Alcohol use in retirement communities

Functional limitation in later-life: the impact of sips, socialization, and sadness

OBJECTIVES

Findings on the health impact of moderate alcohol use in later-life have been discrepant. Unaddressed mechanisms of action and validity concerns may contribute to contrasting results. Several studies have demonstrated a beneficial relationship between moderate alcohol use and functional ability. Research is needed to identify mechanisms of action that explain this relationship, while employing methods to reduce common validity concerns in alcohol use research. This study examines social interaction and depressive symptoms as serial mediators in the relationship between moderate alcohol use and functional limitation in later-life.

METHOD

HRS data from 2012-2016 were utilized (n = 1,474); heavy drinkers, adults younger than 65, and respondents with inconsistent alcohol use from 2008 to 2016 were excluded. Hypotheses were evaluated using a longitudinal serial mediation model with bias-corrected bootstrapping.

RESULTS

Results indicated that, in the context of demographic variables, medical burden, and previous functional limitation, the relationship between 2012 moderate alcohol use and 2016 reduced functional limitation is only present when considering the mediating effect of 2014 depressive symptoms as a single mediator, and 2012 social interaction and 2014 depressive symptoms as serial mediators, respectively (total effect model R²=.167).

CONCLUSIONS

Data indicate that relationships between moderate drinking and reduced functional limitation are explained through increased social interaction and subsequent reduced depressive symptoms. Results identify social interaction as an accessible treatment target to address depressive symptoms and functional limitation, and support increased assessment of IADLs in adults experiencing depressive symptoms (and vice versa) to facilitate early treatment/prevention of functional and emotional decline.

The Benefit of Moderate Alcohol Use on Mood and Functional Ability in Later Life: Due to Beers or Frequent Cheers?

BACKGROUND AND OBJECTIVES

Evidence relates moderate alcohol consumption in later life to fewer depressive symptoms and greater functional ability. This study evaluated social interaction as a mediator of these outcomes.

RESEARCH DESIGN AND METHODS

Data included older adults in the Health and Retirement Study. In Study 1, cross-sectional mediation analyses evaluated social interaction as a mechanism through which moderate alcohol use was related to decreased depressive symptomatology (Model 1; N = 2,294) and less functional limitation (Model 2; N = 2,357). In Study 2, longitudinal cross-lagged path analyses further evaluated the impact of moderate alcohol use and social interaction on future depressive symptoms and functional limitation.

RESULTS

In Study 1, results from Model 1 indicated that moderate alcohol use was associated with decreased depressive symptomatology indirectly via greater social interaction. In Model 2, moderate alcohol use was associated with less functional limitation indirectly via greater social interaction. In Study 2, significant indirect effects corroborated findings from Study 1. In Model 3, moderate alcohol use in 2012 inversely predicted depressive symptomatology in 2014 via greater levels of social interaction in 2012. In Model 4, moderate alcohol use in 2012 predicted less functional limitation in 2014 via greater social interaction in 2012.

DISCUSSION AND IMPLICATIONS

Social interaction is essential to the seemingly beneficial effect of moderate alcohol use on depressive symptomatology and functional ability. Clinically, this suggests caution in attributing health benefits to consumption of alcohol itself and identifies social interaction as a treatment target for improved health outcomes in later life.

Evaluation of adding the community reinforcement approach to motivational enhancement therapy for adults aged 60 years and older with DSM-5 alcohol use disorder: a randomized controlled trial

AIM

To examine whether adding the Community Reinforcement Approach for Seniors (CRA-S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD).

DESIGN

A single blind multi-centre multi-national randomized (1 : 1) controlled trial.

SETTING

Out-patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States).

PARTICIPANTS

Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM-5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA-S (n = 342).

INTERVENTION AND COMPARATOR

MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA-S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA-S included a specially designed module on coping with age and age-related problems.

MEASUREMENTS

The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05% during the 30 days preceding the 26 weeks follow-up (defined as success) or blood alcohol concentration of > 0.05% during the follow-up period (defined as failure). This was assessed by self-report using the Form 90 instrument. The main analysis involved complete cases.

FINDINGS

The follow-up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA-S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9-54.9%] versus 52.3% (95% CI = 46.2-58.3%) in the MET + CRA-S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86-1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results.

CONCLUSIONS

In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out-patient motivational enhancement therapy treatment did not improve drinking outcome.

Social context of drinking among older adults: Relationship to alcohol and traffic risk behaviors

OBJECTIVE

Alcohol use among older adults is a major public health concern given potentially negative effects to health and functioning in this population. Little is known about context in which alcohol use among older adults occurs, or how context of use is associated with risk behaviors.

METHOD

Invitation letters were mailed to licensed drivers 65 years and older in Maryland. A total of 825 participants completed an online survey that assessed demographic characteristics, alcohol use, social context of drinking, and driving behaviors.

