Closely Monitor Alcohol Use in Elderly Patients

Journal of the American Geriatrics Society

Frequent alcohol drinking among the elderly, especially those with comorbidities, is associated with increased risk of death in men, but not in women, a large, population-based study published in the (2006; 54:757-762) has shown.

A total of 4691 participants aged ≥60 years (56% women) from the 1971-1974 National Health and Nutrition Examination Survey (NHANES I) and the 1992 NHANES Epidemiologic Followup Survey who provided data on alcohol use were included. This is the first study to look at the joint effects of alcohol use and comorbidities on mortality risk in older adults.

Respondents who met ≥1 of the following criteria were considered to be at-risk drinkers:

• Alcohol use alone: 3 drinks/day ≥4 times weekly or ≥4 drinks/day at any frequency

• Alcohol use + comorbidity: 2-3 drinks/ day ≥2 times weekly or ≥4 drinks/day at any frequency

• Alcohol use + medications: 2-3 drinks/ day ≥2 times weekly or ≥4 drinks/ day at any frequency.

Of those aged 60 to 74 years at study onset (n = 4700), 3033 reported drinking <12 drinks and 1658 reported drinking ≥12 drinks in the previous year. Overall, 89 women were classified as at-risk drinkers compared with 336 men.

The most common medical conditions associated with drinking and increased risk for death in men were gout (22%) and ulcer disease (16%), with a 1.20 hazard ratio compared with men who are not at-risk drinkers.

In women, the most common medical conditions associated with drinking were ulcer disease (20%) and anxiety disorder (17%), but neither of these associations increased the risk of death.

Among both genders, analgesics were the most frequently used medications among at-risk drinkers—13% of men and 22% of women.

These findings help clarify the connections between alcohol, comorbidity, and mortality by pinpointing groups of elderly drinkers who are at increased risk for death from alcohol consumption and comorbidities, lead investigator Alison A. Moore, MD, MPH, and colleagues write. &#8220;The findings also suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality rates,&#8221; they note.

Key points

• Frequent alcohol use increases risk of death in elderly men, but not in elderly women.

• Gout and ulcer disease associated with drinking increase mortality risk in men.

• Ulcer disease and anxiety disorder are associated with increased drinking in women.

• At-risk drinkers tend to use more pain medications.

• Counsel elderly patients with comorbidities about limiting alcohol use.