Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study

Marital Quality and Alcohol Use among Couples in Mid- and Later-Life

Spouses influence one another’s drinking behavior, but little research has explored how relationship quality may impact older couples’ alcohol use. Using data from the 2014–2018 waves of the Health and Retirement Study (HRS) and actor-partner interdependence models, we examined how marital quality is related to total alcohol consumption and risk of heavy drinking for married couples over age 50. Neither husbands’ nor wives’ perceptions of negative marital quality were related to changes in heavy drinking or number of drinks consumed over the observation period. However, wives’ positive marital quality was associated with increased risk of heavy alcohol use for both wives and husbands, and with an increase in the number of drinks wives consume over time. Couples over age 50 do not appear to use alcohol as a way of coping with negative marital relationships, but rather may increase their drinking in the context of positive relationships.

Increased risk of dementia in older female US veterans with alcohol use disorder

AIM

To determine whether alcohol use disorder (AUD) is associated with increased dementia risk among older women veterans.

DESIGN

Cohort study.

SETTING

United States.

PARTICIPANTS

Women veterans with AUD aged ≥ 55 years (n = 2207), receiving care from Veterans Health Administration medical centers from October 2004 to September 2015 with one or more follow-up visit and an age-matched sample of women veterans without AUD (n = 2207). Women at baseline with prevalent dementia or AUD in remission were excluded.

MEASUREMENTS

AUD, substance use disorder (SUD), smoking, psychiatric (depression, anxiety, post-traumatic stress disorder, anxiety) and medical comorbidities (diabetes, hypertension, stroke, chronic obstructive pulmonary disorder, traumatic brain disorder) and dementia determined by the International Classification of Diseases, 9th revision, Clinical Modification codes. Cox proportional hazards models were used to determine the association between AUD and dementia risk during follow-up. Sensitivity analyses were performed by excluding women (n = 349) with comorbid SUD and by excluding women (n = 1568) currently smoking.

FINDINGS

Veteran women had a mean [standard deviation (SD)] age of 65.0 (5.6) years at baseline. During follow-up (median 4 years, interquartile range: 2-6) 3.7% of women (n = 82) with AUD developed dementia compared with 1.1% (n = 24) without AUD (P < 0.001). After adjustment for demographics, medical and psychiatric conditions and accounting for different Veteran's Integrated Service Networks, the adjusted hazard ratio (aHR) for dementia was 3.12 (95% CI = 1.90-5.12) for women with AUD compared with women without AUD. After removing women with SUD (aHR = 3.53, 95% CI = 2.13-5.85) and women currently smoking (aHR = 3.80, 95% CI = 2.11-6.84), results were similar.

CONCLUSIONS

Alcohol use disorder among female US veterans aged more than 55 years appears to be associated with a more than threefold increase of dementia.

Parental divorce and offspring smoking and alcohol use: a systematic review and meta-analysis of observational studies

OBJECTIVE

This study was conducted to investigate the relationship between parental divorce and smoking and alcohol consumption in offspring, which is based on a systematic review method and ultimately meta-analysis. Method: In a systematic search, three databases were selected. The manuscripts were searched based on the keywords and the time limit for the search was published manuscripts in English until November 2020. For the relationship between parental divorce and smoking/alcohol use in offspring, one main analysis, and four analyses based on sex, study design, adjusted level, and continents were performed. Result: Forty-three studies were synthesized from the collection of manuscripts. The odds of smoking in offspring whose parents were separated was 1.45 (CI 1.37-1.54) and this odds in men was equal to 1.38 (CI 1.11-1.71; Z = 2.91; p = 0.004; I² = 81.5%) and in women, 1.78 (CI 1.51-2.10; Z = 6.88; p < 0.001; I² = 69.6%). The odds of alcohol use in offspring whose parents were separated was 1.43 (CI 1.15-1.77) and this odds in men was equal to 1.69 (CI 1.16-2.47; Z = 2.73; p = 0.006; I² = 99.6%) and in women 1.79 (CI 1.07-2.99). Discussion: The findings of the present study can be used in health-related policies, prevention, and clinical interventions. This study was a subject with limitations, also.

Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta-analysis of cohort studies

BACKGROUND AND AIMS

Alcohol use disorders (AUD) are often comorbid with depressive symptoms. Cohort studies on the association between AUD and subsequent depressive symptoms have produced inconsistent results. Moreover, regarding alcohol intake, the risk of developing depressive symptoms might vary with alcohol intake level. We aimed to investigate the association between AUD, alcohol intake and subsequent depressive symptoms.

DESIGN AND SETTING

We conducted a systematic search in PubMed, Embase and PsycINFO for cohort studies on the association between AUD or alcohol intake and subsequent depressive symptoms.

PARTICIPANTS

We included 338 426 participants from 42 studies. Six and four studies analyzed only females and males, respectively.

MEASUREMENTS

We combined risk estimates for developing depressive symptoms using a random-effects model. We divided alcohol intake into abstinence, light (0-84 g/week), moderate (85-168 g/week) and heavy drinking (> 168 g/week or > 48 g/day at least weekly). We conducted a categorical analysis to compare the risk of depressive symptoms between abstinence and different intake categories. Further, we conducted a dose-response analysis to investigate the alcohol-depression association.

FINDINGS

We analyzed 42 studies (follow-up time: 1-40 years). AUD was associated with significantly increased risk of subsequent depressive symptoms [relative risk (RR) = 1.57, 95% confidence interval (CI) = 1.41-1.76]. Regarding alcohol intake, heavy drinking had an increased risk of depressive symptoms; however, the association was only significant when controls were limited to non-heavy drinkers (RR = 1.13, 95% CI = 1.05-1.22). Taking into consideration the possibility of publication bias and confounding factors made the association non-significant. We observed J-shaped associations in both categorical and dose-response analyses where light-moderate drinking had a significantly decreased risk of depression, while heavy drinking did not show a significant association with depressive symptoms compared with non-drinkers.

