Alcohol intake in the healthy elderly. Changes with age in a cross-sectional and longitudinal study

Determinants of harmful use of alcohol among urban slum dwelling adults in Kenya

BACKGROUND

Harmful alcohol use is a public health problem associated with negative health and socio-economic impacts. However, patterns and dynamics of alcohol use among slum-dwellers in Kenya are poorly understood.

OBJECTIVE

To establish determinants of harmful alcohol use among adults in an urban slum setting in Kenya.

MATERIALS AND METHODS

Cross-sectional study involving a consecutively selected sample (N=215) from Githurai, in Nairobi. A pre-tested questionnaire that captured data on socio-demographics, drinking patterns, type, reasons, initiator, and support system.

RESULTS

Of the respondents, those above 31 years, married, separated/divorced/widowed, of high education, earning above 50 USD, and from dysfunctional families consumed more alcohol. Low earners consumed (p < 0.05) unrecorded while high earners drank (p< 0.001) recorded alcohol. Adults from families with a drinking father and sibling consumed more alcohol (p=0.001). Single, low educational attainment/earners, and those in dysfunctional families (p <0.05) drank due to stress and reported alcohol-related problems. Young, unmarried, and casual laborers were introduced (p < 0.05) to alcohol by friends.

CONCLUSION

Socio-demographic, economic, familial, social interactions, and stress are associated with harmful alcohol use among adults from slums calling for interventions targeting these factors.

Healthier lifestyles after retirement in Europe? Evidence from SHARE

This paper investigates changes in health behaviours upon retirement, using data drawn from the Survey of Health Ageing and Retirement in Europe. By exploiting changes in eligibility rules for early and statutory retirement, we identify the causal effect of retiring from work on smoking, alcohol drinking, engagement in physical activity and visits to the general practitioner or specialist. We provide evidence about individual heterogeneous effects related to gender, education, net wealth, early-life conditions and job characteristics. Our main results--obtained using fixed-effect two-stage least squares--show that changes in health behaviours occur upon retirement and may be a key mechanism through which the latter affects health. In particular, the probability of not practicing any physical activity decreases significantly after retirement, and this effect is stronger for individuals with higher education. We also find that different frameworks of European health care systems (i.e. countries with or without a gate-keeping system to regulate the access to specialist services) matter in shaping individuals' health behaviours after retirement. Our findings provide important information for the design of policies aiming to promote healthy lifestyles in later life, by identifying those who are potential target individuals and which factors may affect their behaviour. Our results also suggest the importance of policies promoting healthy lifestyles well before the end of the working life in order to anticipate the benefits deriving from individuals' health investments.

Alcohol Consumption in Older Adults: A Comparison of Two Assessment Methods

Two methods of assessing alcohol consumption in older adults were compared. Participants (52 men, 82 women) recruited through random-digit-dial telephone contacts completed a survey that included a section on alcohol consumption. Within 1 month, participants completed a paper-and-pencil dietary intake questionnaire (EPAT) that included an alcohol consumption item. The two alcohol assessment measures were significantly correlated (r = –.75); however, 13% reported greater alcohol consumption on the EPAT, and only 1.5% reported higher consumption on the alcohol survey. Rates of agreement were lower among participants who drank more than the sample average (32% reported greater alcohol consumption on the dietary measure). Embedding questions within a more general dietary intake assessment may enhance selfreported alcohol consumption in older adults. Dietary measures such as the EPAT are practical for clinical use because they provide alcohol and nutritional information, areas that should be routinely assessed, and they are brief and easy to administer.

Socioeconomic determinants of risk of harmful alcohol drinking among people aged 50 or over in England

OBJECTIVES

This paper looks into the socioeconomic determinants of risk of harmful alcohol drinking and of the transitions between risk categories over time among the population aged 50 or over in England.

SETTING

Community-dwellers across England.

PARTICIPANTS

Respondents to the English Longitudinal Survey of Ageing, waves 4 and 5.

RESULTS

(Confidence level at 95% or higher, except when stated): ▸ Higher risk drinking falls with age and there is a non-linear association between age and risk for men, peaking in their mid-60s. ▸ Retirement and income are positively associated with a higher risk for women but not for men. ▸ Education and smoking are positively associated for both sexes. ▸ Loneliness and depression are not associated. ▸ Caring responsibilities reduce risk among women. ▸ Single, separated or divorced men show a greater risk of harmful drinking (at 10% confidence level). ▸ For women, being younger and having a higher income at baseline increase the probability of becoming a higher risk alcohol drinker over time. ▸ For men, not eating healthily, being younger and having a higher income increase the probability of becoming a higher risk alcohol drinker. Furthermore, the presence of children living in the household, being lonely, being older and having a lower income are associated with ceasing to be a higher risk alcohol drinker over time.

CONCLUSIONS

Several socioeconomic factors found to be associated with high-risk alcohol consumption behaviour among older people would align with those promoted by the 'successful ageing' policy framework.

The triangular association of ADH1B genetic polymorphism, alcohol consumption and the risk of depression in older men

Alcohol use, particularly alcohol abuse and dependence, are associated with increased risk of depression. Current diagnostic criteria suggest that the relationship is causal, but the evidence has only been derived from observational studies that are subject to confounding and bias. Given the logistic and ethical constraints that would be associated with a trial of alcohol use to prevent depression, we aimed to complete a Mendelian randomization study to determine if a genetic polymorphism associated with alcohol abuse and dependence (ADH1B rs1229984 G-->A) contributed to modulate the risk of depression in a community-derived cohort of older men. This retrospective analysis of a cohort of 3873 community-dwelling men aged 65-83 years living in the metropolitan region of Perth, Western Australia, investigated the triangular association between the rs1229984 G-->A polymorphism and alcohol use and, after 3.2-8.2 years, the presence of current depression or history of depression. The mean number of standard drinks consumed per week (n; standard deviation; range) according to genotype was AA 1.8 (17; 2.7; 0-7), GA 5.9 (262; 7.5; 0-35), GG 8.5 (3594; 10.9; 0-140) (GG>AA, GG>GA; P<0.001). Consumption of 1 or 2 drinks per day decreased the odds of depression (n=610) by 30 and 40%, whereas consumption of more than six drinks daily more than doubled the odds of depression (odds ratio: 2.12, 95% confidence interval: 1.02, 4.40). The ADH1B rs1229984 G-->A polymorphism was not associated with current or past depression (P=0.857). In addition, the presence of the A allele did not interact with the alcohol use to modulate the risk of depression (P=0.725). These results suggest that alcohol consumption does not cause or prevent depression in older men.

Self-reported alcohol consumption in the Irish community dwelling elderly

Objectives: To examine the associations of self-reported alcohol consumption in a community based sample of elderly subjects.

