Changes in Alcohol Consumption and Associated Variables among Older Adults in Spain: A population-based cohort study

Prevalence and change in alcohol consumption in older adults over time, assessed with self-report and Phosphatidylethanol 16:0/18:1 -The HUNT Study

BACKGROUND

Changes in alcohol consumption may affect older adults' health. We examined prevalence and changes in the alcohol consumption of older women and men (≥65 years) in Norway over a 24-year period.

METHODS

Data from three population-based health surveys (The Trøndelag Health Study-HUNT2 1995-97, HUNT3 2006-08, HUNT4 2017-19) were used. Alcohol consumption was measured using self-reported measures and an objective measure of alcohol consumption (Phosphatidylethanol 16:0/18:1, PEth). Self-reported lifetime abstinence, former drinking, current drinking, frequent drinking (≥4 times/week), and risk drinking (≥8 units/week) were measured. The PEth concentrations were stratified: <0.03 μmol/l (abstinence/very low level of alcohol consumption); >0.06 μmol/l (indicating >1 unit/day); >0.10 μmol/l (indicating >3 units/day), and >0.30 μmol/l (heavy alcohol consumption).

RESULTS

In HUNT4, the prevalence of self-reported lifetime abstinence, frequent drinking, and risk drinking was 5.2%, 4.4%, and 5.6%, respectively, while prevalence of PEth <0.03 μmol/l was 68.1% and PEth >0.06 μmol/l was 21.2%. Over the course of the three surveys, the prevalence of self-reported lifetime abstinence decreased, while the prevalence of frequent drinking and risk drinking increased. Men were less often abstainers and more often frequent and risky drinkers than women in all three surveys. Gender differences for abstinence and current drinking reduced with time. From HUNT3 to HUNT4, the prevalence of PEth <0.03 μmol/l decreased, while the prevalence of PEth >0.06 μmol/l increased. Men compared to women, had less often PEth <0.03 μmol/l and more often PEth >0.06 and >0.10 μmol/l in HUNT3 and HUNT4. Women and men ≥75 years were just as likely to have PEth >0.30 μmol/l in HUNT4. The gender differences in PEth concentrations were reduced in HUNT4 among those aged 70-74 years or ≥75 years.

CONCLUSION

Alcohol consumption has increased among Norwegian older adults over a 24-year period, but at a slower pace during the last decade.

Sustained Hypothetical Interventions on Midlife Alcohol Consumption in Relation to All-Cause and Cancer Mortality: The Australian Longitudinal Study on Women's Health

No randomized controlled trial has evaluated the effect of long-term alcohol interventions on mortality. Results reported in existing observational studies may be subject to selection bias and time-varying confounding. Using data from the Australian Longitudinal Study on Women's Health 1946-1951 birth cohort, collected regularly from 1996-2016, we estimated all-cause and cancer mortality had women been assigned various alcohol interventions (in categories ranging from 0 to >30 g/day ethanol, or reduced to ≤20 g/day if higher) at baseline, and had they maintained these levels of consumption. The cumulative risks for all-cause and cancer mortality were 5.6% (10,118 women followed for 20 years) and 2.9% (18 years), respectively. For all-cause and cancer mortality, baseline ethanol up to 30 g/day showed lower risk and >30 g/day showed higher risk relative to abstention. Had women sustainedly followed the interventions, a similar relationship was observed for all-cause mortality. However, the negative association observed for intakes ≤30 g/day and positive association for intakes >30 g/day was not evident for cancer mortality. Our findings suggest that all-cause mortality could have been lower than observed if this cohort of women had consumed some alcohol (no more than 30 g/day) rather than no consumption, but cancer mortality might not.

Association between nutrient intake related to the one-carbon metabolism and colorectal cancer risk: a case-control study in the Basque Country

PURPOSE

Epidemiologic evidence for the association between methyl-donor nutrient intake and colorectal cancer (CRC) risk remains inconclusive. We aimed to examine the relationship between intake of vitamins of the B group, methionine, total choline and betaine and CRC risk, in a population from the CRC screening programme in the Basque Country.

