What Level of Alcohol Consumption Is Hazardous for Older People? Functioning and Mortality in U.S. and English National Cohorts

Testing the mediating mechanism of alcohol use on the association between retirement and depressive symptoms in the United States using generalized mixed effect models

OBJECTIVES

Both alcohol use and the prevalence of depression-depressive disorders, among older adults have increased over the past several decades and have been associated with increased morbidity and mortality. To our knowledge, the interactions between retirement, depression, and alcohol use have not yet been examined. This study aims to longitudinally explore the mediating role of alcohol use on the association between retirement and depressive symptoms in the United States, comparing individuals who are retired and not retired, while also exploring individuals who transitioned into and out of retirement at different times.

METHOD

Data from the Health and Retirement Study (waves 1994 to 2020) were used. Respondents aged 50 years and older who had valid information on retirement status and had observations for at least 3 waves were included in our sample (n = 27,575; nt = 193,642). A generalized longitudinal mixed-effect model was conducted on depressive symptoms (CESD-8). Direct, indirect, and total effects were calculated to test the mediating mechanism of alcohol use.

RESULTS

Retirement was associated with increased depressive symptoms (b = 0.04, p < 0.05), while moderate alcohol use was associated with decreased depressive symptoms (b = -0.09, p < 0.05), and binge drinking was associated with increased depressive symptoms (b = 0.06, p < 0.05). Alcohol played a mediating role in the association between retirement and depressive symptoms, with moderate use serving as a protective factor.

CONCLUSION

Screening and treating depression and alcohol misuse among older adults is key to promoting longer and healthier lives. Providing alternative coping mechanisms to heavy alcohol consumption for retirees is crucial.

Increased mortality from alcohol use disorder, alcohol-associated liver disease, and liver cancer from alcohol among older adults in the United States: 2000 to 2021

BACKGROUND

To investigate the trends in alcohol-associated liver disease (ALD), liver cancer from alcohol, and alcohol use disorder (AUD) burden among older adults in the United States (US).

METHODS

We gathered the ALD, liver cancer from alcohol, and AUD prevalence, mortality, and age-standardized rates (ASRs) from the Global Burden of Disease (GBD) Study 2021 between 2010 and 2021. We estimated the annual percent change (APC) with confidence intervals (CIs) for the burden of ALD, liver cancer from alcohol, and AUD in older adults (>70 years) in the United States. The findings were contrasted with global estimates and categorized by sex and state.

RESULTS

In 2021, there were approximately 512,340 cases of AUD, 56,990 cases of ALD, and 4490 cases of primary liver cancer from alcohol among older adults in the United States. In contrast to declining ASRs of prevalence and mortality in the global burden, these parameters were increased in older adults in the United States. From 2000 to 2021, prevalence from AUD (APC: 0.54%, 95% CI 0.43% to 0.65%), ALD (APC + 0.54%, 95% CI 0.22% to 0.86%), and primary liver cancer from alcohol (APC 2.93%, 95% CI 2.76% to 3.11%) increased. Forty states in the United States exhibited a rise in the prevalence rates of ALD in older adults.

CONCLUSION

Our findings highlighted the increased prevalence and mortality of AUD, ALD, and primary liver cancer from alcohol among older adults in the United Sates, contrasting with the decline in global trends. Public health strategies on ALD, AUD, and primary liver cancer from alcohol, which targets older adults, are urgently needed.

Psychosocial Factors Associated with dizziness and chronic dizziness: a nationwide cross-sectional study

BACKGROUND

Dizziness is a common symptom in adults, and chronic dizziness, such as persistent postural-perceptual dizziness, is also frequently reported and affects the quality of life of patients. This study aimed to identify psychosocial factors related to dizziness and chronic dizziness in a large-scale nationwide cohort.

METHODS

This population-based cross-sectional study used the database of the Eighth Korea National Health and Nutrition Examination Survey in 2020. Data from 4,147 adults over 40 years old were analyzed, and 1,102 adults who experienced dizziness were included in the dizziness cohort. Demographic data, medical conditions, comorbidities, functional status variables, nutritional variables and psychological variables were collected. The pattern of depressive symptoms according to the severity of dizziness was analyzed by network analysis.

RESULTS

The prevalence rate of dizziness was 24.6% in the general population, and chronic dizziness (≥ 3 months) developed in 210 of 1,102 (17.1%) individuals who experienced dizziness. Multiple logistic regression analysis revealed that female sex, stress, and depression were associated with dizziness. Chronic dizziness was related to tympanic abnormalities, diabetes, short sleep duration, and higher levels of stress and depression. Psychomotor retardation/agitation was a central symptom of depression in patients with chronic dizziness.

CONCLUSIONS

This study found sex differences in factors associated with dizziness and identified psychosocial factors linked to chronic dizziness. Focusing on somatic factors rather than depressive symptoms may benefit patients with chronic dizziness.

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994-2020

BACKGROUND

Based on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality.

METHODS

This is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60-99 (53% women).

PRIMARY OUTCOME MEASURES

Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020.

PREDICTOR

Average weekly alcohol consumption (non-drinker, < 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses.

RESULTS

We found that women who consumed ≥100 g/week had better SRH than those who consumed < 100 g/week; OR 1.85 (1.46-2.34). This pattern was not found in men OR 1.18 (0.99-1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73-1.22) and HR 0.89 (0.77-1.03), respectively.

CONCLUSIONS

There was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age.

Risky drinking and cognitive impairment in community residents aged 50 and over

OBJECTIVES

Alcohol misuse is known to be a risk factor for dementia. This study aimed to explore the association between risky drinking and cognitive impairment in a cohort study of middle aged and older people at risk of dementia.

METHOD

The sample comprised 15,582 people aged 50 and over drawn from the PROTECT study. Risky drinking was defined according to a score of 4 or above on the Alcohol Use Disorders Identification Test (AUDIT). Cognitive function was assessed on visual episodic memory, spatial working memory, verbal working memory and verbal reasoning.

RESULTS

Risky drinkers at baseline were more likely to be younger, male, white British, married, of higher educational status, current or past tobacco smokers and to have moderate to severe depression than non-risky drinkers. Risky drinkers were also more likely to be impaired on self-reported instrumental activities of daily living and subjective cognitive decline. At baseline, risky drinkers were less likely than non-risky drinkers to show impairment on verbal reasoning and spatial working memory but not on visual episodic memory or verbal working memory. Risky drinking at baseline predicted decline in cognitive function on visual episodic memory, verbal reasoning and spatial working memory at 2 year follow-up, but only verbal working memory and spatial working memory remained significant outcomes after controlling for possible confounders.

CONCLUSION

Although of small effect size, the association between risky drinking and impairment on measures of working memory and visuospatial function warrants further examination; particularly given the possibility of partial reversibility in alcohol related cognitive impairment.

Alcohol consumption among older adults with symptoms of cognitive decline consulting specialist health care

OBJECTIVES

To explore alcohol consumption among older Norwegian adults with symptoms of cognitive decline, assess the agreement between the reports of older adults and their next of kin regarding a person's alcohol consumption, and explore clinical and sociodemographic variables associated with agreement.

METHOD

Alcohol consumption was measured among 3608 older adults consulting specialist health care for symptoms of cognitive decline. Agreement between the participant and their next of kin regarding the participant's alcohol consumption was assessed with a weighted kappa (κ). A logistic regression analysis for hierarchical data was used to explore variables associated with agreement.

RESULTS

Both the participants and their next of kin reported that more than 20% of the participants consumed alcohol 1-3 times a week, and that approximately 10% consumed alcohol four or more times a week. The agreement between the participant's and their next of kin's report regarding the participant's alcohol consumption was high (κ = .852), and variables associated with agreement were no cognitive decline, not drinking alcohol during the last year or ever as reported by the participant, and low agitation scores on a psychiatric assessment.

