# Presentation: 466934

## Use of Medications, Alcohol, and Smoking in Elderly Japanese-American Men in Hawaii

- A Report From the Honolulu-Asia Aging Study (HAAS)
- Lon White
- Pacific Health Research Institute and the Kuakini Medical Center.
- September 2004

## Honolulu-Asia Aging Study

- An ongoing longitudinal study of older Japanese-American men, focused largely on pathogeneses of Alzheimer’s disease, Parkinson’s disease, related degenerative brain diseases, cerebrovascular disease, and brain aging.

## Honolulu-Asia Aging Studystaff and key collaborators

***Honolulu***:    **L White,  H Petrovitch, GW Ross,  K Masaki,                    ****	**** R Abbott,  J Hardman,  J  Uyehara-ock,  J Nelson,  ****	****	****and :  clinic team, “A” team,  ****	****histopathology, ****	****	****	****genetics****, ****and  administration.**
***NIA  ***  **L Launer, R Peila, D Foley.**
***Kentucky  ***  **Wm Markesbery, D Davis.**
***NIOSH/Morgantown  ***  **J O’Callaghan,  D Miller, **
**           ****C Burchfiel, D Sharp**.
***USC***    **C Zarow, H Chui **

## THE HONOLULU HEART PROGRAMSERIAL EXAMINATIONS

**	****EXAMS**

**YEAR**

**N**

**	****Exam I**

**1965-68**

**8006**

**	****Exam II**

**1968-70**

**7498**

**	****Lipo I**

**1970-72**

**2780**

**	****Exam III**

**1971-74**

**6860**

**	****Lipo II**

**1975-78**

**2386**

**	****Lipo III**

**1980-82**

**1965**

**	****Mail Quest.**

**1988**

**4664**

## Slide 5

## HONOLULU-ASIA AGING STUDY EXAMINATION CYCLES

- exam                     YEAR               age range                         N
- HHP/HAAS 4	   1991-93    71-93yr          3741
- HHP/HAAS 5    1994-96	   74-95	       2705
- HHP/HAAS 6    1997-99	   77-98             1991
- HHP/HAAS 7    1999-00    79-100           1523
- HHP/HAAS 8    2001-03    81-103           1200
- HHP/HAAS 9    2004-        83+                  ?

## How many prescription meds do these men take?

- Based on data from the baseline HAAS exam, 1991-93.
- Limited to 3413 men with normal cognitive functioning.
- Based on examining bottles and pills, and on answers to questions.

## % of men using 0-7 different meds

## % of HAAS men aged 71-74according to # of meds used

## % of HAAS men aged 75-84according to # of meds used

## % of HAAS men aged 85-93according to # of meds used 

## What were the most commonly prescribed meds?

- For hypertension and/or cardiovascular disease (used by more than 50% of men)
- Aspirin, NSAIDS, Tylenol
- Meds for asthma, chronic lung disease
- laxatives

## PERCENT  of HAAS men using Psychoactive meds (1999,  n=1383)

- SSRI antidepressants		1.2 %
- Other antidepressants		0.7 %
- Ambien					0.4 %
- Benzodiazepine			1.2 %
- Other sedative 			0.3 %
- Neuroleptic 				0.2 %
- Trazodone				0.1%
-  ***total******	******	******	******	******	******4.2%***

## Use of psychoactive meds

**3.9% of men used one **
**0.4% (5/1375)  used two**
**2 used a  benzodiazepine + a sedative**
**1 used an SSRI antidepr + a tricyclic **
**1 used an SSRI antidepr + another antidep. **
**1 used an SSRI antidepr + benzodiazepine **
**Only 8 men were taking an opiate, and none were taking a second psychoactive med**

## Is there evidence of abuse or overuse of prescription or OTC meds in the HAAS cohort?

***NO***

## Is there evidence of excessive intake of alcohol, or of smoking?

***YES***

## ACQUISITION OF INFORMATION

- Alcohol – self report:  frequency and size --  units of beer, saki, wine, and liquor;  oz/mo of alcohol calculated 1965, ‘71, ‘87, and ’91
- Cigarettes – self report:  ever/never/now cigs/day, with pack-years calc. 1965, ’71, ’87, and ‘91