DESIGN

This observational study included 308 patients with CRC and 308 age- and sex-matched subjects as controls. During recruitment, dietary, anthropometric, lifestyle, socioeconomic, demographic, and health status information was collected. Conditional logistic regression was used to estimate the odds ratios (ORs) for CRC risk.

RESULTS

The adjusted ORs for CRC risk decreased with higher intakes of choline and betaine (p < 0.05). After further adjustment for folate, high intake of choline and betaine remained associated with a reduced CRC risk (adjusted model for choline, OR third tertile vs first tertile = 0.45, 95% CI 0.26-0.80, p = 0.006; for betaine, OR third tertile vs first tertile = 0.27, 95% CI 0.16-0.47, p < 0.001). Regarding the other nutrients, our findings indicated a non-significant decrease in CRC risk with the high level of intake.

CONCLUSIONS

Our data suggest that choline and betaine intake influence CRC risk in the studied population.

Recurrent risk of hospitalization among older people with problematic alcohol use: a multiple failure-time analysis with a discontinuous risk model

BACKGROUND AND AIMS

Older people with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all-cause, alcohol-, polydrug- and psychiatric-related repeated hospitalizations among older people with problematic alcohol use.

DESIGN

A linked register-based cohort study with discontinuous multiple-failure (time-to-repeated-event) data. Hospitalization and mortality were considered as failure.

SETTING

Sweden, March 2003-November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish cause of death register.

PARTICIPANTS

Participants aged 50 years and older (n = 1741; 28.2% women), with one or more alcohol problem days in the 30 days before an ASI assessment.

MEASUREMENTS

Five mutually exclusive latent classes of problematic alcohol use, identified with 11 ASI items, were the independent variables: 'late onset with fewer consequences (LO:FC; reference group)'; 'early onset/prevalent multi-dimensional problems (EO:MD)'; 'late onset with co-occurring anxiety and depression (LO:AD)'; 'early onset with co-occurring psychiatric problems (EO:PP)'; and 'early onset with major alcohol problem (EO:AP)'. Covariates included socio-demographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization and/or mortality due to: (a) all-cause, (b) alcohol-related disorders and diseases (c) polydrug use and (d) other psychiatric disorders.

FINDINGS

During the study period, more than 75% were hospitalized at least once or died. 57.3% were hospitalized with alcohol-related, 8.5% with polydrug use and 18.5% with psychiatric-related diagnoses. Compared with LO:FC, EO:PP had higher risk for all-cause [adjusted hazard ratio (aHR) = 1.27, 95% confidence interval (CI) = 1.02-1.59] and alcohol-related (aHR = 1.34, 95% CI = 1.02-1.75) hospitalizations. Adjusted risks for polydrug-related hospitalization were 2.55, 95% CI = 1.04-6.27 for EO:MD and 2.62, 95% CI = 1.07-6.40 for EO:PP. Adjusted risk for psychiatric-related hospitalization was higher for LO:AD (aHR = 1.78, 95% CI = 1.16-2.73 and EO:PP (aHR = 2.03, 95% CI = 1.22-3.38).

CONCLUSIONS

Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older people with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

Ocorrência simultânea de uso abusivo de álcool e alimentação não saudável em adultos

Objetivo Estimar a prevalência da coocorrência do uso abusivo de álcool e alimentação não saudável em adultos brasileiros e verificar sua relação com o consumo alimentar, segundo o sexo. Métodos Estudo com dados do inquérito telefônico Vigitel, 2016. Considerou-se uso abusivo de álcool: ingestão ≥5 doses/homens e ≥4/mulheres em uma única ocasião, pelo menos uma vez no último mês. Alimentação não saudável foi caracterizada a partir de um indicador composto por oito alimentos. Foram usados os testes Qui-quadrado de Pearson e Wald, com nível de significância de 5%, e razões de chances ajustadas com regressão logística. Resultados A coocorrência dos fatores de risco (24,7% vs. 10,0%) foi superior nos homens, nos indivíduos com melhor escolaridade, sem cônjuge, com plano de saúde, nas mulheres que se declararam pretas, e foi menor nos adultos (40-59 anos) e idosos. A coocorrência associou-se com menores chances de consumo de hortaliças cruas e cozidas, frutas, suco, leite e frango (≥5 dias/semana), e com maiores chances de consumo de carne vermelha, refrigerante (≥3 dias/semana) e carnes com excesso de gordura. Conclusão Os resultados mostram os prejuízos da coocorrência do uso excessivo de álcool e alimentação inadequada sobre os padrões alimentares da população adulta.

