Factors associated with elevated consumption of alcohol in older adults-comparison between China and Norway: the CLHLS and the HUNT Study

Healthy Lifestyle and the Likelihood of Becoming a Centenarian

Importance

Previous studies have reported that lifestyle factors were associated with life expectancy and/or mortality, but most of them studied the middle-aged or older age groups (aged ≥60 years), and few focused on people aged 80 years or older.

Objectives

To examine healthy lifestyle and the likelihood of becoming centenarians among people aged 80 years or older in China.

Design, Settings, and Participants

Using data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative and one of the largest prospective cohorts targeting people aged 80 years or older established in 1998, a community-based, prospective nested case-control study was performed. Data were analyzed from December 1, 2022, to April 15, 2024.

Exposures

A healthy lifestyle score for 100 (HLS-100, ranging from 0 to 6), including smoking, exercise, and dietary diversity, was constructed, with higher scores indicating potentially better health outcomes.

Main Outcomes and Measures

The primary outcome was survivorship to becoming a centenarian by 2018 (the end of follow-up). Information on sociodemographic characteristics, lifestyle factors, and other covariates was collected.

Results

The sample comprised 5222 individuals (61.7% women, mean [SD] age, 94.3 [3.3] years), including 1454 identified centenarians and 3768 controls (died before becoming centenarians) matched by age, sex, and year of entry. During a median follow-up of 5 (IQR, 3-7) years, 373 of 1486 individuals among the lowest HLS-100 (0-2) group and 276 of 851 individuals among the highest HLS-100 (5-6) group became centenarians. The adjusted odds ratio (AOR) comparing the highest vs the lowest HLS-100 groups was 1.61 (95% CI, 1.32-1.96; P < .001 for trend). An association was noted when we further treated centenarians with relatively healthy status as the outcome, as evaluated by self-reported chronic conditions, physical and cognitive function, and mental wellness (AOR, 1.54; 95% CI, 1.05-2.26). Similar results were observed in other sensitivity analyses.

Conclusions and Relevance

In this case-control study of Chinese older adults, adhering to a healthy lifestyle appears to be important even at late ages, suggesting that constructing strategic plans to improve lifestyle behaviors among all older adults may play a key role in promoting healthy aging and longevity.

Traditional lifestyle factors partly mediate the association of socioeconomic position with intrahepatic lipid content: The Maastricht study

Background & Aims

Recent studies have unveiled an association between socioeconomic position (SEP) and intrahepatic lipid (IHL) content. The aim of this study was to examine to what extent traditional lifestyle factors mediate the relationship between SEP and IHL content, independent of aetiology, and non-alcoholic fatty liver disease (NAFLD).

Methods

We used cross-sectional data derived from The Maastricht Study (N = 4,001; mean age: 60 years, 49% women, 32% low education level, 21% diabetes, 21% NAFLD). Education, income, and occupation were used as indicators of SEP. Physical activity (accelerometer), intake of total energy, alcohol, saturated fat, protein, vitamin E, dietary fibre, and fructose from sugar-sweetened beverages (SSBs) and fruit juice (food frequency questionnaires) were potential mediators. IHL content was quantified by magnetic resonance imaging. Age, sex, and type 2 diabetes were covariates. Multiple parallel mediation analyses (bootstraps = 10,000) were performed.

Results

Individuals with a low education level had a 1.056-fold higher IHL content (95% CI: 1.03-1.08) and a 44% greater NAFLD risk (OR:1.44; 95% CI:1.18-1.77) compared with those with higher education levels. Approximately 8.9% of educational disparity in risk of IHL content was attributable to moderate-to-vigorous physical activity; 6.3% to fructose intake from SSBs; 5.5% to dietary fibre; and -23% to alcohol. Approximately 8.7% of educational disparity in risk of NAFLD was attributable to moderate-to-vigorous physical activity; and 7.7% to fructose intake from SSBs. However, the indirect effect of these mediators was small (0.998 for IHL content and 1.045 for NAFLD) in comparison to the total effect. Similar results were found when income and occupation were used as SEP indicators.

Conclusions

Societal measures may alleviate the burden of NAFLD and further studies that identify mediators other than traditional lifestyle factors are warranted to define the relationship underlying SEP and IHL content.

Impact and implications

Individuals with a low or medium level of education, income, or occupational status had more fat accumulation in their livers than individuals with a higher education, income, or occupational status. This difference may be attributed to the influence of unhealthy lifestyle factors, such as reduced physical activity and a higher intake of sugar-sweetened beverages among individuals with lower socioeconomic position. Nevertheless, other yet unknown factors may also play a role.

