Moderate alcohol consumption and unappreciated risk for alcohol-related harm among ethnically diverse, urban-dwelling elders

'I'd be willing to take that risk for the enjoyment of the time that I have': a COM-B influenced analysis of older people's perspectives on their alcohol consumption

Objectives: To explore how older people understand, perceive, and evaluate the various factors which drive their alcohol consumption behaviours.Methods: Semi-structured interviews were conducted with 33 Australian community-dwelling older adults (aged 65+ years) who drank alcohol at least once a month. Thematic analyses identified common themes which were then mapped onto the COM-B theoretical framework.Results: Drinking behaviours were driven by a lack of capability in the form of poor knowledge regarding safe drinking behaviours and guidelines; high opportunity for consumption due to ease of accessing alcohol and its prominence in social routines; and high motivation to drink due to perceived benefits outweighing perceived risks.Conclusion: Increasing older peoples' knowledge of the risks associated with consumption and safe drinking behaviours represents a key health promotion priority in order to reduce the burden of alcohol-related harms among this group.

Use of web-based screening and brief intervention for unhealthy alcohol use by older adults

BACKGROUND

While the number of older adults who engage in unhealthy drinking is increasing, few studies have examined the role of online alcohol screening and intervention tools for this population. The objective of this study was to describe characteristics of drinking behaviors among older adults who visited an alcohol screening and intervention website, and compare them to younger adults.

METHODS

We analyzed the responses of visitors to Alcoholscreening.org in 2013 (n=94,221). The prevalence of unhealthy alcohol use, behavioral change characteristics, and barriers to changing drinking were reported by age group (ages 21-49, 50-65, 66-80). Logistic regression models were used to identify characteristics associated with receiving a plan to either help cut back or quit drinking.

RESULTS

Of the entire study sample, 83% of respondents reported unhealthy drinking (exceeding daily or weekly recommended limits) with 84% among 21-49year olds, 79% among 50-65year olds, and 85% among adults over 65. Older adults reported fewer negative aspects of drinking, lower importance to change, highest confidence and fewer barriers to change, compared to younger adults. In the adjusted model, females (AOR=1.45, p<0.001) and older adults (AOR=1.55, p<0.002) were more likely to receive a plan to change drinking behaviors.

DISCUSSION

An online screening and intervention tool identified many older adults with unhealthy alcohol use behaviors and most were receptive to change. Web-based screening and interventions for alcohol use have the potential to be widely used among older adults.

The Association Between Moderate Drinking and Heart Rate Variability in Healthy Community-Dwelling Older Women

The relationships among moderate alcohol use, autonomic tone, and arrhythmogenesis in older adults have not been adequately studied. Knowledge about these relationships is of increasing importance in light of population aging and recent epidemiological findings that associate moderate alcohol use with decreased rates of coronary artery disease. The purpose of this study was to assess the association between moderate drinking and autonomic tone in older women. Fifty-two Caucasian female participants (age 69 ± 5.2) were enrolled in the study. Autonomic tone was estimated by time-domain and frequency-domain measures of heart rate variability. Multivariate analysis revealed that alcohol consumption rate in the sample accounted for approximately one third of the 24-h variability in the SDNN and the SDANN, measures of variability cycle lengths of 24-h and more than 5-min, respectively. Significant contributions of alcohol consumption rate to the shorter-term time-domain measures rMSSD and ASDNN, all frequency-domain measures, and HR were not confirmed. However, repeated measures ANOVA revealed that, between the hours of 0000 and 0600, women who drank approximately 0.5 to 3 standard drinks per day had significantly lower [log] HF and [log] LF power compared to abstainers and a tendency toward sympathetic predominance during the evening and nighttime hours. The authors discuss the implications of these findings.

The relationship of tobacco and alcohol use with ageing self-perceptions in older people in Ireland

Background

Health behaviour patterns in older groups, including tobacco and alcohol use, are key factors in chronic disease prevention. We explore ageing self-perceptions as motivating factors behind smoking and drinking alcohol in older adults, and the complex reasons why individuals engage harmfully in these behaviours.