CONCLUSION

This paper found alcohol consumption among older adults with symptoms of cognitive decline that was above the national average in Norway. This is also the first paper to demonstrate that a next of kin can be a reliable source of information regarding older adults' alcohol consumption. Health personnel should consider these findings when performing medical assessments or developing interventions for older adults.

Subjective well-being among male veterans in later life: the enduring effects of early life adversity

OBJECTIVES

This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively.

METHODS

Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships.

RESULTS

Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being.

DISCUSSION

Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.

The Influence of Interpersonal Behaviors and Population Density on Grip Strength of Elderly People: An Analysis of the Direct vs. Indirect Effects via Social Participation

The impact of social participation (SP) on the health of the elderly has been widely recognized, and urban-rural differences in social participation have attracted attention. However, few studies discussed the impact of social participation on specific health indicators and the further subdivision of urban-rural differences. This research aims to use the dimensions of interpersonal behaviors and population density rather than simple urban-rural distinctions to justify community differences and compare these differences' direct and indirect effects on grip strength. This study used 15,871 respondents aged over 50 years from the China Health and Retirement Longitudinal Study (CHARLS). An SEM (Structural Equation Modeling) analysis was used to explore the joint effect of interpersonal behavior and population density on social participation and the consequent impact on changes in grip strength and compare the differences among different genders, ages, wealth levels, and family relationships. The results indicated that community differences characterized by interpersonal behavior and population density have direct effects on grip strength and indirect effects on it through social participation. The conclusion is that the frequency of social activities, such as mah-jong and dancing in the Metropolitan Fringe and county-level cities is higher than that in Metropolitan centers. The high frequency of these activities has a positive and indirect impact on grip strength, and community differences have a more significant impact on women's social participation than men. However, the direct effect of community differences as defined by interpersonal communication and population density on grip strength is greater than the indirect effect of other factors through social participation.

Association of Alcohol and Tobacco Consumption with Depression Severity in the Oldest Old. Results from the Age Different Old Age Cohort Platform

This study aimed to examine the association of alcohol and tobacco use with severity of depression in older age. Analyses were performed on a pooled data set (n = 3724) from two German old-age cohort studies (LEILA 75+, 6 follow-ups and AgeCoDe/AgeQualiDe, 9 follow-ups). Depressive symptoms were assessed via two screening scales for depression (CES-D and GDS-15) which were harmonized for pooled analysis. A mixed-effects linear regression model for the total sample and additional stratified models for men and women were used. Smoking at baseline was significantly associated with a higher level of depression severity (β = 0.142, 95% CI: 0.051–0.233, p = 0.002), whereas drinking was significantly associated with a decreased level of depression (β = −0.069, 95% CI: −0.119–−0.021, p = 0.005). Concurrent substance use at baseline increased longitudinal depression severity (β = 0.193, 95% CI: 0.011–0.375, p = 0.037). Analyses stratified by gender showed a significant inverse association between drinking and depressive symptoms in men (β = −0.138, 95% CI: −0.231–−0.045, p = 0.004), but not in women (β = −0.060, 95% CI: −0.120–0.001, p = 0.052). Given the burden of major depression, it is important that health care providers, especially primary care physicians, assess and monitor lifestyle factors, even at older ages.

Perceived social isolation, social disconnectedness and falls: the mediating role of depression

OBJECTIVES

to estimate the association of social disconnectedness and perceived social isolation with the risk of falls and also investigate whether depression mediated this association.

METHOD

Biennial longitudinal survey data from 2006 to 2012 waves of the U.S. Health and Retirement Study of adults aged 65 and older (N = 22,153 observations) were examined. The outcome variable was number of self-reported falls over the observation period. Independent variables included social isolation (social disconnectedness, perceived social isolation) and number of depressive symptoms. Generalized Estimating Equation regressions were performed to address the research questions.

RESULTS

Regression models indicated that social disconnectedness is associated with a 5% increase in the risk of falls. Perceived social isolation (lack of perceived social support and loneliness combined) was associated with a 33% increase in falls risk. For each increase in the number of depressive symptoms, the risk of falls increased by 13%. Also, the number of depressive symptoms mediated the association between perceived social isolation and risk of falls.

CONCLUSION

Our findings were suggestive of the need to consider social isolation when designing falls prevention programs. More research is needed with research designs that address potential endogeneity bias.

Alcohol consumption and self-rated health among older people: population-based study in Sweden

OBJECTIVE

To analyse alcohol consumption and its association with self-rated health among a representative sample of older people in mid-Sweden.

BACKGROUND

Over the past decades, alcohol consumption has increased in the older population in Sweden, but few studies have investigated the association between alcohol consumption and self-rated health in this group. The aim was therefore to investigate alcohol consumption and self-rated health among older Swedes.

METHODS

The study is based on a cross-sectional study of 11,716 men and women, 65 years and over, answering a survey questionnaire sent to a random population sample in mid-Sweden in 2012. We assessed alcohol consumption with AUDIT-C and its association with self-rated health using logistic regression analysis, adjusting for age, economic situation, educational level, BMI, physical activity, social support and medication use.

RESULTS

Men (83%) were more prone to drink alcohol compared to women (71%). The prevalence of risk drinking was about 2% for both genders. Alcohol consumption declined with age. Moderate consumption of alcohol was associated with lower probability of poor self-rated health compared to non-drinking with an adjusted odds ratio 0.64 (95% confidence interval: 0.54-0.76) for men and 0.68 (0.59-0.79) for women.

CONCLUSION

Since the study was cross-sectional the direction of the association could not be determined, and the results should not be interpreted as an argument for promoting alcohol consumption among older people.

Long-term effects of alcohol consumption on cognitive function: a systematic review and dose-response analysis of evidence published between 2007 and 2018

BACKGROUND

Understanding the long-term health effects of low to moderate alcohol consumption is important for establishing thresholds for minimising the lifetime risk of harm. Recent research has elucidated the dose-response relationship between alcohol and cardiovascular outcomes, showing an increased risk of harm at levels of intake previously thought to be protective. The primary objective of this review was to examine (1) whether there is a dose-response relationship between levels of alcohol consumption and long-term cognitive effects, and (2) what the effects are of different levels of consumption.

METHODS

The review was conducted according to a pre-specified protocol. Eligible studies were those published 2007 onwards that compared cognitive function among people with different levels of alcohol consumption (measured ≥ 6 months prior to first follow-up of cognition). Major cognitive impairment was excluded. Searches were limited to MEDLINE, Embase and PsycINFO (January 2007 to April 2018). Screening, data extraction, and risk of bias assessment (ROBINS-I) were piloted by three authors, then completed by a single author and checked by a second. Analyses were undertaken to identify and characterise dose-response relationships between levels of alcohol consumption and cognition. Certainty of evidence was assessed using GRADE.

RESULTS

We included 27 cohort studies (from 4786 citations). Eighteen studies examined the effects of alcohol consumption at different levels (risk of bias 16 serious, 2 critical). Ten studies provided data for dose-response analysis. The pooled dose-response relationship showed a maximum standardised mean difference (SMD) indicating slightly better cognition among women with moderate alcohol consumption compared to current non-drinkers (SMD 0.18, 95%CI 0.02 to 0.34, at 14.4 grams/day; 5 studies, very low certainty evidence), and a trivial difference for men (SMD 0.05, 95% CI 0.00 to 0.10, at 19.4 grams/day; 6 studies, very low certainty evidence).

CONCLUSIONS

Major limitations in the design and reporting of included studies made it impossible to discern if the effects of 'lower' levels of alcohol intake are due to bias. Further review of the evidence is unlikely to resolve this issue without meta-analysis of individual patient data from cohort studies that address biases in the selection of participants and classification of alcohol consumption.