RESULTS

The analytic sample consisted of 604 older adult current drinkers (55% male). A factor analysis revealed three separate contexts of drinking: social facilitation, emotional comfort, and relaxation. Drinking in the context of social facilitation was associated with driving after drinking. Drinking in the context of emotional comfort was associated with getting drunk, driving after drinking, and running a stop sign or red light. Drinking in the context of relaxation was associated with traffic risk behaviors, including running a stop sign or red light and getting in a near crash or collision.

CONCLUSIONS

Understanding the social context of alcohol use among older adults may be useful for targeting and attempting to modify risky alcohol use and driving behaviors.

Retirement, Social Support, and Drinking Behavior: A Cohort Analysis of Males with a Baseline History of Problem Drinking

Although previous research examining drinking behaviors among older adults suggests that significant life events are likely to have their strongest alcohol-related effects among those with a history of heavy or problematic drinking, to date researchers have not directly examined the association between such events and the drinking behavior of such individuals. Consequently, using longitudinal data, we examine the link between retirement as a significant life event and the severity of problem drinking behavior of retirement-eligible males employed in blue-collar occupations and having a history of problem drinking. We find that while retirement had no significant impact on the problem drinking behavior of a control sample of 236 retirement-eligible blue-collar males with no history of problem drinking, retirement was associated with a net decline in the severity of drinking problems among those 71 retirement-eligible blue-collar males with a history of problem drinking. Much of this effect is explained by the consolidation of the latters' retirement-related social networks, suggesting that for those with a problem drinking history, retirement may provide a kind of “relief” from permissive drinking environments potentially encouraging problem drinking behaviors.

Alcohol, wine and mental health: focus on dementia and stroke

The relative risks of coronary heart disease (CHD) and overall mortality are reduced by moderate consumption of alcoholic beverages, particularly wine, which has major implications for public health. It appears likely that this beneficial effect of alcohol will soon be extended to some mental disorders. Although data on psychosis and mood and anxiety disorders are currently lacking, it appears that the relative risks of developing ischaemic stroke and Alzheimer's or vascular dementia are also lowered by moderate alcohol consumption. Such findings are still tentative because of the inherent methodological problems involved in Population-based epidemiological studies, and it is unclear whether the benefit can be ascribed to alcohol itself or to other constituents specific to wine such as polyphenols. Plausible biological mechanisms have been advanced for the protective effect of alcohol and wine against CHD, many of which will also play roles in their protective actions against cerebrovascular disease and dementia. The specific antioxidant properties of wine polyphenols may be particularly important in preventing Alzheimer's disease. Because of the substantially unpredictable risk of progression to problem drinking and alcohol abuse, the most sensible advice to the general public is that heavy drinkers should drink less or not at all, that abstainers should not be indiscriminately encouraged to begin drinking for health reasons, and that light to moderate drinkers need not change their drinking habits for health reasons, except in exceptional circumstances.

Coping Behaviors as Predictors of Drinking Practices among Primary in-Home Dementia Caregivers

This study examines the predictive value of coping behaviors in discriminating drinkers from nondrinkers among 109 primary in-home dementia caregivers. The participants were enrolled in a caregivers education project and completed comprehensive health and psychosocial assessments prior to receiving education. Coping was measured using the Ways of Coping Questionnaire. Questions on alcohol use were embedded in a self-administered portion of the assessment. A model testing the predictive value of coping behaviors in discriminating drinkers from nondrinkers was found to be significant (p < .0393). Caregivers who used self-controlling or distancing coping were more likely to be classified as drinkers, and those who used positive reappraisal or confrontive coping were more likely to be classified as nondrinkers. As the number of caregivers increases, gaininga greater understanding of relationships between caregiver copingand behaviors with potential for negative health and psychosocial consequences, such as alcohol use, can have useful applications in practice.

A cross-sectional study on quality of life among the elderly in non-governmental organizations' elderly homes in Kuala Lumpur

Background

There is a rapid increase in the population of the elderly globally, and Malaysia is anticipated to become an ageing nation in 2030. Maintaining health, social participation, reducing institutionalization, and improving quality of life of the elderly are public health challenges of the 21^st century. Quality of life among elderly in Elderly Homes in Malaysia is under researched. This study aims to determine the quality of life and its associated factors among the Elderly in Elderly Homes in Kuala Lumpur.

Methods

This was a cross-sectional study among 203 residents aged 60 years or more in eight randomly selected Elderly Homes in Kuala Lumpur in September 2014. Stratified simple random sampling was used to select participants. Study instruments included World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF), Multidimensional Scale for Perceived Social Support, and a questionnaire for Socio-demographic variables. Data collection was by face to face interview. Univariate and Multivariate analysis were used to determine associations, and P-value <0.05 was considered statistically significant.

Results

The mean (Standard deviation) for the physical domain was 14.3 (±2.7), 13.7 (±2.5) for the psychological domain, 10.8 (±3.4) for the social domain, and 13.0 (±2.5) for the environment domain. Factors significantly associated with quality of life included age, gender, level of education, economic status, outdoor leisure activity, physical activity, duration of residence, type of accommodation, co-morbidities, and social support.

