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PubMed2004

The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death.

OBJECTIVES: Few reports address the impact of cumulative exposure to childhood abuse and family dysfunction on teen pregnancy and consequences commonly attributed to teen pregnancy. Therefore, we examined whether adolescent pregnancy increased as types of adverse childhood experiences (ACE score) increased and whether ACEs or adolescent pregnancy was the principal source of elevated risk for long-term psychosocial consequences and fetal death. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 9159 women aged > or = 18 years (mean 56 years) who attended a primary care clinic in San Diego, California in 1995-1997. MAIN OUTCOME MEASURE: Adolescent pregnancy, psychosocial consequences, and fetal death, compared by ACE score (emotional, physical, or sexual abuse; exposure to domestic violence, substance abusing, mentally ill, or criminal household member; or separated/divorced parent). RESULTS: Sixty-six percent (n = 6015) of women reported > or = 1 ACE. Teen pregnancy occurred in 16%, 21%, 26%, 29%, 32%, 40%, 43%, and 53% of those with 0, 1, 2, 3, 4, 5, 6, and 7 to 8 ACEs. As the ACE score rose from zero to 1 to 2, 3 to 4, and > or = 5, odds ratios for each adult consequence increased (family problems: 1.0, 1.5, 2.2, 3.3; financial problems: 1.0, 1.6, 2.3, 2.4; job problems: 1.0, 1.4, 2.3, 2.9; high stress: 1.0, 1.4, 1.9, 2.2; and uncontrollable anger: 1.0, 1.6, 2.8, 4.5, respectively). Adolescent pregnancy was not associated with any of these adult outcomes in the absence of childhood adversity (ACEs: 0). The ACE score was associated with increased fetal death after first pregnancy (odds ratios for 0, 1-2, 3-4, and 5-8 ACEs: 1.0, 1.2, 1.4, and 1.8, respectively); teen pregnancy was not related to fetal death. CONCLUSIONS: The relationship between ACEs and adolescent pregnancy is strong and graded. Moreover, the negative psychosocial sequelae and fetal deaths commonly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se.

Adolescent↗

PubMed1972

The effect of incongruent instructions and consequences on imitation in retarded children.

Three retarded boys served as subjects in a 13-phase experiment. In eight of these phases, the instructions administered by the experimenter before demonstrating a behavior and the consequences for imitative behavior were incongruent (the consequences were not those indicated by the instructions). Consequences rather than instructions controlled imitative behavior when (a) subjects were instructed not to imitate but received reinforcers if they imitated; (b) subjects were instructed to imitate but were differentially reinforced for other behavior; (c) subjects were instructed to imitate but were verbally reprimanded for imitation. Although subjects were highly imitative at the beginning of the study, when there was no reinforcement for imitation subjects gradually stopped imitating when instructed not to imitate. Instructions seemed to control imitative behavior when there was no reinforcement for imitation and subjects were instructed to imitate. These results indicated a need for further investigation of antecedent and consequent variables in imitation experiments and pointed out that certain techniques may be more efficient than others in eliminating well-established responses.

Journal Article↗

PubMed1986

Rule-governed behavior and sensitivity to changing consequences of responding.

Humans were presented with a task that required moving a light through a matrix. Button presses could produce light movements according to a multiple fixed-ratio 18/differential-reinforcement-of-low-rate 6-s schedule, with components alternating every 2 min. Moving the light through the maze earned points worth chances on money prizes. In Experiment 1 four conditions were assessed through between-subject comparisons: minimal instructions, instructions to press rapidly, instructions to press slowly, and instructions that sometimes rapid responding would work while at other times a slow rate would work best. Subjects responded in three successive sessions of 32 min each. The results suggested that instructions affected the nature of the contact made with the programmed consequences and thus subsequent performance. In some cases, responding seemed to result from added contingencies introduced by stating rules. In Experiment 2 the relative contribution of these two effects was assessed by presenting and then withdrawing two lights that had been paired with two specific instructions: "Go Fast" or "Go Slow." There were three conditions. In one condition, only the Go Fast light was on; in a second, only the Go Slow light was on; and in a third, the lights alternated each minute. In each condition, half the subjects had all instruction lights turned off after the first session. The results once again showed an effect of instructions on contact with the programmed consequences. However, responding sometimes continued in a manner consistent with added contingencies for rule-following even when the programmed consequences had been contacted and would have controlled a different type of responding in the absence of instructions. The relevance of added contingencies for rule-following in determining the effects of explicitly programmed consequences is emphasized.