Gender difference in the association between alcohol consumption and depressive symptoms among the elderly in rural areas

To determine gender difference in the nature of the association between alcohol consumption and depressive symptoms in the elderly aged 60 and above in a rural community sample. A cross-sectional face-to-face survey conducted for community residents 60 years of age and older (n = 1,819). Alcohol consumption problems were measured by self-report of the Korean version of Alcohol Use Disorders Identification Test (AUDIT-K) scale. Depressive symptom was measured using the Korean Beck Depression Inventory (K-BDI) scale. Potential explanatory variables included MCS, PCS, and health-related behavior, socio-economics status, and democratic variables. Two gender-specific multivariate regression models were applied for the analysis. A U-shaped relationship between alcohol consumption and depressive symptoms was found, and the relationship did not differ by gender. Non-problem drinkers and hazardous and harmful drinkers were related to an increased risk of depressive symptoms for both men and women. Several correlates for the association were found. No gender difference was found in a U-shaped curvilinear relationship between alcohol consumption and depression found among the elderly aged 60 and above in rural communities in South Korea. The findings of this study suggest the need for further investigation of subgroup differences in the association by using samples of various age groups in rural and urban areas, and samples drawn from different cultural contexts than the studies conducted in Western countries.

Association of tobacco and alcohol consumption with cardiovascular risk factors among elderly population in India

Introduction:

The present study was conducted to assess the association of tobacco and alcohol consumption with cardiovascular risk factors among elderly population living at high altitude regions of India.

Materials and Methods:

A cross-sectional study was conducted among 1003 elderly people living in district Nainital, Uttarakhand state, India. Thirty subjects were identified from 30 villages using population proportionate to size sampling methodology. The data on the consumption of tobacco and alcohol, mini nutritional assessment, Barthel activities of daily living scale, height, weight, blood pressure, fasting blood sugar, triglycerides, and total cholesterol was collected.

Results:

We found that smoking tobacco was associated with high cholesterol, lower body mass index, and low nutritional status (all, P < 0.05). Elderly subjects who consumed alcohol had 1.56 times higher risk of having high fasting blood glucose.

Conclusions:

Consumption of tobacco and alcohol increased the risk of cardiovascular diseases among elderly subjects. There is a need to improve these modifiable health behaviors through targeted educational and rehabilitation programs.

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.

Alcohol use by people in their seventies is not an exception: a preliminary prospective study

The ageing population is rapidly increasing worldwide, and the alcohol-related disease burden in most Western countries is on the rise. However, very few studies assess alcohol use in older people. Here, a self-reported questionnaire was administered to all individuals aged 70 years or more who visited a social centre for older people in western France. The average age of the 98 subjects included in the survey was 79 years (range, 70-97 years; SD=6), and 57.1% (n=56) reported weekly alcohol consumption. An average consumption of over two standard units each day during weekends was reported by 53% subjects (n=52), and the same on each weekday was reported by 34% (n=33). Thus, a significant proportion of subjects aged 70 years or over consumed more alcohol than is recommended in current guidelines. The participants also reported that they rarely discussed alcohol consumption with their general practitioners. Alcohol use should be assessed regularly. District nurses and members of the primary care team should recommend strategies to help older people reduce their alcohol consumption.

Rural-urban differences in the association between disability and body mass index among the oldest-old in China

INTRODUCTION

The issue of disability prevention is considered as a priority for research in geriatrics in modern society, especially for the oldest-old. There are many evidences certificated that obesity is associated with disability in developed countries. However, few studies pay attention to relationship between them in developing countries. Furthermore, it is also unknown whether the association is similar among the oldest-old in rural and urban areas. The purpose of this study is to explore rural-urban differences in the association between disability and BMI among the oldest-old in China.

METHODS

4076 seniors (80+) were included from the 2014 wave of Chinese Longitudinal Healthy Study. Disability, body mass index and other information including socio-demographic variables, health behavior conditions and health status were collected. Logistic regression analysis was employed to examine the association.

RESULTS

Of 4076 respondents, 1817 (44.6%) were urban elderly. Overall, 26.6% of the participants had disability, and 31.8% for urban, 22.4% for rural. After controlling for other variables, the significant association between BMI and disability was found for urban oldest seniors, but not for rural ones. Age, living arrangement, Non-communicable disease and annual physical examination were important determinants related to disability.

CONCLUSIONS

The association between BMI and disability differed according to residence. Both overweight and underweight were red flags of disability among Chines seniors (80+) in urban areas. Therefore, proper weight management is important for preventing disability among urban oldest-old. Additionally, annual physical examination, prevention and control of chronic diseases should be recommended to all of the oldest-old.

Identified mental disorders in older adults in primary care: A cross-sectional database study

INTRODUCTION

Identifying and managing mental disorders among older adults is an important challenge for primary care in Europe. Electronic medical records (EMRs) offer considerable potential in this regard, although there is a paucity of data on their use for this purpose.

OBJECTIVES

To examine the prevalence/treatment of identified mental disorders among older adults (over 55 years) by using data derived from EMRs in general practice.

METHODS

We utilized data from a cross-sectional study of mental disorders in primary care, which identified patients with mental disorders based on diagnostic coding and prescribed medicines. We collected anonymized data from 35 practices nationally from June 2014 to March 2015, and secondary analysis of this dataset examined the prevalence of mental disorders in adults aged over 55 years.

RESULTS

74,261 patients aged over 55 years were identified, of whom 14,143 had a mental health disorder (prevalence rate of 19.1%). There was considerable variation between practices (range: 3.7-38.9%), with a median prevalence of 23.1%. Prevalence increased with age, from 14.8% at 55-59 years to 28.9% at 80-84 years. Most common disorders were depression (17.1%), panic/anxiety (11.3%), cognitive (5.6%), alcohol (3.8%) and substance use (3.8%).

CONCLUSIONS

Examining mental disorders among older adults using data derived from EMRs is feasible. Mental disorders are common among older adults attending primary care and this study demonstrates the utility of electronic medical records in epidemiological studies of large populations in primary care.

Disability subtypes and mortality rates in older adults: A longitudinal population-based study (NEDICES)

OBJECTIVE

We investigated the mortality rates of three subtypes of disability and their specific explanatory factors in older adults.

METHODS

Our data come from NEDICES, a population-based longitudinal cohort study of Spanish older adults. We examined 3816 participants without dementia who completed the Pfeffer's Functional Activities Questionnaire (FAQ) and an assessment of self-perceived functional limitations (SFL) associated with health conditions. Subjects were classified into mutually exclusive subtypes of disability: subtype 1 (SFL), subtype 2 (impaired FAQ), and subtype 3 (impaired FAQ plus SFL). Factors related to all disability subtypes were analyzed using a multinomial logistic regression (MLR), whereas Cox regression (CR) models adjusted by covariates were applied to compare survival rates between groups at the 5-year follow up.

RESULTS

The CR models indicated that SFL and FAQ scores were associated with higher risk of mortality at 5-years. After stratifying by subtypes of disability, mortality was significantly higher in subtype 3 than in subtypes 1 and 2. All models were consistent after adjusting by different covariates. The MLR showed that subtype 1 was specifically associated with the number of comorbidities, whereas subtype 2 was associated with lower MMSE scores depression and living in nursing homes.

CONCLUSIONS

Our results show that the combination of impaired FAQ plus SFL have an increased differential predictive utility for mortality than approaches based on unique measures. They also indicate that both measures of disability are associated with different explanatory factors.

Alcohol Use and Frailty Risk among Older Adults over 12 Years: The Health and Retirement Study

OBJECTIVES

The primary goal was to examine the relationship between alcohol use and frailty, a variable characterizing late-life decline, in a national, longitudinal survey of older adults living in the United States.

