1. 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

2. 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. 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.

3. 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. 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. NIA L Launer, R Peila, D Foley. Kentucky Wm Markesbery, D Davis. Kentucky Wm Markesbery, D Davis. NIOSH/Morgantown J O’Callaghan, D Miller, NIOSH/Morgantown J O’Callaghan, D Miller, C Burchfiel, D Sharp. C Burchfiel, D Sharp. USC C Zarow, H Chui USC C Zarow, H Chui

4. THE HONOLULU HEART PROGRAM SERIAL EXAMINATIONS EXAMSYEARN Exam I1965-688006 Exam II1968-707498 Lipo I1970-722780 Exam III1971-746860 Lipo II1975-782386 Lipo III1980-821965 Mail Quest.19884664

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

7. How many prescription meds do these men take? Based on data from the baseline HAAS exam, 1991-93. Based on data from the baseline HAAS exam, 1991-93. Limited to 3413 men with normal cognitive functioning. Limited to 3413 men with normal cognitive functioning. Based on examining bottles and pills, and on answers to questions. Based on examining bottles and pills, and on answers to questions.

8. % of men using 0-7 different meds

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

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

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

12. What were the most commonly prescribed meds? For hypertension and/or cardiovascular disease (used by more than 50% of men) For hypertension and/or cardiovascular disease (used by more than 50% of men) Aspirin, NSAIDS, Tylenol Aspirin, NSAIDS, Tylenol Meds for asthma, chronic lung disease Meds for asthma, chronic lung disease laxatives laxatives

13. PERCENT of HAAS men using Psychoactive meds (1999, n=1383) SSRI antidepressants1.2 % SSRI antidepressants1.2 % Other antidepressants0.7 % Other antidepressants0.7 % Ambien0.4 % Ambien0.4 % Benzodiazepine1.2 % Benzodiazepine1.2 % Other sedative 0.3 % Other sedative 0.3 % Neuroleptic 0.2 % Neuroleptic 0.2 % Trazodone0.1% Trazodone0.1% – total4.2%

14. Use of psychoactive meds 3.9% of men used one 3.9% of men used one 0.4% (5/1375) used two 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 Only 8 men were taking an opiate, and none were taking a second psychoactive med

15. Is there evidence of abuse or overuse of prescription or OTC meds in the HAAS cohort? NO

16. Is there evidence of excessive intake of alcohol, or of smoking? YES

17. 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 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 Cigarettes – self report: ever/never/now cigs/day, with pack- years calc. 1965, ’71, ’87, and ‘91

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

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

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

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

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

23. % OF MEN RECEIVING ANTIDEPRESSANT MEDS ACCORDING TO LEVEL OF DEPRESSIVE SYMPTOMS

24. Predictors and correlates of alcohol intake among HAAS men who reported any consumption Older age (inverse p<0.0001) Older age (inverse p<0.0001) Education (inverse p<0.0001) Education (inverse p<0.0001) HDL-cholesterol level (direct p<0.001) HDL-cholesterol level (direct p<0.001) Smoking (pack years, direct p<0.0001) Smoking (pack years, direct p<0.0001) Depressive symptoms (direct p<.05) Depressive symptoms (direct p<.05) # of persons available when lonely (inverse p<0.05) # of persons available when lonely (inverse p<0.05) # of children (direct p<0.01) # of children (direct p<0.01) Widowed, divorced, or never married (p=0.004) Widowed, divorced, or never married (p=0.004)

25. Factors NOT significantly associated with alcohol intake among HAAS men who reported any consumption obesity obesity Heart disease or stroke Heart disease or stroke Poor cognitive test scores Poor cognitive test scores # of relatives seen /month # of relatives seen /month # of Rx meds # of Rx meds

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

27. late-life heavy drinkers – 4 types “new” late-life heavy drinker “new” late-life heavy drinker “established” late-life heavy drinker “established” late-life heavy drinker “recidivist” late-life heavy drinker “recidivist” late-life heavy drinker Life-long heavy drinker Life-long heavy drinker

28. “NEW” late-life heavy drinker < 10 oz /mo in 1965 < 10 oz /mo in 1965 < 10 oz/mo in 1971 < 10 oz/mo in 1971 < 10 oz/mo in 1987 < 10 oz/mo in 1987 > 60 oz/mo in 1991 > 60 oz/mo in 1991

29. “established” late-life heavy drinker < 10 oz/mo in 1965 < 10 oz/mo in 1965 < 10 oz/mo in 1971 < 10 oz/mo in 1971 > 10 oz/mo in 1987 > 10 oz/mo in 1987 > 60 oz/mo in 1991 > 60 oz/mo in 1991

30. “recidivist” late-life heavy drinker > 10 oz/mo in either 1965 or 1971 > 10 oz/mo in either 1965 or 1971 < 10 oz/mo in 1987 < 10 oz/mo in 1987 > 60 oz/mo in 1991 > 60 oz/mo in 1991

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

32. “lifelong” late-life heavy drinker > 10 oz/mo in either 1965 or 1971 > 10 oz/mo in either 1965 or 1971 > 10 oz/mo in 1987 > 10 oz/mo in 1987 > 60 oz/mo in 1991 > 60 oz/mo in 1991

33. late-life heavy drinkers – 4 types N % N % new late-life heavy drinker 88 3.9 new late-life heavy drinker 88 3.9 established late-life heavy drinker 26 0.8 established late-life heavy drinker 26 0.8 recidivist late-life heavy drinker 70 2.5 recidivist late-life heavy drinker 70 2.5 life-long heavy drinker 71 2.5 life-long heavy drinker 71 2.5

34. new and established late-life heavy drinking -- risk factors Depressive symptomatology (CES-D 11) Depressive symptomatology (CES-D 11) Widowed, divorced, or never married Widowed, divorced, or never married Greater number of children Greater number of children

35. Recidivist and life-long late life heavy drinkers – risk factors Level and consistency of drinking during middle life Level and consistency of drinking during middle life Lifetime smoking Lifetime smoking High hdl-C High hdl-C

36. Did late-life heavy drinking have a significant impact on survival? “new” late-life heavy drinkers: NO “new” late-life heavy drinkers: NO “established” late-life drinkers: N0 “established” late-life drinkers: N0 “recidivist” late-life drinkers: YES “recidivist” late-life drinkers: YES OR 2.6 (1.45-4.63) for death within 10 yrs* Life long drinkers: MARGINAL 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.

37. Does late life alcohol intake cause dementia? Only rarely. 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. 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. Also not associated with lesions of Alzheimer’s disease, Parkinson’s disease, or for aging-related atrophy.

38. Heavy drinking in late life - - conclusions It occurs often enough to be an important public health matter. 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. There appear to be definable subgroups having different pathogeneses, implying a need for different case-finding and intervention strategies.

39. Heavy drinking and smoking in late life % smoking ------- never past current % smoking ------- never past current New drinkers 12 81 7 New drinkers 12 81 7 Established drinkers 8 77 15 Established drinkers 8 77 15 Recidivist drinkers 7 80 13 Recidivist drinkers 7 80 13 Lifelong drinkers 16 67 17 Lifelong drinkers 16 67 17 other and non-drinkers 40 54 6 other and non-drinkers 40 54 6