CONCLUSION

Alcohol use disorders are associated with increased the risk of subsequent depressive symptoms. Heavy drinking does not significantly predict occurrence of depressive symptoms after adjusting for potential confounders.

Multiple Causes of Dementia as Engineered Senescence

All traumas—cranial, cardiovascular, hormone, viral, bacterial, fungi, parasites, misfolded protein, genetic, behavior, environmental and medication—affect the brain. This paper itemizes studies showing the many different causes of dementia including Alzheimer’s disease. Causes interact with each other, act sequentially by preparing the optimal conditions for its successor, initiate other diseases, allow for other traumas to accumulate and degrade protective features of the brain. Since such age-related cognitive impairment is not exclusively a human attribute there might be support for an evolutionary theory of dementia. Relying on theories of antagonistic pleiotropy and polymorphism, the brain has been designed to sequester trauma. Because of increased longevity, the short-term tactic of sequestering trauma becomes a long-term liability. We are engineered to sequester these insults until a tipping point is reached. Dementia is an evolutionary trade-off for longevity. We cannot cure dementia without understanding the overall biology of aging.

Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement

Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.

Aging with alcohol-related brain damage: Critical brain circuits associated with cognitive dysfunction

Alcoholism is associated with brain damage and impaired cognitive functioning. The relative contributions of different etiological factors, such as alcohol, thiamine deficiency and age vulnerability, to the development of alcohol-related neuropathology and cognitive impairment are still poorly understood. One reason for this quandary is that both alcohol toxicity and thiamine deficiency produce brain damage and cognitive problems that can be modulated by age at exposure, aging following alcohol toxicity or thiamine deficiency, and aging during chronic alcohol exposure. Pre-clinical models of alcohol-related brain damage (ARBD) have elucidated some of the contributions of ethanol toxicity and thiamine deficiency to neuroinflammation, neuronal loss and functional deficits. However, the critical variable of age at the time of exposure or long-term aging with ARBD has been relatively ignored. Acute thiamine deficiency created a massive increase in neuroimmune genes and proteins within the thalamus and significant increases within the hippocampus and frontal cortex. Chronic ethanol treatment throughout adulthood produced very minor fluctuations in neuroimmune genes, regardless of brain region. Intermittent "binge-type" ethanol during the adolescent period established an intermediate neuroinflammatory response in the hippocampus and frontal cortex, that can persist into adulthood. Chronic excessive drinking throughout adulthood, adolescent intermittent ethanol exposure, and thiamine deficiency all led to a loss of the cholinergic neuronal phenotype within the basal forebrain, reduced hippocampal neurogenesis, and alterations in the frontal cortex. Only thiamine deficiency results in gross pathological lesions of the thalamus. The behavioral impairment following these types of treatments is hierarchical: Thiamine deficiency produces the greatest impairment of hippocampal- and prefrontal-dependent behaviors, chronic ethanol drinking ensues mild impairments on both types of tasks and adolescent intermittent ethanol exposure leads to impairments on frontocortical tasks, with sparing on most hippocampal-dependent tasks. However, our preliminary data suggest that as rodents age following adolescent intermittent ethanol exposure, hippocampal functional deficits began to emerge. A necessary requirement for the advancement of understanding the neural consequences of alcoholism is a more comprehensive assessment and understanding of how excessive alcohol drinking at different development periods (adolescence, early adulthood, middle-aged and aged) influences the trajectory of the aging process, including pathological aging and disease.

Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study

Background

The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults.

Methods

We used data from the Nord-Trøndelag Health Study (HUNT3 2006–08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown.

Results

The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality.

Conclusion

Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.

Alcohol Consumption and Physical Activity in Austrian College Students-A Cross-Sectional Study

BACKGROUND

The age of college students is considered as crucial for developing health-related behaviors, e.g., alcohol consumption or a physically active lifestyle. Previous research reported a positive relationship between alcohol consumption and physical activity (PA) in college students. However, the main body of research was done in students from the United States who might differ from European students.

OBJECTIVES

Thus the aim of this study was to analyze the relationship between alcohol consumption and PA in a sample of Austrian college students.

METHODS

In a cross-sectional design, 861 Austrian students from various study fields responded to a web-based questionnaire. Self-reported alcohol consumption, PA, and relevant sociodemographic variables were assessed. Multiple regression analyses were used to study the relationship between alcohol consumption and PA.

RESULTS

In none of the regression models, a significant relationship between alcohol consumption and PA was found. There was a significant influence of sex, age, relationship status, education level, and study field on alcohol consumption. Male, older, and undergraduate students studying social sciences without a relationship reported higher alcohol consumption. Conclusions/Importance: The results do not support a general relationship between alcohol consumption and PA among urban Austrian college students of various study fields. Compared to other variables (e.g., sex, relationship status), PA seems to be less important in relation to the consumption of alcohol. This study challenges a global perspective on a positive relationship between alcohol consumption and PA and highlights the need for more cross-cultural investigations.

Advantageous Selection, Moral Hazard, and Insurer Sorting on Risk in the U.S. Automobile Insurance Market

This study quantifies the role of private information in automobile insurance policy choice using data on subjective beliefs, risk preference, reckless driving, the respondent's insurer and insurance policy characteristics merged with insurer-specific quality ratings distributed by independent organizations. We find a zero correlation between ex post accident risk and insurance coverage, reflecting advantageous selection in policy choice offset by moral hazard. Advantageous selection is partly attributable to insurer sorting on consumer attributes known and used by insurers. Our analysis of insurer sorting reveals that lower-risk drivers on attributes observed by insurers obtain coverage from insurers with higher-quality ratings.

Interventions to reduce the negative effects of alcohol consumption in older adults: a systematic review

BACKGROUND

Older individuals are consuming alcohol more frequently yet there is limited evidence on the effectiveness of current interventions. This systematic review aims to investigate interventions that target alcohol use in individuals aged 55 + .