Conclusion

This study confirms that multiple factors are associated with quality of life among elderly in elderly homes. Social support, chronic co-morbidities, gender and outdoor leisure activity were significantly associated with all the domains of quality of life. Among the four domains of quality of life, the physical domain had the highest score while the social domain had the lowest score. This emphasizes the need for more social support-related interventions in these homes.

Drinking behavior among older adults at a continuing care retirement community: affective and motivational influences

OBJECTIVES

The purpose of this pilot study was to describe patterns of alcohol consumption among continuing care retirement community(CCRC) residents and to explore the role of drinking motives and affective states on drinking context and consumption.

METHOD

We utilized a phone-based daily diary approach to survey older adults about their daily alcohol consumption, context of drinking (e.g. drinking alone), positive and negative affect, and their motives for drinking. Data were analyzed descriptively, and regression models were developed to examine associations between sociodemographic factors, affect, drinking context and motives, and alcohol consumption.

RESULTS

CCRC residents drank most frequently at home and were alone almost half of drinking days on average, although the context of drinking varied considerably by participant. Problem alcohol use was rare, but hazardous use due to specific comorbidities, symptoms and medications, and the amount of alcohol consumption was common. Respondents endorsed higher social motives for drinking and lower coping motives. Social motives were associated with decreased likelihood of drinking alone, but negative affect was associated with decreased likelihood of drinking outside one's home. Coping and social motives were associated with greater consumption, and higher positive affect was associated with lower consumption.

CONCLUSION

Among CCRC residents, alcohol use may be socially motivated rather than motivated by coping with negative affect. Future research should examine other motives for drinking in older adulthood. Evaluation of older adults living in CCRCs should include attention to health factors beyond problem use as other forms of hazardous use may be common in CCRCs.

Substance abuse among older adults

Although the myth that older adults do not use mood-altering substances persists, evidence suggests that substance use among older adults has been underidentified for decades. The baby boom generation is unique in its exposure to, attitudes toward, and prevalence of substance use-causing projected rates of substance use to increase over the next twenty years. Given their unique biological vulnerabilities and life stage, older adults who misuse substances require special attention. Prevalence rates of substance use and misuse among older adults, methods of screening and assessment unique to older adults, and treatment options for older adults are reviewed.

Validation of the Drinking Motives Questionnaire (DMQ) in older adults

Drinking motives have been established as an important construct in the prediction of alcohol use and drinking problems among younger adults, but there is little understanding about the drinking motivations of older adults. Although emerging evidence shows the importance of studying older adults' own reasoning for their alcohol consumption, measures that have been used to assess such reasons lack psychometric assessment. This study aims to validate the three-dimensional structure of the Drinking Motives Questionnaire (DMQ) in older adults and to investigate the relationships between drinking motives and alcohol use. A sample of community dwelling older adults (N=370) completed self-report measures assessing drinking behavior and motives for drinking. Using confirmatory factor analysis, the results supported a three-factor model of drinking motives. Multi-group analysis of invariance showed support for configural and metric invariance, and partial support was met for scalar invariance. Social motivations for drinking were the most frequently endorsed, followed by enhancement, and coping motives. Males reported more frequent drinking for each of the three motives. Social motives were consistently related to drinking behaviors and coping had a direct relationship to drinking problems. Overall, the study shows that the DMQ has promise as a measure for use with older adults.

Alcohol consumption and quality of life among young adults: a comparison among three European countries

The study aims to investigate the relationship between alcohol consumption and quality of life (QoL) on a representative sample of adults aged 25-34 living in France, Italy, and the Netherlands (4,841 subjects). The data was collected in 2008 using telephone interviews and analyzed with cluster analysis using Ward's method. Results show that the impact of alcohol consumption on QoL depends mainly on predominant consumption style and drinking culture that should be investigated further to identify protective factors.

The impact of retirement on the drinking patterns of older adults: a review

OBJECTIVE

Due to the aging of the population, there is renewed focus on the public health issues of middle-aged and older adults. One area of such focus is unhealthy drinking, and researchers seek to understand the unique developmental risk and protective factors among those entering older adulthood. Retirement has been hypothesized as a contributing factor in the onset and maintenance of unhealthy drinking in late life. This review describes the relevant theories and critically reviews empirical evidence that explores the relationship between alcohol and retirement drawn from both the industrial and organizational psychology and substance misuse literatures.

METHOD

Using four research databases, thirteen studies published in the last 25years that investigated the relationship of retirement and alcohol use and met specific selection criteria were reviewed.

RESULTS

The literature suggests that retirement may not have a strong direct impact on drinking behaviors or problems, but attributes of the process (e.g. retirement voluntariness) of transition to retirement and individual attributes, such as having a history of problem drinking, may facilitate or inhibit drinking.

CONCLUSIONS

Future research should delve into the social context of drinking in retirement with a goal of understanding the aspects and conditions of retirement that increase risk of alcohol problems. Investigation should also examine heterogeneity in retirement drinking patterns with a goal of identifying subpopulations that are at greater risk.