Health Behavior Patterns and Associated Risk of Memory-Related Disorders Among Middle-Aged and Older Chinese Couples

Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011-2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013-2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples.

Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway

Introduction

Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway.

Methods

Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up.

Results

Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity.

Conclusion

Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.

Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium

OBJECTIVES

Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults.

METHODS

This is a retrospective cross-sectional study in 1.406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU.

RESULTS

Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU.

CONCLUSIONS

Different characteristics were found as predictors for AU among older men and women.

CLINICAL IMPLICATIONS

Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults.

Effects of potential risk factors on the development of cardiometabolic multimorbidity and mortality among the elders in China

Objectives

To examine the impact of demographic, socioeconomic, and behavioral factors on the development of cardiometabolic multimorbidity and mortality in Chinese elders.

Methods

Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2002–2018 was used in the study. Cardiometabolic multimorbidity was defined as the presence of two or more cardiometabolic disorders, such as hypertension, diabetes, cardiovascular disease (CVD), heart disease, or stroke. Cox regression model and multi-state Markov model were developed to evaluate the association of the study factors with the progression of cardiometabolic conditions and mortality. The outcomes included three states (first cardiometabolic disease, cardiometabolic multimorbidity, and all-cause mortality) and five possible transitions among the three states.

Results

Of the 13,933 eligible individuals, 7,917 (56.8%) were female, and 9,540 (68.50%) were over 80 years old. 2,766 (19.9%) participants had their first cardiometabolic disease, 975 (7.0%) participants suffered from cardiometabolic multimorbidity, and 9,365 (67.2%) participants died. The progression to cardiometabolic multimorbidity was positively associated with being female (HR = 1.42; 95%CI, 1.10 − 1.85), living in the city (HR = 1.41; 95%CI, 1.04 − 1.93), overweight (HR = 1.43; 95%CI, 1.08 − 1.90), and obesity (HR = 1.75; 95% CI, 1.03 − 2.98). A higher risk for the first cardiometabolic disease was associated with being female (HR = 1.26; 95% CI, 1.15 − 1.39), higher socioeconomic status (SES, HR = 1.17; 95%CI, 1.07 − 1.28), lack of regular physical activity (HR = 1.13; 95%CI, 1.04 − 1.23), smoking (HR = 1.20; 95%CI, 1.08 − 1.33), ≤ 5 h sleep time (HR = 1.15; 95%CI, 1.02 − 1.30), overweight (HR = 1.48; 95% CI, 1.32 − 1.66), and obesity (HR = 1.34; 95%CI, 1.06 − 1.69). It also should be noted that not in marriage, lower SES and unhealthy behavioral patterns were risk factors for mortality.

Conclusion

This study emphasized the importance of lifestyle and SES in tackling the development of cardiometabolic conditions among Chinese elders and provided a reference for policy-makers to develop a tailored stage-specific intervention strategy.

Alcohol consumption among older adults with symptoms of cognitive decline consulting specialist health care

OBJECTIVES

To explore alcohol consumption among older Norwegian adults with symptoms of cognitive decline, assess the agreement between the reports of older adults and their next of kin regarding a person's alcohol consumption, and explore clinical and sociodemographic variables associated with agreement.

METHOD

Alcohol consumption was measured among 3608 older adults consulting specialist health care for symptoms of cognitive decline. Agreement between the participant and their next of kin regarding the participant's alcohol consumption was assessed with a weighted kappa (κ). A logistic regression analysis for hierarchical data was used to explore variables associated with agreement.

RESULTS

Both the participants and their next of kin reported that more than 20% of the participants consumed alcohol 1-3 times a week, and that approximately 10% consumed alcohol four or more times a week. The agreement between the participant's and their next of kin's report regarding the participant's alcohol consumption was high (κ = .852), and variables associated with agreement were no cognitive decline, not drinking alcohol during the last year or ever as reported by the participant, and low agitation scores on a psychiatric assessment.

CONCLUSION

This paper found alcohol consumption among older adults with symptoms of cognitive decline that was above the national average in Norway. This is also the first paper to demonstrate that a next of kin can be a reliable source of information regarding older adults' alcohol consumption. Health personnel should consider these findings when performing medical assessments or developing interventions for older adults.

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

Background

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

Methods

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

Results

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

Conclusion

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

Hazardous alcohol consumption among older adults: A comprehensive and multi-national analysis of predictive factors in 13,351 individuals

Background

Older adults exhibit heightened vulnerability for alcohol-related health impairments. Increases in the proportion of older adults within the European Union’s total population and prevalence rates of alcohol use disorders in this age group are being observed. This large scale international study was conducted to identify those older adults with an increased risk to engage in hazardous drinking behaviour.