METHODS

The sample drawn from the Health and Retirement Study included 9,499 stroke-free participants over age 65 in 2000. The sample was 59.1% female, and had a mean age of 74.25 years (SD = 6.99). Follow-up data was from 2004, 2008, and 2012. Frailty was defined phenotypically using the Paulson-Lichtenberg Frailty Index (PLFI). Alcohol use was measured via self-report. Control variables included age, race, education, socio-economic status (SES), depressive symptomatology, medical burden score, body mass index (BMI), and partner status. With abstinent participants as the reference group, logistic regressions were conducted to determine prevalent frailty at 2000, and Cox's proportional hazard models were utilized to determine time to incident frailty over a 12-year period.

RESULTS

Results revealed that age, depressive symptomatology, and medical burden score were significant positive correlates of prevalent and incident frailty (p < .05) for both males and females. Logistic regressions revealed that consumption of 1-7 alcoholic drinks per week was associated with reduced prevalent frailty (OR = .49, p < .001) for females. Survival analysis results reveal that compared with nondrinkers, males and females who reportedly consumed 1-7 drinks per week had a decreased probability of incident frailty (HR = .78-081, p < .05).

CONCLUSIONS

Findings suggest that moderate alcohol use confers reduced frailty risk for both older men and women. Future research should examine the mechanism(s) relating alcohol consumption and frailty.

CLINICAL IMPLICATIONS

Findings support extant literature suggesting some healthcare benefits may be associated with moderate drinking.

Acute Effects of Moderate Alcohol Consumption on Postural Stability in Older Adults

This study involved healthy community-living older adults in an investigation of the association between moderate alcohol consumption (AC) and acute changes in postural stability and whether the association differed according to pre-AC balance skills. Thirty-nine moderate drinkers aged ≥ 65 years (62% women; mean age: 73.9 ± 6.1 years) consumed a moderate dose of alcohol (0.4 g/kg; administered as two drinks). Breath alcohol concentration and postural stability were measured at five time points (pre-AC and 40, 80, 120, and 160 minutes post-AC) using unipedal stance time (UPST) and center of pressure (CoP) displacement. Pre-AC UPST was used to categorize participants into good-balance (≥30 seconds) and poor-balance (<30 seconds) groups. Peak breath alcohol concentration was 30 mg/dL at 40 minutes post-AC. For all participants, postural stability declined significantly at 80 minutes post-AC (UPST, p = .005; anterior–posterior CoP displacement, p = .029). While the poor-balance group did not show a significant decrease in UPST duration over the course of the study, the good-balance group experienced significant decline at 80 minutes compared with baseline ( p < .001) and remained above the 30-second UPST cutoff. Both groups experienced similar worsening in anterior–posterior CoP displacement at 80 minutes post-AC. Thus, moderate AC was associated with acute decline in postural stability in older adults. The worsened anterior–posterior CoP displacement post-AC in the poor-balance group was of particular concern because these participants were already at lower balance functioning pre-AC. Larger, more representative studies of varying groups of participants are needed to further explore how this change relates to fall incidents and fall risk.

Alkohol och äldre

T. Sulander: Increasing numbers of older people use alcohol

The number of older people using alcohol has increased and abstinence has decreased over the past few decades in Finland. However, the average amount of consumed alcohol per week has remained the same.

The rapid lowering of alcohol taxes in 2004 led to a slight increase in alcohol use among people aged 65–84. The number of older people in need of care for their alcohol problems has increased parallel to the increasing trend of moderate drinking. It is, however, difficult to reach heavy drinkers by using different research methods. Therefore, their number in the population could only be estimated.

Alcohol use in Finland has been increasing steadily already before the alcohol tax was considerably lowered in 2004. To reverse this negative trend, alcohol taxes should be considerably increased and health promotion activities should be initiated.

Alcohol consumption and mortality in patients undergoing coronary artery bypass graft (CABG)-a register-based cohort study

BACKGROUND

Previous studies have shown that compared with abstinence and heavy drinking, moderate alcohol consumption is associated with a reduced risk of mortality among the general population and patients with heart failure and myocardial infarction. We examined the association between alcohol consumption and mortality in coronary artery bypass graft (CABG) patients.

METHOD

We studied 1,919 first-time CABG patients using data on alcohol consumption and mortality obtained from Danish national registers from March 2006 to October 2011. Alcohol consumption was divided into the following groups: abstainers (0 units/week), moderate consumers (1-14 units/week), moderate-heavy drinkers (15-21 units/week) and heavy drinkers (>21 units/week). Hazard ratios (HR) of all-cause mortality were calculated using Cox proportional hazard regression analysis.

RESULTS

The median follow-up was 2.2 years [IQR 2.0]. There were 112 deaths, of which 96 (86 %) were classified as cardiovascular. Adjustments for age and sex showed no increased risk of all-cause mortality for the abstainers (HR 1.61, 95 % CI, 1.00-2.58) and moderate-heavy drinkers (HR 1.40, 95 % CI, 0.73-2.67) compared with moderate consumers. However, heavy drinkers had a high risk of all-cause mortality compared with moderate consumers (HR 2.44, 95 % CI, 1.47-4.04). A full adjustment showed no increase in mortality for the abstainers (HR 1.59, 95 % CI, 0.98-2.57) and moderate-heavy drinkers (HR 1.68, 95 % CI, 0.86-3.29), while heavy drinkers were associated with an increased mortality rate (HR 1.88, 95 % CI, 1.10-3.21). There was no increased risk of 30-day mortality for the abstainers (HR 0.74, 95 % CI, 0.23-2.32), moderate-heavy drinkers (HR 0.36, 95 % CI, 0.07-1.93) and heavy drinkers (HR 2.20, 95 % CI, 0.65-7.36).

CONCLUSION

There was no increased risk of mortality for abstainers (0 units/week) or moderate-heavy drinkers (15-21 units/week) following a CABG. Only heavy drinking (>21 units/week) were significantly associated with an increased mortality rate. These results suggest that only heavy drinking present a risk factor among CABG patients.

Alcohol drinking patterns and risk of functional limitations in two cohorts of older adults

BACKGROUND & AIMS

Several studies have found that moderate alcohol intake is associated with lower risk of functional limitations in older adults. However, no previous investigation has assessed this association in older adults from Mediterranean countries, who show characteristic drinking patterns.

METHODS

Data were taken from the UAM and the Seniors-ENRICA cohorts in Spain, comprising community-dwelling people aged ≥60 years. At baseline, participants in both cohorts were classified as non-drinkers, ex-drinkers, moderate drinkers and heavy drinkers (the threshold between moderate and heavy intake was ≥40 g/day in men and ≥24 g/day in women). The Seniors-ENRICA cohort allowed assessment of a Mediterranean Drinking Pattern (MDP), defined as moderate alcohol intake, with wine preference (≥80% of alcohol consumed as wine) and drinking only with meals. The incidence of limitation in mobility, agility, and instrumental activities of daily living (IADL) was ascertained in each cohort at the end of a 3.5-year follow-up. Analyses were adjusted for sex, age, education, lifestyle, BMI, chronic conditions, and functional limitations at baseline others than the studied limitation.

RESULTS

Compared with non-drinkers, ex-drinkers showed a higher risk of IADL limitation (pooled adjusted odds ratio [paOR]: 1.63; 95% confidence interval [CI]: 1.04-2.21). By contrast, moderate drinkers had a lower risk of limitations in mobility (paOR: 0.80; 95% CI: 0.63-0.97), agility (paOR: 0.82; 95% CI: 0.65-0.99) and IADL (paOR: 0.54; 95% CI: 0.39-0.69). Among individuals reporting poor or fair health, the MDP was associated with lower risk of mobility limitation (aOR: 0.51; 95% CI: 0.27-0.97).