Alcohol consumption at midlife and successful ageing in women: a prospective cohort analysis in the nurses' health study

BACKGROUND

Observational studies have documented inverse associations between moderate alcohol consumption and risk of premature death. It is largely unknown whether moderate alcohol intake is also associated with overall health and well-being among populations who have survived to older age. In this study, we prospectively examined alcohol use assessed at midlife in relation to successful ageing in a cohort of US women.

METHODS AND FINDINGS

Alcohol consumption at midlife was assessed using a validated food frequency questionnaire. Subsequently, successful ageing was defined in 13,894 Nurses' Health Study participants who survived to age 70 or older, and whose health status was continuously updated. "Successful ageing" was considered as being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment, or mental health limitations. Analyses were restricted to the 98.1% of participants who were not heavier drinkers (>45 g/d) at midlife. Of all eligible study participants, 1,491 (10.7%) achieved successful ageing. After multivariable adjustment of potential confounders, light-to-moderate alcohol consumption at midlife was associated with modestly increased odds of successful ageing. The odds ratios (95% confidence interval) were 1.0 (referent) for nondrinkers, 1.11 (0.96-1.29) for ≤ 5.0 g/d, 1.19 (1.01-1.40) for 5.1-15.0 g/d, 1.28 (1.03-1.58) for 15.1-30.0 g/d, and 1.24 (0.87-1.76) for 30.1-45.0 g/d. Meanwhile, independent of total alcohol intake, participants who drank alcohol at regular patterns throughout the week, rather than on a single occasion, had somewhat better odds of successful ageing; for example, the odds ratios (95% confidence interval) were 1.29 (1.01-1.64) and 1.47 (1.14-1.90) for those drinking 3-4 days and 5-7 days per week in comparison with nondrinkers, respectively, whereas the odds ratio was 1.10 (0.94-1.30) for those drinking only 1-2 days per week.

CONCLUSIONS

These data suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older ages.

Alcohol use among older adults

Alcohol use is common in older adults and is associated with numerous health and social problems. Recent evidence suggests that in addition to level of alcohol consumption, drinking pattern may also be important. Moderate alcohol intake may confer some cardiac benefits, while heavy episodic drinking seems particularly problematic. Detecting alcohol misuse in older adults is difficult since clinical acumen is often poor, screening questionnaires have serious limitations and laboratory tests are not diagnostic. Brief alcohol interventions to reduce alcohol consumption appear useful in younger populations, but are less studied in older adults. While there is increasing research into the issue of alcohol use among older adults, clinicians and policy-makers must rely on limited evidence when making clinical decisions.

Alcohol misuse, gender and depressive symptoms in community-dwelling seniors

OBJECTIVES

Alcohol misuse in seniors has been studied in clinical samples and in small communities, but relatively few studies are population-based. Objectives are: (1) to describe the characteristics of seniors who score 1 or more on the CAGE (Cut down; Annoyed; Guilty; Eye-opener) questionnaire of alcohol problems; (2) to determine if depressive symptoms are associated with alcohol misuse after accounting for other factors.

METHODS

Cross-sectional study of community-dwelling older people (65+ years) sampled from a representative population registry in Manitoba, Canada. Participants were initially interviewed in 1991-1992 and reinterviewed in 1996-1997. Data from Time 2 were used; 1,028 persons were included in the analyses. Sociodemographic characteristics, the CAGE questionnaire, Activities of Daily Living (ADLs) and instrumental ADLs (IADLs), the Center for Epidemiologic Studies-Depression (CES-D) scale and the Mini-Mental State Examination (MMSE) were assessed by trained interviewers.

RESULTS

Males were more likely to score positive on the CAGE questionnaire. After adjusting for gender, age, and education, there was a strong association between depressive symptoms and alcohol misuse. Poor self-rated health and impairments in IADLs were also associated with alcohol misuse.

CONCLUSIONS

Male gender, depressive symptoms, and poor functional status were associated with alcohol misuse in this population-based study. Attention to depressive symptoms and functional status may be important in the care of seniors with alcohol misuse. Alternatively, physicians should enquire about alcohol use in seniors with functional impairment or depressive symptoms.

Perceived Agency in Retirement and Retiree Drinking Behavior: Job Satisfaction as a Moderator

Based on recent findings that post-retirement adjustment may be influenced by the conditions leading up to the decision to retire, we examine the impact of individual agency in the retirement decision on problematic drinking behavior, as well as the extent to which such an effect may itself depend upon the valence of the pre-retirement work experience. Using a sample of 304 blue-collar retirees, our findings indicate that, when controlling for pre-retirement drinking behavior, perceptions of retirement as the result of a more forced or involuntary decision are associated with greater alcohol consumption, while perceptions of retirement as the result of a more volitional or voluntary process are associated with lower levels of alcohol consumption and a lower risk of problematic drinking behavior. Our results also indicate that pre-retirement job satisfaction amplifies the former relationship, while attenuating the latter one.

