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Abstract

Increased alcohol consumption is associated with substantial morbidity and mortality in young and middle-aged adult populations, but its effects on the health of older adults have received less attention. The objective of the study was to review published studies that assessed the effects of alcohol on falls or fall injuries, functional impairment, cognitive impairment, and all-cause mortality among older adults. MEDLINE database and bibliographies of selected citations were searched for English language studies published between 1966 and 1998 that examined the relationship between alcohol and one or more of the above outcomes. Also a study was analyzed if it included participants 60 years of age or older, or a broader age range of participants and reported results for older subgroups, or predominantly older participants as evidenced by a mean age of 65 years of age or above. Information on studies' sample sizes, exposure and outcome measures, and risk estimates were extracted, and articles were evaluated for methodologic quality using predetermined criteria. Eighty-four studies were identified that examined 91 potential exposure-outcome associations including falls or fall injuries (n = 26); functional impairment (n = 13); cognitive impairment (n = 32); and all-cause mortality (n = 20). The percentage of studies demonstrating harm, no association, or benefit by outcome included falls (15% vs. 81% vs. 4%); functional disability (38% vs. 46% vs. 16%); cognitive impairment (31% vs. 66% vs. 3%); and all-cause mortality (15% vs. 65% vs. 20%). Studies (n = 84) inconsistently adhered to methodologic standards. Although 90% provided eligibility criteria; 61% cited participation rates; and 73% described the methods used to measure alcohol exposure; only 44% adjusted for potentially important confounding factors; and 26% distinguished former drinkers from nondrinkers. Of the cohort studies (n = 47), 30% assessed for change in participants' exposure status over time, and 17% determined whether losses to follow-up varied by exposure status. The magnitude of risk posed by alcohol use for falls or fall injuries, functional disability, cognitive impairment, and all-cause mortality among older adults remains uncertain. Prospective studies are needed to better define the health-related effects of alcohol use in older populations.

Lifestyle Factors Related to Mortality and Survival: A Mini-Review

“…The J-shaped association between alcohol intake and mortality has been established almost exclusively in studies of younger and middle-aged adult populations. In older people, however, this association has not been confirmed [13]. …”

“…In contrast, 4 studies that used a comparable definition of alcohol consumption reported an inverse association between mortality and increased alcohol intake. Furthermore, another 13 studies found no association between alcohol intake and mortality among people ≥60 years [13]. …”

“…However, many biological changes linked to aging could make older adults more vulnerable to excessive alcohol consumption. Older adults are more likely than younger adults to have multiple comorbidities [15] and to use more medication [13]. Alcohol may interact differently with different chronic diseases and with medication to adversely affect health outcomes.…”

Drinking Patterns and the Development of Functional Limitations in Older Adults

“…The preservation of independent functional ability is an important goal for many older adults, and there is a growing interest in the connection between alcohol consumption and physical and mental functioning among the older adult population. Although results from earlier studies on the association between alcohol use and functional disabilities were mixed (Reid et al, 2002), findings from more recent publications have been more consistent in suggesting the association between low to moderate alcohol use and lower risk of functional impairments among older adults (Cawthon et al, 2007; Chen & Hardy, 2009; Karlamangla et al, 2009; Lang et al, 2007; Lee et al, 2009; Maraldi et al, 2009; Sun et al, 2009; Wang et al, 2002). …”

Secular changes in at-risk drinking in Sweden: birth cohort comparisons in 75-year-old men and women 1976–2006

“…Overconsumption of alcohol may increase the likelihood of cognitive impairment, self-neglect, falls and other health risks in older people [1]. Mild-to-moderate alcohol consumption, on the other hand, has been shown to associate with health benefits including better cardiac and cerebrovascular health [2], decreased risk for dementia [3] as well as increased psychological wellbeing and improved quality of life [4].…”