Journal Article↗

PubMed2000

Trends in social consequences and dependence symptoms in the United States: the National Alcohol Surveys, 1984-1995.

OBJECTIVES: Given the decline in alcohol use in the United States since the 1980s, the purpose of this study was to assess shifts in self-reported social consequences of alcohol use (and 5 consequences subscales) and dependence symptoms from 1984 to 1995. METHODS: This study used data from 3 national alcohol surveys based on household probability samples of current drinkers (adults) in 1984, 1990, and 1995; samples sizes were 1503, 1338, and 1417, respectively. RESULTS: Overall, few changes in prevalence of social consequences or dependence symptoms were found. Significantly lower prevalence rates of 2 consequences subscales (accidents/legal problems and work problems) were reported between 1984 and 1990, but prevalence rates did not change for any of the scales from 1990 to 1995. CONCLUSIONS: This stability in alcohol-related outcomes despite reductions in alcohol consumption may be a result of cultural shifts in which problem amplification occurs in "drier" historical periods. Furthermore, rates of alcohol-related problems may be approaching their lowest limit and may not be readily influenced by any additional decreases in alcohol consumption.

Accidents↗

PubMed2001

Attitude and social consequences of tuberculosis in Addis Ababa, Ethiopia.

OBJECTIVE: To gain a better understanding of the attitude and social consequences of tuberculosis (TB) in Addis Ababa, Ethiopia. DESIGN: A cross sectional survey using a structured questionnaire and a qualitative study based on the focus group discussion (FGD) technique. SETTING: Eight different kebeles (urban dwellers' associations) of six woredas (next higher administrative level to kebele). SUBJECTS AND METHODS: Seven hundred and three participants, comprising 326 males and 377 females were interviewed using the written questionnaire and 36 recent and current TB patients through focus group discussion. Data were analysed using SPSS/PC statistical package. The proportions were compared using univariate and bivariate analyses to show the frequency distribution and evaluate the relationship among different variables. In FGD, topics relevant to the research questions were identified, sorted and analysed. Conclusions were then formulated. MAIN OUTCOME MEASURES: Attitude of participants towards TB and its victims and social consequences of being a TB patient. RESULTS: Eighty three per cent of the respondents were aware that TB is a disease transmitted from one person to another and 80.1% perceived TB as an extremely severe disease. Of the total, 81.5% answered that TB is caused by cold, 69.0% feel that TB patients are not accepted in the community and 78.3% fear physical contact with TB patients. Most participants of the FGD sessions agreed that TB is a very dangerous, contagious but curable disease and the community has a generally negative attitude towards them. They also think that TB is associated with HIV/AIDS in the society. These attitudes have social consequences particularly the stigmatization and social isolation of TB patients. Four hundred and four (57.5%) respondents were found to be in favour of the short course chemotherapy against 226 (32.1%) choosing the longer course. Clinical improvement and unavailability of some drugs or their cost were the first and second main reasons indicated, respectively, for defaulting by respondents. CONCLUSION: The perception by most respondents that tuberculosis is incurable, transmittable and associated with HIV/AIDS, led to the understanding that TB is a very dangerous disease. This, in turn, contributes to social avoidance and the resultant consequences in TB patients. Health education must be stepped-up within the TB control programme, and the psychosocial implications of TB should be given due attention.

Adolescent↗

PubMedDate not supplied

Positive consequences of surviving a stroke.

This exploratory study focused on gaining insight into the psychological experience of stroke survivors undergoing inpatient rehabilitation. Specifically it investigated whether stroke survivors undergoing inpatient rehabilitation were able to identify any positive consequence of their stroke. This phenomenon, also know as benefit finding or positive reframing, has recently received more attention in the coping literature examining reactions to severe illness. Using a case series methodology and qualitative analytic techniques, 16 stroke survivors were interviewed using standardized open-ended questions related to identification of positive consequences attributed to surviving a stroke. Sixty-three percent of the patients interviewed were able to identify positive consequences of their stroke. The following five themes regarding positive consequences of stroke emerged from this case series: increased social relationships, increased health awareness, change in religious life, personal growth, and altruism. It was concluded that some individuals who have survived an acute stroke are able to reframe their experience in a positive light. This study provides occupational therapists and others with further insight into the coping mechanisms of those individuals who have survived a stroke. The need for further research is stressed.