Drugs of abuse and the aging brain

Substance abuse among older adults has received little attention in the past, presumably because this population has traditionally accounted for only a small percentage of the drug abuse problem in the United States. The aging of the baby boomer generation (born 1946-1964), however, will soon swell the ranks of older adults and dramatically alter the demography of American society. Several observations suggest that this expansion will likely be accompanied by a precipitous increase in the abuse of drugs, including prescription medications and illicit substances, among older adults. While it is now evident that the brain changes continuously across life, how drugs of abuse interact with these age-related changes remains unclear. The dynamic nature of brain function, however, suggests that substance abuse during older age may augment the risks and require unique considerations for diagnosis and treatment. In addition to describing current and projected prevalence estimates of substance abuse among older adults, the present review discusses how aging affects brain systems involved in drug abuse, and explores the potential impact of drug abuse on the aging brain. Future directions for substance abuse research among older adults will also be considered.

Adding an alcohol-related risk score to an existing categorical risk classification for older adults: sensitivity to group differences

OBJECTIVES

To evaluate a new alcohol-related risk score for research use.

DESIGN

Using data from a previously reported trial of a screening and education system for older adults (Computerized Alcohol-Related Problems Survey), secondary analyses were conducted comparing the ability of two different measures of risk to detect post-intervention group differences: the original categorical outcome measure and a new, finely grained quantitative risk score based on the same research-based risk factors.

SETTING

Three primary care group practices in southern California.

PARTICIPANTS

Six hundred sixty-five patients aged 65 and older.

MEASUREMENTS

A previously calculated, three-level categorical classification of alcohol-related risk and a newly developed quantitative risk score.

RESULTS

Mean post-intervention risk scores differed between the three experimental conditions: usual care, patient report, and combined report (P<.001). The difference between the combined report and usual care was significant (P<.001) and directly proportional to baseline risk. The three-level risk classification did not reveal approximately 57.3% of the intervention effect detected by the risk score. The risk score also was sufficiently sensitive to detect the intervention effect within the subset of hypertensive patients (n=112; P=.001).

CONCLUSION

As an outcome measure in intervention trials, the finely grained risk score is more sensitive than the trinary risk classification. The additional clinical value of the risk score relative to the categorical measure needs to be determined.

A Drink to Healthy Aging: The Association Between Older Women's Use of Alcohol and Their Health-Related Quality of Life

OBJECTIVES

To assess the relationship between alcohol intake and mortality in a cohort of women aged 70 and older and to explore the relationship between level of alcohol use and changes in physical and mental health-related quality of life.

DESIGN

National longitudinal surveys from 1996 to 2002.

SETTING

Community based.

PARTICIPANTS

A national random sample of 12,432 Australian women aged 70 to 75 at baseline.

MEASUREMENTS

Alcohol consumption was the factor of interest, and the main outcome measures were survival and health-related quality of life, with adjustment for potential confounders.

RESULTS

Women who did not consume alcohol or who drank rarely were more likely to die (nondrinkers' hazard (HR) = ratio 1.94, 95% confidence interval (CI) = 1.4-2.6; rare drinkers' HR = 1.58, 95% CI = 1.2-2.1) than women in the low-intake reference category (1-2 drinks per day, 3-6 days per week), or if they survived, they had lower health-related quality-of-life scores on the General Health and Physical Functioning subscales of the Medical Outcomes Study 36-item Short Form Survey after adjustment for smoking, comorbidity, education, body mass index, and area of residence. Nondrinkers also scored lower on the Mental Health and Social Functioning subscales.

CONCLUSION

Being a nondrinker of alcohol was associated with greater risk of death and poorer health-related quality of life. Results for other levels of intake were consistent with current Australian alcohol consumption recommendations for women and indicated that moderate alcohol intake may carry some health benefits for older women in terms of survival and quality of life.

Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey

As individuals live longer, health promotion behaviors become even more important, particularly with regard to maintaining functional independence and improving quality of life (QoL). The purpose of this study was to explore the relationship between health promotion behaviors and QoL in Korean elderly living in the community. This study was a descriptive-correlational study to explore the relationship between health promotion behaviors and QoL among the community-dwelling elderly in Korea. A convenience sample of 2000 community residents who were over 65 years old and cognitively intact were selected from 32 senior centers and 242 public health centers in Korea. A total of 1920 were included in the analyses, following the exclusion of 80 incomplete questionnaires and subject refusals. Participants who consented to participate in the study were interviewed by trained interviewers with a structured questionnaire. The results of the study showed that there were statistically significant differences in QoL of the elderly related to exercise participation, alcohol abstinence and blood pressure (BP) check-up (p<.05). Multiple regression analysis revealed that perceived health status, number of chronic illnesses, activities of daily living, BP checkup, exercise, and gender were statistically significant predictors of QoL. R(2) for this whole regression model was .412, indicating that approximately 41.2% of the variance in QoL was accounted for by the linear combination of these variables. Nurses should enhance the QoL in elderly persons by facilitating health promotion behaviors through formal nursing interventions which will maintain and increase a healthy and active life.

An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol

OBJECTIVES

To evaluate whether providing physicians and older patients with personalized reports of drinking risks and benefits and patient education reduces alcohol-related risks and problems.

DESIGN

Prospective comparison study.

