Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers

History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND

OBJECTIVE

To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later.

METHOD

A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later.

RESULTS

Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND.

CONCLUSIONS

For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

A novel murine model of multi-day moderate ethanol exposure reveals increased intestinal dysfunction and liver inflammation with age

Background

There are currently > 600 million people over the age of 65 globally and this number is expected to double by the year 2050. Alcohol use among this population is on the rise, which is concerning as aging is associated with increased risk for a number of chronic illnesses. As most studies investigating the effects of alcohol have focused on young/middle-aged populations, there is a dearth of information regarding the consequences of alcohol use in older consumers. In addition, most murine ethanol models have concentrated on exposure to very high levels of ethanol, while the vast majority of elderly drinkers do not consume alcohol in excess; instead, they drink on average 2 alcoholic beverages a day, 3–4 days a week.

Methods

We designed a murine model of aging and moderate ethanol consumption to determine if the deleterious effects of alcohol on the gut-liver axis are exacerbated in aged, relative to younger, animals. Aged and young mice were exposed to a multi-day moderate exposure ethanol regimen for 4 weeks and changes in gut permeability along with intestinal tight junction protein and antimicrobial peptide gene expression were measured. In addition, hepatic inflammation was assessed by histological analysis, inflammatory gene expression and flow cytometric analysis of inflammatory infiltrate.

Results

Our results reveal that in aged, but not young mice, moderate ethanol exposure yielded significantly worsened intestinal permeability, including increased bacterial translocation from the gut, elevated serum iFABP and leakage of FITC-dextran from the gut. Interestingly, moderate ethanol exposure in young animals led to gut protective transcriptional changes in the ileum while this protective response was blunted in aged mice. Finally, moderate ethanol exposure in aged mice also resulted in marked inflammatory changes in the liver.

Conclusions

These results demonstrate that aged mice are more susceptible to ethanol-induced gut barrier dysfunction and liver inflammation, even at moderate doses of ethanol. This increased vulnerability to ethanol’s gastrointestinal effects has important implications for alcohol use in the aging population. Future studies will explore whether improving intestinal barrier function can reverse these age-related changes.

Moderate alcohol consumption and lower total mortality risk: Justified doubts or established facts?

For almost a century, the scientific community is aware of the J-shaped curve between alcohol consumption and all-cause mortality. Moderate drinkers seem to live longer than both abstainers and heavy drinkers. These epidemiological observations regarding moderate alcohol consumption and beneficial health effects have been incessantly scrutinised for confounding and bias. This viewpoint discusses previous and recent criticisms regarding the J-shaped curve between alcohol consumption and total mortality risk. The controversies regarding the J-shaped curve between alcohol consumption and mortality are ongoing, as well as the debate among scientists in this area of research, resulting in conflicting messages in media and in different alcohol guidelines. Although it appears quite difficult to come up with a position statement only based on the currently available scientific data, it is imperative to fairly inform the public, without creating confusion and, worst case, disbelief in science.

Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study

Background

The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults.

Methods

We used data from the Nord-Trøndelag Health Study (HUNT3 2006–08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown.

Results

The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality.

Conclusion

Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.

Drinking Status Between Ages 50 and 55 for Men From the San Diego Prospective Study Who Developed DSM-IV Alcohol Abuse or Dependence in Prior Follow-Ups

OBJECTIVE

Although alcohol use disorders (AUDs) are prevalent among older individuals, few studies have examined the course and predictors of AUDs from their onset into the person's 50s. This study describes the AUD course from ages 50 to 55 in participants who developed AUDs according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), during the San Diego Prospective Study (SDPS).

METHOD

Among the 397 university students in the SDPS who were followed about every 5 years from age 20 (before AUD onset), 165 developed AUDs, 156 of whom were interviewed at age 55. Age 50-55 outcomes were compared regarding age 20-50 characteristics. Variables that differed significantly across outcome groups were evaluated using binary logistic regression analyses predicting each outcome type.

