Alcohol and the health of aging men

Alcohol use and cardiovascular health outcomes: a comparison across age and gender in the Winnipeg Health and Drinking Survey Cohort

BACKGROUND

research has reliably demonstrated cardioprotection from regular alcohol use. Heavy episodic drinking (HED), however, negates these beneficial effects and increases the risk of cardiovascular disease (CVD). The impact of age on the health effects of episodic drinking has not been evaluated.

OBJECTIVE

to examine the association between alcohol volume and pattern of consumption on the risk of cardiovascular morbidity and mortality across the lifespan.

DESIGN AND SETTING

prospective, community-based cohort study of adults in Winnipeg, Manitoba, Canada.

SUBJECTS

a total of 1,154 participants (580 men and 574 women) aged 18-64 surveyed at baseline (1990-91) on alcohol consumption levels and pattern of use.

METHODS

usual alcohol consumption was measured using a quantity-frequency approach. HED was estimated by asking participants how often they consumed eight or more drinks in one sitting in the past year. Questions were asked separately for wine, beer and spirits. Surveillance for cardiovascular events was conducted for 10 years (i.e. up to age 74 years). Diagnoses of CVD were obtained via health utilization records. Cox proportional hazard models were derived for both genders and for 'young adults' (baseline age 18-34), 'middle-aged adults' (baseline age 35-49) and 'older adults' (baseline 50-64). Models were adjusted for marital status, cigarette smoking status and educational level.

RESULTS

Reduced risk of CVD was associated with usual consumption, whereas an increased risk was associated with HED. Among male usual drinkers, cardioprotection was afforded only to middle and older age groups. The benefits of regular consumption were seen only in the youngest age group among women. The heaviest usual consumption category was associated with a decreased risk of CVD in men. Heavy episodic drinking increased the risk of coronary heart disease in middle-aged men and was marginally significant in middle-aged women. Risk of hypertension was elevated in older men with heavy episodic drinking.

CONCLUSIONS

The well-established relationship between regular alcohol consumption and decreased risk of CVD may not become evident until middle age or older in men. Women may benefit from usual consumption at a much younger age. In both sexes, however, these beneficial effects of alcohol use are negated when alcohol is consumed in a heavy episodic drinking pattern, particularly for middle-aged and older men.

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

OBJECTIVES

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

DESIGN

National longitudinal surveys from 1996 to 2002.

SETTING

Community based.

PARTICIPANTS

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

MEASUREMENTS

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

RESULTS

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

CONCLUSION

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

Geriatric alcoholism

BACKGROUND

The authors reviewed the clinical features, epidemiology, diagnosis, medical treatment, orofacial findings and dental treatment of geriatric patients with alcoholism.

TYPES OF STUDIES REVIEWED

The authors conducted MEDLINE searches for the period 1995 through 2004 using the terms "alcoholism," "geriatric," "pathophysiology," "treatment" and "dentistry." They selected reports published in English in peer-reviewed journals for further review.

RESULTS

Physiological changes associated with aging permit the harmful effects of drinking alcohol to arise at lower levels of consumption than in younger people. Excessive use of alcohol exacerbates the medical and emotional problems associated with aging and predisposes the person to adverse drug reactions with medications controlling these illnesses.

CLINICAL IMPLICATIONS

The incidence of dental disease in this population is extensive because of diminished salivary flow and a disinterest in performing appropriate oral hygiene techniques. Concurrent abuse of tobacco products worsens dental disease and heightens the risk of developing oral cancer. Identification of patients who abuse alcohol, a cancer-screening examination, preventive dental education, and use of saliva substitutes and anticaries agents are indicated. Clinicians must take precautions when performing surgery and when prescribing or administering analgesics, antibiotics or sedative agents that are likely to have an adverse interaction with alcohol.

The impact of alcohol use in community-dwelling older adults

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

Alcohol Use in a Continuing Care Retirement Community

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

The nurse's role in assessing alcohol use by older people

Nurses have the potential to carry out health promotion activity related to alcohol use in a range of settings where older people receive care. The majority of the literature on alcohol use in later life has focused on abuse, especially on the more common risk of drug-alcohol interactions. In order to work effectively with older people in health prevention and education, nurses need to be knowledgeable about older people's patterns of drinking, the effects of alcohol on medication and the current evidence on the harm and benefits of alcohol to health. In carrying out assessments, a skillful approach needs to be adopted in questioning older clients on what some might regard as a sensitive issue. Screening tools for the detection of alcohol abuse in the general adult population may not be valid for use with older clients. Tools specific to the detection of alcohol abuse by older people will be considered.