Methods

Socio-demographic, socio-economic, personality characteristics (Big Five Inventory, BFI-10), and alcohol consumption patterns of 13,351 individuals from 12 different European countries, collected by the Survey of Health, Aging, and Retirement in Europe, were analyzed using regression models.

Results

Age, nationality, years of education, as well as personality traits, were significantly associated with alcohol intake. For males, extraversion predicted increased alcohol intake (RR = 1.11, CI = 1.07–1.16), whereas conscientiousness (RR = 0.93, CI = 0.89–0.97), and agreeableness (RR = 0.94, CI = 0.90–0.99), were associated with a reduction. For females, openness to new experiences (RR = 1.11, CI = 1.04–1.18) predicted increased alcohol intake. Concerning excessive drinking, personality traits, nationality, and age-predicted consumption patterns for both sexes: Extraversion was identified as a risk factor for excessive drinking (OR = 1.15; CI = 1.09–1.21), whereas conscientiousness was identified as a protective factor (OR = 0.87; CI = 0.823–0.93).

Conclusion

Hazardous alcohol consumption in the elderly was associated with specific personality characteristics. Preventative measures, crucial in reducing deleterious health consequences, should focus on translating the knowledge of the association of certain personality traits and alcohol consumption into improved prevention and treatment.

Alcohol use among older adults: A comparative study across four European countries

Aims:

(i) To examine whether mean consumption and prevalence of at-risk drinking are highly correlated across samples of older adults, and (ii) to explore whether sociodemographic and health characteristics of alcohol use differ across countries.

Method:

Cross-sectional surveys were conducted in four European countries, Norway, Denmark, Belgium, and Portugal, applying identical data collection methods and survey instruments in general population samples of older adults aged 60 to 75 years. Alcohol consumption was measured as units of alcohol per week, which provided the basis for categorising the two outcome measures: abstention (0 units/week) and at-risk drinking (8+ units/week). Cross-tabulations and logistic regression models were estimated to examine associations between sociodemographic and health characteristics on the one hand and alcohol abstention and at-risk drinking on the other.

Results:

Prevalence of abstention was highest in Portugal and lowest in Denmark, whereas at-risk drinking was more prevalent in Denmark and Belgium compared to Norway and Portugal. Among country- and gender-specific samples of drinkers, there was a strong positive correlation between mean consumption and prevalence of at-risk drinkers. Female gender characterised abstention, whereas male gender characterised at-risk drinking in all four countries. Other sociodemographic characteristics and indicators of health and wellbeing were differently associated with abstention and at-risk drinking across the four countries.

Conclusions:

A strong regularity in the distribution of alcohol consumption was observed in the samples of older adults. Gender was the only common factor associated with drinking behaviour across the four countries.

Elevated alcohol consumption among geriatric psychiatric in-patients

Introduction:

Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment.

Aim:

To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption.

Method:

This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs.

Results:

In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively).

Conclusion:

A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.

Alcohol Use Among Mental Health Professionals in China: A Nationwide Cross-sectional Survey

AIM

To survey the use of alcohol, and its correlates by mental health professions in China, a nation where there is rapid increase in alcohol consumption and problems.

METHODS

As a part of a large-scale, nation-wide online survey of healthcare professionals, we collected demographic variables and other health-related variables anonymously. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to collect data on alcohol use.

RESULTS

13,980 mental health professionals completed the survey (4382 doctors, 9339 nurses and 259 clinical psychologists), representing 64% of the total targeted. Respondents were predominantly female (75.1%). Alcohol consumption was reported by 41.8% of participants (by 53.9% of doctors, 36.2% of nurses and 40.5% of clinical psychologists). Based on the cut-off scores of the AUDIT-C (≥3 for women and ≥4 for men), 7.5% were classified as probable alcohol misusers in the past year, and the rates were 10.2% in doctors, 6.3% in nurses and 5.8% in clinical psychologists. Multiple logistic regression showed that male sex (OR = 3.772; CI = 3.206-4.439), being a doctor (OR = 1.259; CI = 1.052-1.506), being divorced or widowed (OR = 1.979; CI = 1.467-2.666), having an associate degree or less (OR = 1.809; CI = 1.040-3.147), working in Northeast China (OR = 1.538; CI = 1.281-1.848) and the habit of smoking (OR = 3.345; CI = 2.280-3.967) were significantly associated with alcohol misuse.

CONCLUSIONS

Alcohol use and misuse were relatively common among mental health professionals in China, and male sex, being a doctor, with lower education, working in Northeast China and cigarette smoking were significant associations. Awareness and interventions are recommended to promote healthier use of alcohol in this professional group, especially among risk subgroups.