Methods: A total of 518 non-institutionalised community dwelling elderly identified from general practice registers were interviewed in their own homes using the Geriatric Mental State (GMS-AGECAT), the Mini-Mental State Examination and the sociodemographic questionnaire. Physical health was rated on a six-point scale. Self reported alcohol consumption was recorded in units per week. The group was then divided according to the presence or absence of excessive alcohol consumption (ie. consumption of over 14 units per week for females and 21 units per week for males). Results were analysed using multivariate regression analysis with excessive alcohol consumption as the dependent variable.

Results: The mean age of the sample was 73 (range 65-95), 63% (n = 329) were female. Thirty-six per cent of the population were abstinent and 7% reported excessive alcohol consumption. Analysis of the data revealed no association between excessive alcohol consumption and diagnosis, age, cognitive function or poor physical health. Excess consumption was found to be significantly associated with gender (male) and widowed status (p < 0.001, p = 0.013 respectively).

Conclusions: As alcohol misuse is commonly missed in the elderly identifying high risk groups is important for the development of intervention strategies. Our results suggest that elderly widowers may be more at risk than their peers of alcohol misuse.

Potential for alcohol and drug interactions in older adults: evidence from the Irish longitudinal study on ageing

BACKGROUND

Older adults are susceptible to adverse effects from the concomitant use of prescription medications and alcohol. This study estimates the prevalence of exposure to alcohol interactive (AI) medications and concomitant alcohol use by therapeutic class in a large, nationally representative sample of older adults.

METHODS

Cross-sectional analysis of a population based sample of older Irish adults aged ≥60 years using data from The Irish Longitudinal Study on Ageing (TILDA) (N = 3,815). AI medications were identified using Stockley's Drug Interactions, the British National Formulary and the Irish Medicines Formulary. An in-home inventory of medications was used to characterise AI drug exposure by therapeutic class. Self-reported alcohol use was classified as non-drinker, light/moderate and heavy drinking. Comorbidities known to be exacerbated by alcohol were also recorded (diabetes mellitus, hypertension, peptic ulcer disease, liver disease, depression, gout or breast cancer), as well as sociodemographic and health factors.

RESULTS

Seventy-two per cent of participants were exposed to AI medications, with greatest exposure to cardiovascular and CNS agents. Overall, 60% of participants exposed to AI medications reported concomitant alcohol use, compared with 69.5% of non-AI exposed people (p < 0.001). Almost 28% of those reporting anti-histamine use were identified as heavy drinkers. Similarly almost one in five, combined heavy drinking with anti-coagulants/anti-platelets and cardiovascular agents, with 16% combining heavy drinking with CNS agents. Multinomial logistic regression showed that being male, younger, urban dwelling, with higher levels of education and a history of smoking, were associated with an increased risk for concomitant exposure to alcohol consumption (both light/moderate and heavier) and AI medications. Current smokers and people with increasing co-morbidities were also at greatest risk for heavy drinking in combination with AI medications.

CONCLUSIONS

The concurrent use of alcohol with AI medications, or with conditions known to be exacerbated by alcohol, is common among older Irish adults. Prescribers should be aware of potential interactions, and screen patients for alcohol use and provide warnings to minimize patient risk.

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.

Complex association between alanine aminotransferase activity and mortality in general population: a systematic review and meta-analysis of prospective studies

Objective

Controversy exists in using alanine aminotransferase (ALT) activity for predicting long-term survival. Therefore, this research study investigated the association between ALT activity and mortality through a systematic review and meta-analysis of previous prospective studies.

Methods

Electronic literature databases, including PubMed, Embase, and the Institute for Scientific Information (ISI), were searched for relevant prospective observational studies (published before Dec 30, 2013) on the association between baseline ALT activity and ensuing all-cause/disease-specific mortality. Information on nationality, sample size, participant characteristics, follow-up duration, comparison, outcome assessment, hazard ratios (HRs) and adjusted covariates was extracted. Pooled HRs and corresponding 95% confidence intervals (CIs) were separately calculated for categorical risk estimates (highest vs. lowest ALT categories) and continuous risk estimates (per 5 U/l of ALT increment) in subgroups separated by age (<70/≥70 years).

Results

A total of twelve prospective cohort studies, totaling 206,678 participants and 16,249 deaths, were identified and analyzed. In the younger age group, the pooled HR for mortality related to liver-disease was about 1.24 (95% CI: 1.23–1.25) per 5 U/l of ALT increment. The dose-response HRs of all-cause mortality, cardiovascular (CV) disease-related mortality, and cancer-related mortality were 0.91 (0.88–0.94), 0.91 (0.85–0.96), 0.92 (0.86–0.98) respectively per 5 U/l of ALT elevation, with insignificant heterogeneity in the older population. There was an approximate decrease of 4‰ observed on HRs of all-cause, CV-related, and cancer-related mortality followed with one year's increment through meta-regression (all P<0.05).

Conclusions

The ALT-mortality association was inconsistent and seems particularly susceptible to age after synthesizing the previous prospective studies. In terms of the age, ALT activity was more valuable in predicting mortality in the older population; extremely low ALT levels indicated a higher all-cause, CV-related, and cancer-related mortality. ALT activity may therefore be a useful biomarker when predicting the long-term survival of elderly patients.

Changes in alcohol intake and their relationship with health status over a 24-year follow-up period in community-dwelling older adults

OBJECTIVES

To determine whether alcohol use changes over time in older adults and whether alcohol intake is associated with common chronic diseases.

DESIGN

Twenty-four-year longitudinal study.

SETTING

Southern California community.

PARTICIPANTS

One thousand seventy-six members of the Rancho Bernardo cohort aged 50 to 89 at baseline.

MEASUREMENTS

Participants completed two to six research visits at approximately 4-year intervals between 1984 and 2009. At each visit, participants completed standard questionnaires on alcohol use, chronic diseases, and behaviors. Mixed-effects linear models were used to examine changes in average weekly alcohol intake over time and in relationship to health status.

RESULTS

Prevalence and frequency of alcohol use was high throughout the study, with more than 60% of participants reporting weekly alcohol intake. The average amount consumed declined with advancing age, regardless of the presence of any of the eight most common chronic diseases. Prevalence of drinking in excess of age- and sex-specific low-risk guidelines was high across all visits and did not vary according to disease burden. At the final visit, 29% of participants drank in excess of low-risk drinking guidelines, including 28% of those with hypertension and 31% with diabetes mellitus.

CONCLUSION

Prevalence and frequency of alcohol intake remained stable over a 24 year follow-up in this cohort of educated, white, middle-class, older adults, although average amount consumed decreased with advancing age. Despite this decrease, a high proportion of older adults, including those with common chronic health conditions, drank in excess of current guidelines. Clinicians should provide more education on the importance of older adults moderating alcohol intake.

