Hazardous drinking in people aged 50 years or older: a cross-sectional picture of Europe, 2011-2013

Evolution of the prevalence of alcohol consumption and characterization of hazardous consumption in Spain: 2005-2022

BACKGROUND AND OBJECTIVE

The objectives of this study were to analyze the evolution of the prevalence of alcohol consumption between 2005 and 2022, to estimate the prevalence of hazardous alcohol consumption in 2022, and to characterize hazardous consumers.

MATERIALS AND METHODS

Microdata from 9 editions of the EDADES survey were used. Prevalences of alcohol consumption were estimated overall, by sex and age group between 2005 and 2022. Additionally, the prevalence of hazardous alcohol consumption at the national level and in the autonomous communities was determined in 2022. Trend analysis was performed by applying joinpoint regression models and multivariate logistic regression models were fitted to characterize hazardous consumers.

RESULTS

The trend in the prevalence of alcohol consumption was found to be stable for lifetime, past 12 months, and past 30 days consumption, while a decreasing trend was observed for daily consumption. In 2022, 6.5% (95%CI: 6.1-6.9) of the Spanish population aged 15-64 years had risky alcohol consumption. This prevalence ranged from 13.1% (95%CI: 11.2-15.3) in the Region of Murcia to 2.9% (95%CI: 1.9-4.3) in Cantabria. The use of cannabis in the last year was the variable with the highest OR for hazardous alcohol consumption overall, in men and in women (OR>2.7).

CONCLUSIONS

The prevalence of alcohol consumption in Spain is high and its trend is stable. The use of other drugs such as tobacco or cannabis increases the odds of having a hazardous alcohol consumption.

Characteristics of people who have received treatment for late-onset problem drinking and alcohol use disorder: A systematic review and narrative synthesis

Aims: The current review investigated the psychosocial characteristics of late-onset problem drinkers, an under-researched area of alcohol harm that accounts for one-third of older problem drinkers. Method: Following the PRISMA model, the protocol and search strategy included a scoping search and main search of nine databases. A total of 1,595 papers were identified; after screening, 26 papers were considered eligible and were included in the review. The review used an investigative framework comprising three categories: standardising age of onset; gender differences; and psychosocial and mental health characteristics. The review also investigated how meaning and purpose in life, and treatment have been reported in relation to this cohort. Findings/Conclusions: The combined onset ages of the reviews’ 26 papers (mean age = 52.69 years) and the participants’ self-reported age at onset (mean age = 56.79 years), suggest that late-onset alcohol use disorder (AUD)/problem drinking is likely to emerge at the age of 55 years and older. Moreover, there is a high prevalence of co-morbid mental health disorders among elderly, late-onset drinkers. Retirement was reported as the most prevalent psychosocial risk factor for late-onset problematic drinking; other late-life events included bereavement, loneliness and social isolation, and boredom. In the context of gender, women are at greater risk of developing late-onset problem drinking than men. Furthermore, late-onset problem drinkers, particularly women, are more treatment compliant than their early-onset counterparts, highlighting the case for bespoke treatments/interventions for late-onset problem drinkers. Finally, the role that meaning and purpose in life plays in late-onset problem drinking has been under-reported and requires further investigation.

Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe

Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU.Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent-child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week).Results: Overall, past week alcohol consumption was 5.0 units (±7.8), prevalence of HAU was 25.4% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent-child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender.Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders.

Sex differences in at-risk drinking and associated factors-a cross-sectional study of 8,616 community-dwelling adults 60 years and older: the Tromsø study, 2015-16

BACKGROUND

Alcohol consumption among older adults is on the rise, which may be an increasing public health concern. The proportion of older adults who drink above defined low-risk drinking limits, associated characteristics and the sex distribution of at-risk drinking vary across countries. The aims of this study were to (i) estimate the prevalence of at-risk drinking among older adults in Norway, (ii) investigate factors associated with at-risk drinking, and (iii) examine sex differences in alcohol consumption in the context of sociodemographic and selected health characteristics.

METHOD

A cross-sectional study based on Tromsø 7 (2015-16), an ongoing population-based cohort survey. Data were retrieved from participants aged 60 and older (60-99 years) who answered questions about alcohol consumption (n = 8,616). Sex-stratified logistic regressions were used to assess the association between three at-risk drinking outcome variables, and sociodemographic and selected health characteristics. The outcome variables were operationalized using the Alcohol Use Disorders Identification Test (AUDIT), and Alcohol Consumption Questions (AUDIT-C), i.e. - cut off for at risk drinking, drinking any 6+ in the past year, and any alcohol problems.