Methods

Cigarette and alcohol use was assessed in a large cross-sectional national sample aged 50 years and above from the Irish Longitudinal Study on Ageing (TILDA) (n = 6,576). The Brief Ageing Perceptions Questionnaire (BAPQ) assessed individual’s views of their own ageing across five domains. Study hypothesis that stronger beliefs on each of the BAPQ domains would be related to drinking and smoking was examined using multinomial logit models (MNLM). Regression parameter estimates for all variables were estimated relative risk ratios (RRR).

Results

More women were non-drinkers (30 % vs. 20 %) and men displayed significantly higher alcohol use patterns. One in five older Irish adults was a current smoker (16.8 % of women, 17 % of men), and smoking and harmful drinking were strongly associated (P < .001). Some domains of ageing perceptions were significantly associated with harmful drinking and smoking. While the risk of being be harmful drinker decreased with stronger beliefs about the positive consequences of ageing (RRR 0.89), it increased with higher scores on both emotional representation and control positive domains.

Greater awareness of ageing and stronger emotional reaction to ageing increased likelihood of smoking. A greater sense of control over the outcomes of ageing was associated with increased risk of both harmful drinking (RRR control positive 1.16) and smoking (RRR control and consequences negative 1.25). This suggests optimistic bias in relation to perceived health risk from smoking and harmful drinking as a potential adverse effect of perceptions of control.

Risks of concurrent smoking and harmful drinking increased with chronic awareness of ageing (RRR 1.24), and negative emotional responses to it (RRR 1.21), and decreased with stronger perceptions of the positive consequences of ageing (RRR 0.85).

Conclusions

The relationship between ageing perceptions, smoking and drinking is complex. Altering perceptions of ageing may be a useful intervention target aimed at facilitating engagement in preventative health behaviours in older people.

Early Life Health, Trauma and Social Determinants of Lifetime Abstention from Alcohol

AIMS

Factors influencing lifetime abstention from alcohol may be relevant to the validity of analyses of alcohol's impact on health outcomes. We evaluate relationships between early life experiences, social factors, and demographic characteristics on lifetime abstainer status in models disaggregating by gender and, among women, race/ethnicity.

METHODS

Analyses use the landline sample (N = 5382) of the 2010 U.S. National Alcohol Survey. Surveyed participants who reported never drinking alcohol were defined as lifetime abstainers. Additional variables assessed included demographics, dispositions to risk taking and impulsivity, and indicators of early life stress like economic difficulty, childhood trauma and early onset of health conditions. Logistic regression models predicting lifetime abstention were estimated.

RESULTS

Lifetime abstainers are more likely to be women and, among women, to be non-White and Latina. Those reporting that their religion discouraged drinking and that religion was very important to them were more likely to be lifetime abstainers. Higher education levels were associated with reduced rates of lifetime abstention among women. Also among women, family problem drinking was associated with lower rates of lifetime abstention. However, childhood economic difficulty significantly predicted lower abstention only for White women, and childhood sexual abuse was significantly related to lower lifetime abstention only for Black women.

CONCLUSIONS

Understanding the characteristics and determinants of individuals who never drink alcohol is relevant to any analysis of alcohol-related health outcomes. Results point to specific factors related to lifetime abstention with potential to bias such analyses if not included as control measures.

SHORT SUMMARY

Analyses evaluating relationships between early life experiences, social factors, and demographics with lifetime abstainer status identified characteristics associated with both poor health and with better health. These included lower risk taking and impulsivity scores and lower rates of family problem drinking, childhood economic difficulties and childhood sexual abuse.

Patterns of alcohol consumption in the older population of Spain, 2008-2010

BACKGROUND

Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe.

OBJECTIVE

The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010.

MAIN OUTCOME MEASURE

Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2.

STATISTICAL ANALYSIS PERFORMED

The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design.

RESULTS

The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake.

