Biopsychosocial factors and health outcomes associated with cannabis, opioids and benzodiazepines use among older veterans.

Background: Older Veterans may experience injuries that result in chronic pain and mental health conditions. Given the increasing availability of medical cannabis, it is important to examine if it serves as a viable or undesirable form of care relative to existing approaches.Objectives: We compared cannabis, prescription opioids, and benzodiazepines use between older Veteran and non-Veterans, and identified outcomes of cannabis use among Veterans. Because of the physical and mental conditions experienced by older Veterans we expected Veterans to report higher use of opioids and benzodiazepines compared to non-Veterans.Methods: We collected surveys from individuals aged 60 and older enrolled in the Illinois Medical Cannabis Patient Program and conducted logistic regression to identify factors associated with cannabis, opioids and benzodiazepines use between Veterans (N = 514, 90.2% male) and Non-Veterans (N = 2758, 41.1% male) across biopsychosocial factors.Results: Both groups reported similar levels of pain, quality of life, social satisfaction, and sleep quality. Veterans were more likely to use cannabis for mental health conditions (p = <.001) while they reported lower use for pain-related conditions (p = <.001) than non-Veterans. Veterans were less likely to use opioids (p = .013) and benzodiazepines (p < .01) compared to non-Veterans. Veterans also reported desirable health outcomes of cannabis use for pain, sleep quality, health conditions, and quality of life.Conclusions: Our work provides insights for clinicians and policy makers to consider whether cannabis can be a viable option to reduce or replace opioid and benzodiazepine use by older Veterans with chronic physical and mental health conditions.

Use of cannabis and opioids for chronic pain by older adults: Distinguishing clinical and contextual influences.

INTRODUCTION AND AIMS: Chronic pain is one of the most common health-related conditions experienced by Americans over the age of 65. In this study, we examine the intersection between pain, opioids and cannabis use among older adults in Colorado and Illinois and examine how medical needs and other variables associated with a persons' background and attitudes influence choices concerning the use of opioids and cannabis to treat pain. DESIGN AND METHODS: Data were collected via a survey about cannabis and opioids use, and questions related to individual need factors (e.g. pain, quality of life) and contextual factors (e.g. sex, finances, personal attitudes, interaction with physicians) were included in this study. We built a logistic regression model to evaluate factors associated with drug use and a multinomial regression model to understand factors that influence drug choices between cannabis and opioids. RESULTS: A total of 436 individuals completed the survey; 62 used opioids only, 71 cannabis only and 72 used both. When comparing drug users to non-drug users, pain was significantly associated with using cannabis and/or opioids when controlling for other covariates. However, when we compared cannabis users to opioid users, pain was no longer a determining factor. Instead, other contextual factors such as sex, personal beliefs and physician attitudes influenced an individual's choice between cannabis or opioids. DISCUSSION AND CONCLUSIONS: This study showed that contextual factors appear to have more influence on an individual's decision to use cannabis as an alternative to opioids than individual need or characteristics.

The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative?

Cannabis use among older Americans is increasing. Although much of this growth has been attributed to the entry of a more tolerant baby boom cohort into older age, recent evidence suggests the pathways to cannabis are more complex. Some older persons have responded to changing social and legal environments and are increasingly likely to take cannabis recreationally. Other older persons are experiencing age-related health care needs, and some take cannabis for symptom management, as recommended by a medical doctor. Whether these pathways to recreational and medical cannabis are separate or somewhat tangled remains largely unknown. There have been few studies examining cannabis use among the growing population of Americans aged 65 and older. In this essay, we illuminate what is known about the intersection between cannabis and the aging American population. We review trends concerning cannabis use and apply the age-period-cohort paradigm to explicate varied pathways and outcomes. Then, after considering the public health problems posed by those who misuse or abuse cannabis, we turn our attention to how cannabis may be a viable policy alternative in terms of supporting the health and well-being of a substantial number of aging Americans. On the one hand, cannabis may be an effective substitute for prescription opioids and other misused medications; on the other hand, cannabis has emerged as an alternative for the undertreatment of pain at the end of life. As intriguing as these alternatives may be, policy makers must first address the need for empirically driven, representative research to advance the discourse.

The Academy Is Aging in Place: Assessing Alternatives for Modifying Institutions of Higher Education.

Institutions of higher education employ a greater proportion of persons over 65 relative to the general labor force, and the median age of the professorate has now surpassed all other occupational groups. Such a novel demographic change in the academic workforce presents several unique challenges. Should institutions modify policies and programs that provide more opportunities for aging faculty to remain healthy and productive, or should efforts focus on facilitating retirement? How universities and colleges choose to retain or retire their aging faculty certainly has become a point for consideration. This forum presents what is known about the aging academic workforce and describes current institutional responses. The discussion then builds on the notion of aging in place, presenting a more holistic approach to the modification of institutional policies and programs that support continued faculty engagement as well as mutually agreeable retirements. In particular, institutions should consider making modifications that increase targeted health and wellness programs, expand retirement counseling services, and offer varied retirement pathway options as viable responses to the continued aging of the academic workforce.

Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries.

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine. METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample. RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period. CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

A longitudinal study of chiropractic use among older adults in the United States.

BACKGROUND: Longitudinal patterns of chiropractic use in the United States, particularly among Medicare beneficiaries, are not well documented. Using a nationally representative sample of older Medicare beneficiaries we describe the use of chiropractic over fifteen years, and classify chiropractic users by annual visit volume. We assess the characteristics that are associated with chiropractic use versus nonuse, as well as between different levels of use. METHODS: We analyzed data from two linked sources: the baseline (1993-1994) interview responses of 5,510 self-respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD), and their Medicare claims from 1993 to 2007. Binomial logistic regression was used to identify factors associated with chiropractic use versus nonuse, and conditional upon use, to identify factors associated with high volume relative to lower volume use. RESULTS: There were 806 users of chiropractic in the AHEAD sample yielding a full period prevalence for 1993-2007 of 14.6%. Average annual prevalence between 1993 and 2007 was 4.8% with a range from 4.1% to 5.4%. Approximately 42% of the users consumed chiropractic services only in a single calendar year while 38% used chiropractic in three or more calendar years. Chiropractic users were more likely to be women, white, overweight, have pain, have multiple comorbid conditions, better self-rated health, access to transportation, higher physician utilization levels, live in the Midwest, and live in an area with fewer physicians per capita. Among chiropractic users, 16% had at least one year in which they exceeded Medicare's "soft cap" of 12 visits per calendar year. These over-the-cap users were more likely to have arthritis and mobility limitations, but were less likely to have a high school education. Additionally, these over-the-cap individuals accounted for 58% of total chiropractic claim volume. High volume users saw chiropractors the most among all types of providers, even more than family practice and internal medicine combined. CONCLUSION: There is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".