RESULTS

The overall prevalence of at-risk drinking among those aged 60-99 years was equal in women and men; 44% and 46%, respectively. At-risk drinking was strongly associated with a higher level of education, with OR 2.65 (CI 2.28-3.10) in women and OR 1.73 (CI 1.48-2.04) in men.

CONCLUSIONS

Almost half of older adults in Norway exceeded sex- and older adult-specific at-risk drinking thresholds. Our findings suggest some differences in factors associated with at-risk drinking between women and men. Explicitly, at-risk drinking was associated with very good health, living with a spouse or partner, and having adequate social support in women, while it was associated with the use of sleeping pills in men. Our findings suggest that women exceed at-risk drinking thresholds with better health, while men exceed at-risk drinking thresholds regardless of good or poor health.

Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases

BACKGROUND

The association between lifetime alcohol abuse and a higher risk to develop dementia is well known. However, it is unknown whether older adults who begin abusing alcohol late in life have an underlying neurodegenerative disease.

OBJECTIVE

Identify the frequency of lifelong alcohol abuse (L-AA), late-onset alcohol abuse (LO-AA), and alcohol abuse as a first symptom of dementia (AA-FS) in patients with neurodegenerative diseases.

METHODS

Cross-sectional retrospective study of patients evaluated at an academic referral center with a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer-type dementia (AD), and semantic variant primary progressive aphasia (svPPA) (n = 1,518). The presence of alcohol abuse was screened with the National Alzheimer's Coordinating Center questionnaire. L-AA was defined as onset < 40 years, LO-AA as onset ≥40 years, and AA-FS was defined when the abuse started within the first three years from symptom onset.

RESULTS

The frequency of LO-AA was 2.2% (n = 33/1,518). LO-AA was significantly more frequent in patients with bvFTD than AD (7.5%, n = 13/173 versus 1.3%, n = 16/1,254, CI:1.0;11.4%), but not svPPA (4.4%, n = 4/91, CI: -4.4;10.7%). Similarly, AA-FS was more frequent in bvFTD patients than AD (5.7%, n = 10/173 versus 0.7%, n = 9/1,254, CI:0.5%;9.5%), but not svPPA (2.2%, n = 2/91, CI:-2.4;9.1%).

CONCLUSION

LO-AA can be a presenting symptom of dementia, especially bvFTD. Alcohol abuse onset later in life should prompt a clinical investigation into the possibility of an underlying neurodegenerative process because delay in diagnosis and treatment may increase patient and caregiver burden. The results need to be interpreted with caution due to the limitations of the study.

History of healthcare use and disease burden in older adults with different levels of alcohol use. A register-based cohort study

BACKGROUND

Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help-seeking behavior in the healthcare system can identify possibilities for prevention and intervention.

METHOD

The current study describes healthcare use, burden of disease, and prior morbidities over a 15-year period by current alcohol use behavior among Danish adults aged 60-70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014-2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12-month abstinent (n = 691), low-risk drinkers (n = 1978), moderate-risk drinkers (n = 602), and high-risk drinkers (n = 467)], and a group of treatment-seeking individuals with a 12-month DSM-5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses.

RESULTS

Low-, moderate-, and high-risk drinkers had similar rates of past healthcare utilization (low-risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25-8.45), outpatient care 0.80 (0.41-1.32) and inpatient care 0.13 (0.10-0.21)). Higher rates were observed for both the 12-month abstinent group (adjusted RR = 1.16-1.26) and the group with AUD (ARR = 1.40-1.60) compared to the group with low-risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve-month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10).

CONCLUSIONS

Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol-related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention.

Alcohol use among older adults: A comparative study across four European countries

Aims:

(i) To examine whether mean consumption and prevalence of at-risk drinking are highly correlated across samples of older adults, and (ii) to explore whether sociodemographic and health characteristics of alcohol use differ across countries.