Neurophysiological correlates of moderate alcohol consumption in older and younger social drinkers

BACKGROUND

Nearly 40% of adults aged 65 and older in the United States consume alcohol. Research in older adults has largely examined potential health effects of a moderate drinking lifestyle. Examination of acute effects in this population is generally lacking. To investigate alcohol-induced alteration of electrophysiological correlates of attention in this population, we employed a covert attentional task. We hypothesized that moderate alcohol administration as well as older age would reduce P3 amplitude and increase latency. We anticipated an interaction such that, relative to their age-matched controls, older adults receiving alcohol would be more affected than their younger counterparts.

METHODS

Participants included healthy older (aged 50 to 67; n = 20; 9 men) and younger (aged 25 to 35; n = 12; 5 men) moderate drinkers. Participants received either a moderate dose of alcohol (breath alcohol concentration ~50 mg/dl) or a placebo beverage. Following absorption, the task was administered and neurophysiological measures were obtained. P3 amplitude and latency were separately subjected to ANOVA across cue conditions using age and dose as independent variables.

RESULTS

As predicted, P3 amplitude in older adults was significantly lower than in younger adults across cue conditions. An age by alcohol interaction was detected, revealing that older adults receiving alcohol showed lower P3 amplitudes than any other group. An age effect for P3 latency was found, with older adults having longer latencies than their younger counterparts. A significant age by alcohol interaction for P3 latency was detected, revealing that older adults receiving alcohol displayed delayed P3 latencies relative to older adults receiving placebo. In contrast, younger adults receiving alcohol had reduced latency compared to those receiving placebo, although this effect did not reach significance.

CONCLUSIONS

Results suggest that older adults demonstrated alcohol-related shifts in P3 characteristics during an intentional attention task, whereas younger adults failed to demonstrate this pattern.

Twenty-year alcohol-consumption and drinking-problem trajectories of older men and women

OBJECTIVE

The aim of this study was to describe older adults' 20-year alcohol-consumption and drinking-problem trajectories, identify baseline predictors of them, and determine whether older men and women differ on late-life drinking trajectory characteristics and predictors.

METHOD

Two-group simultaneous latent growth modeling was used to describe the characteristics and baseline predictors of older community-residing men's (n = 399) and women's (n = 320) 20-year drinking trajectories. Chi-square difference tests of increment in fit of latent growth models with and without gender invariance constraints were used to determine gender differences in drinking trajectory characteristics and predictors.

RESULTS

Unconditional quadratic growth models best described older individuals' within-individual, 20-year drinking trajectories, with alcohol consumption following an average pattern of delayed decline, and drinking problems an average pattern of decline followed by leveling off. On average, older men declined in alcohol consumption somewhat later than did older women. The best baseline predictors of more rapid decline in alcohol consumption and drinking problems were drinking variables indicative of heavier, more problematic alcohol use at late middle age.

CONCLUSIONS

The course of alcohol consumption and drinking problems from late middle age onward is one of net decline, but this decline is neither swift nor invariable. Gender differences in the timing of decline in drinking suggest that ongoing monitoring of alcohol consumption may be especially important for older men. Further research is needed to identify factors known at late middle age that prospectively explain long-term change in late-life use of alcohol.

Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis

BACKGROUND

Alcohol consumption has demonstrated substantial temporal trends, with some evidence suggesting strong birth cohort effects. The identification of at-risk birth cohorts can inform the interpretation of alcohol trends across age, time, and demographic characteristics such as gender. The present literature review has 2 objectives. First, we conduct a cross-national review of the literature on birth cohort differences in alcohol consumption, disorder, and mortality. Second, we determine the consistency of evidence for birth cohort effects on gender differences.

METHODS

A search was conducted and key data on population characteristics, presence and direction of cohort effects, and interactions with gender compiled. Thirty-one articles were included.

RESULTS

Evidence suggests that younger birth cohorts in North America, especially those born after World War II, are more likely than older cohorts to engage in heavy episodic drinking and develop alcohol disorders, but this cohort effect is not found in Australia and western Europe. Cross-nationally, substantial evidence indicates that women in younger cohorts are at especially high risk for heavy episodic drinking and alcohol disorders.

DISCUSSION

Younger birth cohorts in North America and Europe are engaging in more episodic and problem drinking. The gender gap in alcohol problems is narrowing in many countries, suggesting shifting social norms surrounding gender and alcohol consumption. These trends suggest that public health efforts to specifically target heavy drinking in women are necessary.

Patterns and predictors of late-life drinking trajectories: a 10-year longitudinal study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

Patterns and predictors of late-life drinking trajectories: a 10-year longitudinal study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age. Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories. Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption. Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable. However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels. Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption. Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

Age-related changes in drinking patterns from mid- to older age: results from the Wisconsin longitudinal study

BACKGROUND

Drinking has generally been shown to decline with age in older adults. However, results vary depending on the measure of alcohol consumption used and the study population. The goals of this study were to (i) describe changes in drinking in a current cohort of older adults using a variety of measures of drinking and (ii) examine a number of different possible predictors of change.

METHODS

This is a longitudinal study of a community-based sample surveyed at 2 time points, ages 53 and 64 years. We estimated a series of logistic regressions to predict change and stability in drinking categories of nondrinking, moderate drinking, and heavy drinking. Linear regressions were used to predict change in past-month drinking days, past-month average drinks per drinking day, and past-month total drinks.

RESULTS

From age 53 to 64, average drinks per drinking day and heavy drinking decreased. Frequency of drinking increased for men and women, and total drinks per month increased for men. The most consistent predictors of drinking changes were gender, health, and education. Other factors predicted drinking change but were not consistent across drinking measures including: adolescent IQ, income, lifetime history of alcohol-related problems, religious service attendance, depression, debt, and changes in employment.

CONCLUSIONS

Heavy drinking decreases with age, but we may see more frequent moderate drinking with current and upcoming cohorts of older adults. Components of quantity and frequency of drinking change differently. Composite measures of total alcohol consumption may not be adequate for describing relevant changes in drinking over time. A number of factors predicted patterns of change in drinking and warrant further exploration.

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.

Moderate alcohol intake and risk of functional decline: the Health, Aging, and Body Composition study

OBJECTIVES

To investigate the prospective relationship between alcohol consumption and incident mobility limitation.

DESIGN

Cohort study.

SETTING

The Health Aging and Body Composition study, conducted in Memphis, Tennessee, and Pittsburgh, Pennsylvania.

PARTICIPANTS

Three thousand sixty-one adults aged 70 to 79 without mobility disability at baseline.

