Drinking habits among older persons: findings from the NHANES I Epidemiologic Followup Study (1982-84). National Health and Nutrition Examination Survey

Trajectories of Alcohol Consumption among Older Japanese Followed from 1987—1999

This study examined the longitudinal changes in alcohol consumption among elderly Japanese, characterized the subtrajectories within the aggregate trend, and examined potential predictors of these trajectories. Data come from a nationally representative survey of 2,566 persons in Japan, ages 60 to 96, followed over five waves between 1987—1999. Hierarchical linear modeling and cluster analysis were used to uncover trajectories of alcohol use. Multinomial logistic regression was employed to examine the predictors of trajectory association at baseline. Alcohol use appears relatively stable between ages 60 and 70, but declines thereafter. Further, there are three subtrajectories: stable, declining, and curvilinear (in addition to abstainers). Predictors of these trajectories varied by trajectory. Alcohol use may continue to be an important part of life at older ages. However, older drinkers appear to follow four drinking trajectories. Demographic characteristics and stressors may be associated with these trajectories. Knowledge of these trajectories may aid in targeting of interventions.

High Rates of Herpes Simplex Virus Type 2 Infection in Homeless Women: Informing Public Health Strategies

BACKGROUND

Homeless and unstably housed women living in an urban setting are at risk for sexually transmitted diseases, yet the seroprevalence and correlates of herpes simplex virus type 2 (HSV-2) specific to impoverished women are poorly understood.

MATERIALS AND METHODS

Between April and October 2010, we conducted a cross-sectional analysis of sociodemographic, structural, and behavioral factors associated with prevalent HSV-2 infection (recent and historical infections) within a community-recruited cohort of homeless and unstably housed women. Logistic regression modeling was used to identify independent sociobehavioral correlates of HSV-2 infection.

RESULTS

Among 213 women (114 HIV positive and 99 HIV negative), the median age was 49, 48% were African American, and 63% had completed high school. HSV-2 seroprevalence was 88%, and only 17% of infected women were aware of their infection. In adjusted analysis, odds of HSV-2 infection were significantly higher for those reporting at-risk drinking (adjusted odds ratio [AOR] = 7.04; 95% confidence interval [CI] = 1.59, 67.91), heterosexual orientation (AOR = 4.56; 95% CI = 1.81, 11.69), and for those who were HIV positive (AOR = 3.64; 95% CI = 1.43, 10.30). Odds of HSV-2 infection decreased as current income increased (AOR for each $500 monthly increase = 0.90; 95% CI = 0.78, 0.997).

CONCLUSIONS

There is an extremely high seroprevalence of HSV-2 infection among homeless and unstably housed women, and most are unaware of their HSV-2 status. Screening all unstably housed women for HSV-2 infection, with additional counseling for sexual risk and alcohol use, may lead to the identification of more infections and be a first step in reducing additional disease transmission.

Patterns of Alcohol Consumption among Older Persons in Botswana

The objective of this study was to explore patterns of alcohol consumption of older persons in Botswana and to identify sociodemographic correlates of hazardous drinking. This report is based on cross-sectional data from a sub-sample of a national representative sample of older persons. Twelve rural areas and three urban centers were visited. The sample comprised 372 individuals: 183 females and 189 males, ranging in age from 60 to 109 years. Almost two-thirds reported co-resident grandchildren in their household, and many were responsible for one or more orphans. Of the total study population, 42% were lifetime abstainers of alcohol, 24% former drinkers, 22% moderate drinkers (AUDIT 7 and below), and 12% hazardous drinkers (AUDIT 8 and above). Being male, having low socioeconomic status, and having no religious affiliation were found to increase the likelihood of being a moderate or a hazardous drinker. The most popular beverage was a low-cost, homemade sorghum beer; however, hazardous drinking was associated with higher intake of commercial beverages. The findings from this study imply that further research on alcohol consumption in Africa should include also older persons, as a significant number of older persons were found to drink alcohol at hazardous levels. Such drinking may impair their health and social functioning. This may be of importance, taking into account that the present HIV/AIDS epidemic implies that older persons increasingly end up as caretakers for children. The relationship between caregiver drinking and social outcomes for AIDS orphans needs to be further investigated.

Alcohol Use and Older Māori in Aotearoa

This study investigated alcohol use, hazardous and binge drinking prevalence, and their relationships to socio-demographic variables in community dwelling older Māori adults in New Zealand. Alcohol use, hazardous drinking, and binge drinking were assessed with the AUDIT-C in a cross-sectional postal survey of 1042 older Māori people randomly selected from the New Zealand Electoral Roll. A total of 41.2% of all participants reported drinking at hazardous levels. Odds ratios from binomial logistic regression showed hazardous drinking was significantly more likely to occur among males, current smokers, and those with higher local self-contained network scores. Binge drinking was reported by 19.6% of the sample, with odds ratios indicating that males, current smokers, and those with higher Māori cultural identification scores were significantly more likely to report binge drinking. The high rates of hazardous and binge drinking prevalence reported in the current study raise issues of concern when considering the health of older Māori people. Results indicate that social networks, gender, smoking status, and Māori cultural identification may influence hazardous and binge drinking alcohol use. However, limitations of the present study also highlight the need for more focused and in-depth research to be conducted with older Māori people to understand the sociocultural context in which alcohol use occurs.