METHODS

CINAHL, ERIC, MEDLINE, Science Direct, PsychInfo, SCOPUS, Web of Science and socINDEX were searched using terms devised from the PICO (Population, Intervention, Comparison and Outcome) tool. Studies using pharmaceutical interventions, or those that investigated comorbidities or the use of other substances were excluded. Peer reviewed empirical studies written in the English language that compared the outcomes of alcohol related interventions to standard care were included in this review. Studies were appraised and assessed for quality using the relevant Critical Appraisal Skills Programme checklist.

RESULTS

Seven papers were included in this review. Six were conducted in the United States of America and one in Denmark. The interventions were carried out in primary care centres and in community based groups. The studies included in this review showed varying levels of success. Participants showed improvements in at least one area of alcohol consumption or frequency of consumption however, these did not always reach significance.

CONCLUSION

Individuals in this age group appear to respond well to interventions aimed at reducing alcohol consumption. However, included studies had limitations, in particular many did not include a clear intervention description; leaving us unable to fully investigate the components required for success. Further research is needed on the effective components of alcohol interventions targeting older people.

Income disparity and mortality among patients with alcohol use disorder in South Korea

Problems related to alcohol consumption, particularly alcohol disorders, occur frequently in South Korea and are gradually increasing due to the drinking culture and social atmosphere. We analyzed the relationship between mortality and income among patients with alcohol disorders. We used data from the National Sampling Claim Data 2003-2013, which included medical claims filed for 10,593 patients newly diagnosed with alcohol disorders. We performed survival analyses using a Cox proportional hazards model. 12.79% died during the study period. Patients with lower incomes were more positively associated with the risk of mortality than those with higher incomes (0-30 percentile: hazard ratio [HR] = 1.432, 95% confidence interval [CI] = 1.155-1.777; 31-60 percentile: HR = 1.318, 95% CI = 1.065-1.633; 61-90 percentile: HR = 1.352, 95% CI = 1.097-1.665; 91-100 percentile: ref). Such associations were significant in males, patients with mild conditions, or those who lived in metropolitan areas. In conclusion, we found that income disparity was related to mortality among patients diagnosed with disorders due to alcohol use. Thus, healthcare professionals need to provide active intervention in the early phase of alcohol disorders, and consider policy that would improve healthcare accessibility for low-income populations in order to reduce income disparity.

Substance Abuse in Older Psychiatric Inpatients

Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.

The Association between Different Levels of Alcohol Use and Gait under Single and Dual Task in Community-Dwelling Older Persons Aged 65 to 70 Years

Objectives. This study aimed to describe the cross-sectional and longitudinal association between alcohol intake and gait parameters in older persons. Methods. Community-dwelling persons aged 65–70 years (N = 807). Information on health, functional status, and alcohol use was self-reported at baseline and at 3-year follow-up, whereas gait speed and stride-to-stride variability were measured while walking only (single task) and under dual tasking (counting backwards). Results. Compared to light-to-moderate drinking, heavy drinking was associated with slower gait speed in single task (adj. coeff.: −.040, 95% CI: −.0.78 to −.002, p = .035). No significant association was observed between heavy drinking and gait speed variability. Nondrinkers walked significantly slower than light-to-moderate drinkers in dual task and had significantly higher gait speed variability in both single and dual task, but these associations disappeared after adjustment for comorbidity. At follow-up, 35.2% and 34.1% of the participants walked significantly slower in single and dual task, respectively. This proportion varied a little across drinking categories. Conclusion. At baseline, heavy alcohol consumption was significantly associated with slower gait speed in single task. Selective survival of the fittest heavy drinkers probably explains why this association faded in longitudinal analyses. The trend of poorer gait performance in nondrinkers disappeared after adjustment for comorbidity, suggesting confounding by a worse health status.

Changes in Health and Health Behavior Associated With Retirement

Objectives: While poor health contributes to early work exits, it is less clear how early work exits affect health. This study therefore examines changes in health associated with retirement. Method: Survey data from gainfully employed individuals aged 57 to 66 in 2002 were used to assess changes in health status and behaviors associated with retirement (49%) 5 years later ( N = 546). Results: Compared with workers, retirees were more likely to report improvements in mental health (odds ratio [OR] = 1.67), and less likely to report mental health deteriorations (OR = 0.56). Retirees were more likely to both increase (OR = 2.03) and reduce (OR = 1.87) their alcohol intake, and to increase physical activity (OR = 2.01) and lose weight (OR = 1.75). Discussion: As welfare states aim to extend working life to counteract repercussions of population aging, findings on possible health benefits for retirees may warrant more focus on the pros and cons of a prolonged working life.

Association between alcohol drinking behaviour and cognitive function: results from a nationwide longitudinal study of South Korea

OBJECTIVES

This research intends to determine how drinking behaviour, such as episodic heavy drinking, is related to cognitive performance in middle-aged and old-aged people in South Korea.

METHODS

A cohort data of 5157 adults, age 45 years or older, with normal cognitive function (the Korean version of the Mini-mental state examination (K-MMSE) ≥24) at baseline (2006), was derived from the Korean Longitudinal Study of Aging. Alcohol drinking behaviour was assessed using the CAGE (Cut down, Annoyed, Guilty, Eye-opener) questionnaire. The relationships between baseline drinking behaviour (in 2006) to the extent of cognitive decline (between 2006 and 2012) and development of cognitive impairment (in 2012) were assessed.

RESULTS

Individuals with problematic drinking behaviour at baseline experienced a faster decline in cognitive function than those with non-problematic drinking (p<0.05) during 6 years of follow-up, especially among those with relatively lownormal K-MMSE score (24-26) at baseline (p<0.05). Problematic alcohol drinking behaviour was also significantly associated with onset of severe cognitive impairment (SCI) (K-MMSE score ≤17) among those with relatively low-normal K-MMSE score (adjusted OR (aOR)=3.76, 95% CI 1.46 to 9.67). In addition, abstinence, compared with non-problematic drinking, was related to higher risk for developing SCI among men (aOR=1.62, 95% CI 1.09 to 2.39).

