Pain, Depression and Alcohol Use in Later Life

描述（由申请人提供）：持续的，新的和新的饮酒问题是许多成年人在中老年生活中的重要健康问题。晚年的身体健康变化，如疼痛增加，可能在这些问题的发展和维持中发挥重要作用，但几乎没有研究集中在疼痛和晚年饮酒之间的关系上。在基于经验的概念模型的指导下，拟议的研究将需要对两个现有的纵向数据集（酒精和老龄化，n=1,231；健康和退休研究，n=6,121）进行二次分析，这些数据集由初步评估时55-65岁的个人的调查数据组成，这些人分别在未来10年和8年的多个时间点上重新进行了相应的调查项目。其主要目标是：(a)确定中老年个体的疼痛和酒精使用之间的潜在关系，(b)阐明抑郁症状在这种关系中的中介作用，以及(c)确定关键个人特征（性别、种族、年龄、终生饮酒问题史、回避应对）和生活环境因素（压力源和社会资源）在疼痛、抑郁症状和饮酒结果之间的关系中的调节作用。此外，分析将(d)确定疼痛升高、抑郁症状和危险饮酒是否最终导致老年人较差的健康相关结果，以及(e)在中老年基线评估时已知的终生饮酒问题史是否预示着未来8至10年更多的疼痛和更多的疼痛负面后果。为了实现这些目标，分析将首先侧重于使用源自经典测试和项目反应理论的统计程序，然后是并发效度和预测效度测试，以确定两个关键测量的心理测量特性：疼痛，通过参与者疼痛医疗状况的数量和慢性来评估，以及酒精-药物不良相互作用的风险，通过参与者的酒精消费和药物使用信息来计算。接下来，目标将通过使用适合纵向数据分析的多层次统计方法来实现，包括多层次回归、潜在转移、离散时间生存分析和结构方程建模。这些分析的结果将为该领域未来的初步研究提供基础，并将对改善老年人的医疗保健产生影响。具体来说，它们将帮助卫生保健提供者确定哪些出现疼痛的老年患者可能会增加随后不良饮酒和相关健康结果的风险。此外，他们将为卫生保健提供者强调饮酒史和当前饮酒问题对预测老年患者疼痛症状的发展和过程的相关性。公共卫生相关性：研究结果将通过帮助临床医生确定哪些以疼痛为表现的老年患者可能有较高的随后不良饮酒和相关健康结果的风险，从而有助于公共卫生。此外，他们将为临床医生强调当前和终生饮酒史对预测以后生活中疼痛症状的程度和过程的相关性。这一信息应鼓励卫生保健提供者在向老年患者提供卫生保健时更好地将疼痛评估和治疗与更详细的酒精筛查结合起来。

DESCRIPTION (provided by applicant): Persisting, new, and renewed drinking problems are a significant health issue for many adults in mid- to late life. Physical health changes in later life, such as increased pain, may play an important role in the development and maintenance of these problems, but almost no research has focused on the relationship between pain and use of alcohol in later life. Guided by an empirically-based conceptual model, the proposed research will entail secondary analyses of two existing longitudinal datasets (Alcohol and Aging, n=1,231; and Health and Retirement Study, n=6,121) comprised of survey data from individuals age 55-65 at initial assessment who were readministered commensurate survey items over multiple time-points for the next 10 and 8 years, respectively. Its main objectives are to: (a) determine prospective relationships between pain and alcohol use among individuals in mid- to late-life, (b) elucidate the mediating role of depressive symptoms in this relationship, and (c) ascertain the moderating roles of key personal characteristics (gender, race, age, lifetime history of drinking problems, avoidance coping) and life context factors (stressors and social resources) on relationships among pain, depressive symptoms, and drinking outcomes. In addition, analyses will (d) determine whether elevated pain, depressive symptoms, and hazardous drinking culminate in poorer health related outcomes for older adults, and (e) whether a lifetime history of drinking problems, known at baseline assessment in late-middle-age, foreshadows more pain, and more negative consequences of pain, over the next 8 to 10 years. To meet these objectives, analyses will first focus on use of statistical procedures derived from classical test and item response theory, followed by tests of concurrent and predictive validity, to determine the psychometric properties of two key measures: pain, as assessed by number and chronicity of participants' painful medical conditions, and risk of adverse alcohol-medication interactions, as calculated from information about participants' alcohol consumption and medication use. Next, objectives will be met through use of multilevel statistical methods appropriate for analysis of longitudinal data, including multilevel regression, latent transition, discrete-time survival analyses, and structural equation modeling. Results of these analyses will provide the foundation for future primary research in this area and will have implications for improved healthcare for older adults. Specifically, they will help health care providers identify which of their older patients presenting with pain may be at elevated risk for subsequent adverse drinking and related health outcomes. Moreover, they will highlight for health care providers the relevance of drinking history and current drinking problems for predicting the development and course of pain symptoms among older patients. PUBLIC HEALTH RELEVANCE: Findings will contribute to public health by helping clinicians identify which of their older patients presenting with pain may be at elevated risk for subsequent adverse drinking and related health outcomes. Further, they will highlight for clinicians the relevance of current and lifetime history of drinking problems for predicting the extent and course of pain symptoms in later life. This information should encourage health care providers to better integrate pain assessment and treatment with more detailed alcohol screening in the delivery of health care to older patients.