Visits by the elderly to United States EDs for alcohol-related disorders

OBJECTIVES

The objectives are to estimate the number of elderly patients presenting to emergency departments (EDs) in the United States from 2006 to 2011 for alcohol-related disorders and examine their demographic and clinical features.

METHODS

This study used 2006 to 2011 data from the Nationwide ED Sample, a stratified, multistage sample designed to give national estimates of US ED visits each year. Clinical Classifications Software 660 code ("alcohol-related disorders") was used. The clinical and demographic features that were examined were as follows: number of admissions, disposition, sex, age, expected payer, income, geographic region, charges, and primary diagnoses and procedures performed.

RESULTS

From 2006 to 2011, there were 1620345 ED visits for alcohol-related disorders in elderly patients. Roughly one-third were discharged from the ED, whereas 66% (1078677) were admitted to the hospital. Approximately 73% were male, and the mean age was 73 years. Most patients used Medicare (84%), resided in neighborhoods with the lowest median income national quartile (29%), and lived in the South (36.4%). The average charge for discharged patients was $4274.95 (4050.30-4499.61) and $37857.20 (36813.00-38901.40) for admitted patients. The total charges for all patients treated and released from the ED were $2166082965.40 and admitted was $40835690924.40.

CONCLUSIONS

This study provided insight not only into the sociodemographic characteristics of this patient population but also the health care costs related to alcohol-related ED visits. These results may contribute to the development of future interventions targeted toward this population.

The effect of an educational intervention on alcohol consumption, at-risk drinking, and health care utilization in older adults: the Project SHARE study

OBJECTIVE

The purpose of this study was to examine the effectiveness of a patient-provider educational intervention in reducing at-risk drinking among older adults.

METHOD

This was a cluster-randomized controlled trial of 31 primary care providers and their patients ages 60 years and older at a community-based practice with seven clinics. Recruitment occurred from July 2005 to August 2007. Eligibility was determined by telephone and a baseline mailed survey. A total of 1,186 at-risk drinkers were identified by the Comorbidity Alcohol Risk Evaluation Tool. Follow-up patient surveys were administered at 3, 6, and 12 months after baseline. Study physicians and their patients were randomly assigned to usual care (n = 640 patients) versus the Project SHARE (Senior Health and Alcohol Risk Education) intervention (n = 546 patients), which included personalized reports, educational materials, drinking diaries, physician advice during office visits, and telephone counseling delivered by a health educator. Main outcomes were alcohol consumption, at-risk drinking (overall and by type), alcohol discussions with physicians, health care utilization, and screening and intervention costs.

RESULTS

At 12 months, the intervention was significantly associated with an increase in alcohol-related discussions with physicians (23% vs. 13%; p ≤ .01) and reductions in at-risk drinking (56% vs. 67%; p ≤ .01), alcohol consumption (-2.19 drinks per week; p ≤ .01), physician visits (-1.14 visits; p = .03), emergency department visits (16% vs. 25%; p ≤ .01), and nonprofessional caregiving visits (12% vs. 17%; p ≤ .01). Average variable costs per patient were $31 for screening and $79 for intervention.

CONCLUSIONS

The intervention reduced alcohol consumption and at-risk drinking among older adults. Effects were sustained over a year and may have been associated with lower health care utilization, offsetting screening and intervention costs.

Factors associated with alcohol consumption patterns in a Puerto Rican urban cohort

OBJECTIVE

There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts.

DESIGN

Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender.

SETTING

Greater Boston area, MA, USA.

SUBJECTS

Puerto Rican adults (n 1292), aged 45-75 years.

RESULTS

Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers.

CONCLUSIONS

High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.

Why do older unhealthy drinkers decide to make changes or not in their alcohol consumption? Data from the Healthy Living as You Age study

OBJECTIVES

To understand characteristics of older at-risk drinkers and reasons why they decide to change or maintain their alcohol consumption.

DESIGN

Secondary analysis of data from a randomized controlled trial to reduce drinking in at-risk drinkers.

SETTING

Three primary care sites in southern California.

PARTICIPANTS

Six hundred thirty-one adults aged 55 and older who were at-risk drinkers at baseline, 521 of whom who completed a 12-month assessment.

MEASUREMENTS

Sociodemographic and alcohol-related characteristics of 12-month assessment completers and noncompleters and among those completing the 12-month assessment by telephone or mail were compared using descriptive statistics. Reasons why respondents maintained or changed average alcohol consumption were asked of those who completed a 12-month assessment by telephone. Factors that might motivate at-risk drinkers to reduce drinking were asked about, and frequencies were calculated for these responses.