Method:

Cross-sectional surveys were conducted in four European countries, Norway, Denmark, Belgium, and Portugal, applying identical data collection methods and survey instruments in general population samples of older adults aged 60 to 75 years. Alcohol consumption was measured as units of alcohol per week, which provided the basis for categorising the two outcome measures: abstention (0 units/week) and at-risk drinking (8+ units/week). Cross-tabulations and logistic regression models were estimated to examine associations between sociodemographic and health characteristics on the one hand and alcohol abstention and at-risk drinking on the other.

Results:

Prevalence of abstention was highest in Portugal and lowest in Denmark, whereas at-risk drinking was more prevalent in Denmark and Belgium compared to Norway and Portugal. Among country- and gender-specific samples of drinkers, there was a strong positive correlation between mean consumption and prevalence of at-risk drinkers. Female gender characterised abstention, whereas male gender characterised at-risk drinking in all four countries. Other sociodemographic characteristics and indicators of health and wellbeing were differently associated with abstention and at-risk drinking across the four countries.

Conclusions:

A strong regularity in the distribution of alcohol consumption was observed in the samples of older adults. Gender was the only common factor associated with drinking behaviour across the four countries.

Alcohol and educational inequalities: Hazardous drinking prevalence and all-cause mortality by hazardous drinking group in people aged 50 and older in Europe

Background: We examined educational inequalities in hazardous drinking prevalence among individuals aged 50 or more in 14 European countries, and explored educational inequalities in mortality in hazardous drinkers in European regions. Methods: We analyzed data from waves 4, 5 and 6 of the Survey of Health Ageing and Retirement in Europe (SHARE). We estimated age-standardized hazardous drinking prevalence, and prevalence ratios (PR) of hazardous drinking by country and educational level using Poisson regression models with robust variance. We estimated the relative index of inequality (RII) for all-cause mortality among hazardous drinkers and non-hazardous drinkers using Cox proportional hazards regression models and for each region (North, South, East and West). Results: In men, educational inequalities in hazardous drinking were not observed (PR_medium = 1.09 [95%CI: 0.98-1.21] and PR_high = 0.99 [95%CI: 0.88-1.10], ref. low), while in they were observed in women, having the highest hazardous drinking prevalence in the highest educational levels (PR_medium = 1.28 [95%CI: 1.15-1.42] and PR_high = 1.53 [95%CI: 1.36-1.72]). Overall, the Relative Index of Inequality (RII) in all-cause mortality among hazardous drinkers was 1.12 [95%CI: 1.03-1.22] among men and 1.10 [95%CI: 0.97-1.25] among women. Educational inequalities among hazardous drinkers were observed in Eastern Europe for both men (RII_hazardous = 1.21 [95%CI: 1.01-1.45]) and women (RII_hazardous = 1.46 [95%CI: 1.13-1.87]). Educational inequalities in mortality among non-hazardous drinkers were observed in Southern, Western and Eastern Europe among men, and in Eastern Europe among women. Conclusions: Higher educational attainment is positively associated with hazardous drinking prevalence among women, but not among men in most of the analyzed European countries. Clear educational inequalities in mortality among hazardous drinkers were only observed in Eastern Europe. Further research on the associations between alcohol use and inequalities in all-cause mortality in different regions is needed.

Epidemiology of at-risk alcohol use and associated comorbidities of interest among community-dwelling older adults: a protocol for a systematic review

INTRODUCTION

There is little epidemiological evidence and knowledge about at-risk alcohol use among community-dwelling older adults and their chronic and acute alcohol-related comorbidities of interest. This systematic review will summarise and examine relevant studies about the epidemiology of at-risk alcohol use and associated comorbidities of interest in this population.

METHODS

We will search the following databases, without language or date restrictions, from inception to 31 August 2019: Embase.com, Medline Ovid SP, Pubmed (NOT medline[sb]), CINAHL EBSCO, PsycINFO Ovid SP, Central-Cochrane Library Wiley and Web of Science (Core Collection). Search strategies will be developed in collaboration with a librarian. We will use predefined search terms for alcoholism, epidemiology, the elderly, living place and comorbidities of interest, as well as terms related to the identification of "measurements", "tools" or "instruments" for measuring harm from alcohol use. At-risk status will be determined by the amount of alcohol consumed and any comorbidities of interest associated with at-risk alcohol use, with the latter being documented separately or using an assessment tool for at-risk drinking. We will also examine the bibliographies of all the relevant articles found and search for unpublished studies. We will consider publications in all languages.

ETHICS AND DISSEMINATION

No ethical approval is necessary. Results will be presented in national and international conferences on addiction and published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42018099965.

