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The Prevalence of Harmful and Hazardous Alcohol Consumption in Older U.S. Adults: Data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES)

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A Capsule Commentary to this article was published on 22 October 2013

BACKGROUND

Alcohol consumption and its interaction with disease, medication use, and functional status may result in serious health problems, but little information exists about the national prevalence of alcohol-related health risk in older adults.

OBJECTIVE

To estimate the prevalence of harmful and hazardous alcohol use and the prevalence of consumption in excess of National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommendations, in people aged 65 and older, and by sex and race/ethnicity sub-group.

DESIGN

Cross-sectional, using data from the 2005–2008 National Health and Nutrition Examination Survey of the non-institutionalized U.S. population.

PARTICIPANTS

One thousand and eighty-three respondents aged 65 and older who consume alcohol.

MAIN MEASURES

Participants’ alcohol consumption was classified as Harmful, Hazardous, or Healthwise, in the context of their specific health status, using the Alcohol-Related Problems Survey classification algorithm.

KEY RESULTS

Overall, 14.5 % of older drinkers (95 % CI: 12.1 %, 16.8 %) consumed alcohol above the NIAAA’s recommended limits. However, when health status was taken into account, 37.4 % of older drinkers (95 % CI: 34.9 %, 40.0 %) had Harmful consumption and 53.3 % (95 % CI: 50.1 %, 56.6 %) had either Hazardous or Harmful consumption. Among light/moderate drinkers, the proportions were 17.7 % (95 % CI: 14.7 %, 20.7 %) and 28.0 % (95 % CI: 24.8 %, 31.1 %), respectively. Male drinkers had significantly greater odds of Hazardous/Harmful consumption than female drinkers (OR = 2.14 [95 % CI: 1.77, 2.6]). Black drinkers had worse health status and significantly greater odds of Hazardous/Harmful consumption than white drinkers (OR = 1.49; 95 % CI: 1.02, 2.17), despite having no greater prevalence of drinking in excess of NIAAA-recommended limits.

CONCLUSION

Most older Americans who drink are light/moderate drinkers, yet substantial proportions of such drinkers drink in a manner that is either harmful or hazardous to their health. Older adults with risky alcohol consumption are unlikely to be identified by health care providers if clinicians rely solely on whether patient consumption exceeds the NIAAA-recommended limits.

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REFERENCES

  1. Anderson G. Chronic Care: Making the Case for Ongoing Care. Princeton: Robert Wood Johnson Foundation; 2010.

    Google Scholar 

  2. Mukamal KJ, Chen CM, Rao SR, Breslow RA. Alcohol consumption and cardiovascular mortality among U.S. adults, 1987 to 2002. J Am Coll Cardiol. 2010;55:1328–35.

    Article  PubMed  Google Scholar 

  3. Mukamal KJ, Kuller LH, Fitzpatrick AL, Longstreth WT Jr, Mittleman MA, Siscovick DS. Prospective study of alcohol consumption and risk of dementia in older adults. JAMA. 2003;289:1405–13.

    Article  CAS  PubMed  Google Scholar 

  4. Chermack ST, Blow FC, Hill EM, Mudd SA. The relationship between alcohol symptoms and consumption among older drinkers. Alcohol Clin Exp Res. 1996;20:1153–8.

    Article  CAS  PubMed  Google Scholar 

  5. Moos RH, Brennan PL, Schutte KK, Moos BS. Older adults’ health and changes in late-life drinking patterns. Aging Ment Health. 2005;9:49–59.

    Article  CAS  PubMed  Google Scholar 

  6. Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Phamacother. 2007;5:64–74.

    Article  Google Scholar 

  7. Adams WL. Potential for adverse drug-alcohol interactions among retirement community residents. J Am Geriatr Soc. 1995;43:1021–5.

    CAS  PubMed  Google Scholar 

  8. National Institute on Alcohol Abuse and Alcoholism. Special populations and co-occurring disorders: older adults. [cited 2012 May 29]; Available from: http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adults.

  9. National Institute on Alcoholism and Alcohol Abuse. Helping patients who drink too much: A clinician’s guide. Bethesda: National Institutes of Health, US Department of Health and Human Services; 2005.

    Google Scholar 

  10. Fink A, Elliott MN, Tsai M, Beck JC. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc. 2005;53:1937–43.

    Article  PubMed  Google Scholar 

  11. Fink A, Morton SC, Beck JC, Hays RD, Spritzer K, Oishi S, et al. The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients. J Am Geriatr Soc. 2002;50:1717–22.

    Article  PubMed  Google Scholar 

  12. Adams WL, Yuan Z, Barboriak JJ, Rimm AA. Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States. JAMA. 1993;270:1222–5.

    Article  CAS  PubMed  Google Scholar 

  13. Tobias CR, Lippmann S, Pary R, Oropilla T, Embry CK. Alcoholism in the elderly. How to spot and treat a problem the patient wants to hide. Postgrad Med. 1989;86(67–70):5–9.

    Google Scholar 

  14. Dufour M, Fuller R. Alcohol in the elderly. Ann Rev Med. 1995;46:123–32.

    Article  CAS  PubMed  Google Scholar 

  15. Blow FC, Barry KL. Alcohol and substance misuse in older adults. Curr Psychiatry Rep. 2012;14:310–9.

    Article  PubMed  Google Scholar 

  16. Blow FC, Barry KL. Use and misuse of alcohol among older women. Alcohol Res Health. 2002;26:308–15.

    PubMed  Google Scholar 

  17. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–14.