RESULTS

Participants were primarily male, white, highly educated, and in good health. Those who responded to the 12-month assessment by mail were more likely to be working, to be in the intervention arm, and to drink more. Most who reduced alcohol consumption and heavy drinking did so because they thought it would benefit them. Those who did not thought that drinking was not a problem for them. Both groups cited their environment and circumstances as influencing their drinking. Remaining at-risk drinkers reported that medical evidence that alcohol was harming them would motivate them to reduce drinking.

CONCLUSION

Older adults report that they reduce their drinking when they recognize that their drinking habits may be causing them harm; one's environment can hinder or help one to reduce drinking.

Prevalence of at-risk drinking among older adults and associated sociodemographic and health-related factors

OBJECTIVES

Recognition of alcohol-related health problems in the elderly is challenging. Alcohol use also tends to be a hidden issue. The aim of this study was to examine the prevalence and at-risk drinking patterns in community-dwelling older adults and their associations with socio-demographic and health-related factors.

DESIGN

The data were collected with a postal questionnaire from a random sample of 2100 elderly people (≥ 65 years) living in the medium-sized city of Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. We defined the amount of at-risk drinking as 1) consuming >7 drinks per week or 2) >5 drinks on a typical drinking day or 3) using >3 drinks several times per week.

RESULTS

Of the respondents, 8.2% (N=114) were at-risk drinkers. At-risk drinking was associated with younger age and male sex, higher level of education, good income, living with a spouse, and current smoking. In addition, good functioning was associated with at-risk drinking. Although frequency and quantity of alcohol consumption declined with age, of our respondents nearly one-fifth of men aged 71-80 years and one-tenth of men aged 81-90 years could be classified as at-risk drinkers. At-risk drinkers had comorbidities and multiple medications as often as non-risk group. A significantly larger proportion of the at-risk drinking group relative to the non-risk group admitted falling or injuring themselves (5.3% vs. 0.7%) or forgotten to take their medications because of the use of alcohol.

CONCLUSIONS

At-risk drinking is prevalent among older adults, particularly among males, despite prevalent comorbidities and multiple medications. At-risk drinking is associated with adverse events such as a tendency for injuries.

Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline

OBJECTIVES

To examine drinking trajectories followed by two cohorts of older women over 8 to 10 years of follow-up.

DESIGN

Longitudinal analyses of two nationally representative cohorts using semiparametric group-based models weighted and adjusted for baseline age.

SETTING

Study data were obtained from detailed interviews conducted in the home or by telephone.

PARTICIPANTS

One cohort included 5,231 women in the Health and Retirement Study (HRS) aged 50 to 65 in 1996; the other included 1,658 women in the National Longitudinal Survey (NLS) aged 50 to 65 in 1995.

MEASUREMENTS

Both cohorts reported any recent drinking and average number of drinks per drinking day using similar but not identical questions. HRS women completed six interviews (one every other year) from 1996 to 2006. NLS women completed five interviews from 1995 to 2003.

RESULTS

All trajectory models yielded similar results. For HRS women, four trajectory groups were observed in the model based on drinks per day: increasing drinkers (4.9% of cohort), infrequent and nondrinkers (61.8%), consistent drinkers (25.9%), and decreasing drinkers (7.4%). Corresponding NLS values from the drinks per day model were 8.8%, 61.4%, 21.2%, and 8.6%, respectively. In 2006, the average number of drinks per day for HRS women in the increasing drinker and consistent drinker trajectories was 1.31 and 1.59, respectively. In 2003, these values for NLS women were 0.99 and 1.38, respectively.

CONCLUSION

Most women do not markedly change their drinking behavior after age 50, but some increase their alcohol use substantially, whereas others continue to exceed current recommendations. These findings underscore the importance of periodically asking older women about their drinking to assess, advise, and assist those who may be at risk for developing alcohol-related problems.

Correlates of alcohol-related discussions between older adults and their physicians

OBJECTIVES

To identify predictors of alcohol-related patient-physician discussions.

DESIGN

Cross-sectional study using baseline data from a randomized controlled trial.

SETTING

Community-based group practice.

PARTICIPANTS

Thirty-one physicians in Project Senior Health and Alcohol Risk Education and 3,305 of their patients aged 60 and older who use alcohol and completed a survey that included the Comorbidity Alcohol Risk Evaluation Tool (CARET).

MEASUREMENTS

At study baseline, older adults were asked whether alcohol-related discussions with a physician had occurred in the prior year. This outcome was modeled using logistic regression models with physician random effects. Predictor variables included patient-level variables such as demographics and seven CARET-defined risk factors, specifically a medical or psychiatric comorbidity that alcohol might worsen, a potentially alcohol-related symptom, use of a medication that may interact negatively with alcohol, excessive quantity or frequency of alcohol use, binge drinking, concern from others about drinking, and drinking and driving. Physician-level predictors (age, sex, years since graduation, specialty) were also included.

RESULTS

The probability of reporting alcohol-related discussions declined with patient age (e.g., odds ratio (OR)=0.40 for patients aged ≥80) and was significantly lower for Latinos (OR=0.38). Drinking and driving (OR=1.69) or concern from others (OR=6.04) were significantly associated with alcohol-related discussions; having comorbidities or using medications that may interact with alcohol were not.

