Changes in health status predict changes in alcohol consumption in older adults: the Seniors-ENRICA cohort

At-Risk Drinking in US Adults with Health Conditions: Differences by Gender, Race, and Ethnicity in the National Survey of Drug Use and Health, 2015-2019

Few studies in the US address alcohol consumption patterns in adults with chronic health conditions, and little is known about race and ethnicity differences. This study examined at-risk drinking prevalence rates among US adults with hypertension, diabetes, heart condition or cancer and assessed differences by gender and, among adults aged 50 and older, by race and ethnicity. We used data from the 2015-2019 National Survey on Drug Use and Health (N = 209,183) to estimate (1) prevalence rates and (2) multivariable logistic regression models predicting odds of at-risk drinking among adults with hypertension, diabetes, heart condition, or cancer, compared to adults with none of these conditions. To examine subgroup differences, analyses were stratified by gender (ages 18-49 and ages 50 +) and by gender and race and ethnicity for adults ages 50 + . Results showed that all adults with diabetes and women ages 50 + with heart conditions in the full sample had lower odds of at-risk drinking relative to their counterparts without any of the four conditions. Men ages 50 + with hypertension had greater odds. In race and ethnicity assessments among adults ages 50 + , only non-Hispanic White (NHW) men and women with diabetes and heart conditions had lower odds, and NHW men and women and Hispanic men with hypertension had greater odds of at-risk drinking. There were differential associations of at-risk drinking with demographic and lifestyle indicators across race and ethnicity groups. These findings underscore tailored efforts in community and clinical settings to reduce at-risk drinking in subgroups with health condition diagnoses.

Alcohol consumption patterns and growth differentiation factor 15 among life-time drinkers aged 65+ years in Spain: a cross-sectional study

AIMS

To examine the association of alcohol consumption patterns with growth differentiation factor 15 (GDF-15) in older drinkers, separately among individuals with cardiovascular disease (CVD)/diabetes and those without them, as GDF-15 is a strong biomarker of chronic disease burden.

DESIGN

Cross-sectional study.

SETTING

Population-based study in Madrid (Spain).

PARTICIPANTS

A total of 2051 life-time drinkers aged 65+ years included in the Seniors-ENRICA-2 study in 2015-17. Participants' mean age was 71.4 years and 55.4% were men.

MEASUREMENTS

According to their average life-time alcohol intake, participants were classified as occasional (≤ 1.43 g/day), low-risk (men: > 1.43-20 g/day; women: > 1.43-10 g/day), moderate-risk (men: > 20-40 g/day; women: > 10-20 g/day) and high-risk drinkers (men: > 40 g/day; women: > 20 g/day; or binge drinkers). We also ascertained wine preference (> 80% of alcohol derived from wine), drinking with meals and adherence to a Mediterranean drinking pattern (MDP) defined as low-risk drinking, wine preference and one of the following: drinking only with meals; higher adherence to the Mediterranean diet; or any of these.

FINDINGS

In participants without CVD/diabetes, GDF-15 increased by 0.27% [95% confidence interval (CI) = 0.06%, 0.48%] per 1 g/day increment in alcohol among high-risk drinkers, but there was no clear evidence of association in those with lower intakes or in the overall group, or across categories of alcohol consumption status. Conversely, among those with CVD/diabetes, GDF-15 rose by 0.19% (95% CI = 0.05%, 0.33%) per 1 g/day increment in the overall group and GDF-15 was 26.89% (95% CI = 12.93%, 42.58%) higher in high-risk versus low-risk drinkers. Drinking with meals did not appear to be related to GDF-15, but among those without CVD/diabetes, wine preference and adherence to the MDP were associated with lower GDF-15, especially when combined with high adherence to the Mediterranean diet.

CONCLUSIONS

Among older life-time drinkers in Madrid, Spain, high-risk drinking was positively associated with growth differentiation factor 15 (a biomarker of chronic disease burden). There was inconclusive evidence of a beneficial association for low-risk consumption.

Alcohol consumption patterns and unhealthy aging among older lifetime drinkers from Spain

BACKGROUND

The protective health effects of light alcohol consumption are debated due to potential selection biases, reverse causation and confounding. We examined cross-sectional and prospective associations of alcohol consumption patterns with unhealthy aging among older drinkers addressing these methodological issues.

METHODS

2081 lifetime drinkers aged 65 + years from the Seniors-ENRICA-2 cohort followed-up for 2.4 years were classified as occasional (average lifetime alcohol intake [g/day] ≤1.43), low-risk (men: >1.43-20; women: >1.43-10), moderate-risk (men: >20-40; women: >10-20) and high-risk drinkers (men: >40; women: >20; or binge drinkers). A Mediterranean drinking pattern (MDP) was defined as occasional/low-risk drinking, wine preference and drinking only with meals. Unhealthy aging was measured with a 52-item health deficit accumulation index (DAI), with higher values indicating more health deficits.