CONCLUSION

In older adults, moderate alcohol consumption, as well as the MDP in specific subgroups, is associated with lower risk of functional limitation. These results should not serve to promote alcohol intake, because older adults are particularly vulnerable to its harmful effects.

Disability and all-cause mortality in the older population: evidence from the English Longitudinal Study of Ageing

Despite the vast body of literature studying disability and mortality, evidence to support their association is scarce. This work investigates the role of disability in explaining all-cause mortality among individuals aged 50+ who participated in the English Longitudinal Study of Aging. The aim is to explain the gender paradox in health and mortality by analysing whether the association of disability with mortality differs between women and men. Disability was conceived following the International Classification of Functioning, Disability and Health (ICF), proposed by the WHO, that conceptualizes disability as a combination of three components: impairment, activity limitation and participation restriction. Latent variable models were used to identify domain-specific factors and general disability. The association of the latter with mortality up to 10 years after enrolment was estimated using discrete-time survival analysis. Our work confirms the validity of the ICF framework and finds that disability is strongly associated with mortality, with a time-varying effect among men, and a smaller constant effect for women. Adjusting for demographic, socioeconomic and behavioural factors attenuated the association for both sexes, but overall the effects remained high and significant. These findings confirm the existence of gender paradox by showing that, when affected by disability, women survive longer than men, although if men survive the first years they appear to become more resilient to disability. Sensitivity analyses suggested that the gender paradox cannot be solely explained by gender-specific health conditions: there must be other mechanisms acting within the pathway between disability and mortality that need to be explored.

Alcohol consumption in very old age and its association with survival: A matter of health and physical function

BACKGROUND

Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old.

METHODS

Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed until 2014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed.

RESULTS

Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant.

CONCLUSIONS

The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to-moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

Alcohol Consumption and Longitudinal Trajectories of Physical Functioning in Central and Eastern Europe: A 10-Year Follow-up of HAPIEE Study

Background:

Physical functioning (PF) is an essential domain of older persons’ health and quality of life. Health behaviors are the main modifiable determinants of PF. Cross-sectionally, alcohol consumption appears to be linked to better PF, but longitudinal evidence is mixed and very little is known about alcohol consumption and longitudinal PF trajectories.

Methods:

We conducted longitudinal analyses of 28,783 men and women aged 45–69 years from Novosibirsk (Russia), Krakow (Poland), and seven towns of the Czech Republic. At baseline, alcohol consumption was measured by a graduated frequency questionnaire and problem drinking was evaluated using the CAGE questionnaire. PF was assessed using the Physical Functioning Subscale of the SF-36 instrument at baseline and three subsequent occasions. Growth curve modeling was used to estimate the associations between alcohol consumption and PF trajectories over 10-year follow-up.

Results:

PF scores declined during follow-up in all three cohorts. Faster decline in PF over time was found in Russian female frequent drinkers, Polish female moderate drinkers, and Polish male regular heavy drinkers, in comparison with regular and/or light-to-moderate drinkers. Nondrinking was associated with a faster decline compared with light drinking only in Russian men. Problem drinking and past drinking were not related to the decline rate of PF.

Conclusions:

This large longitudinal study in Central and Eastern European populations with relatively high alcohol intake does not strongly support the existence of a protective effect of alcohol on PF trajectories; if anything, it suggests that alcohol consumption is associated with greater deterioration in PF over time.

Alcohol use, socioeconomic deprivation and ethnicity in older people

OBJECTIVES

This study explores the relationship between alcohol consumption, health, ethnicity and socioeconomic deprivation.

PARTICIPANTS

27,991 people aged 65 and over from an inner-city population, using a primary care database.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures were alcohol use and misuse (>21 units per week for men and >14 for units per week women).

RESULTS

Older people of black and minority ethnic (BME) origin from four distinct ethnic groups comprised 29% of the sample. A total of 9248 older drinkers were identified, of whom 1980 (21.4%) drank above safe limits. Compared with older drinkers, older unsafe drinkers contained a higher proportion of males, white and Irish ethnic groups and a lower proportion of Caribbean, African and Asian groups. For older drinkers, the strongest independent predictors of higher alcohol consumption were younger age, male gender and Irish ethnicity. Independent predictors of lower alcohol consumption were Asian, black Caribbean and black African ethnicity. Socioeconomic deprivation and comorbidity were not significant predictors of alcohol consumption in older drinkers. For older unsafe drinkers, the strongest predictor variables were younger age, male gender and Irish ethnicity; comorbidity was not a significant predictor. Lower socioeconomic deprivation was a significant predictor of unsafe consumption whereas African, Caribbean and Asian ethnicity were not.

CONCLUSIONS

Although under-reporting in high-alcohol consumption groups and poor health in older people who have stopped or controlled their drinking may have limited the interpretation of our results, we suggest that closer attention is paid to 'young older' male drinkers, as well as to older drinkers born outside the UK and those with lower levels of socioeconomic deprivation who are drinking above safe limits.

Examining the Impact of Separate Components of a Multicomponent Intervention Designed to Reduce At-Risk Drinking Among Older Adults: The Project SHARE Study

BACKGROUND

Health promotion interventions often include multiple components and several patient contacts. The objective of this study was to examine how participation within a multicomponent intervention (Project SHARE) is associated with changes in at-risk drinking among older adults.

METHODS

We analyzed observational data from a cluster-randomized trial of 31 primary care physicians and their patients aged ≥60 years, at a community-based practice with 7 clinics. Recruitment occurred between 2005 and 2007. At-risk drinkers in a particular physician's practice were randomly assigned as a group to usual care (n = 640 patients) versus intervention (n = 546 patients). The intervention included personalized reports, educational materials, drinking diaries, in-person physician advice, and telephone counseling by health educators (HEs). The primary outcome was at-risk drinking at follow-up, defined by scores on the Comorbidity Alcohol Risk Evaluation Tool (CARET). Predictors included whether a physician-patient alcohol risk discussion occurred, HE call occurred, drinking agreement with the HE was made, and patients self-reported keeping a drinking diary as suggested by the HE.

RESULTS

At 6 months, there was no association of at-risk drinking with having had a physician-patient discussion. Compared to having had no HE call, the odds of at-risk drinking at 6 months were lower if an agreement was made or patients reported keeping a diary (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37 to 0.90), or if an agreement was made and patients reported keeping a diary (OR 0.52, CI 0.28 to 0.97). At 12 months, a physician-patient discussion (OR 0.61, CI 0.38 to 0.98) or an agreement and reported use of a diary (OR 0.45, CI 0.25) were associated with lower odds of at-risk drinking.

CONCLUSIONS

Within the Project SHARE intervention, discussing alcohol risk with a physician, making a drinking agreement, and/or self-reporting the use of a drinking diary were associated with lower odds of at-risk drinking at follow-up. Future studies targeting at-risk drinking among older adults should consider incorporating both intervention components.

Visits by the elderly to United States EDs for alcohol-related disorders

OBJECTIVES

The objectives are to estimate the number of elderly patients presenting to emergency departments (EDs) in the United States from 2006 to 2011 for alcohol-related disorders and examine their demographic and clinical features.

METHODS

This study used 2006 to 2011 data from the Nationwide ED Sample, a stratified, multistage sample designed to give national estimates of US ED visits each year. Clinical Classifications Software 660 code ("alcohol-related disorders") was used. The clinical and demographic features that were examined were as follows: number of admissions, disposition, sex, age, expected payer, income, geographic region, charges, and primary diagnoses and procedures performed.