SETTING

Community primary care.

PARTICIPANTS

Twenty-three physicians and 665 patients aged 65 and older.

INTERVENTION

Combined report, in which six physicians and 198 [corrected] patients received reports of patients' drinking classifications and patients also received education; patient report, in which 245 patients received reports and education, but their five physicians did not receive reports; and usual care.

MEASUREMENTS

Assessments at baseline and 12 months later to determine patients' nonhazardous (no known risks), hazardous (risks for problems), or harmful (presence of problems) classifications using the Computerized Alcohol-Related Problems Survey (CARPS). The CARPS contains a scanned screening measure and scoring algorithms and automatically produces patient and physician reports and patient education.

RESULTS

At baseline, 21% were harmful drinkers, and 26% were hazardous drinkers. The patient report and combined report interventions were each associated with greater odds of lower-risk drinking at follow-up than usual care (odds ratio=1.59 and 1.23, respectively, P<.05 for each). The patient report intervention significantly reduced harmful drinking at follow-up from an expected 21% in usual care to 16% and increased nonhazardous drinking from 52% expected in usual care to 58%. Patients in the combined report intervention experienced a significantly greater average decrease in quantity and frequency.

CONCLUSION

Older primary care patients can effectively reduce their alcohol consumption and other drinking risks when given personalized information about their drinking and health.

Alcohol, wine and mental health: focus on dementia and stroke

The relative risks of coronary heart disease (CHD) and overall mortality are reduced by moderate consumption of alcoholic beverages, particularly wine, which has major implications for public health. It appears likely that this beneficial effect of alcohol will soon be extended to some mental disorders. Although data on psychosis and mood and anxiety disorders are currently lacking, it appears that the relative risks of developing ischaemic stroke and Alzheimer's or vascular dementia are also lowered by moderate alcohol consumption. Such findings are still tentative because of the inherent methodological problems involved in population-based epidemiological studies, and it is unclear whether the benefit can be ascribed to alcohol itself or to other constituents specific to wine such as polyphenols. Plausible biological mechanisms have been advanced for the protective effect of alcohol and wine against CHD, many of which will also play roles in their protective actions against cerebrovascular disease and dementia. The specific antioxidant properties of wine polyphenols may be particularly important in preventing Alzheimer's disease. Because of the substantially unpredictable risk of progression to problem drinking and alcohol abuse, the most sensible advice to the general public is that heavy drinkers should drink less or not at all, that abstainers should not be indiscriminately encouraged to begin drinking for health reasons, and that light to moderate drinkers need not change their drinking habits for health reasons, except in exceptional circumstances.

The impact of alcohol use in community-dwelling older adults

The purpose of this study was to explore the use of alcohol in community-dwelling older adults and to consider differences in physical and mental health, function, cognitive status, and social supports between those who drink minimal (1 to 3 glasses weekly), moderate (4 to 7 glasses weekly), or no alcohol. A total of 3305 older adults with a mean age of 81.6 -/+ 6.0 participated in the study. Twenty-two percent (n = 709) of the participants had 1 to 3 drinks weekly, only 1% (n = 18) reported 4 to 7 drinks weekly, and none of the participants admitted to 8 or more drinks. There was no difference in drinking behavior with regard to age (F = 1.1, p >.05) or social supports (F =.39, p >.05). There was a difference in drinking behavior with regard to physical health (F = 4.9, p <.05), functional status (F = 7.7, p <.05), cognitive status (F = 11.8, p <.05), and mental health (F = 6.9, p <.05). Health care providers should use an individualized approach to alcohol use in older adults and help these individuals establish, as appropriate, safe drinking habits that will augment health and quality of life.

Alcohol Use in a Continuing Care Retirement Community

The purpose of this study was to explore alcohol use among older adults living in a continuing care retirement community (CCRC) and to consider differences in overall health, number of chronic illnesses, falls, age, and exercise behavior between those who drink moderately versus those who do not. A one-time face-to-face interview was conducted with a total of 316 residents living in an urban CCRC in the northeast. The participants were 86.6 6 6.3 years of age, and the majority were women (79%), unmarried (75%), White (9%), and middle to upper socioeconomic status (100%). The majority of these individuals (63%) drank moderately, consuming at least one drink daily. No difference was found between men's and women's drinking behaviors (chi 2 = .47, p > .05). Adults who drank moderately were older (F = 8.7, p < .05), more likely to exercise regularly (chi 2 = 27, p < .05), and were more likely to have had a fall (F = 3.7, p < .05). No statistically significant difference was found between the groups related to perceptions of overall health, number of chronic illnesses, number of medications, overall or number of medications that interact with alcohol, or cognitive status. Although not statistically significant, a greater percentage of individuals who drink moderately had fractures (12%) when compared to the percentage of individuals who do not drink at least moderately (7%). Recognizing both benefits and risks to alcohol use in older adults suggests that an individual approach to educating these individuals about their use of alcohol should be conducted.