CONCLUSIONS

Our results suggest that those with problematic alcohol drinking behaviour could be at an increased risk of cognitive impairment/decline. While further research will provide stronger evidence, intervention targeting alcohol abuse may play a role in prevention of cognitive impairment.

Does Marriage Make Us Healthier? Inter-Country Comparative Evidence from China, Japan, and Korea

OBJECTIVES

This study focuses on East Asian countries and investigates the difference in the marriage premium on the health-marriage protection effect (MPE) between younger and older generations and the intra-couple education concordance effect (ECE) on the health of married individuals. This study used inter-country comparative data from China, Japan, and Korea.

METHODS

This study focused on individuals (n = 7,938) in China, Japan, and Korea who were sampled from the 2010 East Asian Social Survey. To investigate MPE and ECE, four health indicators were utilized: a physical and mental components summary (PCS and MCS), self-rated health status (Dself), and happiness level (Dhappy). Ordinary least squares regression was conducted by country- and gender-specific subsamples.

RESULTS

We found that the MPE on PCS, MCS, and Dself was more significant for the older generation than for the younger generation in both China and Japan, whereas the results were inconclusive in Korea. With regard to the ECE on happiness (Dhappy), for both men and women, couples tend to be happier when both the husband and the wife are well educated ("higher balanced marriage") compared to couples with a lower level of educational achievement ("lower balanced marriage"). Significant benefits from a "higher balanced marriage" on MCS and Dself were observed for women only. In contrast, no statistically significant differences in health status were observed between "higher balanced marriage" couples and couples with different levels of educational achievements ("upward marriage" or "downward marriage").

CONCLUSIONS

This study found that (1) the MPE was more significant for the older generation, and (2) the health gap, particularly the happiness gap, between higher- and lower-balanced married couples was significant. The inter-country comparative findings are useful to explain how the role of marriage (and therefore of family) on health has been diluted due to the progress of industrialization and modernization.

Longitudinal Predictors of Functional Impairment in Older Adults in Europe--Evidence from the Survey of Health, Ageing and Retirement in Europe

Objective

To examine time-dependent predictors of functional impairment in older adults in Europe longitudinally.

Methods

Data were derived from the Survey of Health Ageing, and Retirement in Europe (2004–2013). Functional impairment was assessed by using activities of daily living (ADL) and instrumental activities of daily living (IADL) indices. Fixed effects regressions were used to estimate the effects of sociodemographic factors (age, marital status, living situation, and income deciles (median split)), lifestyle factors (smoking status and alcohol consumption per week), depression, cognitive function and chronic diseases on the outcome variables.

Results

Longitudinal regressions revealed that functional impairment increased significantly with age, the occurrence of depression, cognitive impairment, the number of chronic conditions, and less than daily alcohol consumption in the total sample and in both sexes. Moreover, the onset of smoking and living without a spouse/partner in household increased functional impairment in the total sample. The effect of depression on functional impairment was significantly more pronounced in men.

Conclusion

Our findings highlight the relevance of changes in age, depression, cognitive function, smoking and chronic diseases for functional impairment. Since particularly depression and smoking may be avoidable, developing strategies to prevent depression or stop smoking might be useful approaches to postpone functional impairment in older adults.

Impact of Mid-Life Symptoms of Alcoholism on the Health and Wellbeing of Aging Parents of Adults with Disabilities

The study examined the effect of adult children's disability on parents' physical health in later life and the extent to which parents' symptoms of alcoholism in mid-life moderates the link between children's disability and later life parental health. Analyses are based on data from the Wisconsin Longitudinal Study. The analytic sample included parents of children with developmental disabilities (n = 145) or mental health problems (n = 200) and 2,432 parents of unaffected children. The results showed that the negative health consequences in later life of having a child with a developmental disability were greater for those who showed more symptoms of alcoholism in mid-life. However, symptoms of alcoholism in mid-life did not significantly moderate the impact of an adult child's mental health problems on parents' later life physical health. The findings suggest a potential area where gerontological social workers could intervene, given the negative impact of symptoms of alcoholism on the health of aging parents of children with a disability who may be significantly more susceptible to the negative health impacts of alcohol compared to their younger counterparts.

Pharmacologic management of comorbid post-traumatic stress disorder and addictions

BACKGROUND AND OBJECTIVES

Post-traumatic Stress Disorder (PTSD) and substance use disorders (SUD) frequently co-occur, and their combination can increase poor health outcomes as well as mortality.

METHODS

Using PUBMED and the list of references from key publications, this review article covered the epidemiology, neurobiology and pharmacotherapy of PTSD with comorbid alcohol, opiate, and cannabis use disorders. These SUD represent two with and one without FDA approved pharmacotherapies.

RESULTS

SUD is two to three times more likely among individuals with lifetime PTSD, and suicide, which is made more likely by both of these disorders, appears to be additively increased by having this comorbidity of SUD and PTSD. The shared neurobiological features of these two illnesses include amygdalar hyperactivity with hippocampal, medial prefrontal and anterior cingulate cortex dysfunction. Medications for comorbid PTSD and SUD include the PTSD treatment sertraline, often used in combination with anticonvulsants, antipsychotics, and adrenergic blockers. When PTSD is comorbid with alcohol use disorder (AUD), naltrexone, acamprosate or disulfiram may be combined with PTSD treatments. Disulfiram alone may treat both PTSD and AUD. For PTSD combined with opiate use disorder methadone or buprenorphine are most commonly used with sertraline. Marijuana use has been considered by some to be a treatment for PTSD, but no FDA treatment for this addiction is approved. Pregabalin and D-cycloserine are two innovations in pharmacotherapy for PTSD and SUD.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Comorbid PTSD and SUD amplifies their lethality and treatment complexity. Although they share important neurobiology, these patients uncommonly respond to a single pharmacotherapy such as sertraline or disulfiram and more typically require medication combinations and consideration of the specific type of SUD.