Space and Place in Alcohol Research

PURPOSE OF REVIEW

To summarize the recent literature on social and physical environments and their links to alcohol use and identify empirical research strategies that will lead to a better understanding of alcohol use in contexts.

RECENT FINDINGS

Recent research has continued to describe the importance of neighborhood and regional contexts on alcohol use, while a smaller emerging scientific literature assesses the impacts of contexts on drinking.

SUMMARY

The dynamic, longitudinal, and multiscale processes by which social and physical structures affect social interactions and substance use have not yet been uncovered or quantified. In order to understand and quantify these processes, assessments of exposures (e.g., how individuals use space) and risks within specific locations are essential. Methods to better assess these exposures and risks include model-based survey approaches, ecological momentary assessment (EMA) and other forms of ecologically- and temporally-specific analyses, affiliation network analyses, simulation models, and qualitative/multi-methods studies.

Factors associated with elevated consumption of alcohol in older adults-comparison between China and Norway: the CLHLS and the HUNT Study

OBJECTIVES

The primary objective was to investigate the prevalence and factors associated with elevated alcohol consumption among older adults 65 years and above in China and Norway. The secondary objective was to compare the prevalence and factors in the two countries.

DESIGN

A secondary data analysis was conducted using two large cross-sectional studies (Chinese Longitudinal Healthy Longevity Survey data in 2008-2009 and Nord-Trøndelag Health Study data in 2006-2008).

PARTICIPANTS

A total of 3223 (weighted) Chinese older adults and 6210 Norwegian older adults who responded drinking alcohol were included in the analysis.

OUTCOME MEASURES

The dependent variable was elevated alcohol consumption, which was calculated as a ratio of those with elevated drinking among current drinkers. Multivariable logistic regression was used to test the dependent variable.

RESULTS

The prevalence of elevated alcohol consumption among current drinkers for the Chinese and Norwegian samples were 78.3% (weighted) and 5.1%, respectively. Being male was related to a higher likelihood of elevated alcohol consumption in both Chinese and Norwegian samples (OR=2.729, 95% CI 2.124 to 3.506, OR=2.638, 95% CI 1.942 to 3.585). Being older, with higher levels of education and a living spouse or partner were less likely to have elevated drinking in the Chinese sample (OR=0.497, 95% CI 0.312 to 0.794, OR=0.411, 95% CI 0.260 to 0.649, OR=0.533, 95% CI 0.417 to 0.682, respectively). Among Norwegian older adults, a higher level of education was related to higher likelihood of elevated drinking (OR=1.503, 95% CI 1.092 to 2.069, OR=3.020, 95% CI 2.185 to 4.175). Living in rural areas and higher life satisfaction were related to lower likelihood of elevated drinking in the Norwegian sample (OR=0.739, 95% CI 0.554 to 0.984, OR=0.844, 95% CI 0.729 to 0.977, respectively).

CONCLUSIONS

The elevated alcohol consumption patterns were strikingly different between China and Norway in regards to prevalence and socioeconomic distribution. To develop and implement culturally appropriate public health policies regarding alcohol in the future, public health policy makers and professionals need to be aware of the cultural differences and consider the demographic, social and economic characteristics of their intended population.

Cancer and Alcohol Consumption in People Aged 50 Years or More in Europe

Aims

To estimate the prevalence of hazardous drinking in individuals aged 50 and older who had or had had cancer in 17 European countries and Israel and to analyze the factors associated with their consumption.

Methods

Cross-sectional study based on data from 2011 to 2013 SHARE surveys. A total of 69,509 individuals aged 50 or more from 17 European countries and Israel participated in the study. Prevalence of hazardous drinking in people with cancer was estimated (adapting the SHARE questionnaire to the AUDIT-C). To ascertain whether type of cancer or time since diagnosis were associated with hazardous drinking, Poisson regression models with robust variance were estimated, obtaining prevalence ratios (PR).

Results

Overall, 5.4% of participants reported having been diagnosed with cancer. Prevalence of hazardous drinking in people with cancer was 18% in women and 23% in men. After adjusting for various socioeconomic and health variables, no significant differences were observed between hazardous drinking and type of cancer [PR = 0.99 (95% confidence interval (95% CI) = 0.83-1.17) in people with alcohol-related cancers compared to non-alcohol related cancers] and time since diagnosis [PR = 1.01 (95% CI = 0.82-1.25) in people with a cancer diagnosed >5 years ago compared to those diagnosed ≤5 years ago]. Significant differences were found between hazardous drinking and smoking status and self-perceived health.

