Mental Health Treatment Use, Perceived Treatment Need, and Reasons for Non-Use Among U.S. Adults with Serious Suicidal Thoughts During the COVID-19 Pandemic.

Analyzing the 2021 National Survey on Drug Use and Health data with generalized linear models, we examined: (1) COVID pandemic-related and other correlates of mental health treatment use and unmet perceived treatment need among U.S. adults who experienced serious suicidal thoughts (N = 3,177); and (2) correlates of self-reported reasons for not receiving treatment. We found that 61% used any mental health treatment, and 48% of users and 37% of nonusers reported perceived treatment need. Significant correlates of treatment use were demographic factors, insurance, major depressive disorder, and illicit drug use disorder. Significant correlates of perceived treatment need were age 18-34, some college education, and major depressive episode. Perceived negative effect of the COVID pandemic on mental health was a significant factor for both treatment use and perceived need. The most frequent reasons for not getting treatment were the cost of treatment or lack of insurance and stigma-related concerns.

Suicide from intimate partner and other relationship conflicts: demographic and clinical correlates'.

BACKGROUND: A significant portion of suicides are precipitated by interpersonal relationship problems. AIMS: To examine demographic and clinical correlates of any intimate partner conflicts (IPC) and other interpersonal conflicts (OPC) as suicide precipitants. METHODS: We analyzed data on 92,805 (72,628 male; 20,177 female) adult suicide decedents from the 2017 to 2019 U.S. National Violent Death Reporting System, using multinomial and binary logistic regression models. We included case examples from coroners/medical examiner (CME) and law enforcement (LE) agency reports. RESULTS: Of all decedents, 23.6% had IPC and 8.0% had OPC as a suicide precipitant. Compared to those without any relationship conflict, those who had IPC or OPC were younger and more likely to have had previous suicide attempt(s), alcohol/other substance use problems, and job/finance/housing and legal problems. Compared to those with OPC, those with IPC were more likely to be male and Hispanic and had higher odds of previous suicide attempt, depression diagnosis, alcohol problems, and more acute crises. CME/LE reports showed distress of divorce/break-up, other life stressors, prior suicide attempt(s), alcohol/other substance involvement, and/or loss of family support. CONCLUSIONS: Access to behavioral health treatment for those at risk of suicide in the face of IPC or OPC is essential for suicide prevention.

Associations of Depression/Anxiety with Technology Use, Discontinued Use, and Nonuse in Older Adults.

OBJECTIVES: To examine correlates of the changes in technology use among older adults and the associations of depression/anxiety symptoms with technology use changes. METHODS: We used the 2019-2021 U.S. National Health and Aging Trends Study (N = 3,063; age 70+). We fitted multinomial logistic regression models to examine: (1) correlates of never use and discontinued use versus use of email/texting and the internet during the 3-year study period; and (2) associations of past-month depression/anxiety symptoms in 2021 with use and discontinued use versus never use of email/texting and social network site (SNS). RESULTS: The findings show age, socioeconomic, and health barriers to technology use. Email/texting and SNS use in 2021, compared to never use in all 3 years, was associated with a lower likelihood of moderate/severe depression/anxiety symptoms in 2021 (RRR = 0.54, 95% CI = 0.37-0.81 for email/texting use; RRR = 0.56, 95% CI = 0.33-0.97 for SNS use). Video calls with family/friends were not associated with depression/anxiety symptoms. CONCLUSIONS: The findings expand the existing knowledge base regarding potential impact of technology use on mental health beyond the early months of the COVID-19 pandemic. CLINICAL IMPLICATIONS: More concerted efforts are warranted to help older adults' technology uptake and continued use and to promote mental health benefits of technology use.

Healthcare Cost Burden and Self-Reported Frequency of Depressive/Anxious Feelings in Older Adults.

Using the 2018-2021 National Health Interview Survey data, we examined the associations between healthcare cost burden and depressive/anxious feelings in older adults. Nearly12% reported healthcare cost burden and 18% daily/weekly depressive/anxious feelings. Healthcare cost burden was higher among women, racial/ethnic minorities, those with chronic illnesses, mobility impairment, and those with Medicare Part D, but lower among individuals with Medicare-Medicaid dual eligibility, Medicare Advantage, VA/military insurance, and private insurance. Daily/weekly depressive/anxious feelings was higher among healthcare cost burden reporters. The COVID-19 pandemic-related medical care access problems were also associated with a higher risk of reporting healthcare cost burden and depression/anxiety.

