Abstract
Substance use disorders are common in US Veterans receiving care at Veteran health care facilities. Substance use disorders are associated with unhealthy lifestyles, mental and physical multimorbidity, increased healthcare utilization and higher mortality. Substance use disorders have also been implicated in the development of cognitive impairment. The pernicious effects of substance use disorders may lead to frailty, a state of increased vulnerability to stressors due to multiple physiological dysfunctions. However, the association of substance use disorders and frailty is unknown. The purpose of the study was to determine whether substance use disorders were associated with frailty in Older Veterans with cognitive impairment enrolled at a VA Memory Disorders Clinic.
Participants and Setting: Cognitively impaired US Veterans enrolled in a VA Memory Disorders Clinic during a period of 2016-2019. Study design: Cross-sectional study. Measures and Outcomes: We constructed a 44-item frailty index using all potential variables such as demographics, comorbidities, number of medications, laboratory tests, and activities of daily living. Patients were categorized into non-frail (FI <0.21) and frail (FI ≥0.21). We extracted data from the VA electronic health record (EHR) to obtain socio-demographic information (age, gender, race, ethnicity), number of medications, functional status, and median household income. Substance use disorders including alcohol, cannabis, opioids, cocaine were ascertained from medical records using ICD-9 and 10 codes. Data Analysis: Odds Ratios (OR) and 95% confidence intervals (CI) were calculated using binomial logistic regression using frailty as the dependent variable and substance use disorders as the independent variable adjusted for covariates (age, race, ethnicity, median household income, education, body mass index (BMI), and number of medications).
Two-hundred twenty-seven, cognitively impaired Veterans enrolled in a VA Memory Disorders Clinic were included in the study. Patients were 54.6% (n=124) white, and 75.3% (n=171) non-Hispanic, 114 (50.0%) had mild cognitive impairment, and 113 (50.7%) had dementia. The mean age was 75.5 (SD=8.4) years. The proportion of frail and non-frail patients was 47.1% (n=107) and 52.9% (n=120) respectively. Veterans with a history of substance use disorders represented 17.6% (n=40) of the sample. Substance use disorders included alcohol (14.1%, n=32), cannabis (1.3%, n=3), opioids (0.4%, n=1) and cocaine (2.6%, n=6). Substance use disorder was associated with an increased risk of frailty, unadjusted OR: 2.44 95%CI: 1.14-5.22, p=0.02). However, after adjusting for covariates, substance use disorder was no longer associated with frailty in cognitively impaired Veterans, OR: 2.17 95%CI: 0.94-5.01, p=0.06).
Conclusion: Substance use disorder was not cross-sectionally associated with frailty in cognitively impaired Veterans after controlling for known covariates.
This research was funded by: No funding