CONCLUSION

Although patient demographics, including age and ethnicity, are associated with the occurrence of alcohol-related discussions, clinical factors that may negatively interact with alcohol to increase risk are not. This suggests that physicians may not be attuned to the entire spectrum of alcohol-related risks for older adults.

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.

Prevalence and neuropsychiatric comorbidities of alcohol use disorders in an elderly Korean population

OBJECTIVES

We investigated the prevalence and comorbidities of problem drinking in community-dwelling elders living in Korea.

METHODS

Structured face-to-face diagnostic interviews were administered to the 714 Korean elders randomly sampled from Seongnam, Korea. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and the Alcohol Use Disorders Identification Test (AUDIT) scores, the participants were categorized into one of six diagnostic groups: lifetime abstainer, ex-drinker, social drinking, at-risk drinking, alcohol abuse, and alcohol dependence.

RESULTS

Prevalence rates of social drinking, at-risk drinking, alcohol abuse, and alcohol dependence were estimated to be 13.60%, 5.42%, 2.28%, and 2.92%, respectively. Problem drinking was associated with increased risks of smoking (OR = 3.52), whereas social drinking was associated with decreased risks of stroke (OR = 0.27) and depression (OR = 0.49).

CONCLUSIONS

Problem drinking was common particularly in men and associated with smoking. Social drinking was associated with the lower risks of stroke and depression.

Evaluation and management of osteoporosis and fragility fractures in the elderly

Osteoporosis is characterized by low bone mass and microarchitectural deterioration that leads to increased bone fragility and fracture. The medical, psychosocial and economic burden that fragility fractures have on individuals and society is staggering. As the geriatric segment of the population continues to expand, so to will the magnitude of this epidemic. There are multiple mechanisms influencing bone quality and bone loss with age. Fragility fracture is a composite of multiple intrinsic and extrinsic factors related to the individual and their environment. Fall prevention remains the cornerstone of management in this problem. The FRAX® fracture risk assessment program, which estimates the 10-year probability of a major osteoporotic fracture, is an exciting new tool in assessing risk. Novel therapeutics, including zoledronic acid, strontium and teriparatide, are now available to complement proven osteoporosis treatments and more effectively decrease fracture risk in vulnerable individuals. Agents in Phase III trials, including denosumab and lasofoxifene, will probably increase the armamentarium of tools clinicians can use to combat the growing problem of osteoporosis and its complications.

Older adults' alcohol consumption and late-life drinking problems: a 20-year perspective

AIMS

The aim of this study was to identify changes in patterns of alcohol consumption over a 20-year interval among older women and men, and to examine the associations between guideline-defined excessive drinking and late-life drinking problems. DESIGN, PARTICIPANTS AND MEASURES: A community sample of 719 adults between 55 and 65 years of age who consumed alcohol at or prior to baseline participated in a survey of alcohol consumption and drinking problems and was followed 10 years and 20 years later.

FINDINGS

The likelihood of excessive drinking declined over the 20-year interval as adults matured into their 70s and 80s. However, at ages 75-85, 27.1% of women and 48.6% of men consumed more than two drinks per day or seven drinks per week. At comparable guideline levels of alcohol consumption, older men were more likely to have drinking problems than were older women. Consumption of more than two drinks per day or seven drinks per week was identified as a potential conservative guideline for identifying excessive drinking associated with an elevated likelihood of drinking problems.

CONCLUSIONS

A substantial percentage of older adults who consume alcohol engage in guideline-defined excessive drinking and incur drinking problems. The finding that older men may be more likely than older women to experience problems when they drink beyond guideline levels suggests that alcohol guidelines for men should not be set higher than those for women.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN AND SETTING

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

SUBJECTS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Alcohol consumption in late-life--the first Brazilian National Alcohol Survey (BNAS)

To investigate the alcohol consumption in later life in Brazil and its association with socio-demographic characteristics. This study was a cross-sectional analysis of nationally representative survey data. A multistage cluster sampling procedure was used to select 3007 individuals of 14 years of age and older from the Brazilian household population. In this study we analyzed data from all 400 participants who were over 60 years old. Alcohol Abuse and Dependence Syndrome was established according to DSM-IV and Risky Drinking was defined in two ways: heavy drinkers (>7 drinks/week) and as binge drinkers (>3 drinks/one occasion). Twelve percent of participants reported heavy drinking behavior while 10.4% and 2.9% were binge drinkers and alcohol dependent respectively. In the adjusted logistic regression only gender was associated with heavy drinking behavior. Males, the youngest and the wealthiest were more likely to report binge drinking behaviors. In conclusion, alcohol related-problems are common but under recognized among older adults. Health professionals should be aware that common definitions of alcohol abuse and dependence may not apply as readily to older people, who have had biological changes for alcohol tolerance and its effects on the Central Nervous System.