Suicidal intent disclosure among adult suicide decedents: Four age group comparisons.

Research on who does/does not disclose suicidal intent (SI) and related factors has important implications for suicide risk management. In this paper based on the 2017-2019 National Violent Death Reporting System, we compared four age groups (18-24, 25-44, 45-64, and 65+ years) of suicide decedents with respect to associations between SI disclosure and (1) suicide contributing/precipitating factors, and (2) suicide means. The results shows that those age 18-44 were more likely to disclose SI than those age> =45, especially among those with relationship problems. Physical health problems and death/suicide of family/friend increased the likelihood of SI disclosure in the 65+ age group.

Changes in Older Adults' Frequency of Going Outside between 2020 and 2021: Associations with Health Status and Environmental Factors.

OBJECTIVES: To examine the changes in the frequency of going outside among U.S. older adults between 2020 and 2021 (post-COVID vaccine) and correlates of those changes. METHODS: We used the 2019-2021 National Health and Aging Trend Study (NHATS) (N = 3,063, age 70+) and multinomial logistic regression to analyze associations of increased and decreased frequencies in going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use as the independent variables. RESULTS: In 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency. CONCLUSIONS: Most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020. CLINICAL IMPLICATIONS: Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

Opioid poisoning cases aged 50+ in the 2015-2020 National Poisoning Data System: suspected suicides versus unintentional poisoning and other intentional misuse/abuse.

High rates of opioid overdose and suicide among the 50+ age group call for an examination of suicidal intent in overdose incidents. Using 2015-2020 National Poison Data System opioid poisoning cases aged 50+ (n = 83 153), we examined the types of opioids and other substances associated with suspected suicides compared to intentional misuse/abuse without suicidal intent. During the six years, prescription opioid cases decreased, while illicit opioid cases increased. Among both types of opioid poisoning cases, the proportions of suspected suicides decreased and those of intentional misuse/abuse without suicidal intent increased. However, due to the large increase in illicit opioid cases, the number of suspected suicide cases involving illicit opioids increased. Multivariable analyses showed that among prescription opioids, acetaminophen with opioid (IRR = 1.17, 95% CI = 1.11-1.24) and tramadol (IRR = 1.12, 95% CI = 1.06-1.47) were associated with higher risk of suspected suicides than intentional misuse/abuse without suicidal intent. Among illicit opioid cases, fentanyl poisoning cases were associated with lower risk of suspected suicides (IRR = 0.40, 95% CI = 0.17-0.94). Of other medications, use of benzodiazepines and antipsychotics was consistently associated with higher risk of suspected suicides in both prescription and illicit opioid cases. Alcohol and cocaine were also associated with higher risk of suspected suicide. Along with continued reductions in opioid prescribing, more effective monitoring of individual patient misuse/abuse behaviors and suicide risk assessment are needed. Healthcare professionals should also review other prescription medications frequently co-prescribed with opioids that may have additive effects on suicidal behaviors among older adults.

Cannabis and binge alcohol use among older individuals with major depressive episode.