MEASUREMENTS

Incidence of mobility limitation, defined as self-report at two consecutive semiannual interviews of any difficulty walking one-quarter of a mile or climbing stairs, and incidence of mobility disability, defined as severe difficulty or inability to perform these tasks at two consecutive reports. Alcohol intake, lifestyle-related variables, diseases, and health status indicators were assessed at baseline.

RESULTS

During a follow-up time of 6.5 years, participants consuming moderate levels of alcohol had the lowest incidence of mobility limitation (total: 6.4 per 100 person-years (person-years); men: 6.4 per 100 person-years; women: 7.3 per 100 person-years) and mobility disability (total: 2.7 per 100 person-years; men: 2.5 per 100 person-years; women: 2.9 per 100 person-years). Adjusting for demographic characteristics, moderate alcohol intake was associated with lower risk of mobility limitation (hazard ratio (HR)=0.70, 95% confidence interval (CI)=0.55-0.89) and mobility disability (HR=0.66, 95% CI=0.45-0.95) than never or occasional consumption. Additional adjustment for lifestyle-related variables substantially reduced the strength of the associations (HR=0.85, 95% CI=0.66-1.08 and HR=0.81, 95% CI=0.56-1.18, respectively). Adjustment for diseases and health status indicators did not affect the strength of the associations, suggesting that lifestyle is most important in confounding this relationship.

CONCLUSION

Lifestyle-related characteristics mainly accounted for the association between moderate alcohol intake and lower risk of functional decline over time. These findings do not support a direct causal effect of alcohol intake on physical function.

Effects of acute alcohol consumption in older and younger adults: perceived impairment versus psychomotor performance

OBJECTIVE

Perceived impairment and psychomotor performance following acute alcohol administration in older (ages 50-74, n=42; 22 male) and younger (ages 25-35, n=26; 12 male) adults were investigated in this study.

METHOD

Double-blind, placebo-controlled alcohol administration techniques were designed to produce peak levels of breath alcohol concentration consistent with an episode of social drinking (40 mg/100 ml). Behavioral measures (Trail Making Test, Forms A and B), as well as measures of self-reported perceived intoxication and impairment, were administered on the ascending and descending limbs at common time points after beverage ingestion.

RESULTS

Results indicated that psychomotor performance differences did not parallel self-reported levels of perceived impairment. Relative to younger adults, older adults exhibited performance deficits on the ascending limb while simultaneously reporting less perceived impairment. Conversely, on the descending limb, older adults who received alcohol reported more perceived impairment than did those who received placebo, although psychomotor performance between these two groups of older drinkers did not differ. For younger participants, a moderate dose of alcohol facilitated performance on the ascending limb; however, these differences were not reflected on the descending limb.

CONCLUSIONS

These results reinforce the common knowledge that self-reported measures may not provide an accurate reflection of performance outcomes and, importantly, that older adults may be impaired even under a moderate dose of alcohol, although they may not be aware (i.e., report) of this impairment.

Alcohol use and prostate cancer: a meta-analysis

Past reviews have concluded that there is no association between alcohol use and prostate cancer incidence. We performed a meta-analysis of existing epidemiological studies finding, in contrast, evidence to suggest that prostate incidence is positively linearly associated with heavier alcohol use. This finding was largely due to the contribution of population case-control studies and those measuring men recruited before age 60. No relationship between alcohol consumption and prostate cancer was found for cohort and hospital case-control studies. Analyses of design effects modestly suggests that population case-control studies were probably better suited to identify potential alcohol-prostate cancer relationships due to the close temporal proximity of the measurement of level of alcohol consumption to diagnosis. Future efforts should be made to exclude all ill subjects from control groups/baseline samples in addition to accounting for changes in consumption with advancing age and the onset of illness. The alcohol-prostate cancer association remained significant despite controlling for the degree to which studies endeavored to eliminate false negatives from their control groups.

Nine-year psychiatric trajectories and substance use outcomes: an application of the group-based modeling approach

This study identifies longitudinal psychiatric trajectories of 934 adult individuals entering chemical dependency treatment in a private, managed care health plan and examines the relationship of these trajectories with substance use (SU) outcomes. The authors apply a group-based modeling approach to identify trajectory groups based on repeated measures of psychiatric severity for 9 years and identify four distinct groups. Results of multivariate logistic generalized estimating equation models find an association between psychiatric trajectories and long-term SU. Older cohorts and life course measures of marital status and employment status as individuals changed over time are related to drug and some alcohol outcomes.

Time trends in heavy drinking among middle-aged and older adults in Denmark

BACKGROUND

Studies have indicated an increasing proportion of heavy drinking among middle-aged and older Danes. Trends in consumption are often extremely sensitive to influence from various components of the time trends but only few have explored the age, period and cohort-related influences on late life alcohol consumption. By using age, period, and cohort modeling this study explores the time trends in heavy drinking.

METHODS

Data derive from five National Health and Morbidity Surveys conducted by the Danish National Institute of Public Health in 1987, 1994, 2000, 2003, and 2005. A total of 15,144 randomly selected Danes between the age of 50 and 74 were interviewed about their alcohol intake on the last weekday and their alcohol intake in the last week. By applying the age-period-cohort model the probability of heavy alcohol drinking is estimated to separate the influence of age, period (calendar time) and cohort (year of birth).

RESULTS

The unadjusted probability of heavy drinking declines by age and increases by calendar year and year of birth for both men and women. However, the negative effect of age is attenuated for women when adjusted for birth cohort, indicating that the proportion of heavy drinking women increases in younger birth cohorts. This trend is not observed for men as their drinking pattern mainly increase slightly by calendar year.

CONCLUSIONS

Our Danish observations for older aged individuals correspond to the social and cultural changes in the 1960s and 1970s that possibly have affected the drinking behavior of the cohorts. Time trend analyses, such as this may serve as an excellent opportunity to extrapolate and forecast alcohol mortality and morbidity.

Moderate alcohol use and reduced mortality risk: systematic error in prospective studies and new hypotheses

We have provided recent evidence suggesting that a systematic error may be operating in prospective epidemiological mortality studies that have reported "light" or "moderate" regular use of alcohol to be "protective" against coronary heart disease. Using meta-analysis as a research tool, a hypothesis first suggested by Shaper and colleagues was tested. Shaper et al suggested that people decrease their alcohol consumption as they age and become ill or frail or increase use of medications, some people abstaining from alcohol altogether. If these people are included in the abstainer category in prospective studies, it is reasoned that it is not the absence of alcohol elevating their risk for coronary heart disease (CHD) but, rather, their ill health. Our meta-analytic results indicate that the few studies without this error (i.e., those that did not contaminate the abstainer category with occasional or former drinkers) show abstainers and "light" or "moderate" drinkers to be at equal risk for all-cause and CHD mortality. We explore the history of this hypothesis, examine challenges to our meta-analysis, and discuss options for future research.

