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一个重要的健康问题。晚年身体健康的变化，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与晚年饮酒之间的关系。在以经验为基础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，这些数据集包括最初评估时年龄为55-65岁的个人的调查数据，这些人在未来10年和8年的多个时间点分别接受了相称的调查项目。它的主要目标是：(A)确定中老年个体中疼痛与饮酒之间的潜在关系，(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、饮酒问题终生史、回避应对)和生活背景因素(应激源和社会资源)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)确定疼痛加剧、抑郁症状和危险饮酒是否最终会导致老年人的健康相关结果较差，以及(E)在中后期进行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年会有更多疼痛及疼痛的负面后果。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，然后进行同时和预测有效性测试，以确定两个关键指标的心理测量学特性：通过参与者痛苦的医疗条件的数量和长期性评估的疼痛，以及根据参与者的酒精消费和药物使用信息计算的酒精-药物不良相互作用的风险。接下来，将通过使用适用于纵向数据分析的多水平统计方法来实现目标，包括多水平回归、潜在转变、离散时间生存分析和结构方程建模。这些分析的结果将为这一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。具体地说，他们将帮助卫生保健提供者确定他们的哪些老年患者出现疼痛可能是随后不良饮酒和相关健康后果的高风险。此外，他们将强调卫生保健提供者饮酒史和当前饮酒问题的相关性，以预测老年患者疼痛症状的发展和病程。与公共健康相关：研究结果将有助于临床医生确定哪些老年患者出现疼痛可能会增加随后不良饮酒和相关健康后果的风险。此外，它们将为临床医生强调当前和终生饮酒问题史与预测晚年疼痛症状的程度和过程的相关性。这些信息应该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.