Conclusion

In total, 20% of people diagnosed with cancer were hazardous drinkers, despite the known relationship between alcohol use and a worse prognosis of the disease and an increased likelihood of recurrence.

Short Summary

Overall, 20% of people diagnosed with cancer were hazardous drinkers. There were no significant differences in the prevalence of hazardous drinking depending on the type of cancer (alcohol-related versus non-alcohol related cancers). Highest prevalence of hazardous drinking in people with cancer is found in smokers and people with good self-perceived health.

Hazardous Drinking Prevalence and Correlates in Older New Zealanders: A Comparison of the AUDIT-C and the CARET

Objectives: The study compared the proportion of older adults identified as drinking hazardously based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) with the older adult-specific Comorbidity Alcohol Risk Evaluation Tool (CARET) and investigated whether sociodemographics, comorbidities, health, medication use, and alcohol-related risk behaviors explained discrepancies between the screens in classification of hazardousness. Method: The AUDIT-C and the CARET were administered to 3,673 adults aged 55 to 89 years. Classification agreement between the screens was evaluated using Cohen's kappa. Hazardous drinking groups were compared using logistic regression. Results: Analysis indicated moderate agreement between the screens. Drinkers classified as "hazardous on the CARET only" consumed less alcohol, but were more likely to drink-drive. Introducing a drink-driving criterion into the calculation of hazardousness on the AUDIT-C substantially decreased the classification discrepancy between the measures. Discussion: Standard screening can be improved by investigating comorbidities, medication use, and alcohol-related risk behaviors in those initially identified as nonhazardous drinkers.

Assessing health, quality of life and urogenital function in a sample of the Swedish general population: a cross-sectional study

OBJECTIVE

Evaluate the urinary, bowel and sexual function as well as stress symptoms and depression in a sample of the Swedish population.

DESIGN

A random sample of Swedish men and women in age groups from 30 to 89 years, a total of 3000 individuals, were contacted and after receiving informed consent, a questionnaire was sent.

MAIN OUTCOME MEASURES

Measures of urinary, bowel, sexual function and quality of life.

RESULTS

The questionnaire was sent to 2094 individuals who gave informed consent. The questionnaire was answered by 1078 individuals. Quality of life, stress symptoms and depressed mood were relatively constant across age groups for both men and women. Urinary function differed significantly across gender and age groups, but bowel function was relatively unaffected by age. Overall bowel dysfunction was slightly more prevalent among women compared with men. For both men and women, the frequency of intercourse or other sexual activities decreased with age, whereas sexually associated distress increased by age in men, but decreased among women.

CONCLUSIONS

In a general population, the urinary function varied across age and sex. Overall bowel dysfunction was slightly more prevalent among women compared with men. Sexually associated distress increased by age for men, but decreased for women.

TRIAL REGISTRATION NUMBER

NCT02392923; Results.

Alcohol, aging, and innate immunity

The global population is aging: in 2010, 8% of the population was older than 65 y, and that is expected to double to 16% by 2050. With advanced age comes a heightened prevalence of chronic diseases. Moreover, elderly humans fair worse after acute diseases, namely infection, leading to higher rates of infection-mediated mortality. Advanced age alters many aspects of both the innate and adaptive immune systems, leading to impaired responses to primary infection and poor development of immunologic memory. An often overlooked, yet increasingly common, behavior in older individuals is alcohol consumption. In fact, it has been estimated that >40% of older adults consume alcohol, and evidence reveals that >10% of this group is drinking more than the recommended limit by the National Institute on Alcohol Abuse and Alcoholism. Alcohol consumption, at any level, alters host immune responses, including changes in the number, phenotype, and function of innate and adaptive immune cells. Thus, understanding the effect of alcohol ingestion on the immune system of older individuals, who are already less capable of combating infection, merits further study. However, there is currently almost nothing known about how drinking alters innate immunity in older subjects, despite innate immune cells being critical for host defense, resolution of inflammation, and maintenance of immune homeostasis. Here, we review the effects of aging and alcohol consumption on innate immune cells independently and highlight the few studies that have examined the effects of alcohol ingestion in aged individuals.