When children of problem drinkers grow old: does the increased risk of mental disorders persist?

It is well established that children of problem drinkers have an increased risk of developing mental health problems, not only during childhood but also when they grow up into adolescents and adults. However, it has not been examined whether this risk is also present during the old age of these children. In this study, we examine the question whether this increased risk is present in inhabitants of eleven residential homes (mean age 85 years). A total of 355 residents indicated whether one of their parents ever had problems with alcohol. We also used the MINI diagnostic interview to assess the presence of mental disorders. We found that parental problem drinking was significantly associated with having a major depression (current and lifetime), and with the number of drinks in the past week. No significant relationship was found with alcohol-related disorders and anxiety disorders. It was already known that parental problem drinking results in mental health problems in children. We found clear indications that these problems do not disappear when these children grow old.

Changing drinking pattern does not influence health perception: a longitudinal study of the atherosclerosis risk in communities study

OBJECTIVE

To investigate if dynamic changes in the pattern of alcoholic beverages consumption are associated with modifications in health perception.

DESIGN, SETTING, AND PARTICIPANTS

This study investigated 12 332 middle aged men and women from the atherosclerosis risk in communities study who reported drinking status and perceived health triennially from 1987 to 1995. Crude and adjusted risks for change in health perception between visits two and three by change in drinking status between visits one and two were computed. In the multivariate analysis the sample was restricted to participants with stable drinking status between visit two and three and stable health perception between visits one and two, to assure that exposure and outcome were not temporary. Covariates included age, sex, race, income, smoking status, educational level, and obesity.

RESULTS

Health for persons who stopped or started drinking, or continued to abstain was more likely to decline than was health for persons who continued to drink even after adjustment and restrictions (drinking cessation: OR = 1.6, 95% CI = 1.1, 2.3; started drinking; OR = 1.4, 95% CI = 0.9, 2.2; continued abstaining from alcohol: OR = 1.5, 95% CI = 1.3, 1.9). Among participants with poor perceived health, starting, stopping, or continuing to abstain from alcohol did not improve health in relation to participants that continued to drink.

CONCLUSION

Increasing and decreasing drinking patterns and continuous abstinence were associated with declining health perception in comparison with continuous drinking, while starting or stopping drinking did not improve health perception of persons with poor perceived health. These findings suggest that change in health perception was not biologically related to alcohol consumption.

Potential for alcohol and prescription drug interactions in older people

OBJECTIVES

To examine the patterns and prevalence of concomitant alcohol and alcohol-interactive (AI) drug use in older people.

DESIGN

Cross-sectional analysis of survey and prescription claims data.

SETTING

The Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program, a state-funded program providing prescription benefits to older people with low to moderate incomes.

PARTICIPANTS

A total of 83,321 PA-PACE cardholders (age range 65-106) who were using any prescription medications at the time of survey completion.

MEASUREMENTS

All AI drugs were identified using a database of medication warning labels obtained from First DataBank. Prescription drug claims were used to characterize AI drug exposure according to therapeutic class of prescription drug use. A mail survey of PA-PACE cardholders was used to examine alcohol use, as well as sociodemographic and health factors associated with concomitant use of alcohol and AI drugs.

RESULTS

Seventy-seven percent of all prescription drug users were exposed to AI medications, with significant variation in exposure and concomitant alcohol use according to therapeutic class. Overall, 19% of AI drug users reported concomitant alcohol use, compared with 26% of non-AI drug users (P<.001). Multinomial logistic regression analyses showed that certain groups of older people, including younger older people, men, and those with higher educational levels, were at greater risk for concomitant exposure to alcohol and AI drugs.

CONCLUSION

Many older people use alcohol in combination with AI prescription drugs. Clinicians should warn every patient who is prescribed an AI drug about alcohol-drug interactions, especially those at high risk for concomitant exposure.

Longitudinal trajectories of heavy drinking in adults in the United States of America

AIMS

To estimate age, period, cohort and other demographic influences on heavy alcohol consumption and trajectories of heavy drinking in American adults.

DESIGN

Prospective cohort of 14 127 participants, aged 25-74 years at baseline. Generalized estimating equations to model longitudinal change in the probability of heavy drinking and its association with demographic factors. Setting National, population-based sample of non-institutionalized civilians.

MEASUREMENTS

Heavy alcohol consumption (usual number of drinks per occasion >or= five for men; >or= four for women) at baseline (1971-74) and three follow-ups until 1992.

FINDINGS

Heavy alcohol consumption declined with increasing age (age effect) and tracked national average consumption (period effect). There was no cohort effect. Higher probability of heavy drinking was associated with male gender (relative risk: RR = 2.4), being not married (RR = 1.4), having less than high school education (RR = 1.7), having annual income below the median (RR = 1.5), not living in the South-east (RR = 1.7), and smoking (RR = 3.4). Getting married and quitting smoking during the study were each associated with reduction in heavy drinking (RR = 0.55 and 0.61, respectively). Slower age-related decline in the probability of heavy drinking was seen in men (P < 0.0001), married individuals (P = 0.03), and smokers (P = 0.05).

CONCLUSIONS

Demographic predictors of trends in heavy drinking are different from those for trends in average alcohol consumption. The likelihood of heavy drinking declined more slowly with increasing age in men and smokers, suggesting that the negative health effects of alcohol in older ages may be greatest in these groups.

Sex differences in spatial visualization and episodic memory as a function of alcohol consumption

AIMS

Sex differences in visuospatial ability as well as episodic memory have been reliably demonstrated, irrespective of alcoholism. Studies in alcoholics have consistently documented cognitive deficits in visuospatial ability, problem solving and memory function. This cross-sectional, population-based study examined if sex differences in cognitive performance could be impacted by alcohol consumption.

METHODS

Drinking data were collected from 2224 randomly sampled adults, aged between 35 and 85 years, who participated in the Betula study on memory, health and aging. Participants were classified into non-, light, moderate and heavy drinking subgroups based on sex-adjusted normative values. Cognitive tasks demonstrating clear sex differences, such as episodic memory tasks (favouring women) and spatial visualization tasks (favouring men), were conducted and performance was assessed by sex and the drinking group.

RESULTS

After controlling for age and education, overall analyses found expected sex differences in episodic memory and spatial visualization that were apparent across the entire population. When these sex differences were examined by drinking group, visuospatial performance favouring men disappeared for the moderate to heavy drinking groups, but higher performance by women on episodic memory tasks was consistent across all levels of alcohol consumption. Traditional biomarkers of increased alcohol consumption (GGT and MCV) correlated with the reported drinks/day.