    Article  PubMed  Google Scholar 

  18. Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45:529–38.

    Article  PubMed  Google Scholar 

  19. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206–52.

    Article  CAS  PubMed  Google Scholar 

  20. National Center for Health Statistics. National Health and Nutrition Examination Survey. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2012 [cited 2010]; Available from: http://www.cdc.gov/nchs/nhanes.htm.

  21. National Center for Health Statistics. Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES). In: US Department of Health and Human Services, editor. Hyattsville, MD: Centers for Disease Control and Prevention; 2006.

  22. Moore AA, Beck JC, Babor TF, Hays RD, Reuben DB. Beyond alcoholism: identifying older, at-risk drinkers in primary care. J Stud Alcohol. 2002;63:316–24.

    PubMed  Google Scholar 

  23. Moore AA, Hays RD, Reuben DB, Beck JC. Using a criterion standard to validate the Alcohol-Related Problems Survey (ARPS): a screening measure to identify harmful and hazardous drinking in older persons. Aging (Milano). 2000;12:221–7.

    CAS  Google Scholar 

  24. Fink A, Tsai MC, Hays RD, Moore AA, Morton SC, Spritzer K, et al. Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients. Arch Gerontol Geriatr. 2002;34:55–78.

    Article  PubMed  Google Scholar 

  25. Wilson SR, Fink A, Verghese S, Beck JC, Nguyen K, Lavori P. Adding an alcohol-related risk score to an existing categorical risk classification for older adults: sensitivity to group differences. J Am Geriatr Soc. 2007;55:445–50.

    Article  PubMed  Google Scholar 

  26. Moore AA, Morton SC, Beck JC, Hays RD, Oishi SM, Partridge JM, et al. A new paradigm for alcohol use in older persons. Med Care. 1999;37:165–79.

    Article  CAS  PubMed  Google Scholar 

  27. Kranzler HR, Tennen H, Babor TF, Kadden RM, Rounsaville BJ. Validity of the longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders. Drug Alcohol Depend. 1997;45:93–104.

    Article  CAS  PubMed  Google Scholar 

  28. Saunders JB, Aasland OG. World Health Organization collaborative project on the identification and treatment of persons with harmful alcohol consumption: report on Phase I development of a screening instrument. Geneva, Switzerland, 1987.

  29. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction. 1993;88:791–804.

    Article  CAS  PubMed  Google Scholar 

  30. National Center for Health Statistics. Analytic Note Regarding 2007–2010 Survey Design Changes and Combining Data Across other Survey Cycles. In: US Department of Health and Human Services, editor. Hyattsville, MD: Centers for Disease Control and Prevention; 2010.

  31. D'Amico EJ, Paddock SM, Burnam A, Kung FY. Identification of and guidance for problem drinking by general medical providers: results from a national survey. Med Care. 2005;43:229–36.

    Article  PubMed  Google Scholar 

  32. Moore AA, Blow FC, Hoffing M, Welgreen S, Davis JW, Lin JC, et al. Primary care-based intervention to reduce at-risk drinking in older adults: a randomized controlled trial. Addiction. 2011;106:111–20.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000;15:84–91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Kuehn BM. Despite benefit, physicians slow to offer brief advice on harmful alcohol use. JAMA. 2008;299(7):751–3.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Contributors

The authors gratefully acknowledge the insight and contributions of John C. Beck, MD, David Geffen School of Medicine, UCLA, Emeritus, and the Langley Research Institute; and Philip W. Lavori, PhD, Department of Health Policy and Research, Stanford University School of Medicine, in their review of draft of this manuscript.

Funders

This work was supported by the Palo Alto Medical Foundation Research Institute and the Langley Research Institute.

Prior Presentations

Results from this paper were presented at the 2012 National Conference for Health Statistics in Washington, D.C. (SRW), the 2012 meeting of the Australasian Professional Society on Alcohol and Drugs (APSAD) (AF), and at the 2013 annual conference of the HMO Research Network in April, 2013 (SK).

Conflict of Interest

Sandra R. Wilson, PhD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Authors Sandra R. Wilson, PhD; Sarah B. Knowles, PhD; and Qiwen Huang, MS report no conflicts of interest. The ARPS is copyrighted by Arlene Fink Associates, Inc. (AFA), 2012, but, with permission, is available for research use at no cost. AFA has received licensing fees from the use of the ARPS by non-profit entities in the U.S., Australia and France.

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Authors and Affiliations

  1. Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA

    Sandra R. Wilson PhD, Sarah B. Knowles PhD, MPH & Qiwen Huang MS

  2. David Geffen School of Medicine, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA

    Arlene Fink PhD

  3. Langley Research Institute, Pacific Palisades, CA, USA

    Arlene Fink PhD

Authors
  1. Sandra R. Wilson PhD
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  2. Sarah B. Knowles PhD, MPH
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  3. Qiwen Huang MS
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  4. Arlene Fink PhD
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Correspondence to Sandra R. Wilson PhD.

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Wilson, S.R., Knowles, S.B., Huang, Q. et al. The Prevalence of Harmful and Hazardous Alcohol Consumption in Older U.S. Adults: Data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES). J GEN INTERN MED 29, 312–319 (2014). https://doi.org/10.1007/s11606-013-2577-z

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