Background: Research shows significant associations of major depression with cannabis and binge alcohol use. However, despite increasing cannabis and binge alcohol use rates among the 50+ age group, research on this age group is scant. Methods: We used the 2015-2019 National Survey on Drug Use and Health data (n = 44,007 age 50+) and multinomial logistic regression models to examine associations of a major depressive episode (MDE) with cannabis and binge alcohol use and co-use and associations of binge alcohol use with nonmedical and medical cannabis use. Results: Of individuals age 50+, 89.6% had no history of MDE, 5.7% had prior-to-past-year MDE, and 4.7% had past-year MDE. The rates of past-month cannabis use were 4.3%, 7.7%, and 11.6% and binge alcohol use were 17.3%, 18.7%, and 19.9% among those with no MDE history, prior-to-past-year MDE, and past-year MDE, respectively. Compared to no MDE history, prior-to-past-year MDE (RRR = 1.70, 95% CI = 1.30-2.23) and past-year MDE (RRR = 1.80, 95% CI = 1.27-2.55) were significantly associated with past-month cannabis use (with or without binge alcohol use). However, MDE status was not associated with past-month binge alcohol use. Among cannabis users, binge alcohol use was significantly associated with nonmedical cannabis use only (RRR = 2.50, 95% CI = 1.95-3.21). Users of cannabis and/or binge alcohol also had a higher likelihood of using tobacco products and illicit drugs. Conclusions: Healthcare professionals treating individuals age 50+ with depression should screen for substance use, provide education on the potential adverse effects of polysubstance use, and help them access treatment for co-occurring depression and substance use problems.

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

Objectives: 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. Methods: 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. Results: 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. Conclusions: Correlates of dual cannabis and PPNR use/misuse among older adults are poor physical and mental health problems and problematic cannabis use. Clinical Implications: Older adults with cannabis and PPNR misuse need access to evidence-based treatment, including medication-assisted treatment when needed.

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

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.

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

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.

Poisoning deaths among late-middle aged and older adults: comparison between suicides and deaths of undetermined intent.

BACKGROUND: Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+. METHODS: Data were from the 2005-2015 US National Violent Death Reporting System (N = 15,453). χ2 tests and multinomial logistic regression models were used to compare three groups of decedents: suicide decedent who left a suicide note, suicide decedent who did not leave a note, and UnD cases. RESULTS: Compared to suicide decedents without a note (37.7% of the sample), those with a note (29.4%) were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases (32.9%) were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR = 2.65, 95% CI = 2.42-2.90) and cocaine (RRR = 2.59, 95% CI = 2.09-3.21) positive but less likely to be antidepressant positive. Blacks were more than twice as likely as non-Hispanic Whites to be UnDs. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar. CONCLUSIONS: Many UnDs may be more correctly classified as unintentional overdose deaths. Along with more accurate determination processes for intent/manner of death, substance use treatment and approaches to curbing opioid and other drug use problems are needed to prevent intentional and unintentional poisoning deaths.

Fall-related emergency department visits and hospitalizations among community-dwelling older adults: examination of health problems and injury characteristics.

BACKGROUND: Fall injuries and related healthcare use among older adults are increasing in the United States. This study examined chronic illnesses, sensory and memory problems, and injury characteristics that were associated with ED visits and hospitalizations among older adults who received medical attention for fall injuries within a 91-day reference period. METHODS: Data were from the publicly available 2013-2017 US National Health Interview Survey files (unweighted N = 1840 respondents aged > 60 years with fall injuries). We first described socioeconomic, health/mental health, healthcare utilization, and injury characteristics among three groups: those who neither visited an ED nor were hospitalized for their fall injury, those who visited an ED only, and those who were hospitalized. Then, using multinomial logistic regression analysis, we examined associations of healthcare utilization (ED visit only and hospitalization vs. no ED visit/hospitalization) with chronic illnesses, other health problems, and injury characteristics, controlling for socioeconomic factors. RESULTS: Of older adults who received medical attention for fall injuries, a little more than one-third had an ED visit only and a little less than a fifth had an overnight hospital stay. Multivariable analysis showed that lung disease and memory problems were associated with higher risk of ED visit only; hip and head injuries, facial injuries, and broken bones/fractures (from any type of injury) were more likely to result in hospitalization than other injuries. Fall injuries sustained inside the home, falls from loss of balance/dizziness, and living alone were also more likely to result in hospitalization. CONCLUSIONS: These healthcare utilization findings indicate the significant toll that fall injuries exact on older adults and healthcare systems. Fall prevention should target risk factors that are specific to serious injuries requiring costly care. Strategies for implementing scalable, adaptable, and measurable fall prevention models by primary care and emergency medical service providers and ED staff are needed.

Adults who misuse opioids: Substance abuse treatment use and perceived treatment need.