CONCLUSIONS

Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

Perceived social support and preventive health behavioral outcomes among older women

Although research has documented that social support is a positive pathway to healthpromoting behavioral practices, very few longitudinal studies have assessed the relationship between social support and health-promoting behaviors among older, diverse women. Three waves of data from the Americans' Changing Lives (ACL) survey assessed whether or not changes in perceived social support influenced behavioral outcomes among 671 African American women and non-Hispanic white women aged 60 years and older. Positive social support from friends was the most successful in predicting physical activity across the life span while positive spousal support, positive support from children, and health behavior-specific support were insignificant determinants of physical activity. The results suggest that social support from friends may be an important predictive factor in engaging older women in physical activity during the aging process.

Alcohol use and mortality in older men and women

AIMS

To compare the effect of alcohol intake on 10-year mortality for men and women over the age of 65 years.

DESIGN, SETTING AND PARTICIPANTS

Two prospective cohorts of community-dwelling men aged 65-79 years at baseline in 1996 (n = 11 727) and women aged 70-75 years in 1996 (n = 12 432).

MEASUREMENTS

Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all-cause and cause-specific mortality.

FINDINGS

Compared with older adults who did not consume alcohol every week, the risk of all-cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol-free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease.

CONCLUSIONS

In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol-free days per week.

Longitudinal course of substance treatment benefits in older male veteran at-risk drinkers

BACKGROUND

This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared.

METHODS

This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version.

RESULTS

Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weekly consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study.

CONCLUSIONS

Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC.

Unhealthy drinking patterns in older adults: prevalence and associated characteristics

OBJECTIVES

To examine the prevalence of unhealthy drinking patterns in community-dwelling older adults and its association with sociodemographic and health characteristics.

DESIGN

Cross-sectional analysis of nationally representative survey data.

SETTING

The data source was the 2003 Access to Care file of the Medicare Current Beneficiary Survey, which represents the continuously enrolled Medicare population.

PARTICIPANTS

Community-dwelling Medicare beneficiaries aged 65 and older (N=12,413).

MEASUREMENTS

The prevalence of unhealthy alcohol use by older adults defined in relation to two parameters of recommended limits: monthly use exceeding 30 drinks per typical month and "heavy episodic" drinking of four or more drinks in any single day during a typical month in the previous year. Sociodemographic and health status variables were also included.

RESULTS

Nine percent of elderly Medicare beneficiaries reported unhealthy drinking, with higher prevalence in men (16%) than women (4%). In logistic regression analyses with the full sample, higher education and income; better health status; male sex; younger age; smoking; being white; and being divorced, separated, or single were associated with higher likelihood of unhealthy drinking. Among drinkers, in addition to sociodemographic variables, self-reported depressive symptoms were positively associated with unhealthy drinking. Among unhealthy drinkers, race and ethnicity variables were associated with likelihood of heavy episodic drinking.

CONCLUSION

Almost one in 10 elderly Medicare beneficiaries report exceeding recommended drinking limits. Several distinct unhealthy drinking patterns were identified and associated with sociodemographic and health characteristics, suggesting the value of additional targeted approaches within the context of universal screening to reduce alcohol misuse by older adults.

Interpreting laboratory values in the rehabilitation setting

Treating patients in rehabilitation settings is becoming increasingly complex for a variety of reasons, such as the presence of several comorbid conditions, increased age, and earlier discharge from acute care facilities. As a result, careful monitoring and assessment by nurses is essential. Laboratory testing can improve the assessment when nurses are able to recognize when and what should be reported and what types of treatments may be needed. Understanding what laboratory findings should be monitored and what added assessment criteria are necessary can be daunting. Therefore, this article reviews critical laboratory and other assessment findings in light of common health problems faced by patients in rehabilitation settings. A case study is used to highlight the importance of laboratory testing.