RESULTS

From 2006 to 2011, there were 1620345 ED visits for alcohol-related disorders in elderly patients. Roughly one-third were discharged from the ED, whereas 66% (1078677) were admitted to the hospital. Approximately 73% were male, and the mean age was 73 years. Most patients used Medicare (84%), resided in neighborhoods with the lowest median income national quartile (29%), and lived in the South (36.4%). The average charge for discharged patients was $4274.95 (4050.30-4499.61) and $37857.20 (36813.00-38901.40) for admitted patients. The total charges for all patients treated and released from the ED were $2166082965.40 and admitted was $40835690924.40.

CONCLUSIONS

This study provided insight not only into the sociodemographic characteristics of this patient population but also the health care costs related to alcohol-related ED visits. These results may contribute to the development of future interventions targeted toward this population.

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.

Alcohol consumption and physical functioning among middle-aged and older adults in Central and Eastern Europe: results from the HAPIEE study

Background: light-to-moderate drinking is apparently associated with a decreased risk of physical limitations in middle-aged and older adults.

Objective: to investigate the association between alcohol consumption and physical limitations in Eastern European populations.

Study design: a cross-sectional survey of 28,783 randomly selected residents (45–69 years) in Novosibirsk (Russia), Krakow (Poland) and seven towns of Czech Republic.

Methods: physical limitations were defined as <75% of optimal physical functioning using the Physical Functioning (PF-10) Subscale of the Short-Form-36 questionnaire. Alcohol consumption was assessed by a graduated frequency questionnaire, and problem drinking was defined as ≥2 positive responses on the CAGE questionnaire. In the Russian sample, past drinking was also assessed.

Results: the odds of physical limitations were highest among non-drinkers, decreased with increasing drinking frequency, annual consumption and average drinking quantity and were not associated with problem drinking. The adjusted odds ratio (OR) of physical limitations in non-drinkers versus regular moderate drinkers was 1.61 (95% confidence interval: 1.48–1.75). In the Russian sample with past drinking available, the adjusted OR in those who stopped drinking for health reasons versus continuing drinkers was 3.19 (2.58–3.95); ORs in lifetime abstainers, former drinkers for non-health reasons and reduced drinkers for health reasons were 1.27 (1.02–1.57), 1.48 (1.18–1.85) and 2.40 (2.05–2.81), respectively.

Conclusion: this study found an inverse association between alcohol consumption and physical limitations. The high odds of physical limitations in non-drinkers can be largely explained by poor health of former drinkers. The apparently protective effect of heavier drinking was partly due to less healthy former heavy drinkers who moved to lower drinking categories.

Alcohol consumption among the over 50s: international comparisons

AIM

Research exploring alcohol consumption patterns and behaviour change among older adults is relatively scarce, often necessitating reliance on international evidence. To understand the degree to which findings may be generalizable across countries, this review compares recent epidemiological evidence from developed countries on the prevalence of abstention and potentially problematic alcohol consumption in older adults.

METHODS

Medline, EMBASE, Web of Science and PsychInfo were searched for English language publications, identifying 21 peer-reviewed publications and six reports, including data from 17 national surveys and 10 general practice and community samples published since 2000.

RESULTS

Of the developed countries for which data are available on adults aged over 50 years, rates of past 12-month abstention and former drinking are lowest in England and Finland, and highest in Korea and the USA. The prevalence of binge drinking varies widely between studies, whilst rates of alcohol dependence are broadly similar.

CONCLUSIONS

Older adults in developed countries report different rates of abstention and alcohol consumption. This places obvious limitations on the extrapolation of results from specific research findings and policy strategies to other countries.

Understanding older adults' attitudes and beliefs about drinking: perspectives of residents in congregate living

Drinking motives may change as adults age, yet few studies in the United States of America have examined older adults' perspectives about their own drinking habits. The current study explored beliefs and attitudes of alcohol use of retired adults residing in a congregate care setting in the Baltimore/Washington DC metro area. Individual interviews were conducted with a sub-sample of 11 individuals who participated in a daily diary study on alcohol use among older adults. All participants in the study were identified as regular drinkers, meaning they had an alcoholic beverage on at least six of the eight days prior to screening. The participants' mean age was 81.5 years with a majority being women (54.5%). Older adults reported alcohol use as a long-term habit or routine. Participants also recognised that their alcohol use was influenced by peer drinking and by the availability of alcohol at the congregate care setting. Participants normalised their drinking as a form of routine socialisation carried from earlier life stages. Participants did not report reactive drinking, suggesting that older drinkers do not see their alcohol use as driven by specific reactions to life stresses or losses associated with ageing. The study also indicates that drinking may provide older adults in congregate care with a sense of continuity from before retirement and preserve their identity and autonomy.

Gender differences in alcohol consumption among middle-aged and older adults in Australia, the United States and Korea

OBJECTIVES

To compare gender differences in alcohol use and the socioeconomic correlates of at-risk drinking among middle-aged and older adults in Australia, the United States (US) and South Korea.

METHOD

Data were drawn from large nationally representative surveys of people aged 45 years and older, collected in 2006.

RESULTS

Rates of any drinking and at-risk drinking (>14 US standard drinks/week) were higher for males than females in all countries and these gender differences were largest in Korea. Socioeconomic differentials for at-risk drinking varied by country and gender. In the US, at-risk drinking was associated with lower educational levels among men, but higher educational levels among women; in Korea, it was associated with being unpartnered, particularly for women; and in Australia, at-risk drinking was associated with higher income.

CONCLUSIONS

Gender-role expectations differ between countries and may influence both the levels at which older adults consume alcohol and the ways in which at-risk drinking is associated with socioeconomic factors.

IMPLICATIONS

Heavy alcohol use in middle-aged and older adults is a cause for concern. Health promotion strategies should target older age groups and consider the ways in which gender, marital status and education influence norms and opportunities for risky alcohol use.

Late-life factors associated with healthy aging in older men

OBJECTIVES

To identify potentially modifiable late-life biological, lifestyle, and sociodemographic factors associated with overall and healthy survival to age 85.

DESIGN

Prospective longitudinal cohort study with 21 years of follow-up (1991-2012).

SETTING

Hawaii Lifespan Study.

PARTICIPANTS

American men of Japanese ancestry (mean age 75.7, range 71-82) without baseline major clinical morbidity and functional impairments (N = 1,292).

MEASUREMENTS

Overall survival and healthy survival (free from six major chronic diseases and without physical or cognitive impairment) to age 85. Factors were measured at late-life baseline examinations (1991-1993).

RESULTS

Of 1,292 participants, 1,000 (77%) survived to 85 (34% healthy) and 309 (24%) to 95 (<1% healthy). Late-life factors associated with survival and healthy survival included biological (body mass index, ankle-brachial index, cognitive score, blood pressure, inflammatory markers), lifestyle (smoking, alcohol use, physical activity), and sociodemographic factors (education, marital status). Cumulative late-life baseline risk factor models demonstrated that age-standardized (at 70) probability of survival to 95 ranged from 27% (no factors) to 7% (≥ 5 factors); probability of survival to 100 ranged from 4% (no factors) to 0.1% (≥ 5 factors). Age-standardized (at 70) probability of healthy survival to 90 ranged from 4% (no factors) to 0.01% (≥ 5 factors). There were nine healthy survivors at 95 and one healthy survivor at 100.

CONCLUSION

Several potentially modifiable risk factors in men in late life (mean age 75.7) were associated with markedly greater probability of subsequent healthy survival and longevity.