A population-based study on binge drinking among elderly Brazilian men: evidence from the Belo Horizonte and Bambuí health surveys

OBJECTIVES: To assess the prevalence and factors associated with binge drinking in two populations of older adults (≥ 60 years). METHOD: A random sample of 685 subjects in the metropolitan area of Belo Horizonte (4.4 million inhabitants) and 643 subjects (92.7% from total residents) in Bambuí City (15,000 inhabitants), both in Southeast Brazil, participated in the study. The dependent variable was binge drinking (≥ 5 drinks on a single occasion in the last 30 days), and independent variables included sociodemographic characteristics, social network, health conditions and use of health services. RESULTS: The prevalence of binge drinking was higher in the metropolitan area of Belo Horizonte (27.0%) than in Bambuí (13.7%). In the multivariate analysis, worse self-rated health was the only variable associated with binge drinking in both populations (Prevalence ratios [PR] 0.62; 95%CI 0.45-0.85 and 0.57; (0.40-0.83), respectively). On the other hand, two important differences were found: 1) in the metropolitan area of Belo Horizonte, binge drinking was associated with higher school level [8+ years] (PR = 1.55; 95%CI 1.07-2.26) and functional disability (PR = 0.12); 95%CI (0.02-0.83) 2) in Bambuí, binge drinking was associated with being divorced or separated (PR = 2.49; 95%CI 1.55-3.99). CONCLUSIONS: Among older adults, differences of prevalence and factors associated with binge drinking can be found in a same country, probably due to sociocultural influences.

Alcoholic liver disease in the elderly

Although per capita alcohol consumption, and thus the prevalence of alcoholic liver disease, decreases generally with age in Europe and in the United States, recently an increase in alcohol consumption has been reported in individuals over 65 years. Reasons explaining this observation may include an increase in life expectancy or a loss of life partners and, thus, loneliness and depression. Although ethanol metabolism and ethanol distribution change with age, and an elderly person's liver is more susceptible to the toxic effect of ethanol, the spectrum of alcoholic liver diseases and their symptoms and signs is similar to that seen in patients of all ages. However, prognosis of alcoholic liver disease in the elderly is poor. In addition, chronic alcohol consumption may enhance drug associated liver disease and may also act as a cofactor in other liver diseases, such as viral hepatitis and nonalcoholic fatty liver disease.

Alcohol consumption among older adults in primary care

BACKGROUND

Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients.

OBJECTIVES

To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients.

DESIGN

Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers.

PARTICIPANTS

Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients.

MEASUREMENTS

Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety.

RESULTS

Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1-7 drinks/week), 4.1% were at-risk drinkers (8-14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables.

CONCLUSIONS

The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.

Acute alcohol use among patients with acute hip fractures: a descriptive incidence study in southeastern Finland

AIM

To assess the very recent use of alcohol among patients admitted to two Finnish hospitals due to an acute hip fracture.

METHOD

Very recent use of alcohol was recorded according to the patient's or the relatives' report. Ethanol was measured in blood samples taken at admission. Serum gamma-glutamyltransferase, aspartate aminotransferase and alanine aminotransferase, and vitamin D concentration were measured. Reported use of medication, vitamin D, and/or calcium supplementation was recorded.

RESULTS

Complete data were obtained on 222 of 375 eligible patients; 71% of those enrolled were women. The mean age of women was 80.5 years (SD 10) and of men 73 years (SD 12) (P < 0.001). The fracture type was femoral neck in 50%, trochanteric in 41%, and subtrochanteric in 9%. The use of alcohol within 24 h before the accident leading to hip fracture was reported by 21.5% of men and 7% of women; positive serum alcohol levels were noted in 17% (19% of men and 16% of women) and 2.2% had a level of >1.0 mg/l. Recent alcohol use was more common among patients in the age group of 65-74 years than among older patients (P < 0.001). The use of alcohol was associated strongly with tobacco use (P = 0.00012) but had no association with vitamin D levels. Alcohol users used less medication than non-users (P < 0.01). Women seemed to conceal their use of alcohol more than men (P < 0.005).

CONCLUSIONS

Alcohol consumption was common among patients with an acute hip fracture, being more common in younger than in older patients. Use of alcohol in the 24 h prior to the injury was reported by 21.5% of men and 7% of women. Alcohol concentration in blood was positive in 19% of men and 16% of women.

Nutritional Differences between Elderly Men and Women

BACKGROUND

Many differences exist between the two genders, i.e., biological, sociological, and also behavioral, which often depend on age.

OBJECTIVES

The aim of this study was to find characteristic differences between nutritional habits of elderly men and women.

METHODS

266 elderly people (109 men >65 years, and 157 women >60 years) were consecutively selected from primary care patients, in Budapest, Hungary. A self-managed questionnaire was filled in on lifestyle and eating habits, including a food frequency questionnaire. Medical check-up, registration of anthropometrical parameters, and laboratory tests were also performed. 53 subjects were also involved in a 3-day dietary recall.