Aged↗

PubMed2001

Meeting the threat of weapons of mass destruction terrorism: toward a broader conception of consequence management.

As the importance of psychosocial issues in domestic preparedness has come to be better understood, it has become evident that there are significant conceptual limitations in existing approaches to weapons of mass destruction consequence management. This article identifies six problems: (1) most understandings of consequence management focus on short-term issues with longer-term recovery issues receiving far less attention; (2) while psychological issues are beginning to be introduced, social issues are generally not addressed; (3) although more attention is being paid to mental health issues, scenarios that are predominantly psychosocial in their effects are not generally considered; (4) social and behavioral science insights are not adequately incorporated; (5) despite the further inclusion of psychological issues, the overall approach is not sufficiently integrated or interdisciplinary; and (6) although psychological issues are receiving more attention, fundamental macro-level issues such as the re-establishment of trust after a weapons of mass destruction terrorist incident rarely receive significant attention. These limitations could seriously weaken efforts to address the consequences of a chemical, biological, radiological, or nuclear terrorist attack. There is an urgent need, therefore, to re-think current approaches and to develop a broader conception of consequence management.

Disaster Planning↗

PubMed2002

Health-related consequences of overactive bladder.

OBJECTIVE: Overactive bladder (OAB) is a condition of urgency, with or without urge incontinence, usually with frequency and nocturia. This study assesses whether people with OAB are at greater risk for urinary tract infections (UTIs), falls and injuries, and increased number of visits to the doctor compared to age- and gender-matched controls. The study also estimates costs associated with these health-related consequences. PATIENTS & METHODS: A US representative telephone survey under the National Overactive Bladder Evaluation (NOBLE) Program was conducted with 5204 English-speaking adults older than 18 years. The survey asked respondents about bladder symptoms. Based on the telephone survey, 865 symptom-identified OAB cases and 903 age- and gender-matched controls were sent a postal questionnaire. A total of 397 cases and 522 controls returned the questionnaires. Nonrespondent cases and controls did not differ with regard to age, gender, educational status, diabetes, congestive heart failure, and self-rated health status. Regression analyses were conducted to assess the effect of OAB on health-related consequences, controlling for age, gender, race, education, marital status, number of previous births, self-reported health status, diabetes, and congestive heart failure. RESULTS: People with OAB reported 0.84 (20%) more visits to the physician (P < .05) and 0.21 (138%) more UTIs in the last year than people without OAB (P < .001). Overactive bladder cases also had over twice the odds of being injured in a fall than people without OAB (odds ratio = 2.26; 95% confidence interval 1.46, 3.51). Consistent with having more falls, OAB cases had an increased risk of bone fracture (P < .1). This effect, however, was not statistically significant (at alpha level 0.05) due to the limited sample size. The estimated cost of UTIs associated with OAB was approximately $1.37 billion US dollars in year 2000. The cost of falls without bone fracture due to OAB was $55 million. Falls with bone fracture accounted for approximately $386 million; however, further research with a larger sample is needed to accurately estimate these costs. CONCLUSION: People with OAB self-report significantly more UTIs and a greater risk of being injured in a fall. Given the large prevalence of UTIs and concerns of overprescribing antibiotics, these results are important for health plans and policy makers. In addition, people with OAB visit their physicians more often than people without OAB. These consequences entail significant economic costs, of which a large percentage will be incurred by health plans. To the extent that OAB causes these consequences, there may be significant savings from effectively treating OAB.

Accidental Falls↗

PubMed2005

What happened? Sexual consequences of prostate cancer and its treatment.