Background: Opioid use disorder (OUD) and overdose deaths among the US population continue to increase. This study examined associations of OUD and other substance use disorders with substance abuse treatment use and perceived treatment need among US adults aged 18+ who misused opioids. Methods: The 2015-2016 National Survey on Drug Use and Health provided data (n = 5100 respondents who misused opioids in the past year). We used multivariable logistic regression models to examine associations of opioid and other substance use disorders with treatment use and perceived treatment need, adjusting for sociodemographic and health statuses. Results: The data showed that 4.7% of adults misused opioids and 19.1% of those who misused had an OUD. Of those with an OUD, only 31.5% had received substance abuse treatment in the past year and 13.6% perceived the need for such treatment. Of those with an OUD, heroin use disorder (adjusted odds ratio [AOR] = 2.59, 95% confidence interval [CI] = 1.59-4.23) and having been arrested/booked (AOR = 1.98, 95% CI = 1.18-3.33) were associated with higher odds of receiving treatment, whereas lack of health insurance (AOR = 0.49, 95% CI = 0.25-0.94) was associated with lower odds. Heroin use disorder (AOR = 2.16, 95% CI = 1.23-3.83) and higher mental health impairment scores (AOR = 1.05, 95% CI = 1.01-1.09) were associated with higher odds of perceived treatment need. Conclusions: The overall low socioeconomic status and high rates of polysubstance use disorders among those with OUD indicate that they need financial and other help to access treatment and relapse prevention services. The very low rates of perceived treatment need also point to the need for strategies to increase individuals' recognition of their need for treatment.

Older adults' marijuana use, injuries, and emergency department visits.

BACKGROUND: Despite increasing marijuana use among older adults, little research has been done on marijuana's effects on their healthcare use. OBJECTIVES: To examine whether (1) marijuana use is associated with the likelihood of emergency department (ED) visits through increased injury risk, and (2) marijuana use patterns are associated with injury risk and ED visits among older adults. METHODS: Using the 2012-2013 National Epidemiologic Survey on Alcohol and Related Problems (N = 14,715 aged 50+; 6,379 men and 8,336 women), descriptive statistics were used to compare past-year marijuana users to nonusers on sociodemographic and physical/mental health characteristics. Structural equation modeling was used to simultaneously estimate whether injury mediates past-year marijuana use's association with ED visits. Logistic regression analysis was used to examine associations of marijuana use patterns with injury and ED visits. RESULTS: Past-year injury rates were 18.9% for nonusers and 28.8% for users (3.9% of the 50+ age group), and past-year ED visit rates were 23.5% for nonusers and 30.9% for users (p < .001). Logistic regression models showed that marijuana use was associated with injury (OR = 1.48, 95% CI = 1.18-1.85), and injury was associated with ED visits (OR = 6.14, 95% CI = 1.70-1.93). Mediation analysis found significant indirect effect (z = 2.86, p = .004) and direct effect not significantly differing from zero (OR = 1.16, 95% CI = 0.90-1.50), indicating that marijuana use increases the likelihood of ED visits through increased injury risk. Marijuana use patterns were not associated with injuries or ED visits. CONCLUSIONS: Healthcare providers should screen for marijuana and other substance use among older adults and provide education about associated injury risks.

Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years.

BACKGROUND: Given growing numbers of older adults with mental and substance use disorders (MSUDs), this study examined the association between ten types of adverse childhood experiences (ACEs) and lifetime MSUDs among those aged 50+. METHODS: Data (N = 14,738 for the 50+ age group) came from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions. Using multivariable binary logistic regression analyses, we examined relationships between ten ACEs and six lifetime MSUDs (major depressive disorder (MDD) and anxiety, post-traumatic stress, alcohol use, drug use, and nicotine use disorders). Gender differences were examined using tests of interaction effects and gender-separate logistic regression models. RESULTS: Of the sample, 53.2% of women and 50.0% of men reported at least one ACE. For both genders, parental/other adult's substance abuse was the most prevalent (22.6%), followed by physical abuse, and emotional neglect. Child abuse and neglect and parental/other adult's mental illness and substance abuse had small but consistently significant associations with MSUDs (e.g., odds ratio = 1.28, 95% CI = 1.12-1.46 for parental/other adult's substance misuse and MDD). Although the relationship between total number of ACEs and MSUDs was cumulative for both men and women, the associations of physical abuse, sexual abuse, emotional neglect, and parental separation/divorce with MSUDs were stronger among men. CONCLUSIONS: This study underscores the significant yet modest association between ACEs and lifetime MSUDs in late life. More research is needed to investigate why ACEs seem to have greater effects on older men and to discern the sources of gender differences in ACEs' effects.

Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept.

Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine.

Relationship between marijuana and other illicit drug use and depression/suicidal thoughts among late middle-aged and older adults.

BACKGROUND: Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA. METHODS: The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts. RESULTS: Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17-2.03), 2.75 (95% CI = 1.75-4.33), and 2.12 (95% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE. CONCLUSIONS: Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults.

Nonsuicidal self-injury and suicide attempts among ED patients older than 50 years: comparison of risk factors and ED visit outcomes.

BACKGROUND: Although the number of older adults who engage in nonsuicidal self-injury (NSSI) is not insignificant, research on older adults' NSSI is scant. The current study examined the prevalence and characteristics of NSSI compared to suicide attempt (SA) in adults older than 50 years who were seen at Emergency Departments (EDs) and their ED visit outcomes. METHODS: Data came from the 2012 Nationwide Emergency Department Sample. We used binary logistic regression analysis to examine demographic and clinical characteristics of NSSI versus SA among 67,069 visits with a diagnosis of either SA or NSSI, and multinomial logistic regression analysis to examine associations between NSSI versus SA and ED outcomes. RESULTS: Of self-inflicted intentional injuries, 76.89% were SA and 23.11% were NSSI. Visits for NSSI were associated with lower levels of psychiatric disorders and alcohol use disorders than SA and were more likely than SA visits to occur among older age groups (65-74 and 75+), females, and those with multiple injuries and drug use disorders. NSSI visits were also associated with greater risks of hospital admission (relative risk ratio [RRR]=1.45, 95% CI=1.36-1.54) and death (RRR=18.64, 95% CI=14.19-24.49), as opposed to treat-and-release, but lower risks of facility transfer/discharge with home health care (RRR=0.77, 95% CI=0.72-0.83). CONCLUSIONS: The findings of higher hospitalization and death rates among those with NSSI than SA show how lethal intentional self-destructive behaviors in late life can be even if they are not classified as suicide attempts. The need for mental health and substance abuse treatment is discussed.

Sociodemographic Characteristics and Health Status of Lifetime Abstainers, Ex-Drinkers, Bingers, and Nonbingers Among Baby Boomers and Older Adults.

BACKGROUND: Health risks associated with abstention from alcohol drinking in previous studies may have been exaggerated because the pool of abstainers in many studies included both lifetime abstainers and ex-drinkers, including sick-quitters. OBJECTIVES: This study compared sociodemographic and health statuses among lifetime abstainers, exdrinkers, bingers, and nonbingers in the 50-64 age group (baby boomers) and the 65+ age group. METHODS: Data are from the 2008 to 2012 National Survey on Drug Use and Health (N = 18,443 for the 50-64 age group and N = 11,191 for the 65+ age group). Descriptive statistics and multinomial and binary logistic regression analyses were used to examine the study questions. RESULTS: 10% of the 50-64 age group and 20% of the 65+ age group reported lifetime abstention, and 21% and 28% of each group, respectively, reported being ex-drinkers (i.e., last used alcohol more than 12 months ago). In both age groups, lifetime abstainers, exdrinkers, and bingers had lower socioeconomic status than nonbingers. In the 50-64 age group, lifetime abstainers did not differ from or were less likely than nonbingers to have vascular and hepatic/gastrointestinal (HGI) disorders, but exdrinkers were more likely to have these diseases, and both lifetime abstainers and exdrinkers were more likely to have diabetes. In the 65+ age group, lifetime abstainers did not differ from nonbingers on high blood pressure, heart disease, and HGI, but both they and the exdrinkers were more likely to have stroke and diabetes. CONCLUSIONS/IMPORTANCE: Diabetes screening/monitoring and stroke prevention/care are recommended for both age groups of abstainers and exdrinkers.