RESULTS

The meal frequency was increased during aging in both genders, especially in men. Lunch was preferred by most of the women as a principal meal, but one quarter of the men had a filling dinner instead of lunch. Alcoholic beverages were consumed more and frequently by men. The fluid intake was low, especially in women. Milk and diary products, fresh fruit, bread, biscuits, chocolate, coffee and vitamin supplements were consumed more frequently by women. Almost all types of meat, eggs, and vegetables were more preferred by men and their energy intake was also higher (9.75 vs. 8.78 MJ). In both genders, fat represented a higher ratio (39%) of energy intake than recommended. The increase of body weight from youth to elderly was greater in women (14.04 vs. 10.65 kg). Prices had a higher impact on food purchases by women.

CONCLUSION

High energy intake over decades led to overweight in both genders (BMI >27 kg/m(2)). It seemed that the eating habits and food choices of women were closer to healthy ones and recent recommendations, although due to metabolic reasons and to the lower energy expenditure, they gained more weight. The elderly are the target population on every level of medical care. Further evaluations are needed to determine the differences in nutrition and to promote better administration of drugs and to establish public health suggestions.

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.

Substance misuse in the older population

Substance misuse among the older population is largely overlooked and underreported. Many factors contribute to this, not least the fact that presentation may be atypical and hence easily missed by the medical practitioner. There may be many clues to its existence, provided the physician remains alert to these. Despite this it is quite comforting to know that once identified, the evidence to date suggests that older people may respond at least as well as younger people to treatment.

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.

High-risk alcohol consumption and late-life alcohol use problems

OBJECTIVES

We used several different guidelines for appropriate alcohol use to identify patterns of high-risk alcohol consumption among older women and men and examined associations between these patterns and late-life alcohol use problems.

METHODS

A sample of 1291 older adults participated in a survey of alcohol consumption and alcohol use problems and was studied again 10 years later.

RESULTS

Depending on the guideline, 23% to 50% of women and 29% to 45% of men engaged in potentially unsafe alcohol use patterns. The likelihood of risky alcohol use declined over the 10 years; however, the numbers of drinks consumed per week and per day were associated with alcohol use problems at both assessment intervals.

CONCLUSION

Our findings imply that guidelines for alcohol consumption should be no more liberal for older men than for older women.

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.

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.

Comparison of consumption effects of brief interventions for hazardous drinking elderly

We sought to determine if Brief Interventions [BIs, Motivational Enhancement (ME), and Brief Advice (BA)] reduced alcohol consumption among hazardous alcohol drinking elderly (65 years or older) and whether the elderly responded similarly to younger populations. In 12 primary care offices from October 1995 to December 1997, we screened 13,438 patients of whom 2702 were elderly (180 were hazardous drinkers). Forty-five elderly enrollees were randomized to receive ME (n = 18), BA (n = 12), and Standard Care (SC, n = 12). At baseline, the elderly drank more alcohol and abstained fewer days than the younger cohort (p < 0.05). During the year, the elderly in ME, BA, and SC intervention arms increased the number of days abstained, decreased the number of drinks per day, and reduced the number of total days per month drinking. There were trends toward decreases in the alcohol consumption measures in the ME and BA treatment arms compared to SC. The elderly's response to all interventions was similar to that of the younger cohort. This study suggests that hazardous alcohol consumption in the elderly is common and that BIs reduce alcohol consumption in the elderly similar to younger populations.

Treatment for alcohol-related problems: special populations: research opportunities

For the subgroups indicated, a few questions/issues are relevant to all three (women, elderly, minorities): 1. Heterogeneity of the special populations, for example, Hispanic-Americans are from different countries with different cultures. Women and the elderly vary by age, education, income, social class, health status, etc., to say nothing of ethnicity/color/religion. 2. Of therapy modalities, professional and indigenous, which are more efficacious? 3. Are group-specific therapies needed, or will sensitivity to a particular group work as well? WOMEN: Stereotypes and myths have prevailed, for example, the long-standing belief that women have poorer prognoses than male alcoholics. When female and male alcoholics are compared, women report more positive family history, a later onset of drinking and problems, more marital disruption, more comorbidity, etc. The review of treatment outcomes (Vannicelli, 1986) showed few significant gender differences in outcomes. Research recommendations include biological and genetic studies, women's view of and use of therapeutic modalities, and outcome studies of different modalities, including all female facilities. ELDERLY: Medications are used more by older patients, and such patients are more likely to experience adverse drug reactions. In the moderate social use of alcohol, there are conflicting reports and the extent of elderly use awaits decisive study. The etiology of problem drinking by older persons is studied rarely. An attempt has been made to explain onset later in life (vs. earlier onset) based on the stresses of aging (loss, loneliness, health problems, etc.); research results have not been supportive. Consequences of older persons' heavy drinking seems to be most often alcohol-related medical disorders, although there are often familial and social consequences. Atkinson (1995) recommended the development of elder-specific outcome measures, study of the efficacy of different treatment modalities, and study of the efficacy of treatment for patients in elder-specific and mixed age groups, etc. MINORITIES: Each of the federally mandated minority groups in the United States is heterogeneous. The epidemiology of use and abuse of alcohol and other drugs is well studied, but treatment issues are not. AMERICAN INDIANS: There are more than 200 tribes; each has its own customs and culture. Some tribes are abstinent; others have big problems with abuse of alcohol, and other drugs. Orthodox treatment methods, used by professional counselors and therapists, have not worked very well.