OBJECTIVE: To describe the sexual consequences of prostate cancer and its treatments (prostatectomy, external beam radiation, brachytherapy, androgen deprivation therapy) and to suggest treatments for sexual side effects of these therapies. QUALITY OF EVIDENCE: Most studies of the sexual consequences of prostate cancer treatments and studies of therapy for these side effects provide level II evidence. MAIN MESSAGE: Diagnosis of prostate cancer in itself can cause sexual dysfunction. All forms of treatment for this cancer cause serious sexual problems for men. Treatments for the erectile dysfunction that results have varying success rates. Prostatectomy has been shown to cause erectile dysfunction in 30% to 98% of men, depending on whether both, one, or neither nerve bundles was spared. Radiation therapy results in erectile dysfunction in more than 70% of those treated; brachytherapy produces the least amount of sexual deficit. Hormone ablation therapy has serious consequences: more than 80% of men report loss of erections at 1 year after therapy in addition to profound loss of libido. CONCLUSION: Family physicians are ideally placed to provide anticipatory guidance to men with prostate cancer on the sexual consequences of both the cancer and its treatments. Family physicians can also assist men and their partners in managing these sexual side effects.

Erectile Dysfunction↗

PubMed2005

[Consequences of thallium poisoning in adolescent].

INTRODUCTION: Thallium poisoning appears very rare in developmental age and its consequences are quite different. The aim of this study was to characterised the course of thallium poisoning in adolescent and especially electroneurophysiological consequences of it. PATIENT AND METHODS: In a 15 year old boy with sensory-motor polyneuropathy thallium poisoning was recognised in the third week duration of the symptoms. Hemodialysis and hemodiaperfusion were used in the therapy. Data of the repeated electroneurographic and videoEEG examinations were collected. RESULTS: First electroneurographic data showed axonal motor polyneuropathy. Control after 1 year presented the largest form of the motor-sensory polyneuropathy. On videoEEG tape rejestered in the 5th month of clinical symptoms of poisoning, present were tonic seizures (although EEG pattern was flat with short low voltage theta activity). After next the 3 months of encephalopathy and phenobarbital therapy, voltage of the EEG pattern was slightly higher without any background and seizure activity. CONCLUSIONS: Thallium poisoning may result with catastrophic clinical consequences of polyneuropathy and encephalopathy. Electroneurographic and electroencephalographic changes 1 year after indicate that clinical consequences of the poisoning are un-remediable.

Adolescent↗

PubMedDate not supplied

[Justa-renal aortic aneurysms repair: consequences of the supra-renal aortic clamping, based on an experience of 44 operated cases].

The present study is aimed at the evaluation of the consequences of the supra-renal aortic clamping in the surgical management of justa-renal aortic aneurysms, based on a personal experience of 44 cases operated on for the last 25 years. The series includes 42 men (95.5%) and 2 women (4.5%) with an average age of 70 years. All patients were operated on transperitonealy and the transection and reconstruction of left renal vein was made in 15 instances. Supra-renal aortic clamping and renal average ischemic time was 13'3 minutes, and no significant functional renal alterations could be noticed, nor the need for hemodialysis support. Contrarily, significant occlusive lesions of the renal arteries (4 instances) or the superior mesenteric artery (1 case) resulted as a mechanical consequences of the supra-renal aortic clamping. Three cases were recognized and repaired intraoperatively, through renal revascularization, one case was not diagnosed, coursed with anuric renal failure and death (mortality 2.2%). Patient with mesenteric artery occlusion developed an acute mesenteric ischemia which was successfully managed conservatively. The author concludes by enhancing the risks of the mechanical consequences arising from the supra-renal aortic clamping, namely renal or mesenteric ischemia. Its prompt recognition and repair seems mandatory, in order to avoid the severe and even fatal consequences that it may cause, raising the morbi-mortality rates that sometimes accompanies the surgical management of justa-renal aortic aneurysms.

Aged↗

PubMed1991

Behavioral consequences of epilepsy in children. Developing a psychosocial vocabulary.