Do preferences of drinker-drivers differ?

Why people engage in illegal activities is not well understood. Using data collected for this research from eight cities in four states, this study investigates alternative explanations as to why people drive while intoxicated (DWI). We find that preferences and subjective beliefs about arrest/incarceration of persons who drink and drive do differ systematically from others in terms of benefits and costs of drink and driving, and in their risk tolerance. While most findings imply that DWI is a deliberate choice, we do find that drinker drivers tend to be more impulsive and lack self-control in their drinking.

Health in the news: an analysis of magazines coverage of health issues in veterans and military service organizations

The purpose of this study was to conduct a content analysis of Veterans and Military Service Organizations (VMSOs) magazines to determine what health-related topics VMSOs target and how they inform their constituencies about health issues. Health-related topics in 288 VMSOs' magazines from 21 VMSOs published in 2011 and 2012 were coded by trained raters using a standardized manual. The top three most addressed health topics were Health Services (Health care, Insurance), Disability and Disability benefits, and post-traumatic stress disorder. Topics least frequently covered were Tobacco and Smoking cessation, Illegal drugs, Alcohol, Gulf War Syndrome, and Weight and Body composition. VMSOs are concerned about the health and well-being of their members given the considerable amount of content devoted to certain health topics such as health insurance concerns, disability, and post-traumatic stress disorder. However, other health concerns that affect a considerable number of both current military personnel and veterans and cost both the Department of Veterans Affairs and the Department of Defense millions annually, such as drug and alcohol problems, and tobacco use and smoking cessation, are infrequently covered. The results of this study improve our understanding of the health-related information that reaches the military and veteran populations through this important media outlet.

History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study

OBJECTIVE

To assess the effects of a history of alcohol use disorders (AUDs) on risk of severe cognitive and memory impairment in later life.

METHODS

We studied the association between history of AUDs and the onset of severe cognitive and memory impairment in 6,542 middle-aged adults born 1931 through 1941 who participated in the Health and Retirement Study, a prospective nationally representative U.S. cohort. Participants were assessed at 1992 baseline and follow-up cognitive assessments were conducted biannually from 1996 through 2010. History of AUDs was identified using the three-item modified CAGE questionnaire. Cognitive outcomes were assessed using the 35-item modified Telephone Interview for Cognitive Status at last follow-up with incident severe cognitive impairment defined as a score ≤ 8, and incident severe memory impairment defined as a score ≤ 1 on a 20-item memory subscale.

RESULTS

During up to 19 years of follow-up (mean: 16.7 years, standard deviation: 3.0, range: 3.5-19.1 years), 90 participants experienced severe cognitive impairment and 74 participants experienced severe memory impairment. History of AUDs more than doubled the odds of severe memory impairment (odds ratio [OR] = 2.21, 95% confidence interval [CI] = 1.27-3.85, t = 2.88, df = 52, p = 0.01). The association with severe cognitive impairment was statistically non-significant but in the same direction (OR = 1.80, 95% CI = 0.97-3.33, t = 1.92, df = 52, p = 0.06).

CONCLUSION

Middle-aged adults with a history of AUDs have increased odds of developing severe memory impairment later in life. These results reinforce the need to consider the relationship between alcohol consumption and cognition from a multifactorial lifespan perspective.

Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men

BACKGROUND

Knowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission.

METHODS

In community-dwelling US men aged ≥65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000-2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model.

RESULTS

We identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0-3.8), poor mental health (OR=1.9, 95% CI: 1.1-3.4), BMI≥25.0 kg m(-2) (OR=1.7, 95% CI: 1.0-2.8), hypertension (OR=1.5, 95% CI: 1.0-2.4) and back pain (OR=1.5, 95% CI: 1.0-2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1-4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2-0.9).

CONCLUSIONS

Several non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men.

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.

The effect of retirement on alcohol consumption: results from the US Health and Retirement Study

BACKGROUND

Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use.

METHODS

This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic.

RESULTS

We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave (β = 1.9, 95% confidence interval = 0.43-3.36). No association was observed among women.

CONCLUSION

Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use.

The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.

Alcohol intake, wine consumption and the development of depression: the PREDIMED study

BACKGROUND

Alcoholic beverages are widely consumed. Depression, the most prevalent mental disorder worldwide, has been related to alcohol intake. We aimed to prospectively assess the association between alcohol intake and incident depression using repeated measurements of alcohol intake.

METHODS

We followed-up 5,505 high-risk men and women (55 to 80 y) of the PREDIMED Trial for up to seven years. Participants were initially free of depression or a history of depression, and did not have any history of alcohol-related problems. A 137-item validated food frequency questionnaire administered by a dietician was repeated annually to assess alcohol intake. Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression, and/or initiated the use of antidepressant drugs. Cox regression analyses were fitted over 23,655 person-years.

RESULTS

Moderate alcohol intake within the range of 5 to 15 g/day was significantly associated with lower risk of incident depression (hazard ratio (HR) and 95% confidence interval (95% CI) = 0.72 (0.53 to 0.98) versus abstainers). Specifically, wine consumption in the range of two to seven drinks/week was significantly associated with lower rates of depression (HR (95% CI) = 0.68 (0.47 to 0.98)).

CONCLUSIONS

Moderate consumption of wine may reduce the incidence of depression, while heavy drinkers seem to be at higher risk.

Predictors of initial and sustained remission from alcohol use disorders: findings from the 30-year follow-up of the San Diego Prospective Study

BACKGROUND

Individuals who report problematic drinking early in life often recover from alcohol-related disorders, with or without formal treatment. While risk factors associated with developing alcohol use disorders (AUDs), such as a family history of alcoholism and the genetically influenced low level of response (LR) to alcohol, have been identified, less is known about characteristics that relate to remission from AUDs.

