reported reasons for older felt age. Senior center programs that enable older adults to stay active and socially integrated may contribute to their well-being.
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http://dx.doi.org/10.1177/0733464820903906DOI Listing
April 2021

Physical Activity Frequency Among Older Adults With Diabetes or Prediabetes: Associations With Sociodemographics, Comorbidity, and Medical Advice.

J Aging Phys Act 2020 Jan 16:1-11. Epub 2020 Jan 16.

To examine the differences in physical activity (PA) between older adults with and without diabetes/prediabetes and the correlates of PA frequency and associations between medical advice on PA and/or diet/weight loss and increasing PA among those with diabetes/prediabetes. Multinomial and binary logistic regression models using 2016-2017 National Health Interview Survey data (N = 4,860 aged 65+ years with diabetes/prediabetes). About 44.2% of those with diabetes/prediabetes, compared with 48.1% of a matched sample without, engaged in any PA three plus times a week. The low PA group (PA frequency was zero to two times a week) was more socioeconomically disadvantaged and had more chronic illnesses than the medium (three to four times a week) or high (five plus times a week) PA groups. Any PA and/or diet/weight loss medical advice was associated with two to three times higher odds of increasing PA. Health care providers should consider prescribing PA and/or diet/weight loss for patients with diabetes/prediabetes.
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http://dx.doi.org/10.1123/japa.2019-0338DOI Listing
January 2020
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