Elderly who drink alcohol are at greater risk for adverse effects due to the interaction of alcohol and prescription drugs compared to the general population of alcohol users because of the elderly's increased use of prescription drugs and the physiological changes which accompany the aging process. Although on the average elderly tend to decrease the quantity of alcohol they consume as they age, it appears that the frequency of drinking among the elderly may not change. While there is a great deal of clinical information about alcohol-drug interactions, much of this information is in the form of case reports of serious adverse effects and mortality involving large doses of alcohol and prescription drugs. Very little is known about the prevalence of the concomitant use of prescription drugs and alcohol in """"""""normal"""""""" use patterns, i.e., low or moderate dose situations, especially among the elderly. Therefore, we propose to conduct both an epidemiologic study of the use of alcohol-interactive prescription drugs by an elderly population (card-holders in the largest pharmaceutical assistance program in the nation, the Pennsylvania Pharmaceutical Assistance Contract for the Elderly -- PACE) and a longitudinal study of samples of these cardholders, including alcohol drinkers, former drinkers, and lifetime abstainers, who use these drugs. This latter study will assess alcohol-related behaviors, knowledge of risks related to alcohol-drug use, compliance behaviors, measures of functional status (including self-reported physical and mental health), signs and symptoms of adverse effects and outcomes associated with alcohol-drug interactions (e.g., falls, postural hypotension, etc.), and changes in these behaviors and outcomes after one year. The results of this research will have important practical significance for the design and implementation of programs that include alcohol-related information in drug utilization review, drug surveillance and drug education activities in existing and several newly-emerging federal and state programs for pharmaceutical assistance.