METHODS

The male subjects (98% Caucasian) for this study were 129 probands from the San Diego Prospective Study who were first evaluated at age 20 as drinking but not alcohol-dependent young men, most of whom were college graduates by follow-up. The individuals evaluated here met criteria for an AUD at their first follow-up at ages 28 to 33 and were followed every 5 years for the next 2 decades. Discrete-time survival analysis was used to examine rates of initial and sustained AUD remission and to evaluate the relationships of premorbid characteristics and other risk factors to these outcomes.

RESULTS

Sixty percent of the sample met criteria for an initial AUD remission of 5 or more years, including 45% with sustained remission (i.e., no subsequent AUD diagnosis). Higher education, lower drinking frequency, and having a diagnosis of alcohol abuse (rather than dependence) were associated with higher rates of initial AUD remission. A lower LR to alcohol at age 20, as well as lower drinking frequency, having received formal alcohol treatment, and older age at the first follow-up all predicted a greater likelihood of sustained AUD remission.

CONCLUSIONS

This study identified key factors associated with initial and sustained AUD remission in subjects diagnosed with AUD in young adulthood. Characteristics associated with better outcomes early in the life span, such as lower drinking frequency and early treatment, appear to have a lasting impact on remission from AUD across adulthood.

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.

A longitudinal assessment of alcohol intake and incident depression: the SUN project

Background

Longitudinal studies assessing the long-term association between alcohol intake and depression are scarce. The type of beverage may also be important. Therefore we aimed to prospectively evaluate the influence of alcohol intake on incident depression in a Mediterranean cohort.

Methods

We assessed 13,619 university graduates (mean age: 38 years, 42% men) participating in a Spanish prospective epidemiological cohort (the SUN Project), initially free of depression. They were recruited between 1999–2008 and biennially followed-up during 2001–2010. At baseline, a 136-item validated food–frequency questionnaire was used to assess alcohol intake. Wine was the preferred beverage. Participants were classified as incident cases of depression if they reported a new clinical diagnosis of depression by a physician and/or initiated the use of antidepressant drugs. Cox regression and restricted cubic splines analyses were performed over 82,926 person-years.

Results

Only among women, an U-shaped relationship between total alcohol intake and depression risk was found (P=0.01). Moderate alcohol intake (5–15 g/day) was associated with lower risk (Hazard Ratio: 0.62; 95% Confidence Interval: 0.43-0.89). No association was apparent for higher intakes of alcohol or for any specific type of alcoholic beverage.

Conclusions

Moderate alcohol intake might protect against depression among women. Further confirmatory studies are needed.

Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults

OBJECTIVE

This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults.

METHOD

Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence.

RESULTS

Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women.

DISCUSSION

Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Mortality in alcohol use disorder in the Lundby Community Cohort--a 50 year follow-up

AIMS

To describe the mortality and causes of death among subjects with alcohol use disorder in comparison with those without alcohol disorder and to study whether mental disorders increase mortality in alcoholics.

DESIGN AND SETTING

Data were analysed from the database of the Lundby Study, comprising 3563 subjects followed from 1947 to 1997.

METHOD

A community-based sample was investigated in 1947 with follow-ups in 1957, 1972 and 1997. Best-estimate consensus diagnoses of mental disorders, including alcohol use disorder, were assessed. In the total cohort, 427 cases of alcohol use disorders were identified. Differences in mortality between subjects with alcohol use disorders and non-alcoholics were studied using Cox regression models and causes of death were compared between alcoholic subjects and other participants. Risk factors for mortality among the 348 individuals with alcohol use disorders and known age-of-onset were analysed by means of Cox regression analyses.

RESULTS

The hazard ratio for mortality was higher for alcoholics compared to other subjects in the cohort. A substantial proportion of the causes of death among the alcoholics was suicide N=27 (6.3%) (26 males, 1 female). In the multivariate models of risk factors in alcohol use disorders, anxiety disorders, psychotic disorders, alcohol induced psychotic disorders and dementia were risk factors for premature death.

CONCLUSION

The mortality risk for subjects with alcohol use disorder was increased, females were especially vulnerable. The risk for suicide was high among males with alcohol problems. Anxiety disorders and severity of alcohol use disorder turned out as risk factors for premature death.

Depression trajectories and obesity among the elderly in Taiwan

BACKGROUND

The present study aimed to (a) characterize 10-year trajectory patterns of depressive symptoms and (b) investigate the association between depressive trajectory and subsequent obesity, metabolic function and cortisol level.

METHOD

In a prospective study of Taiwanese adults aged ≥60 years (n=3922) between 1989 and 1999, depression was assessed using a 10-item short-form of the Center for Epidemiologic Studies Depression Scale and information on body mass index (BMI) was collected by self-report. A subsample (n=445) of the original cohort in 1989 was drawn to assess metabolic variables and cortisol levels in a 2000 follow-up. After trajectory analyses were performed, multinomial logistic regression analyses were used to estimate the association estimates.

RESULTS

We identified four distinctive trajectories of depressive symptoms: class 1 (persistent low, 41.8%); class 2 (persistent mild, 46.8%); class 3 (late peak, 4.2%); and class 4 (high-chronic, 7.2%). The results from both complete cases and multiple imputation analyses indicated that the odds of obesity were lower in the class 2, 3 or 4 elderly, as compared with those in class 1, while the odds of underweight were higher. The classes of older adults with more and persistent depressive symptoms showed a trend toward having both a lower BMI (p=0.01) and a higher cortisol level (p=0.04) compared with those with low depressive symptoms.

CONCLUSIONS

Incremental increases in depressive symptoms over time were associated with reduced risk of obesity and higher cortisol levels.

