Alcohol use and functional disability among cognitively impaired adults

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.

Beyond Ischemic Heart Disease: Are There other Health Benefits from Drinking Alcohol?

Evidence is growing that alcohol consumption confers health benefits beyond protection from ischemic heart disease. We review this evidence with regard to cerebrovascular disease, peripheral vascular disease, diabetes, cholelithiasis (gallstones), cognitive functioning, and stress reduction and subjective psychosocial benefits. Other possible benefits are briefly considered. The weight of evidence suggests that low-level alcohol consumption offers some protection against ischemic stroke. The evidence that moderate alcohol consumption protects against diabetes and gallstones is also fairly strong. The possibility of other health benefits cannot be dismissed. For all the conditions considered, more research is indicated. The application of more appropriate statistical techniques, studies of patterns of drinking, and experimental approaches to delineating underlying mechanisms should enable firmer conclusions to be drawn. A better understanding of both the benefits and the risks of alcohol use for individuals and populations will facilitate the development of appropriate program and policy interventions to promote health.

Systemic Lisbon Battery: Normative Data for Memory and Attention Assessments

Background

Memory and attention are two cognitive domains pivotal for the performance of instrumental activities of daily living (IADLs). The assessment of these functions is still widely carried out with pencil-and-paper tests, which lack ecological validity. The evaluation of cognitive and memory functions while the patients are performing IADLs should contribute to the ecological validity of the evaluation process.

Objective

The objective of this study is to establish normative data from virtual reality (VR) IADLs designed to activate memory and attention functions.

Methods

A total of 243 non-clinical participants carried out a paper-and-pencil Mini-Mental State Examination (MMSE) and performed 3 VR activities: art gallery visual matching task, supermarket shopping task, and memory fruit matching game. The data (execution time and errors, and money spent in the case of the supermarket activity) was automatically generated from the app.

Results

Outcomes were computed using non-parametric statistics, due to non-normality of distributions. Age, academic qualifications, and computer experience all had significant effects on most measures. Normative values for different levels of these measures were defined.

Conclusions

Age, academic qualifications, and computer experience should be taken into account while using our VR-based platform for cognitive assessment purposes.

Moderate alcohol intake and risk of functional decline: the Health, Aging, and Body Composition study

OBJECTIVES

To investigate the prospective relationship between alcohol consumption and incident mobility limitation.

DESIGN

Cohort study.

SETTING

The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Three thousand sixty-one adults aged 70 to 79 without mobility disability at baseline.

MEASUREMENTS

Incidence of mobility limitation, defined as self-report at two consecutive semiannual interviews of any difficulty walking one-quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle-related variables, diseases, and health status indicators were assessed at baseline.

RESULTS

During a follow-up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person-years (person-years); men: 6.4 per 100 person-years; women: 7.3 per 100 person-years) and mobility disability (total: 2.7 per 100 person-years; men: 2.5 per 100 person-years; women: 2.9 per 100 person-years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55-0.89) and mobility disability (HR=0.66, 95% CI=0.45-0.95) than never or occasional consumption. Additional adjustment for lifestyle-related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66-1.08 and HR=0.81, 95% CI=0.56-1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship.

CONCLUSION

Lifestyle-related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.

Light to moderate alcohol consumption and disability: variable benefits by health status

In adults, light to moderate alcohol consumption is associated with lower risks for heart disease, diabetes, and mortality. This study examined whether light to moderate alcohol use is also associated with lower risk of incident physical disability over two 5-year periods in 4,276 noninstitutionalized adults in the United States, aged 50 years or older, by using data from 3 waves of the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study surveys from 1982 to 1992. Light/moderate drinking (<15 drinks per week and <5 per drinking day or 4 per drinking day for women) was associated with reduced risk for incident disability or death over 5 years, compared with abstention (adjusted odds ratio = 0.77; P = 0.008). Among survivors, light/moderate drinking was associated with lower risk for incident disability, compared with abstention (adjusted odds ratio = 0.75; P = 0.009). In stratified analyses, disability risk decreased with light/moderate drinking in a dose-dependent fashion in men and women with good or better self-reported health but not in men or women with fair or worse self-reported health. Alcohol consumption in moderation might reduce the risk of developing physical disability in older adults in good health but not in those in poor health.

Prognostic factors for mortality following interhospital transfers to the medical intensive care unit of a tertiary referral center

OBJECTIVE

To describe characteristics of patients transferred from outside hospitals to a tertiary medical intensive care unit and to identify patient-level and system-level prognostic factors.

DESIGN

Retrospective cohort study.

SETTING

Tertiary university hospital.