National Institute on Alcohol Abuse and Alcoholism Report on Moderate Drinking

In support of the 2005 update of the U.S. Department of Agriculture/U.S. Department of Health and Human Services Dietary Guidelines, the National Institute on Alcohol Abuse and Alcoholism was asked to assess the strength of the evidence related to health risks and potential benefits of moderate alcohol consumption, with particular focus on the areas of cardiovascular disease, breast cancer, obesity, birth defects, breastfeeding, and aging. The findings were reviewed by external researchers with extensive research backgrounds on the consequences and benefits of alcohol consumption. This report now serves as the National Institutes of Health's formal position paper on the health risks and potential benefits of moderate alcohol use.

Older males, cognitive function, and alcohol consumption

We investigated the question, how do older men who drink alcohol differ from those who do not drink on measures of cognitive function, memory, affect, and health? Of the nonprobability sample of male participants (N = 60), 35 (58%) of the males reported some degree of alcohol consumption. Eleven men had one or more drinks per day, 14 had one or more drinks per week, and 9 were occasional drinkers. The drinkers reported significantly less depression, had higher self-reported general health and vitality, and had higher cognitive performance, cognitive flexibility, and verbal memory, and greater knowledge of memory processes.

Predictors of alcohol misuse and abuse in older women

PURPOSE

To determine the predictive ability of self-report questions, physical measures, and biomarkers to detect alcohol misuse and abuse among older women.

DESIGN AND METHODS

Healthy women volunteers age 60 and older who fit selection criteria were enrolled. The 135 participants were divided into nondrinkers (ND; n = 63) and drinkers (D; n = 72) based on self-reports of quantity and frequency of standard drinks consumed per month. The mean ages for the groups were 69.2 (ND) and 69.6 (D).

FINDINGS

The best predictor was a score >0 on the T-ACE, a four-item instrument to detect alcohol abuse. Other significant predictors were: (a) behaviors: smoking, mixing over-the-counter (OTC) drugs with alcohol, heavy coffee drinking, using alcohol to sleep, and less sleep latency; and (b) biomarkers: higher mean corpuscular volume (MCV), hemoglobin (Hgb), hematocrit (Hct), and high-density lipoprotein cholesterol (HDL). The heaviest drinker subgroup had more physical stigmata, including broken blood vessels in nose and larger liver spans.

CONCLUSIONS

The "best predictor model" showed that older women who were at risk for alcohol misuse or abuse had T-ACE scores of 1 or higher, used two or more OTC drugs regularly, drank large amounts of coffee, used alcohol to fall asleep, and had less sleep latency. Because positive T-ACE scores have high sensitivity and specificity for alcohol abuse, scores of 1 or greater should be addressed in clinical settings, e.g., referrals for more definitive diagnoses and relevant treatment.

Older women's cognitive and affective response to moderate drinking

OBJECTIVE

In this paper we investigated the question, how do older women who drink moderate amounts of alcohol differ from those who do not drink on measurements of cognitive function, memory, affect and health?

METHODS

The nonprobability sample of female participants (n=182) averaged 75 years of age and had a Mini Mental State Examination scores of 28. The participants were asked to indicate whether they drank alcohol or abstained (yes/no) and if they indicated that they did drink, to describe how many drinks they consumed in a given period of time (day/week/month).

RESULTS

None of the participants acknowledged drinking more than 2 drinks a day. Caucasian women had the largest number of moderate drinkers (53% vs 47%), while the majority of African-American and Hispanic women reported not drinking. The moderate drinkers reported less depression, had higher self-reported health, performed better on instrumental everyday tasks, had stronger memory self-efficacy, and used more strategies to improve memory performance. In addition, these women had higher performance on tests of executive function: attention, concentration, psychomotor skills, verbal-associative capacities, and oral fluency.

CONCLUSIONS

The circumstances under which people drink are complex and were not evaluated in this study. Therefore, rather than endorsing drinking behavior, these findings suggest that future research might examine why elders make the decision to drink, the circumstances that predispose women to drink (alone/with others), and other qualities that characterize female drinkers over the age of 65.