RESULTS

Between ages 50 and 55, 16% had low-risk drinking, 36% had high-risk drinking, 38% met DSM-5 AUD criteria, and 10% were abstinent. Baseline predictors of outcome at ages 50-55 included earlier low levels of response to alcohol predicting DSM-5 AUDs and abstinence, higher drinking frequency predicting DSM-5 diagnoses and lower predicting low-risk drinking, higher participation in treatment and/or self-help groups predicting abstinence and lower predicting DSM-5 AUDs, later ages of AUD onset predicting high-risk drinking, and cannabis use disorders predicting abstinent outcomes.

CONCLUSIONS

Despite the high functioning of these men, few were abstinent or maintained low-risk drinking during the recent 5 years, and 38% met DSM-5 AUD criteria. The data may be helpful to both clinicians and researchers predicting the future course of AUDs in their older patients and research participants.

Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults

BACKGROUND

There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers.

METHODS

We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals.

RESULTS

A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality.

CONCLUSIONS

Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.

Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern

OBJECTIVE

Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems.

METHOD

The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years).

RESULTS

Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%.

CONCLUSIONS

Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.

Mediation of effects of the level of response to alcohol and impulsivity 15 years later in 36-year-old men: Implications for prevention efforts

BACKGROUND

Although the prevalence of alcohol use disorders (AUDs) has increased in older individuals in the recent decade, there are few programs to mitigate that increase. The current analyses evaluate the feasibility of applying to older drinkers elements of an approach to prevent heavier drinking in young adults by focusing on mediators of effects of two risk factors for alcohol problems, low levels of response to alcohol (low LRs) and higher impulsivity.

METHODS

Data were extracted from the San Diego Prospective Study (SDPS). Structural Equation Models evaluated relationships among age 36 low LRs and higher impulsivity; age 46 perceived peer drinking, alcohol expectancies, and drinking to cope; and age 51 alcohol problems, even after controlling for age 36 alcohol problems.

RESULTS

Relationships of age 36 low LRs to later alcohol problems was both direct and linked to age 46 heavy drinking peers. LR also operated indirectly through peer drinking to alcohol expectancies and drinking to cope. Age 36 impulsivity had no direct path to later alcohol problems and operated primarily through mediation by alcohol expectancies and via expectancies to drinking to cope. After controlling for age 36 alcohol problems, the low LR and impulsivity results remained robust.

CONCLUSIONS

Programs for mitigating increases in alcohol problems in middle-age drinkers should consider identifying individuals with low LRs and/or higher impulsivity and implementing prevention approaches similar to a program used in young adults. The approach should emphasize some different mediators for older drinkers with low LRs and those with higher impulsivity.

Intersections of poverty, race/ethnicity, and sex: alcohol consumption and adverse outcomes in the United States

We examine whether intersectionality theory-which formalizes the notion that adverse health outcomes owing to having a marginalized social status, identity, or characteristic, may be magnified for individuals with an additional marginalized social status, identity, or characteristic-can be applied using quantitative methods to describe the differential effects of poverty on alcohol consumption across sex and race/ethnicity. Using the National Epidemiologic Survey on Alcohol and Related Conditions, we analyze longitudinal data from Black, Hispanic, and White drinkers (n = 21,140) to assess multiplicative interactions between poverty, as defined by the US Census Bureau, sex, and race/ethnicity, on adverse alcohol outcomes. Findings indicated that the effect of poverty on the past-year incidence of heavy episodic drinking was stronger among Black men and Black women in comparison to men and women of other racial/ethnic groups. Poverty reduction programs that are culturally informed may help reduce racial/ethnic disparities in the adverse outcomes of alcohol consumption.

One size should not fit all, so use the right tool for the job

The 4/5+ criterion for heavy drinking has limited validity as an index of treatment efficacy, and use of continuous and multi-dimensional measures of outcome are recommended. The 4/5+ criterion continues to be a useful indicator of alcohol-related risk for screening and prevention.