PATIENTS

We studied 3,347 patients who were transferred to the medical intensive care unit from outside hospitals from January 1990 through September 1999.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Data collected included patient demographics, insurance type, discharge diagnoses, length of stay, mortality, admitting service, and distance traveled. The Charlson Comorbidity Score was used to adjust for comorbidity and the diagnostic related group risk level for risk of adverse outcome. Multivariate logistic models of early mortality (<72 hrs) and overall hospital mortality rate were developed. The most common major diagnostic categories included neurologic (10%), respiratory (10%), digestive diseases (10%), and drug overdose (10%). Most patients (70%) were transferred from >60 miles away. Mean medical intensive care unit length of stay was 5.3 days vs. 3.9 days for nontransfer patients. Transfer patients accounted for 49% of medical intensive care unit admits and 56% of intensive care unit patient-days. The overall mortality rate for transfer patients to the medical intensive care unit was 25% (95% confidence interval, 23-26), significantly higher than the 21% (95% confidence interval, 19-22) mortality rate among those admitted directly. Independent prognostic factors for early death (<72 hrs) included male gender, summer season, admitting service, diagnostic related group level, Charlson Comorbidity Score, insurance type, and major diagnostic category. Independent prognostic factors for overall hospital mortality rate included length of stay, medical complication, distance traveled, insurance type, and major diagnostic category.

CONCLUSIONS

Interhospital transfers to the medical intensive care unit are patients at high risk for mortality and other adverse outcomes. System-level and patient-level characteristics influence both early and overall hospital mortality rates. These variables should be considered when risk stratifying medical intensive care unit patients and in studying outcomes of care.

Is there a relationship between excessive drinking and functional impairment in older persons?

OBJECTIVES

To investigate the relationship between (1) two thresholds of excessive alcohol drinking, (2) binge drinking, and (3) impairments in functional status in older drinkers.

DESIGN

Cross-sectional study.

SETTING

Ten internal medicine practices affiliated with an academic medical center.

PARTICIPANTS

One hundred sixty-one persons aged 60 and older who reported drinking one or more drinks in the previous 3 months.

MEASUREMENTS

Two commonly used thresholds of excessive drinking: (1) eight to 14 drinks per week for women and men (lower threshold) and (2) more than 14 drinks per week for women and men (higher threshold); a measure of binge drinking (> or =3 drinks per occasion for women or > or =4 drinks per occasion for men); and self-reported instrumental activities of daily living (IADLs) and advanced activities of daily living (AADLs).

RESULTS

Compared with older persons consuming seven or fewer drinks per week, those exceeding the higher threshold of excessive drinking were more likely to have impairments in IADLs (adjusted odds ratio (AOR) = 8.4) and, to a lesser extent, AADLs (AOR = 3.7); those exceeding the lower threshold were more likely to have impairments in IADLs (AOR 5 6.0) but not in AADLs (AOR = 1.7). Binge drinkers were also more likely to have impairments in IADLs (AOR = 3.0) but not in AADLs (AOR = 1.5).

CONCLUSIONS

In this group of older men and women, drinking more than seven drinks per week was associated with impairments in IADLs and, to a lesser extent, AADLs. Drinking more than three drinks per occasion was associated with impairments in IADLs.

Alcohol abuse, cognitive impairment, and mortality among older people

OBJECTIVES

To estimate the prevalence of alcohol abuse, the association of alcohol abuse with cognitive impairment, and the contribution of alcohol abuse to short-term mortality in a cohort of older people screened for dementia.

DESIGN

Using the Canadian Study of Health and Aging (CSHA)--a representative, national cohort study of 10,268 older persons (> or = 65 years) from communities and long-term care institutions conducted in 1991--alcohol abuse and dementia were diagnosed during clinical examinations. Death was determined by telephone interview 18 months after baseline and verified by vital statistics records.

SETTING

36 regional community and 17 regional institutional populations in Canada.

PARTICIPANTS

The 2,873 individuals from the clinical sample of the CSHA.

MEASUREMENTS

Diagnosis of alcohol abuse (questionable, definite, none), diagnosis of dementia.

RESULTS

The prevalence of clinically detected definite alcohol abuse was 8.9% (95% confidence interval (CI) 7.9-9.9) and of questionable alcohol abuse was 3.7% (95% CI 3.0-4.4). Definite or questionable alcohol abuse was associated with a younger average age compared with no such abuse history, and men were significantly more likely than women to comprise definite and questionable diagnostic groups as compared with the group without alcohol abuse. The occurrence of all types of dementia except probable Alzheimer's disease was higher in those with definite or questionable alcohol abuse. Mortality at 18 months was higher among those with definite (14.8%, 95% CI 13.5-16.1) or questionable (20.0%, 95% CI 18.5-21.5) alcohol abuse, as compared with those with no alcohol abuse history (11.5%, 95% CI 10.3-12.7), and alcohol abuse (definite or questionable) conferred a 56% additional risk of short-term mortality (odds ratio (OR) 1.56, 95% CI 1.11-2.20) after adjusting for age, sex, and a diagnosis of dementia.

CONCLUSIONS

Alcohol abuse among older people is common and occurs more frequently among men. It is associated with cognitive impairment and independently with short-term mortality. Physician screening for alcohol abuse can yield a group of older people at risk for adverse health outcomes.