RECOMMENDATION

study of traditional Indian forms of healing practices combined with other treatment; this would be a culture-sensitive model. BLACK AMERICANS: This includes not only African-Americans but people from the Caribbean, Central and South America, etc. Among African-Americans, there is a history of ambivalence toward alcohol: on the one hand, a tolerant "nightclub culture" and on the other, church beliefs in temperance and abstinence. There is "respectable drinking" and "problem drinking," most often defined as solitary or public drinking. The primary source of support is considered familial, so people tend to be distrustful of therapy from "strangers." They are anonymous in promoting sobriety and study of subcultural norms and the history of slavery. Earlier ethnographic works (Liebow, 1967) were of "street-corner men," slum dwellers, ghetto norms; recommended: studies of middle-class African-American life and drinking behaviors. ASIAN-AMERICANS: A study in Los Angeles reports differences among Chinese, Japanese, Filipinos, and Koreans in drinking beliefs and behavior. Of these groups, the Japanese in Japan and the Japanese-Americans report the largest number of heavy drinkers. It is, however, considered a private matter, even when associated with social problems. Interestingly, there is an organization called the All Nippon Sobriety Association (like Alcoholics Anonymous). RECOMMENDATIONs: studies of generational differences among Japanese-Americans in use and efficacy of treatment. For the Chinese-Americans, who are fairly permissive about older persons' drinking and share a belief in the health benefits of alcohol, a gender/gerontological study is recommended. HISPANIC-AMERICANS: As a total group, they drink more and present more alcohol-related problems than other immigrant minorities. Age, ethnicity, and gender patterns in permissiveness to drink need to be explored. Treatment sought is often in pentecostal churches and Centros for Espiritismo. Hispanics are not likely to seek help in formal clinical settings which emphasize alcohol consumption as the basic, core problem. They are more likely to seek out and be responsive to the perception of their drinking problem as sin and a rejection of Jesus. It is not that minorities do not recognize problems and seek out help. They are not likely to seek out the health profession's offering of outpatient clinics, residential treatments, etc.

Health promotion practices of older adults: model testing

The purpose of this study was to describe the primary and secondary health promotion activities of a group of older adults living independently in a continuing care retirement community. Primary and secondary health promotion activities were described and compared among the young old (ages 65-80), the old (ages 81-85), and the old-old (ages 86-101). Model testing of the factors that influence participation in health-promoting activities was also completed. This descriptive study included 206 of 210 residents who participated in a single face-to-face interview. The majority of the participants were female (79%), white (99%), and cognitively intact. Those in the old-old age group were less likely than the old and young-old groups to have: (1) their stools checked for occult blood; (2) their skin checked for lesions; or (3) a recent mammogram, Pap test, or prostate exam. Model testing found that age, chronic illnesses, degree of physical and mental health, and cognitive status directly or indirectly influenced older adults' participation in primary and secondary health behaviors.

Health promotion practices of older adults: testing an individualized approach

The world's population is getting older. Consequently, the World Health Organization has focused efforts on health promotion activities for these individuals. The purpose of this study was to explore the factors that influence health promotion behaviours and to describe the impact of an individualized approach to decision-making with regard to health promotion activities in a group of older adults living in a continuing care retirement community. The study used a single group pre- and post-test design that included a total of 134 residents. Descriptive statistics were used to describe the sample. A McNemar test was used to compare health promotion activities pre- and postintervention. Regression analysis was used to consider the factors that influenced health promotion activities in these individuals. The survey included questions about health promotion activities and both mental and physical health status. In the year between baseline and follow-up testing a geriatric nurse practitioner provided both formal and informal education about health promotion activities. With the exception of monitoring dietary fat intake, there was not a statistically significant difference in primary and secondary health promotion behaviours pre- and post-testing. There was, however, a decline in smoking and alcohol use, an increase in physical activity and a slight decline in the percentage of older adults who engaged in cancer screenings. An individualized approach may be a useful way to help older adults make health decisions and engage in those health promotion activities that will increase their quality of life.

Is there a relationship between excessive drinking and functional impairment in older persons?

OBJECTIVES

To investigate the relationship between (1) two thresholds of excessive alcohol drinking, (2) binge drinking, and (3) impairments in functional status in older drinkers.

DESIGN

Cross-sectional study.

SETTING

Ten internal medicine practices affiliated with an academic medical center.

PARTICIPANTS

One hundred sixty-one persons aged 60 and older who reported drinking one or more drinks in the previous 3 months.

MEASUREMENTS

Two commonly used thresholds of excessive drinking: (1) eight to 14 drinks per week for women and men (lower threshold) and (2) more than 14 drinks per week for women and men (higher threshold); a measure of binge drinking (> or =3 drinks per occasion for women or > or =4 drinks per occasion for men); and self-reported instrumental activities of daily living (IADLs) and advanced activities of daily living (AADLs).

