Alcohol and mortality in older people: understanding the J-shaped curve

The Impact of Social Vulnerability on Alcohol Consumption and Mortality: A 20-year Age, Sex-stratified Analysis from the Taiwan Longitudinal Study of Aging

OBJECTIVE

This study aimed to use the Social Vulnerability Index (SVI) to encapsulate the complex and multidimensional nature of social determinants and their influence on alcohol intake and mortality in middle-aged and older individuals.

DESIGN

Cohort study.

SETTING AND PARTICIPANTS

Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with 3945 study participants aged 50 years and older.

METHODS

The TLSA questionnaire defined SVI (51 items including living conditions, social support, socially oriented activities of daily living, social engagement and leisure, empowerment of life, satisfaction about life, and socioeconomic status) and alcohol intake (behavior as well as type and frequency of alcohol intake). Multivariate Cox proportional hazard models were used to estimate the association between alcohol intake and mortality, stratified by sex and SVI groups.

RESULTS

Men with high social vulnerability and high alcohol intake exhibit an elevated mortality risk [adjusted hazard ratio (aHR), 1.51; 95% CI, 1.01-2.24], whereas notably, women in similar social circumstances but with moderate alcohol intake face a quintupled mortality risk (>35 g/wk; aHR, 5.67; 95% CI, 2.37-13.61). The impact of alcohol and social vulnerability on mortality was more pronounced in men younger than 65. Among them, those with high social vulnerability and moderate (35-140 g/wk; aHR, 2.83; 95% CI, 1.50-5.36) to high (>140 g/wk; aHR, 2.24; 95% CI, 1.15-4.35) alcohol intake was associated with an increased risk of mortality.

CONCLUSIONS AND IMPLICATIONS

Various factors throughout the life course of both men and women significantly impact the risk of all-cause mortality due to alcohol intake, underscoring the importance of social vulnerability as a determinant of both alcohol intake behavior and mortality risk.

Relationship between alcohol consumption and cognitive impairment in the adult population over 60 years of age: A systematic review

INTRODUCTION

Alcohol is the most consumed substance in Western culture and its use is a causal factor in more than 200 diseases and disorders. Our objective was to determine the relationship between alcohol consumption and cognitive impairment in people aged ≥60, and identify which cognitive functions are most affected by prolonged alcohol consumption.

METHODS

Search in MEDLINE, PsycInfo, Psicodoc, Cochrane and Web of Science databases. The search was limited to articles published from 2010 to 2020. A total of 8716 articles were obtained. Those repeated and unrelated to the topic were eliminated, leaving a total of seven articles: five longitudinal studies, covering the relationship between alcohol and cognitive impairment; and two cross-sectional studies, which helped identify which cognitive functions are more affected. This systematic review was carried out in accordance with the criteria of the PRISMA statement.

RESULTS

Most of the studies found conclude that no or excessive alcohol consumption is associated with a higher risk of cognitive impairment, compared to moderate consumption. In addition, excessive and prolonged alcohol consumption can evolve into secondary alcoholic dementia such as Marchiafava-Bignami disease, Wernicke-Korsakoff syndrome or pellagra. In people with alcohol use disorder, the cognitive functions that are most affected are executive functions, visuospatial skills, attention and memory.

The Risk of Breast Cancer between Western and Mediterranean Dietary Patterns

Breast cancer is a significant public health problem globally and prevention strategies have become of great interest as its incidence rises. Exploring the connection between dietary patterns and the reduction of breast cancer risk is considered a promising approach. High levels of fiber, phytochemicals, a good antioxidant profile, and a composition of advantageous fatty acids are characteristics of healthy dietary programs such as the Mediterranean diet. This review summarized and discussed the active compounds that are considered important in preventing breast cancer, including dietary components from recent related reports. These include polyunsaturated fatty acids, fiber, phytochemicals, and alcohol. Although the exact mechanism for preventing breast cancer using these dietary factors is not well understood, the combination of all the elements in a healthy diet plays a role in reducing breast cancer risk. Considering the elevated probability of breast cancer relapse and mortality, it is crucial to investigate the correlation between a nutritious dietary pattern and breast cancer, while identifying bioactive components that have the potential to mitigate the risk of breast cancer incidence.

Active ageing profiles among older adults in Spain: A Multivariate analysis based on SHARE study

BACKGROUND

Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age.

METHODS

A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA).

RESULTS

Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life.

DISCUSSION AND CONCLUSIONS

The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Alcohol-Related Dementia: Rethink How Much You Drink

People have consumed alcohol for centuries. Most clinicians who work with people who have dementia acknowledge that alcohol may cause or exacerbate dementia's symptoms. Alcohol-related dementia (ARD) has been recognized since the 1960s, but clinicians rarely use this diagnosis. Regardless, it is common and develops pursuant to long-term excessive alcohol consumption. It may, in some cases, evolve into Wernicke-Korsakoff syndrome. Diagnosis can be obscured if patients are not truthful about their alcohol consumption. Often, friends or family provide a better picture of the patient's alcohol history than patients do themselves. Thiamine treatment may prevent or improve symptoms. Abstinence from alcohol is critical, but it is difficult for older people with long histories of heavy drinking. Consultant pharmacists can help the heath care team develop nuanced care plans for patients who have ARD.

The association of alcohol use with all-cause and cardiovascular disease-related hospitalizations or death in older, high-risk Veterans

BACKGROUND

The prevalence of alcohol misuse among older adults has grown dramatically in the past decade, yet little is known about the association of alcohol misuse with hospitalization and death in this patient population.

METHODS

We examined the association between alcohol use (measured by a screening instrument in primary care) and rates of all-cause and cardiovascular disease (CVD)-related 6-month hospitalization or death via electronic health records (EHRs) in a nationally representative sample of older, high-risk Veterans. Models were adjusted for sociodemographic and clinical characteristics, including frailty and comorbid conditions.

RESULTS

The all-cause hospitalization or death rate at 6 months was 14.9%, and the CVD-related hospitalization or death rate was 1.8%. In adjusted analyses, all-cause hospitalization or death was higher in older Veterans who were nondrinkers or harmful use drinkers compared to moderate use drinkers, but CVD-related hospitalization or death was similar in all categories of drinking.

CONCLUSIONS

These findings suggest that the complex association between alcohol and all-cause acute healthcare utilization found in the broader population is similar in older, high-risk Veteran patients. These findings do not support an association between alcohol consumption and CVD-specific hospitalizations.