In this chapter we have described some of the experiences of a special psychiatric clinic for children with epilepsy, drawing our examples from a series of 50 children. The behavioral consequences of epilepsy cannot be adequately described within the limited nosology available for classifying the behavior disorders of children. As an alternative, a series of behaviors which children actually require in order to maintain their social existence have been identified; furthermore, impairments of those behaviors have been pointed to, and consequences of these behavioral impairments have been outlined. The behavioral consequences of epilepsy are often multiple and are sometimes mutually interactive. The extent to which these behavioral deviations depend both upon the exhibition of seizures and the presence of structural abnormalities in the brain is made most evident by the marked changes in behavior which can be achieved when epilepsy is relieved and a lesion is removed. Unfortunately, such a stratagem is not available to the majority of children with epilepsy. For the time being, their cerebral impairment and the continuation of their epilepsy have to be taken for granted, and intervention then consists of the best possible management of their impairments and their distressing behaviors. Such management clearly requires psychiatric and psychological skills, although these skills do not necessarily lead to greater success than does the use of anticonvulsants or the use of surgery. Success is not an adequate measure of the appropriateness of the endeavor. It goes without saying that not all children with epilepsy suffer behavioral consequences along these lines, and indeed behavioral disturbances were not universal even in this highly selected series. Some children were seen merely as a way of improving their medical status or achieving surgical treatment. These more traditional medical maneuvers are easier to undertake and are more understandable to parents than are complex strategies of psychiatry. In any event, parents deserve considerable support. The language of psychiatry for children with organic cerebral impairments is extremely limited; this chapter has been an attempt to improve our vocabulary, which will be a necessary underpinning in order to improve the quality of our classification. Finally, we return to Bridge's statement. Firstly, we do not regard epilepsy as a disease any more than we would regard cough as a disease, and we find that orientations in that direction are likely to thwart our attempt at piece-by-piece dismantling of the many sorts of disease which might be associated with seizures.(ABSTRACT TRUNCATED AT 400 WORDS)

Adaptation, Psychological↗

PubMed1990

Stability of psychological symptoms: drug use consequences and intervening processes.

We integrate aspects of coping response, impaired ability, and motivational explanations for the causes and consequences of drug abuse, all which were cast previously as competing or alternative paradigms. We projected a model of 1) continual daily drug use as a consequence of early adolescent psychological symptoms and 2) continual daily drug use as an influential variable in maintaining or exacerbating these symptoms over the young adult life-course. Gender, race, and education also were modeled explicitly according to their presumed theoretical importance. Finally, we modeled contemporaneous factors such as physical health and employment status as the common consequences of the shared independent variables in order to reduce bias in the estimated structural relationships. We found that continual daily drug use is significantly dependent on early psychopathology and increases psychological symptoms significantly. Daily proximate drug use has direct negative effects on education. Education, in turn, improves both mental and physical symptoms significantly. During young adulthood, psychological symptoms are related significantly to contemporaneous unemployment and physical health limitations; thus modeling these symptoms as common consequences reduces potentially biased estimates of the effect of shared independent variables.

Adaptation, Psychological↗

PubMedDate not supplied

Measures to assess drug abuse and the health, social and economic consequences of such abuse: summary of information from 21 countries. United Nations Secretariat.

This article summarizes the replies received from 21 Governments to a survey undertaken in June 1982 of measures to assess drug abuse and its consequences. A large number of programmes for the assessment of drug abuse were reported, and these were classified either as population surveys or as reporting systems of existing institutional data on drug abuse, depending on the methodology used. Each method was described as having certain advantages and limitations, which varied according to the aims of the assessment and the circumstances under which it was carried out. A well-established reporting system, which obtained data from law enforcement agencies, health services or other institutions that came into contact with drug abusers, was reported to be an effective means of assessing the consequences of drug abuse, but it provided information only on cases that were brought to the attention of the authorities. On the other hand, a survey covering, for example, the general population, students or conscripts, based on a probability sample, represented the population studied and detected cases of drug abuse that were not recorded by institutions. In many of the replies it was stated that drug abuse imposed a considerable burden on society in terms of health impairment and disabilities, as well as in terms of its social and economic consequences. Drug abuse diminished the ability and motivation of drug abusers to engage in the complex tasks required in modern society. Dropping out of school, performing poorly at work and losing employment were the most common consequences of drug abuse. It was also reported that drug abuse played an important role in the development of criminal, delinquent and anti-social behaviour.

Amphetamines↗

PubMedDate not supplied

Prevalence and consequences of smoking, alcohol use, and illicit drug use at five worksites.

Employers are becoming increasingly concerned about the consequences and costs of substance use in their workplaces. Despite this heightened awareness, little information is available to guide them in setting up worksite-based prevention and assistance programs. Most estimates of the prevalence or consequences of substance use are derived from large national surveys of households or individual persons. The primary contribution of this research to the public health literature is the empirical results from a unique data set. In particular, this study presents results of a survey administered to more than 1,200 employees at five different worksites. Descriptive statistics for the prevalence of smoking, alcohol and illicit drug use, prescription drug misuse, and workplace consequences, such as reduced performance and absenteeism, are reported, as well as findings from a multivariate analysis of substance use prevalence and consequences. Compared with national averages, workers at these five sites tended to have substance use profiles similar to or slightly lower than estimates from large national surveys. The study's estimates may help employers identify the extent of a substance abuse problem in their worksites and specific areas to target for possible intervention.