Alcohol use among older adults: SABE cohort study, São Paulo, Brazil

In recent years, Brazil has demonstrated a new demographic pattern characterized by a reduction in both birth and mortality rates and a significant increase in the number of older adults. The purpose of the present study was to describe the frequency of alcohol intake in a representative sample community of older adults in the city of São Paulo, Brazil, followed over a six-year period. A prospective Saúde, Bem-Estar e Envelhecimento (SABE [Health, Wellbeing and Aging]) cohort study conducted in 2000 and 2006 in City of São Paulo, Brazil. 2,143 individuals aged 60 years or older selected through multi-stage sampling in the year 2000 (41.4% male and 58.6% women) and 1,115 individuals belonging to the follow-up cohort evaluated in 2006. The frequency of alcohol intake in the previous three months was obtained through self-reports of interviewees. The results demonstrate that in 2000, alcohol consumption was less than one day a week among 79.7% of the sample, one to three days a week among 13.0% and four or more days a week among 7.3%. In agreement with findings on other populations, consumption four or more days a week was more frequent among the male gender as well as those with greater schooling and income and good self-rated health (p<0.05). The longitudinal analysis demonstrated an increase in the frequency of alcohol consumption one to three times a week among the individuals in the 2006 follow-up study. In the present population-based sample, alcohol intake was low and the frequency of moderate alcohol consumption increased over the years. The present study can assist understanding the changes in alcohol intake among older adults throughout time and the ageing process.

A qualitative study of alcohol, health and identities among UK adults in later life

Increasing alcohol consumption among older individuals is a public health concern. Lay understandings of health risks and stigma around alcohol problems may explain why public health messages have not reduced rates of heavy drinking in this sector. A qualitative study aimed to elucidate older people's reasoning about drinking in later life and how this interacted with health concerns, in order to inform future, targeted, prevention in this group. In 2010 a diverse sample of older adults in North East England (ages 50–95) participated in interviews (n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female). Data were analysed using grounded theory and discursive psychology methods. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. Each of these identities could be applied in older people's accounts of either moderate or heavy drinking. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking was also presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Drinking patterns did not appear to be strongly defined by gender, although some gendered expectations of drinking were described. Identities offer a useful theoretical concept to explain the rises in heavy drinking among older populations, and can inform preventive approaches to tackle this. Interventions should engage and foster positive identities to sustain healthier drinking and encourage at the community level the identification of heavy drinking as neither healthy nor synonymous with dependence. Future research should test and assess such approaches.

Alcohol, hospital admissions, and falls in older adults: a longitudinal evaluation

BACKGROUND

There are limited data on the impacts of alcohol use in older adults. We aimed to evaluate self-reported hospital admissions and falls against current Australian alcohol consumption guidelines.

METHODS

We conducted a longitudinal analysis of data from five Australian cohort studies. The study comprised 16,785 people aged 65 years or older at baseline. Alcohol consumption was categorized using Australian guidelines in standard (10 g) drinks per day as "abstinent," "low-risk" (>0 ≤2), "long-term risk" (>2 ≤4), or "short-term risk" (>4). Separate generalized estimating equations for men and women, controlling for key demographic, and health variables (depression, diabetes, circulatory and musculoskeletal conditions) were used to examine the relationship of alcohol consumption with hospitalization and falls against a reference category of low-risk consumption.

RESULTS

Most participants were in the low (10,369, 62%) or abstinent (5,488, 33%) categories. Among women, all alcohol groups had greater odds of admission than low-risk users; among men, only the abstinent group had increased odds. For both genders, depression, diabetes, circulatory and musculoskeletal conditions all increased the odds of admission. For both genders, the unadjusted model showed that abstainers had increased odds of falling, with depression, diabetes, and for women, musculoskeletal conditions also associated with falls in the adjusted model.

CONCLUSION

These outcomes suggest that older women in particular could benefit from targeted alcohol consumption messages or interventions. In relation to falls, other health conditions appear better targets for intervention than alcohol use.

AUDIT-C scores as a scaled marker of mean daily drinking, alcohol use disorder severity, and probability of alcohol dependence in a U.S. general population sample of drinkers

BACKGROUND

Brief alcohol screening questionnaires are increasingly used to identify alcohol misuse in routine care, but clinicians also need to assess the level of consumption and the severity of misuse so that appropriate intervention can be offered. Information provided by a patient's alcohol screening score might provide a practical tool for assessing the level of consumption and severity of misuse.

METHODS

This post hoc analysis of data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) included 26,546 U.S. adults who reported drinking in the past year and answered additional questions about their consumption, including Alcohol Use Disorders Identification Test-Consumption questionnaire (AUDIT-C) alcohol screening. Linear or logistic regression models and postestimation methods were used to estimate mean daily drinking, the number of endorsed alcohol use disorder (AUD) criteria ("AUD severity"), and the probability of alcohol dependence associated with each individual AUDIT-C score (1 to 12), after testing for effect modification by gender and age.

RESULTS

Among eligible past-year drinkers, mean daily drinking, AUD severity, and the probability of alcohol dependence increased exponentially across increasing AUDIT-C scores. Mean daily drinking ranged from < 0.1 to 18.0 drinks/d, AUD severity ranged from < 0.1 to 5.1 endorsed AUD criteria, and probability of alcohol dependence ranged from < 1 to 65% across scores 1 to 12. AUD severity increased more steeply across AUDIT-C scores among women than men. Both AUD severity and mean daily drinking increased more steeply across AUDIT-C scores among younger versus older age groups.

CONCLUSIONS

Results of this study could be used to estimate patient-specific consumption and severity based on age, gender, and alcohol screening score. This information could be integrated into electronic decision support systems to help providers estimate and provide feedback about patient-specific risks and identify those patients most likely to benefit from further diagnostic assessment.

Predicting 10-year alcohol use trajectories among men age 50 years and older

OBJECTIVE

To describe common 10-year drinking trajectories followed by men age 50 years or older and identify risk factors for those trajectories.

DESIGN

Longitudinal data were used to derive a semiparametric group-based model.

PARTICIPANTS

Men from the Health and Retirement Study age 50-65 years in 1998 who completed three or more of the six interviews conducted from 1998 to 2008, including our 1998 baseline interview.

MEASUREMENTS

Biannual data on number of drinks per drinking day were used to derive drinking trajectories. Risk factors included baseline age, race, ethnicity, education, marital status, retirement, smoking, binge drinking, vigorous exercise, body mass index, depression, pain, self-reported health, and chronic disease.

RESULTS

The best-fitting model included consistent infrequent drinkers and nondrinkers (40.6% of cohort), increasing drinkers (5.5%), decreasing drinkers (7.6%), consistent at-risk drinkers (15.6%), and consistent moderate drinkers (30.7%). Adjusted logistic regression models comparing men with similar 1998 drinking levels who subsequently followed different trajectories identified significant risks associated with age, education, smoking, binge drinking, depression, pain, and self-reported health. To illustrate, odds ratios (ORs) and 95% confidence intervals (95% CIs) suggest that baseline infrequent drinkers were less likely to follow an increasing drinkers trajectory if they were older (OR: 0.57, 95% CI: 0.38-0.82) and smoked cigarettes (OR: 0.47, 95% CI: 0.30-0.74). Baseline drinkers were less likely to follow a decreasing trajectory if they reported more than 12 years of education (OR: 0.58, 95% CI: 0.42-0.82) and thought that their health was excellent or very good (OR: 0.54, 95% CI: 0.39-0.76).

CONCLUSION

Only 30.7% of older men in this cohort were moderate drinkers throughout the follow-up. Many older men may benefit from brief counseling on the risks and benefits of drinking.

Unhealthy drinking in the Belgian elderly population: prevalence and associated characteristics

BACKGROUND

Knowledge about alcohol consumption patterns and alcohol problems among the Belgian elderly population is scarce. The aims of this study were to explore alcohol consumption patterns and alcohol problems among the Belgian elderly population aged ≥ 65 years living at home, and to determine their association with socio-demographic characteristics, health status and socio-economic status.