Increasing and decreasing alcohol use trajectories among older women in the U.S. across a 10-year interval

Older women who routinely drink alcohol may experience health benefits, but they are also at risk for adverse effects. Despite the importance of their drinking patterns, few studies have analyzed longitudinal data on changes in drinking among community-based samples of women ages 50 and older. Reported here are findings from a semi-parametric group-based model that used data from 4,439 randomly sampled U.S. women who enrolled in the Health and Retirement Study (HRS) and completed ≥ 3 biannual alcohol assessments during 1998-2008. The best-fitting model based on the drinks per day data had four trajectories labeled as "Increasing Drinkers" (5.3% of sample), "Decreasing Drinkers" (5.9%), "Stable Drinkers" (24.2%), and "Non/Infrequent Drinkers" (64.6%). Using group assignments generated by the trajectory model, one adjusted logistic regression analysis contrasted the groups with low alcohol intake in 1998 (Increasing Drinkers and Non/Infrequent Drinkers). In this model, baseline education, physical activity, cigarette smoking, and binge drinking were significant factors. Another analysis compared the groups with higher intake in 1998 (Decreasing Drinkers versus Stable Drinkers). In this comparison, baseline depression, cigarette smoking, binge drinking, and retirement status were significant. Findings underscore the need to periodically counsel all older women on the risks and benefits of alcohol use.

Drinking patterns and the development of functional limitations in older adults: longitudinal analyses of the health and retirement survey

OBJECTIVE

To examine whether consistent low-risk drinking is associated with lower risk of developing functional limitations among older adults.

METHOD

Data were obtained from five waves of the Health and Retirement Study. Function was assessed by questions measuring four physical abilities and five instrumental activities of daily living. Five different drinking patterns were determined using data over two consecutive survey periods.

RESULTS

Over the follow-up periods, 38.6% of older adults developed functional limitations. Consistent low-risk drinkers had lower odds of developing functional limitations compared with consistent abstainers, and the effect of consistent low-risk drinking was greater among those aged 50 to 64 years compared with those aged ≥65 years. Other drinking patterns were not associated with lower odds of incident functional limitation.

DISCUSSION

Consistent low-risk drinking was associated with lower odds of developing functional limitations, and this association was greater among older middle-aged adults aged 50 to 64 years.

Alcohol use among older adults

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

Older adults' health and late-life drinking patterns: a 20-year perspective

OBJECTIVES

This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems.

METHODS

A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later.

RESULTS

Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems.

CONCLUSION

Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil

OBJECTIVES

To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors.

METHODS

A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment.

RESULTS

Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, 'mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism.

CONCLUSIONS

The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries.

Alcohol consumption and health status in older adults: a longitudinal analysis

Objective. This longitudinal study examines the relationship of alcohol consumption to mortality and changes in mental and functional health in older adults. Method.In a national population health survey, 4,187 participants aged 50 and older at baseline provided information on alcohol consumption, potential confounders, and follow-up vital status. Logistic regression estimated the odds ratio for mortality, increase in psychological distress, and decline in functional health 10 years later. Results. Compared with lifelong abstainers, light and moderate drinkers were at nonsignificantly lower risk of mortality. Among survivors, alcohol consumption showed no consistent relationship with increases in psychological distress. Occasional and light drinkers had significantly reduced risk of a substantial functional health decline, whereas moderate drinkers had nonsignificantly reduced risk. Discussion. Findings suggest that light-to-moderate alcohol consumption reduces the risk of substantial functional health decline in older middle-aged drinkers.

Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies

The relationships between alcohol consumption and dementia and cognitive decline were investigated in a systematic review including meta-analyses of 15 prospective studies. Follow-ups ranged from 2 to 8 years. Meta-analyses were conducted on samples including 14,646 participants evaluated for Alzheimer disease (AD), 10,225 participants evaluated for vascular dementia (VaD), and 11,875 followed for any type of dementia (Any dementia). The pooled relative risks (RRs) of AD, VaD, and Any dementia for light to moderate drinkers compared with nondrinkers were 0.72 (95% CI = 0.61-0.86), 0.75 (95% CI = 0.57-0.98), and 0.74 (95% CI = 0.61-0.91), respectively. When the more generally classified "drinkers," were compared with "nondrinkers," they had a reduced risk of AD (RR = 0.66, 95% CI = 0.47-0.94) and Any dementia (RR = 0.53, 95% CI = 0.53-0.82) but not cognitive decline. There were not enough data to examine VaD risk among "drinkers." Those classified as heavy drinkers did not have an increased risk of Any dementia compared with nondrinkers, but this may reflect sampling bias. Our results suggest that alcohol drinkers in late life have reduced risk of dementia. It is unclear whether this reflects selection effects in cohort studies commencing in late life, a protective effect of alcohol consumption throughout adulthood, or a specific benefit of alcohol in late life.

Alcohol problems and all-cause mortality in men and women: predictive capacity of a clinical screening tool in a 21-year follow-up of a large, UK-wide, general population-based survey

OBJECTIVE

While the relation between alcohol consumption and mortality has been well explored, little is known about the link between alcohol problems and mortality in general population-based studies, particularly among women. This was the objective of the present study

METHODS

In this prospective cohort study, 5333 non-abstaining individuals (2539 women) from the UK-wide Health and Lifestyle Survey (aged 42.9 years at study induction) completed the CAGE questionnaire of alcohol problems and participated in a medical examination in 1984/1985; they were then followed up for mortality experience until 2005.

RESULTS

Alcohol problems at baseline were less common in women (2.4%) than in men (7.8%). A total of 21 years of follow-up gave rise to 1201 deaths. Elevated rates of mortality were evident in persons reporting symptoms of alcohol problems in comparison to those who did not. In gender-stratified analyses, alcohol problems were more strongly associated with mortality risk in women (age-adjusted hazards ratio: 2.25; 95% confidence interval: 1.22-4.12) than in men (1.49; 1.12-1.99), although this effect modification was not statistically significant (P value for interaction=0.125). Controlling for a range of covariates--including socioeconomic position, co-morbidity (somatic and psychiatric), and alcohol intake--had essentially no impact on these associations.