RESULTS

A 10-g/day increment in lifetime average alcohol intake was cross-sectionally associated with a higher DAI among all drinkers (mean difference [95% confidence interval] = 0.35 [0.16, 0.53]) and moderate-/high-risk drinkers (0.41 [0.17, 0.65]), but not among occasional/low-risk drinkers. Also, the DAI was 1.35 (0.06, 2.65) points higher in high-risk versus low-risk drinkers and 2.07 (0.59, 3.60) points higher in non-adherers versus adherers to the MDP. Most associations strengthened when restricting analyses to individuals with lower disease burden and did not generally remain after 2.4 years.

CONCLUSIONS

We found no evidence of a beneficial association between low-risk alcohol consumption and unhealthy aging, but a detrimental one for high-risk drinking, which strengthened when accounting for reverse causation, although attenuated over the follow-up likely due to selective attrition of those less resilient to the harmful effects of alcohol.

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.

A Review of Nutritional Requirements of Adults Aged ≥65 Years in the UK

Appropriate dietary choices in later life may reduce the risk of chronic diseases and rate of functional decline, however, there is little well-evidenced age-specific nutritional guidance in the UK for older adults, making it challenging to provide nutritional advice. Therefore, the aim of this critical review was to propose evidence-based nutritional recommendations for older adults (aged ≥65 y). Nutrients with important physiological functions in older adults were selected for inclusion in the recommendations. For these nutrients: 1) recommendations from the UK Scientific Advisory Committee for Nutrition (SACN) reports were reviewed and guidance retained if recent and age-specific, and 2) a literature search conducted where SACN guidance was not sufficient to set or confirm recommendations for older adults, searching Web of Science up to March 2020. Data extracted from a total of 190 selected publications provided evidence to support age-specific UK recommendations for protein (1.2 g·kg-1·d-1), calcium (1000 mg·d-1), folate (400 μg·d-1), vitamin B-12 (2.4 μg·d-1), and fluid (1.6 L·d-1 women, 2.0 L·d-1 men) for those ≥65 y. UK recommendations for carbohydrates, free sugars, dietary fiber, dietary fat and fatty acids, sodium, and alcohol for the general population are likely appropriate for older adults. Insufficient evidence was identified to confirm or change recommendations for all other selected nutrients. In general, significant gaps in current nutritional research among older adults existed, which should be addressed to support delivery of tailored nutritional guidance to this age group to promote healthy aging.

A Prospective Study of Health Conditions Related to Alcohol Consumption Cessation Among 97,852 Drinkers Aged 45 and Over in Australia

BACKGROUND

Evidence suggests that people who develop serious health conditions are likely to cease drinking alcohol (sometimes known as "sick-quitters"). We quantified the likelihood of quitting drinking in relation to the onset of a variety of health conditions.

METHODS

Odds ratios (ORs) and 95% confidence intervals (CIs) of ceasing alcohol consumption after diagnosis of 28 health conditions and 4 general indicators of health were derived from logistic regression among 97,852 drinkers aged ≥ 45 years between baseline (2006 to 2009) and median 5.3 years of follow-up in the New South Wales 45 and Up Study. Incident health conditions at follow-up were self-reported.

RESULTS

At follow-up, 9.6% (n = 9,438) of drinkers had ceased drinking. Drinking cessation was significantly associated with 24 of 32 health conditions examined: 15.4% of participants with newly diagnosed diabetes quit drinking (OR for quitting vs. continuing 1.77, 95% CI: 1.60 to 1.96), 16.4% with Parkinson's disease (1.71, 1.35 to 2.17), 17.8% with poor memory (1.68, 1.43 to 1.97), 19.2% with hip fracture (1.64, 1.30 to 2.06), 14.7% with stroke (1.45, 1.27 to 1.66), 12.5% with depression (1.40, 1.26 to 1.55), 15.0% with breast cancer (1.38, 1.18 to 1.61), 12.3% with heart disease (1.34, 1.25 to 1.44), and 13.3% with osteoarthritis (1.22, 1.12 to 1.33). Strong associations with quitting were observed in those with a decline in self-rated overall health (2.93, 2.53 to 3.40) and quality of life (2.68, 2.24 to 3.21). Some health conditions not significantly associated with quitting were prostate cancer, melanoma, nonmelanoma skin cancer, hay fever, and hearing loss. Findings were generally consistent for men and women, by age group and by smoking status.

CONCLUSIONS

Diagnosis with a variety of health conditions appears to prompt drinking cessation in older adults.