METHODS

In this cross-sectional study based on a representative sample of 4825 non-institutionalized Belgian elderly people (≥ 65 years) in the Belgian Health Interview Surveys 2001 and 2004, alcohol consumption patterns and alcohol problems were estimated according to age, gender, survey year, living situation, frequency of social contacts, smoking status, and socio-economic status.

RESULTS

In all, 50.4% of the sample were non- or occasional drinkers, 29.1% were moderate drinkers, 10.4% at-risk drinkers, 4.6% heavy drinkers and 5.5% problematic drinkers. In total, 20.5% of the Belgian elderly population drank in excess of the National Institute on Alcohol Abuse and Alcoholism guidelines, and 4.7% had an alcohol problem according to the CAGE. In addition, 81.3% of the elderly people who consume alcohol used prescribed medications in the past 2 weeks. After adjustment for risk factors we found that, compared with moderate drinking, unhealthy drinking was significantly associated with age, gender, frequency of social contacts, health status and socio-economic status.

CONCLUSIONS

Belgian health policy should be aware of the high level of at-risk drinkers in the elderly population and the underdetection and misdiagnosis of alcohol problems in this age group. An increased attention in public health initiatives among the Belgian elderly population is needed.

Impact of behavioural risk factors on death within 10 years for women and men in their 70s: absolute risk charts

Background

Estimates of the absolute risk of death based on the combined effects of sex, age and health behaviours are scarce for elderly people. The aim of this paper is to calculate population based estimates and display them using simple charts that may be useful communication tools for public health authorities, health care providers and policy makers.

Methods

Data were drawn from two concurrent prospective observational cohort studies of community-based older Australian women (N = 7,438) and men (N = 6,053) aged 71 to 79. The outcome measure was death within ten years. The predictor variables were: sex, age, smoking status, alcohol consumption, body mass index and physical activity.

Results

Patterns of risks were similar in men and women but absolute risk of death was between 9 percentage points higher in men (17 %) than in women (8 %) in the lowest risk group (aged 71–73 years, never smoked, overweight, physically active and consumed alcohol weekly) and 21 % higher in men (73-74 %) than women (51-52 %) in the highest risk group (aged 77–79 years, normal weight or obese, current smoker, physically inactive and drink alcohol less than weekly).

Conclusions

These absolute risk charts provide a tool for understanding the combined effects of behavioural risk factors for death among older people.

Moderate alcohol consumption and the risk of mortality

There has been a growing consensus that moderate consumption of alcohol is associated with a lower risk of mortality and that this association is probably causal. However, a recent review article has raised a serious challenge to this consensus. In short, it determined that most prior research in this area committed serious misclassification errors; furthermore, among those studies that were free of these misclassification errors, no support for a protective role of alcohol consumption was found. This article reexamines the issue using prospective data for more than 124,000 persons interviewed in the U.S. National Health Interview Surveys of 1997 through 2000 with mortality follow-up through 2002 using the Linked Mortality File. The study involves about 488,000 person-years. Controlling for a variety of covariates, this study finds that compared with nondrinkers, those who consume a moderate amount of alcohol have lower all-cause and CHD mortality. The fact that the current study has taken care to avoid the pitfalls of some earlier studies and still finds that those who consume a moderate amount of alcohol have lower all-cause mortality and CHD mortality lends credence to the argument that the relationship is causal.

Impact of alcohol use on mortality in the elderly: results from the Korean Longitudinal Study on Health and Aging

BACKGROUND

To examine the effects of problematic drinking, amount of alcohol use and binge drinking on all-cause mortality in the elderly.

METHODS

We investigated 45-month all-cause mortality of 997 randomly sampled community-dwelling elderly Koreans aged 65 years or older who participated in the Korean Longitudinal Study on Health and Aging. Problematic drinking was defined as having alcohol use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria or having 8 or higher of the Alcohol Use Disorders Identification Test. Light drinking was defined as drinking 7 alcoholic drinks or less, and heavy drinking as having 14 alcoholic drinks more per week during past 12 months. Binge drinking was defined as having 6 or more drinks on a single occasion at least monthly.

RESULTS

One hundred and thirteen participants (11.3%) died during the 45-month follow-up period. Heavy drinking (>14 alcoholic drinks per week) increased the all-cause mortality risk when in association with problematic drinking (hazard ratio [HR]=2.604, 95% confidence interval [CI]=1.221-5.553, p=0.012) or binge drinking (HR=2.823, 95% CI=1.259-6.328, p=0.013). Light drinking (≤ 7 alcoholic drinks per week) was associated with decreased all-cause mortality (HR=0.114, 95% CI=0.015-0.833, p=0.032).

CONCLUSIONS

Problematic drinking is associated with increased all-cause mortality in elderly Koreas, particularly when it is heavy and/or combined with binge drinking.

Prevalence of at-risk drinking among older adults and associated sociodemographic and health-related factors

OBJECTIVES

Recognition of alcohol-related health problems in the elderly is challenging. Alcohol use also tends to be a hidden issue. The aim of this study was to examine the prevalence and at-risk drinking patterns in community-dwelling older adults and their associations with socio-demographic and health-related factors.

DESIGN

The data were collected with a postal questionnaire from a random sample of 2100 elderly people (≥ 65 years) living in the medium-sized city of Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. We defined the amount of at-risk drinking as 1) consuming >7 drinks per week or 2) >5 drinks on a typical drinking day or 3) using >3 drinks several times per week.

RESULTS

Of the respondents, 8.2% (N=114) were at-risk drinkers. At-risk drinking was associated with younger age and male sex, higher level of education, good income, living with a spouse, and current smoking. In addition, good functioning was associated with at-risk drinking. Although frequency and quantity of alcohol consumption declined with age, of our respondents nearly one-fifth of men aged 71-80 years and one-tenth of men aged 81-90 years could be classified as at-risk drinkers. At-risk drinkers had comorbidities and multiple medications as often as non-risk group. A significantly larger proportion of the at-risk drinking group relative to the non-risk group admitted falling or injuring themselves (5.3% vs. 0.7%) or forgotten to take their medications because of the use of alcohol.

CONCLUSIONS

At-risk drinking is prevalent among older adults, particularly among males, despite prevalent comorbidities and multiple medications. At-risk drinking is associated with adverse events such as a tendency for injuries.

Limitations to functioning and independent living after the onset of coronary heart disease: what is the role of lifestyle factors and obesity?

Background: People with coronary disease have a higher risk of functional limitations than their same-age counterparts without disease. This study examined prospectively the extent to which functioning and independent living among individuals with coronary disease in early old age are associated with lifestyle factors before and after disease onset. Methods: Participants were 986 British civil servants (657 men and 329 women aged 35–55 years), who were free of coronary disease at study entry in 1985–88 but developed disease during 21 years follow-up (the Whitehall II study). Lifestyle factors (obesity, smoking, alcohol, diet and physical activity) were measured at baseline and follow-up in 2007–09. Post-disease limitations to functioning were measured in 2006–09 at mean age is 68 years using activities of daily living scales. Results: Low physical activity and being overweight [body mass index (BMI) ≥25] before and after disease onset were associated with having one or more limitations in activities of daily living among coronary patients [age-, sex- and socio-economic position adjusted odds ratios for pre-disease inactivity and obesity 1.53 [95% confidence interval (95% CI) 0.99–2.35] and 2.53 (95% CI 1.53–4.18), respectively]. A decrease in physical activity [odds ratio (OR): 2.42, 95% CI 1.59–3.68] and an increase of >5 U in BMI (OR: 2.05, 95% CI 1.34–3.13) were also related to limitations in activities of daily living after disease onset. These relationships were not accounted for by measured co-morbidities. No robust associations were observed for smoking, alcohol use and diet. Conclusion: Physical activity and weight control across the adult life course are associated with fewer limitations to functioning and independent living after the onset of coronary disease.