CONCLUSION

The CAGE questionnaire may have some utility in routine health assessments in the general population.

Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers

OBJECTIVES

To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN

Prospective cohort.

SETTING

The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS

Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS

Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS

Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95% CI=0.57-0.91).

CONCLUSION

Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

Three-year changes in adult risk drinking behavior in relation to the course of alcohol-use disorders

OBJECTIVE

This study examines the associations between the course of alcohol-use disorder (AUD) and changes in average daily volume of ethanol intake, frequency of risk drinking, and maximum quantity of drinks consumed per day over a 3-year follow-up interval in a sample of U.S. adults.

METHOD

Data were taken from a longitudinal study of a nationally representative sample of U.S. adults, who were 18 years of age and older (mean age = 46.4) when initially interviewed in 2001-2002 and successfully reinterviewed approximately 3 years later (n = 22,245 baseline drinkers). The time reference period for the drinking measures was the 12 months preceding the interview. Changes in consumption reflect differences between Wave 1 and Wave 2 measures for individuals with nonmissing values at both Waves (n = 22,003 for volume of intake, 22,132 for frequency of risk drinking and 21,942 for maximum quantity of drinks).

RESULTS

There were positive changes in all consumption measures associated with developing an AUD and negative changes associated with remission of an AUD, even among individuals who continued to drink. Increases and decreases associated with onset and offset of dependence exceeded those associated with onset/ offset of abuse only, and the decreases associated with full remission from dependence exceeded those associated with partial remission. There were few changes in consumption among individuals whose AUD status did not change. Interactions of AUD transitions with other factors indicate that development of an AUD is associated with a greater increase in consumption among men, possibly reflecting their greater total body water and lower blood alcohol concentration in response to a given dose of ethanol, and among individuals with high baseline levels of consumption.

CONCLUSIONS

Changes in consumption associated with onset and offset of AUD are substantial enough to have important implications for the risk of associated physical and psychological harm.

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

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

Problem drinking and exceeding guidelines for 'sensible' alcohol consumption in Scottish men: associations with life course socioeconomic disadvantage in a population-based cohort study

BACKGROUND

With surveys suggesting that exceeding guidelines for 'sensible' alcohol intake is commonplace, the health and social impact of modifying intake on a population level is potentially considerable. If public health interventions are to be successfully implemented, it is first important to identify correlates of such behaviours, including socioeconomic disadvantage. This was the aim of the present study.

METHODS

Population-representative cohort study of 576 men from the West of Scotland. Data on life course socioeconomic position were collected in 1988 (at around 55 years of age). Alcohol consumption patterns (detailed seven day recall) and problem drinking (CAGE questionnaire) were ascertained in 1990/2 (at around 59 years of age). A relative index of inequality was computed to explore the comparative strength of different indicators of social circumstances from different periods of the life course.

RESULTS

Socioeconomic adversity in both early life and in adulthood was related to an increased risk of exceeding the weekly and daily alcohol guidelines, with adult indicators of socioeconomic position revealing the strongest associations. Of these, material indicators of socioeconomic deprivation in adulthood - car ownership, housing tenure - were marginally more strongly related to heavy alcohol intake and problem drinking than education, income and occupational social class. A substantial proportion of the influence of early life deprivation on alcohol intake was mediated via adult socioeconomic position. Similar results were apparent when problem drinking was the outcome of interest.

CONCLUSION

In men in this cohort, exposure to disadvantaged social circumstances across the lifecourse, but particularly in adulthood, is associated with detrimental patterns of alcohol consumption and problem drinking in late middle age.

Health behaviors of head and neck cancer patients the first year after diagnosis

BACKGROUND

This prospective, cohort study is the first to describe 5 health behaviors of head and neck cancer patients the first year after diagnosis.

METHODS

Patients (N = 283) were recruited in otolaryngology clinic waiting rooms and asked to complete written surveys. A medical record audit was also conducted. Descriptive statistics and multivariate analyses were conducted to determine which variables were associated with the 5 health behaviors.

RESULTS

Half of the patients smoked and 25% were problem drinkers. Over half of the smokers and drinkers quit 1 year post-diagnosis. Smoking and problem drinking were highly associated and both were associated with lower body mass index (BMI) (p < .01). Moreover, physical activity and sleep were associated with each other (p < .01). Low SLEEP (Medical Outcomes Study Sleep Scale) scores were common and highly associated with depression (p < .01).

CONCLUSION

The health behaviors of head and neck cancer patients are interrelated, and assessing and treating these behaviors together may be beneficial.

Alcohol dependence, mortality, and chronic health conditions in a rural population in Korea

To determine the effects of excessive drinking and alcohol dependency on mortality and chronic health problems in a rural community in South Korea, this study represents a nested case-control study. In 1998, we conducted the Alcohol Dependence Survey (ADS), a population survey of a village in Korea. To measure the effects of alcohol on chronic health conditions and mortality over time, in 2004, we identified 290 adults from the ADS sample (N=1,058) for follow-up. Of those selected, 145 were adults who had alcohol problems, either alcohol dependence as assessed in the ADS by the Severity of Alcohol Dependence Questionnaire (N=59), or excessive drinking without dependency (N=86). Further 145 nondrinkers were identified, matching those with alcohol problems in age and sex. We revisited the village in 2004 and completed personal interviews with them. In multivariate logistic regressions, the rates of mortality and morbidity of chronic health conditions were three times greater for alcohol dependents compared with the rate for nondrinkers. Importantly, however, excessive drinking without dependency was not associated with the rates of either mortality or morbidity. Future investigations would benefit by attending more specifically to measures for alcohol dependence as well as measures for alcohol consumption.