Health promotion practices of older adults: model testing

The purpose of this study was to describe the primary and secondary health promotion activities of a group of older adults living independently in a continuing care retirement community. Primary and secondary health promotion activities were described and compared among the young old (ages 65-80), the old (ages 81-85), and the old-old (ages 86-101). Model testing of the factors that influence participation in health-promoting activities was also completed. This descriptive study included 206 of 210 residents who participated in a single face-to-face interview. The majority of the participants were female (79%), white (99%), and cognitively intact. Those in the old-old age group were less likely than the old and young-old groups to have: (1) their stools checked for occult blood; (2) their skin checked for lesions; or (3) a recent mammogram, Pap test, or prostate exam. Model testing found that age, chronic illnesses, degree of physical and mental health, and cognitive status directly or indirectly influenced older adults' participation in primary and secondary health behaviors.

Health promotion practices of older adults: testing an individualized approach

The world's population is getting older. Consequently, the World Health Organization has focused efforts on health promotion activities for these individuals. The purpose of this study was to explore the factors that influence health promotion behaviours and to describe the impact of an individualized approach to decision-making with regard to health promotion activities in a group of older adults living in a continuing care retirement community. The study used a single group pre- and post-test design that included a total of 134 residents. Descriptive statistics were used to describe the sample. A McNemar test was used to compare health promotion activities pre- and postintervention. Regression analysis was used to consider the factors that influenced health promotion activities in these individuals. The survey included questions about health promotion activities and both mental and physical health status. In the year between baseline and follow-up testing a geriatric nurse practitioner provided both formal and informal education about health promotion activities. With the exception of monitoring dietary fat intake, there was not a statistically significant difference in primary and secondary health promotion behaviours pre- and post-testing. There was, however, a decline in smoking and alcohol use, an increase in physical activity and a slight decline in the percentage of older adults who engaged in cancer screenings. An individualized approach may be a useful way to help older adults make health decisions and engage in those health promotion activities that will increase their quality of life.

Features of excessive alcohol drinking in older adults distinctively captured by behavioral and biological screening instruments. An epidemiological study

The entire > or =65-year-old population living in a small Italian town, where alcohol use is almost ubiquitous, was assessed with a frequency-quantity questionnaire for alcohol intake and with two screening instruments for alcohol problems, the CAGE questionnaire and the MCV-gammaGT test. Aim of the study was to assess whether these instruments identify different subsets of subjects with alcohol problems. Of the 649 participants, 19.1% were at-risk drinkers (average intake > 40 g/day in men and > 20 g/day in women). Both the screening instruments were positive in only a minority of participants. Of the 377 drinkers, 53 gave > or =1 affirmative response to the CAGE questionnaire, whereas 24 had a positive MCV-gammaGT test. The concordance between positive CAGE questionnaire and MCV-gammaGT test was limited to seven subjects (kappa = 0.10), and these tests identified subjects who differed for several health and psychosocial characteristics. Participants aged > or =75 years drank less, but had similar prevalence of CAGE and MCV-gammaGT positive markers as compared to younger participants. In conclusion, excessive drinking is common in the elderly. Screening tests based on behavioral and biological markers identify two different sets of subjects with possible alcohol problems. This might indicate the opportunity to use these instruments in conjunction.

Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers?

OBJECTIVES

To describe the (1) prevalence of at-risk drinking and participation in health-related behaviors and practices and (2) associations of at-risk drinking with other health-related behaviors and practices among older persons completing a health-risk appraisal for the elderly (HRA-E).

DESIGN

Cross-sectional study using data from a self-administered, mailed survey sample.

SETTINGS

Persons from three organizations were surveyed: (1) the American Association of Retired Persons; and (2) a large medical group and (3) a community-based senior health center in southern California.

PARTICIPANTS

1,889 persons age 55 years and older.

MEASUREMENTS

The HRA-E included items on health characteristics, drinking behaviors (including amount of alcohol use and two alcoholism screening measures: the CAGE (Cut down, Annoyed, Guilty, Eye opener) and Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G), and participation in selected health-related behaviors and practices. Social drinkers were defined as those who drank fewer than 14 drinks weekly and screened negative on the CAGE (defined as two or more "no" responses) and SMAST-G. Hazardous drinkers drank fewer than 14 drinks weekly and screened negative. Harmful drinkers drank fewer than 14 drinks weekly and screened positive. Possible at-risk drinkers drank 14 or more drinks weekly and screened positive. Least squares regression models were used to assess the effects of hazardous, harmful, and possible at-risk drinking on each of the health-related practices and behaviors. We also conducted these analyses using three other definitions of social, possible at-risk, hazardous, and harmful drinking.

RESULTS

Of all respondents, 40% were social drinkers, 3% were harmful drinkers, 2% were hazardous drinkers, and 11% were possible at-risk drinkers. Hazardous, harmful, and possible at-risk drinkers commonly reported driving after drinking or being driven by someone who had been drinking (67%, 76%, and 64% respectively). Harmful and possible at-risk drinkers were more likely than social drinkers to smoke and were less likely to use seatbelts regularly. These findings were observed regardless of how the drinking groups were defined.