CONCLUSIONS

These results lend support to the theory that moderate alcohol intake may be beneficial to cognitive function in women, but not necessarily in men.

Longitudinal patterns and predictors of alcohol consumption in the United States

OBJECTIVES

We examined demographic predictors of longitudinal patterns in alcohol consumption.

METHODS

We used mixed-effects models to describe individual alcohol consumption and change in consumption with age, as well as the associations between consumption and birth year, national alcohol consumption, and demographic factors, among 14 105 adults from the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study.

RESULTS

Alcohol consumption declined with increasing age, and individual consumption mirrored national consumption. Higher consumption was associated with male gender, being White, being married, having a higher educational level, having a higher income, being employed, and being a smoker. Faster age-related decline in consumption was associated with earlier cohorts, being male, being married, having a lower educational level, and being a smoker.

CONCLUSIONS

Compared with alcohol consumption among earlier cohorts, that among recent cohorts declined more slowly with increasing age, suggesting that negative health effects of alcohol could increase in the future.

Smoking and Drinking Habits Five Years after Baseline in the JACC Study

BACKGROUND

Observing longitudinal changes in smoking and drinking habits is important for evaluating the risk of incidence and death from cancer or other diseases in a cohort study.

METHODS

Smoking and drinking habits at baseline and about five years later among 18,312 males and 28,338 females were obtained from the baseline and interim surveys in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study) sponsored by Monbusho (Ministry of Education, Science, Sports and Culture of Japan). Changes in smoking and drinking habits between the two surveys were observed. Odds ratios for quitting these habits at interim survey were estimated.

RESULTS

Percentages of current smokers at baseline and interim surveys were 51.0% and 45.5% in males, and 5.2% and 4.8% in females, respectively. Percentages of current drinkers at baseline and interim surveys were 78.0% and 73.2% in males, and 29.5% and 23.5% in females, respectively. The number of cigarettes per day among male current smokers and the usual amount of alcohol consumed on each occasion among current drinkers decreased between the two surveys. Odds ratios for smoking cessation increased with age at baseline and decreased with the number of cigarettes per day at baseline. Odds ratios for drinking cessation increased with age at baseline and decreased with the usual amount of alcohol consumed on each occasion at baseline.

CONCLUSION

The decrease in smoking and drinking habits was observed during the five-year follow-up period. Higher age and lower levels of exposure were associated with quitting smoking or drinking.

Older adults' health and changes in late-life drinking patterns

This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

Effects of gender, ethnicity, and medical illness on drinking cessation in older primary care patients

OBJECTIVE

This study examined the effects of gender, ethnicity, and medical illness on cessation of alcohol consumption in late life by analyzing characteristics that distinguish current drinkers from former drinkers.

METHOD

Participants were 211 medical patients aged 55 to 91 years, recruited from four urban public sector primary care clinics. Respondents completed the Short Michigan Alcohol Screening Test and provided health and demographic data. A subset (n = 139) reported drinking history. Of these participants, 40% reported cessation of alcohol consumption at least 1 year prior to their participation in the study.

RESULTS

Older age, hypertension, and heart problems were associated with drinking cessation among women but not among men. In a logistic regression model, drinking cessation was predicted by being unmarried, being a member of an ethnic minority group, heart problems, and diabetes.

DISCUSSION

Physical illnesses may contribute to drinking cessation, especially in older women. Results have implications for alcohol interventions with older adults.

ALCOHOL CONSUMPTION AND MIDLIFE COGNITIVE CHANGE IN THE BRITISH 1946 BIRTH COHORT STUDY

AIMS

Cross-sectional studies suggest that alcohol consumption benefits cognitive function. However, more longitudinal studies are required to confirm that alcohol has an effect on cognitive change and to rule out the possibility that those of higher ability engage in a lifestyle that protects against cognitive decline.

METHODS

We investigated the association between self-reported alcohol consumption and change in memory, speed and concentration in midlife, in 903 men and 861 women enrolled in the MRC National Survey of Health and Development (the British 1946 birth cohort).

RESULTS

After controlling for educational attainment, occupational social class and general cognitive ability, it was found that alcohol consumption was associated with a slower memory decline from 43 to 53 years in men, but a more rapid decline in visual search speed for the same interval in women. These effects were not explained by a further control for health status (body water weight, smoking, exercise, cardio-respiratory disease and affective state).

CONCLUSIONS

Our data suggest that alcohol consumption is associated with a slower memory decline. However, the negative association between alcohol and psychomotor function in women is a potential cause for concern.

Smoking and alcohol consumption among the elderly: trends and associations, 1985-2001

BACKGROUND

Despite their clear association with health, smoking and alcohol consumption among elderly people have not been extensively researched. This study examined changes in smoking and alcohol consumption and their sociodemographic patterning among the Finnish population aged 65-79 years over the period 1985-2001.

METHODS

Population-based monitoring surveys conducted biennially from 1985 to 2001 were pooled into three time periods. Trends in smoking and alcohol consumption and their sociodemographic variations among 5870 men and 5923 women were calculated. Logistic regression was used as the main method of analysis.

RESULTS

Smoking declined slightly among men, and consumption of higher levels of alcohol rose in both genders from the mid-1980s to the early 2000s. Smoking among women remained at a very low level throughout the study period. Smoking and higher level of alcohol consumption were more prevalent among the younger elderly and among the men than among their counterparts. Higher alcohol use was more common among retired office workers than other former employees. Smoking was clearly more prevalent among unmarried than married people.

CONCLUSIONS

Declining numbers of male smokers and remarkably few female smokers, together with positive changes already noted in diet and functional ability, suggest healthier senior years ahead. On the other hand, the rising trend of alcohol use poses a challenge to future public health.

Ten-year patterns of alcohol consumption and drinking problems among older women and men

AIMS

This study focused on changes in 10-year patterns of alcohol consumption among older women and men, late-life and life history predictors of drinking problems, and gender differences in these predictors.

DESIGN, SETTING, PARTICIPANTS

A sample of late-middle-aged community residents (N = 1291) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 1 year, 4 years and 10 years later.

MEASUREMENTS

At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems and health-related and life context factors. Participants also provided information about their life history of drinking.

RESULTS

Over the 10 years, the proportion of individuals who consumed alcohol declined. Among individuals who continued to drink, women and men showed comparable declines in alcohol consumption, minor concomitants of alcohol consumption and drinking problems. In addition to the amount of alcohol consumption, smoking, friends' approval of drinking and avoidance coping consistently predicted late-life drinking problems. With respect to life history factors, heavy drinking, drinking problems and increased drinking in response to life events were related to a higher likelihood of late-life drinking problems; obtaining help from family members and friends and, among men, participation in Alcoholics Anonymous, were related to a lower likelihood of problems.