A systematic review of self-report measures used in epidemiological studies to assess alcohol consumption among older adults

Background

There is a lack of standardization regarding how to assess and categorize alcohol intake in older adults. The aim of this study was to systematically review methods used in epidemiological studies to define drinking patterns and measure alcohol consumption among older adults.

Methods

A systematic search was conducted in the MEDLINE, PubMed, PsycINFO, EMBASE, and CINAHL databases for studies published from January 2009 to April 2021. Studies were included if they were observational studies with a quantitative design; the mean age of the participants was ≥ 65 years; questionnaires, screening tools, or diagnostic tools were used to define alcohol consumption; and alcohol consumption was self-reported.

Results

Of 492 studies considered, 105 were included. Among the 105 studies, we detected 19 different drinking patterns, and each drinking pattern had a wide range of definitions. The drinking patterns abstaining from alcohol, current drinking, and risk drinking had seven, 12 and 21 diverse definitions, respectively. The most used questionnaire and screening tools were the quantity-frequency questionnaire, with a recall period of 12 months, and the full and short versions of the Alcohol Use Disorders Identification Test, respectively.

Conclusion

No consensus was found regarding methods used to assess, define, and measure alcohol consumption in older adults. Identical assessments and definitions must be developed to make valid comparisons of alcohol consumption in older adults. We recommend that alcohol surveys for older adults define the following drinking patterns: lifetime abstainers, former drinkers, current drinkers, risk drinking, and heavy episodic drinking. Standardized and valid definitions of risk drinking, and heavy episodic drinking should be developed. The expanded quantity-frequency questionnaire including three questions focused on drinking frequency, drinking volume, and heavy episodic drinking, with a recall period of 12 months, could be used.

Applying Geriatric Principles to Hazardous Drinking in Older Adults

Older adults continue to drink as they age. Aging changes alcohol kinetics just as with any other drug. Older adults have increased sensitivity to acute alcohol intake that accounts for the increased risk of falls, traffic accidents, and other injury. The Annual Medicare Wellness Exam is an excellent opportunity to introduce screening for unsafe drinking along with accumulated risks and deficits of aging. Older adults have responded well to brief interventions for unhealthy drinking. In the presence of alcohol use disorder or serious comorbidity including psychiatric illness, referral to specialized multidisciplinary care can be lifesaving.

Managing older people's perceptions of alcohol-related risk: a qualitative exploration in Northern English primary care

BACKGROUND

Risk of harm from drinking increases with age as alcohol affects health conditions and medications that are common in later life. Different types of information and experiences affect older people's perceptions of alcohol's effects, which must be navigated when supporting healthier decisions on alcohol consumption.

AIM

To explore how older people understand the effects of alcohol on their health; and how these perspectives are navigated in supportive discussions in primary care to promote healthier alcohol use.

DESIGN AND SETTING

A qualitative study consisting of semi-structured interviews and focus groups with older, non-dependent drinkers and primary care practitioners in Northern England.

METHOD

A total of 24 older adults aged ≥65 years and 35 primary care practitioners participated in interviews and focus groups. Data were analysed thematically, applying principles of constant comparison.

RESULTS

Older adults were motivated to make changes to their alcohol use when they experienced symptoms, and if they felt that limiting consumption would enable them to maintain their quality of life. The results of alcohol-related screening were useful in providing insights into potential effects for individuals. Primary care practitioners motivated older people to make healthier decisions by highlighting individual risks of drinking, and potential gains of limiting intake.

CONCLUSION

Later life is a time when older people may be open to making changes to their alcohol use, particularly when suggested by practitioners. Older people can struggle to recognise potential risks or perceive little gain in acting on perceived risks. Such perceptions may be challenging to navigate in supportive discussions.