CONCLUSION

All groups of at-risk drinkers more commonly engaged in selected adverse health-related behaviors and practices than did social drinkers.

Alcohol consumption by non-institutionalised elderly women: the EPIDOS Study

The prevalence of alcohol use declines with age, but studies suggest that between 2% and 4% of the elderly population have a particularly high alcohol consumption. The objective of this study was to verify or refute this finding and identify clinical or social characteristics associated with alcohol consumption. We measured alcohol consumption by autoquestionnaire in 7575 women, aged 75 or older, recruited at five centers in France. The alcohol consumption was computed taking account of the number of beer, wine or liquor (or spirits) drinks consumed per day. The mean age of the respondents was 80+/-6 y. Forty percent used some alcohol and 2.5% drank more than 30 grams per day. Smoking, good health status, higher socioeconomic status or single marital status were factors whose percentages increased significantly with increasing alcohol use. Despite the advanced age of this population, regular alcohol intake was prevalent but not heavy and abusive consumption drinking. Drinking appears to be associated with some medical or social characteristics and possibly with better health status.

Promoting health in older adults: a four-year analysis

PURPOSE

The purpose of this study was to consider the influence of selected health promotion and disease prevention interventions in elderly residents of a continuing care retirement community (CCRC) over a four-year period by comparing actual health promotion practices of the residents.

DATA SOURCES

Original research using a descriptive design, face-to-face interviews of residents (N = 176-200), chart reviews, and administration of a mini-mental state exam (MMSE) and health survey administered annually.

CONCLUSIONS

In each year the mean age of the residents was at least 85, the majority were female, Caucasian, and unmarried. With the exception of checking stools for occult blood, there was a statistically significant change in all health promotion behaviors over the four-year period. The most significant change was in the area of exercise behavior, which increased from 24% of the residents participating in regular exercise in year one to 61% by year four.

IMPLICATIONS FOR PRACTICE

The purpose of health promotion and disease prevention in older adults is to reduce the potential years of life lost in premature mortality and ensure better quality of remaining life. In addition to regularly scheduled interventions (group education, on-site administration of pneumonia and flu vaccines, on-site exercise room and walking group), individualized counseling regarding the pros and cons of health-promotion activities was provided to help residents make an educated decision about engaging in these activities. These interventions can be used to help facilitate participation in health promotion activities as appropriate and desired for each older adult.

Exploring psychological benefits associated with moderate alcohol use: a necessary corrective to assessments of drinking outcomes?

The aim of this paper is to identify positive psychological concomitants of moderate alcohol consumption. Current research and public-health perspectives on alcohol emphasize harms disproportionately relative to benefits. The major exception is research establishing beneficial effects of moderate drinking on cardiovascular health and overall mortality. In addition, much observational and experiential data suggest the widespread prevalence of positive drinking experiences. This paper is one of the first attempts since 1985 to codify such benefits in epidemiological terms. Methodological difficulties in accomplishing this include defining moderate drinking, controlling for confounding variables, and establishing causality. Nonetheless, evidence of psychological benefits has been found in experimental, observational, interview, self-report, correlational, and some prospective research. These positive findings are in the areas of subjective health, mood enhancement, stress reduction, sociability, social integration, mental health, long-term cognitive functioning, and work income/disability. Problem drinkers and alcoholics also seek mood and other benefits from alcohol, but are more likely to drink to counteract negative feelings and to support their egos than are social drinkers. It is as yet impossible to determine to what extent moderate alcohol consumption causes positive psychological outcomes and to what extent it is part of a complex pattern of mutually reinforcing variables.

Health promotion practices of the older adult

The purposes of this study were to explore the overall primary and secondary health promotion activities of a group of older adults who resided in a life care community. This was a descriptive study, and included 194 out of 200 residents who participated in a single face-to-face interview. The majority of the participants were female (80%), white (98%), and cognitively intact (Mini Mental Status Exam [MMSE] scores of 27.0 +/- 4.1). Those in the oldest age group were less likely to monitor their cholesterol intake, have their stools checked for occult blood, or have a mammogram or Pap test over the previous 2 years. The most common reasons for not having these tests were advanced age, not being told to by their primary health care provider, and no interest in pursuing abnormal findings. Health care providers should consider an individualized approach to health promotion and disease prevention and help the older adult make his or her own decisions regarding participation in these activities.

Alcohol and the health of aging men

Alcohol drinking, alcohol abuse, and alcoholism are more common among men than women at all ages. This article reviews the epidemiology and clinical effects of alcohol use in aging men. Alcoholism demands aggressive intervention when encountered in cognitively impaired people.

Health promotion practices of the old-old

The purpose of this study was to describe the health promotion activities of older adults in a life care community. A total of 195 older adults participated in a health promotion survey. The old and old-old age groups demonstrated a decrease in cancer screening behaviors, aerobic exercise, and compliance with a low cholesterol diet. Moreover, these individuals indicated that they had lived a sufficient period of time, and were no longer interested in disease prevention and prolongation of life. Older adults may benefit from an individualized approach to health promotion that focuses on quality rather than quantity of life.