CONCLUSION

Older women and men show comparable declines in alcohol consumption and drinking problems. Specific late-life social context and coping variables, and life history indices, are risk factors for late-life drinking problems among both women and men.

Epidemiology of late-life mental disorders

This article reviews the prevalence and incidence of mental disorders in older adults. The authors outline the epidemiologic challenges in determining the frequency of mental disorders in late-life and discuss issues that are critical for understanding the prevalence of the disorders and for reviewing the evidence from epidemiologic studies of mental disorders in this population. The authors summarize the epidemiologic data for depression, anxiety, dementia, schizophrenia, and alcoholism. Also included is a discussion of risk factors and outcomes of these disorders and a discussion of the implications of these epidemiologic findings for geriatric medicine.

The impact of alcohol use in community-dwelling older adults

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

Alcohol Use in a Continuing Care Retirement Community

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

Race, religion, and abstinence from alcohol in late life

OBJECTIVE

This study aimed to see whether involvement in religion helps explain why older Blacks are more likely to avoid drinking alcohol than older Whites.

METHODS

Interviews were conducted with a nationwide sample of older Whites and older Blacks. Survey items were administered to assess whether study participants consume alcohol, whether they affiliate with fundamentalist congregations, how often they attend religious services, how often they pray privately, and whether they derive a sense of meaning from their faith.

RESULTS

The findings reveal that older people who affiliate with fundamentalist churches and who find meaning in religion are more likely to avoid drinking. However, neither church attendance nor private prayer are related to alcohol use. Race differences in the odds of drinking were no longer statistically significant once the religion measures were added to the model.

DISCUSSION

The findings highlight the importance of religion in shaping the health behaviors of older adults.

Alcohol consumption and incidence of dementia in a community sample aged 75 years and older

To explore the relationship between light to moderate alcohol consumption and risk of dementia and Alzheimer's disease in very old people, a community-based dementia-free cohort (n = 402) was followed for almost 6 years to detect incident dementia using the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised criteria. Data from the entire cohort and a subpopulation of those with baseline Mini-Mental State Examination score > or =24 (n = 317) were analyzed with Cox models. In the entire population, light to moderate drinking was significantly associated with a decreased risk of incident dementia and Alzheimer's disease compared with nondrinking (adjusted relative risk 0.5, 95% confidence interval 0.3 to 0.7). In the analysis of the subpopulation, however, the inverse association between light to moderate drinking and risk of incident dementia and Alzheimer's disease was less evident and no longer statistically significant. This study suggested that light to moderate alcohol drinking might protect against dementia and Alzheimer's disease among old people, although the possibility that such an association may be due to information bias cannot be totally ruled out.

Gender related differences in clinical characteristics and hospital based resource utilization among older adults with schizophrenia

OBJECTIVE

This report is an analysis of gender related differences in clinical characteristics and hospital based health resource utilization among older adults with schizophrenia and schizoaffective disorder in an acute care, state hospital over a one-year period.

METHODS

This retrospective record review is an analysis of age of illness onset, psychiatric and medical comorbidity, hospital utilization, and psychotropic medication use.

RESULTS

There were a total of 66 individuals with either schizophrenia or schizoaffective disorder. Mean age of this group was 55.2 +/- 4.62 years. Women were significantly over-represented among individuals with late onset schizophrenia and schizoaffective disorder. Men with schizophrenia had more comorbid substance abuse compared to women with schizophrenia (p < 0.05). Women and men did not differ significantly in hospital length of stay, amount or type of antipsychotic medication prescribed, or in utilization of seclusion/restraint in hospital. Both genders had substantial utilization of antipsychotic medication. Use of conventional antipsychotic medication monotherapy was always associated with use of anti-extrapyramidal symptom (anti-EPS) medication, while use of atypical antipsychotic medication monotherapy was more rarely associated with use of anti-EPS medication.

CONCLUSIONS

In later life, women and men may have some areas of differing health care needs. Women in particular may benefit from psychoeducational approaches that address the experience of psychiatric illness of relatively recent onset (for example, symptom identification and acceptance of illness). Men may benefit from particular emphasis on treatment of comorbid substance abuse disorders.

Features of excessive alcohol drinking in older adults distinctively captured by behavioral and biological screening instruments. An epidemiological study

The entire > or =65-year-old population living in a small Italian town, where alcohol use is almost ubiquitous, was assessed with a frequency-quantity questionnaire for alcohol intake and with two screening instruments for alcohol problems, the CAGE questionnaire and the MCV-gammaGT test. Aim of the study was to assess whether these instruments identify different subsets of subjects with alcohol problems. Of the 649 participants, 19.1% were at-risk drinkers (average intake > 40 g/day in men and > 20 g/day in women). Both the screening instruments were positive in only a minority of participants. Of the 377 drinkers, 53 gave > or =1 affirmative response to the CAGE questionnaire, whereas 24 had a positive MCV-gammaGT test. The concordance between positive CAGE questionnaire and MCV-gammaGT test was limited to seven subjects (kappa = 0.10), and these tests identified subjects who differed for several health and psychosocial characteristics. Participants aged > or =75 years drank less, but had similar prevalence of CAGE and MCV-gammaGT positive markers as compared to younger participants. In conclusion, excessive drinking is common in the elderly. Screening tests based on behavioral and biological markers identify two different sets of subjects with possible alcohol problems. This might indicate the opportunity to use these instruments in conjunction.

Moderate alcohol consumption and adverse drug reactions among older adults

PURPOSE

To assess the effect of moderate alcohol consumption on Adverse Drug Reactions (ADRs) among older adults admitted to acute care hospitals and to examine the consistency of this effect across gender and age groups.

METHODS

We used the GIFA (Italian Group of Pharmacoepidemiology in the Elderly) database, which includes information on patients admitted to 81 medical centers in Italy. For this study we examined exclusively the ADRs detected at hospital admission that were classified as definite or probable based on the Naranjo algorithm.