RESULTS

Compared with older persons consuming seven or fewer drinks per week, those exceeding the higher threshold of excessive drinking were more likely to have impairments in IADLs (adjusted odds ratio (AOR) = 8.4) and, to a lesser extent, AADLs (AOR = 3.7); those exceeding the lower threshold were more likely to have impairments in IADLs (AOR 5 6.0) but not in AADLs (AOR = 1.7). Binge drinkers were also more likely to have impairments in IADLs (AOR = 3.0) but not in AADLs (AOR = 1.5).

CONCLUSIONS

In this group of older men and women, drinking more than seven drinks per week was associated with impairments in IADLs and, to a lesser extent, AADLs. Drinking more than three drinks per occasion was associated with impairments in IADLs.

Knowledge and self-efficacy of community health nurses concerning interactions of prescription medicines with over-the-counter agents and alcohol

Knowledge and self-efficacy concerning interactions of prescription medications with over-the-counter (OTC) agents were assessed in community health nurses. Three convenience samples of community nurses were recruited to complete the instruments. The first was a sample of 20 experienced nurses working for a local visiting nurse agency (VNARNs). The second was a sample of 20 bachelor of science in nursing (BSN) students (graduate nurses [GNs]) completing their final nursing rotation with the VNARNs. The third was a sample of 31 nurses enrolled in a graduate program training nurses for advanced practice (APRNs). There were no significant differences in overall mean self-efficacy scores among the groups of community health nurses. The mean scores indicated moderate self-efficacy about prescription-OTC interactions. Post-hoc analyses determined VNARNs had significantly greater knowledge scores than APRNs. Overall mean self-efficacy was not correlated with mean knowledge scores. Inspection of the knowledge item responses revealed nine general misconceptions about OTC medications held by many community nurses in the sample. The data can guide the development of continuing education programs about prescription-OTC interactions aimed at community health nurses.

Assessment and treatment of alcoholism and substance-related disorders in the elderly

Substance-related disorders in the elderly remain overlooked and undertreated. Up to 16% of the elderly have alcohol use disorders. With Americans age 65 and older constituting the fastest growing segment of our population, this issue becomes increasingly important. The author reviews the prevalence of geriatric alcoholism, the two typical drinking patterns seen in the elderly, the acute and chronic consequences of alcohol consumption with particular relevance to older persons, barriers to proper assessment of alcoholism in this age group, usefulness of available screening tools, treatment of alcohol withdrawal in the elderly, treatment of alcohol dependence in the elderly with focus on brief intervention, and aspects of nonalcohol drug abuse in the elderly.

Delivering health information about self-medication to older adults: use of touchscreen-equipped notebook computers

Preventing Drug Interactions in Active Older Adults is an educational intervention to prevent prescription and over-the-counter (OTC) drug and alcohol interactions in active, community-living older adults. The objectives of the program are to increase older adults' knowledge of potential interactions of prescription medications with OTC drugs and alcohol and to increase their confidence (self-efficacy) about how to avoid such interactions. An interactive multimedia computer software program (Personal Education Program or PEP) was designed for the learning styles and psychomotor skills of older adults. Focus groups of older adults evaluated PEP components in a formative manner during development. The program content dealing with antacids, calcium supplements, and acid reducers was pilot tested with 60 older adults recruited from local senior centers. Participants used the PEP on notebook computers equipped with infrared-sensitive touchscreens. Users of PEP had greater knowledge and self-efficacy scores than controls. Participants indicated a high degree of satisfaction with the PEP and reported their intent to make specific changes in self-medication behaviors.

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.

Alcohol consumption by non-institutionalised elderly women: the EPIDOS Study

The prevalence of alcohol use declines with age, but studies suggest that between 2% and 4% of the elderly population have a particularly high alcohol consumption. The objective of this study was to verify or refute this finding and identify clinical or social characteristics associated with alcohol consumption. We measured alcohol consumption by autoquestionnaire in 7575 women, aged 75 or older, recruited at five centers in France. The alcohol consumption was computed taking account of the number of beer, wine or liquor (or spirits) drinks consumed per day. The mean age of the respondents was 80+/-6 y. Forty percent used some alcohol and 2.5% drank more than 30 grams per day. Smoking, good health status, higher socioeconomic status or single marital status were factors whose percentages increased significantly with increasing alcohol use. Despite the advanced age of this population, regular alcohol intake was prevalent but not heavy and abusive consumption drinking. Drinking appears to be associated with some medical or social characteristics and possibly with better health status.

Nutritional effects of alcoholism

Alcohol is the most frequently used drug worldwide and remains a socially acceptable hepatotoxin. Although the toxic effects of alcohol on various organs (liver, pancreas, heart, and intestine) are well recognized, the role of alcohol in overall energy and protein metabolism is less well understood. In particular, the efficiency of alcohol as a source of calories and as a substrate for energy production appears to be influenced by the amount of both alcohol and fat consumption as well as by gender. The relationship between alcohol intake and body weight is complex, but it is a clinical dilemma with important nutritional implications for weight management in addition to specific organ toxicity.