Absenteeism↗

PubMedDate not supplied

[Factors influencing the consequences of disease on urologic patients].

OBJECTIVES: This study analyzed various factors that may affect social and personal consequences of disease in urological patients, as well as any possible relationships between these factors and disadvantageous situations they might produce. METHODS: A two-year retrospective study on patients of the University Hospital of Valladolid was conducted. The material used included a thorough analysis of case histories and questionnaires comprising all factors considered of interest by the most relevant Bodily Harm Valuers. The data obtained were processed and analyzed by the Statistics and Operations Research Departments of the University of Valladolid. RESULTS: In our study, sex and age were remarkably influential on sexual, economic and disablement damages. The different types of illnesses and the types of operations performed (non-surgical operations presented less consequences than surgical ones), as well as other factors such as distance from the patients' home to hospital, had a statistically significant correlation with the consequences of disease. CONCLUSIONS: We can detect certain disadvantageous situations through a previous study of the different variables that are collected in case histories, such as social, personal and economic circumstances. Thus, we can plan support programs in the future that will certainly reduce the consequences of disease.

Aged↗

PubMedDate not supplied

[Perforation in Crohn's ileitis and its impact on the natural history of the disease. Note 1. Pathogenic process of the event, its relationship with intestinal obstruction, and its immediate consequences].

The pathogenesis and consequences of perforation in Crohn's disease were studied in 175 patients submitted to surgery. Perforation occurred in 40 (23%) patients with ileitis or ileocolitis, always in the terminal ileum; so-called "free" perforation occurred in 1 patient, "limited" perforation in all the others. Perforation is always a consequence of a chronic intestinal obstruction caused by the stricture of the terminal ileum, which becomes absolute because of the blocking by solid intestinal content. It occurs in the borderline between the stricture and proximal dilated loop, where the fissures (typical of Crohn's ileitis) are stretched to the utmost and dilated by the hyperpressure and distension of the wall following ileal stenosis. Perforation in the peritoneal cavity is always free; its consequence is usually not a diffuse septic peritonitis but an abscess, because only a small amount of intestinal content leaks out. This happens because in the proximal occluded bowel, pressure decreases abruptly following the spilling of intestinal content, particularly of gas. The abscess fed by intestinal content enlarges and finally opens into a hollow organ or onto the skin, causing a fistula (internal or external). The rational therapeutic approach to perforation and its consequences (the infrequent diffuse septic peritonitis, or the more common abscesses and fistulas) is always and only ileal stenosis removal.

Crohn Disease↗

PubMed1996

Alcohol-related problems in older persons. Determinants, consequences, and screening.

Demographic trends reveal the elderly to be the fastest growing segment of the population. Physicians can therefore anticipate encountering increasing numbers of older patients with alcohol-related problems. These problems include liver disease, dementia, confusion (masquerading as dementia), peripheral neuropathy, insomnia, late-onset seizure disorder, poor nutrition, incontinence, diarrhea, myopathy, inadequate self-care, macrocytosis, depression, fractures, and adverse reactions to medications. Despite the prevalence of alcohol use in older people, their risks and problems are often unrecognized. We reviewed published literature on the determinants and consequences of alcohol-related problems in persons aged 65 years and older and the usefulness of available screening measures. Thirteen of 25 eligible studies on determinants and consequences met quality criteria and were reviewed. Nine additional studies on screening tests were also evaluated. Determinants include history of alcohol use and abuse, social isolation, and reduced mobility; consequences consist of risks of hip fracture from falls, neoplasms, and psychiatric illness. Currently accessible screening tests focus on high levels of alcoholic beverage use and abuse and dependence. They are not useful in screening for hazardous consumption that may result from relatively low levels of alcohol use alone or in combination with medications, medical illness, or preexisting diminished physical, emotional, or social function. Research is needed on the consequences of lower levels of alcohol consumption on the physical and psychosocial health of older individuals and on methods for distinguishing alcohol-related from age-related problems. Existing screening tests should be expanded or new screening methods developed in anticipation of a growing public health problem.

Aged↗