RESULTS

Among 22,778 participants, 894 were found to have one or more ADRs (3.9%). Gastrointestinal complications (n = 210; 0.9% of the population) were the most frequent ADRs, followed by metabolic/endocrine (n = 156; 0.7%), dermatological/allergic (n = 102; 0.4%) and arrhythmic (n = 78; 0.3%) complications. Diuretics were the most frequent culprit drugs, followed by NSAIDs and digoxin. An ADR was recorded in 383/10,427 (3.7%) non-drinkers and in 511/12,351 (4.1%) moderate drinkers. After adjusting for potential confounders, moderate alcohol consumption was associated with a 24% increased risk of ADRs (OR 1.24; 95%CI: 1.08-1.43). This effect seemed more evident among women (OR 1.30; 95%CI: 1.09-1.55), than men (OR 1.14; 95%CI: 0.90-1.43), while it was similar across different age groups (< 65 years OR 1.28; 95%CI: 0.99-1.66; 65-79 years OR 1.22; 95%CI: 0.98-1.52; > or = 80 years OR 1.20; 95%CI: 0.93-1.56). Considering the most common ADRs, moderate alcohol users presented a significantly higher risk of drug-related headache (OR 3.89; 95%CI: 1.43-10.61) and metabolic/endocrine complications (OR 1.67; 95%CI: 1.19-2.33).

CONCLUSIONS

Moderate alcohol intake is associated with an increased risk of ADRs; this effect seems more evident among women than men, and it does not differ across age groups.

Older women and alcohol. Use and abuse

Although estimates of elderly problem drinkers and alcohol-related health problems among the elderly are approximate, there does appear to be a decline in the number of drinkers and the number of heavy drinkers. As with all age groups, there are fewer women who drink than men and fewer women problem drinkers. Moderate social drinking varies with health and income. Among older women, there may well be more problematic use of prescribed psychoactive drugs than alcohol. In the few studies of older problem drinkers available, there are gender differences: Older men are more likely to be married, divorced, or separated, but older women problem drinkers show a hgh rate of widowhood; onset is more recent for older women than for older men; older women are more problematic users of prescribed psychoactive drugs; and the prevailing comorbidity among older women alcohol abusers is probably depressive disorder.

Alkoholkonsum in der Altenbevölkerung: Ergebnisse einer Feldstudie

Zusammenfassung: Epidemiologische Studien zum Alkoholkonsum und -missbrauch bei älteren Menschen zeigen ein sehr widersprüchliches Bild. In einer repräsentativen Bevölkerungsstichprobe bei über 75-jährigen Bewohnern in Privathaushalten, sowie in Alten- und Pflegeheimen wird der Alkoholkonsum im Zusammenhang mit soziodemographischen Variablen analysiert und diskutiert. Es zeigt sich, dass in den Alten- und Pflegeheimen weniger Alkohol getrunken wird als in den Privathaushalten. Mit zunehmendem Alter nimmt der Alkoholkonsum ab. Deutliche geschlechtliche Unterschiede zeigen sich in der Konsummenge und -häufigkeit. Verglichen mit der Gesamtbevölkerung ist die Prävalenz starken Alkoholkonsums bei den 75-jährigen als niedrig einzuschätzen.

Alcohol abuse, cognitive impairment, and mortality among older people

OBJECTIVES

To estimate the prevalence of alcohol abuse, the association of alcohol abuse with cognitive impairment, and the contribution of alcohol abuse to short-term mortality in a cohort of older people screened for dementia.

DESIGN

Using the Canadian Study of Health and Aging (CSHA)--a representative, national cohort study of 10,268 older persons (> or = 65 years) from communities and long-term care institutions conducted in 1991--alcohol abuse and dementia were diagnosed during clinical examinations. Death was determined by telephone interview 18 months after baseline and verified by vital statistics records.

SETTING

36 regional community and 17 regional institutional populations in Canada.

PARTICIPANTS

The 2,873 individuals from the clinical sample of the CSHA.

MEASUREMENTS

Diagnosis of alcohol abuse (questionable, definite, none), diagnosis of dementia.

RESULTS

The prevalence of clinically detected definite alcohol abuse was 8.9% (95% confidence interval (CI) 7.9-9.9) and of questionable alcohol abuse was 3.7% (95% CI 3.0-4.4). Definite or questionable alcohol abuse was associated with a younger average age compared with no such abuse history, and men were significantly more likely than women to comprise definite and questionable diagnostic groups as compared with the group without alcohol abuse. The occurrence of all types of dementia except probable Alzheimer's disease was higher in those with definite or questionable alcohol abuse. Mortality at 18 months was higher among those with definite (14.8%, 95% CI 13.5-16.1) or questionable (20.0%, 95% CI 18.5-21.5) alcohol abuse, as compared with those with no alcohol abuse history (11.5%, 95% CI 10.3-12.7), and alcohol abuse (definite or questionable) conferred a 56% additional risk of short-term mortality (odds ratio (OR) 1.56, 95% CI 1.11-2.20) after adjusting for age, sex, and a diagnosis of dementia.

CONCLUSIONS

Alcohol abuse among older people is common and occurs more frequently among men. It is associated with cognitive impairment and independently with short-term mortality. Physician screening for alcohol abuse can yield a group of older people at risk for adverse health outcomes.

Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers?

OBJECTIVES

To describe the (1) prevalence of at-risk drinking and participation in health-related behaviors and practices and (2) associations of at-risk drinking with other health-related behaviors and practices among older persons completing a health-risk appraisal for the elderly (HRA-E).

DESIGN

Cross-sectional study using data from a self-administered, mailed survey sample.

SETTINGS

Persons from three organizations were surveyed: (1) the American Association of Retired Persons; and (2) a large medical group and (3) a community-based senior health center in southern California.

PARTICIPANTS

1,889 persons age 55 years and older.

MEASUREMENTS

The HRA-E included items on health characteristics, drinking behaviors (including amount of alcohol use and two alcoholism screening measures: the CAGE (Cut down, Annoyed, Guilty, Eye opener) and Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G), and participation in selected health-related behaviors and practices. Social drinkers were defined as those who drank fewer than 14 drinks weekly and screened negative on the CAGE (defined as two or more "no" responses) and SMAST-G. Hazardous drinkers drank fewer than 14 drinks weekly and screened negative. Harmful drinkers drank fewer than 14 drinks weekly and screened positive. Possible at-risk drinkers drank 14 or more drinks weekly and screened positive. Least squares regression models were used to assess the effects of hazardous, harmful, and possible at-risk drinking on each of the health-related practices and behaviors. We also conducted these analyses using three other definitions of social, possible at-risk, hazardous, and harmful drinking.

RESULTS

Of all respondents, 40% were social drinkers, 3% were harmful drinkers, 2% were hazardous drinkers, and 11% were possible at-risk drinkers. Hazardous, harmful, and possible at-risk drinkers commonly reported driving after drinking or being driven by someone who had been drinking (67%, 76%, and 64% respectively). Harmful and possible at-risk drinkers were more likely than social drinkers to smoke and were less likely to use seatbelts regularly. These findings were observed regardless of how the drinking groups were defined.

CONCLUSION

All groups of at-risk drinkers more commonly engaged in selected adverse health-related behaviors and practices than did social drinkers.