## % of HAAS men in 7 strata of alcohol intake(N=3268;   aged 71-93;   1991-93)

## % of HAAS men reporting high monthly alcohol intake, 1965 data

## % of HAAS men reporting high monthly alcohol intake, 1971 data

## % of HAAS men reporting high monthly alcohol intake, 1987 data

## % of HAAS men reporting high monthly alcohol intake, 1991 data

## % OF MEN RECEIVING ANTIDEPRESSANT MEDS ACCORDING TO LEVEL OF DEPRESSIVE SYMPTOMS 

## Predictors and correlates of alcohol intake among HAAS men who reported any consumption

**Older age (inverse  p<0.0001)**
**Education (inverse p<0.0001) **
**HDL-cholesterol level (direct p<0.001)**
**Smoking (pack years, direct   p<0.0001)**
**Depressive symptoms (direct  p<.05)**
**# of persons available when lonely (inverse  p<0.05)**
**# of children (direct p<0.01)**
**Widowed, divorced, or never married (p=0.004)**

## Factors NOT significantly associated with alcohol intake among HAAS men who reported any consumption

- obesity
- Heart disease or stroke
- Poor cognitive test scores
- # of relatives seen /month
- # of Rx meds

## Heavy alcohol drinking in elderly Japanese-American men

**It does occur, and high intake is associated with specific risk factors.**
**The decrease with advanced age is modest.**
**The % of men consuming >60 ounces of alcohol / month  remains at 1-4% even among men in their 80s.**

## late-life heavy drinkers – 4 types

**  “****new”  late-life heavy drinker**
**  “****established”  late-life heavy drinker**
**  “****recidivist”  late-life heavy drinker**
**   ****Life-long heavy drinker**

## “NEW”   late-life heavy drinker

**           ****< 10  oz /mo in 1965**
**             ****< 10  oz/mo in 1971**
**             ****< 10  oz/mo in 1987**
**              ****> 60  oz/mo in 1991**

## “established”   late-life heavy drinker

**              ****< 10 oz/mo in 1965**
**              ****< 10 oz/mo in 1971**
**            ****> 10 oz/mo in 1987**
**               ****> 60 oz/mo in 1991**

## “recidivist” late-life heavy drinker

***        ******> 10 oz/mo in either 1965 or 1971***
***      ******< 10 oz/mo in 1987***
**      ****> 60 oz/mo in 1991**

## WHO ARE THESE GUYS?    WHY ARE THEY DRINKING SO MUCH?   IS IT REALLY BAD FOR THEM?

## “lifelong” late-life heavy drinker

***        ******> 10 oz/mo in either 1965 or 1971***
***      ******> 10 oz/mo in 1987***
**      ****> 60 oz/mo in 1991**

## late-life heavy drinkers – 4 types

**                                                                     ****N       %**
**     *****new***** late-life heavy drinker                  88      3.9**
**     *****established ***** late-life heavy drinker     26      0.8**
**     *****recidivist*****  late-life heavy drinker        70       2.5**
**     *****life-long*****  heavy drinker                       71       2.5**

## new and established late-life heavy drinking  -- risk factors

- Depressive symptomatology (CES-D 11)
- Widowed, divorced, or never married
- Greater number of children

## Recidivist and life-long late life heavy drinkers – risk factors

- Level and consistency of drinking during middle life
- Lifetime smoking
- High hdl-C

## Did late-life heavy drinking have a significant impact on survival?

*“**new” late-life heavy drinkers:        NO *
*“**established” late-life drinkers:       N0*
*“**recidivist” late-life drinkers:         YES*
*	**OR 2.6 (1.45-4.63) for death within 10 yrs**
*Life long drinkers:         MARGINAL*
*	**OR 1.5 (0.91-2.63) for death within 10 yrs**
****controlling for age, heart disease, stroke, cognitive test score, smoking (packyears), midlife blood pressure, midlife and latelife BMI, midlife and late life cholesterol, diabetes/blood glucose, and HDL.** *

## Does late life alcohol intake cause dementia?

- Only rarely.
- In this cohort, late life EthOH intake is not a risk factor for cognitive test scores, or for decline, or for prevalent or incident dementia.
- Also not associated with lesions of Alzheimer’s disease, Parkinson’s disease, or for aging-related atrophy.

## Heavy drinking in late life -- conclusions

**It occurs often enough to be an important public health matter.**
**There appear to be definable subgroups having different pathogeneses, implying a need for different case-finding and intervention strategies.**

## Heavy drinking and smoking in late life

**                       ****%  smoking ------- never   past  current**
**New drinkers                              12       81       7**
**Established drinkers                     8       77     15**
**Recidivist drinkers                       7        80     13**
**Lifelong drinkers                        16       67     17**
** ****other and non-drinkers             40       54       6**

## Slide 40