Mohammed T. Abou-Saleh

608 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRY55+, 17% reported that they had consumed alcohol every day inthe past 2 weeks. In controlled regression analyses, more peopleaged 65–74 drank every day, compared to those 55–64(OR=1.36), but people aged 75+ drank less than those 55–64.Males and Whites used alcohol more frequently and were morelikely to be heavy drinkers than females and non-Whites. Thelower one’s perceived health status, the lower the odds of drinkingevery day. Believing excessive drinking increases the chances ofgetting cirrhosis of the liver decreased the odds of moderate andheavy drinking 17 .There are various explanations why the prevalence of alcoholuse is lower in the elderly. Selective survival may be a factor, inthat persons who drink are less likely to survive to older ages.Cohort effects are also possible. Persons who grew up in the era ofProhibition and economic depression prior to World War II mayhave had lower alcohol use throughout their lives 5 . Studies havealso shown that some elderly decrease their use of alcohol as theygrow older. Barnes found half of the subjects aged 60+ who werecurrent abstainers reported that they were former drinkers, with‘‘bad health’’ most often given as a reason for giving updrinking 14 . Busby et al. 18 investigated alcohol use in a communitybasedsample of adults aged 70+ in New Zealand. Both frequencyand quantity of intake decreased with age. A total of 60.1% of themen and 30.3% of the women said they drank less compared tomiddle age, and only 7.4% of the men and 11.1% of the womensaid they drank more. The main reasons cited for decreased use ofalcohol were change in health and fewer social opportunities, withreasons cited for increased intake being more time and money 18 .Similarly, a significant proportion of male current drinkers, butnot abusers, selected from medical admissions aged 65+ in theUK reported heavier drinking in the past. The most frequentreasons given for reduction in intake were onset of ill-health(36%), loss of social contact (28%) and financial difficulties(19%) 19 .Using data from the Normative Aging Study, Glynn et al. 20studied generational effects on alcohol consumption in a sampleof 1859 male adult volunteers interviewed at baseline and 9years later. Older men drank less than younger men at bothassessments, yet there was no tendency for men to decreasetheir consumption levels over time. Each older cohort had alower prevalence of problems with drinking than the nextyoungest cohort. The authors suggested that their results showthat aging is not as important as generational changes inprevalence 20 . In contrast, Adams et al. followed a cohort of 270healthy community-dwelling elderly aged 60+ over 7 years 21 .At baseline, the investigators found a decline in the percentageof drinkers with increasing age 22 . In the 7 year follow-up, therewas a 2%/year decline in the percentage of subjects consumingany alcohol, but mean alcohol intake did not change for thosewho continued to drink, except among heavy drinkers,suggesting an age-related decline rather than a cohort effect 21 .Smart and Adlaf 23 pooled data from four cross-sectionalsurveys of adults in Ontario and found no dramatic changesin alcohol use between 1976 and 1984 among persons aged60+. Elderly respondents were more likely to report abstentionfrom drinking than those younger (40% of those aged 60+compared to 15% of those 30–59 and 13% of those 18–29). Ofthe elderly respondents, 17% reported consuming five or moredrinks in a single sitting, a much lower prevalence than amongthose 30–59 (44%) and those 18–29 (60%) 23 .Regardless of a decline with age, the prevalence of alcohol usein the elderly remains high. Meyers et al. found, in their study ofthe drinking behavior of 928 residents of Boston aged 60+, that53% were abstainers, 26% had less than one drink/day, 16% oneto two drinks/day and 6% two or more drinks/day 24 . In a sampleof 270 healthy men and women aged 65–89 living in thesouthwestern USA, 48% of the participants reported in their3 day diet record they had consumed alcohol, with 66% reportingthat they consumed alcohol at least monthly 22 .The prevalence of alcohol use in the recently conducted multisiteEstablished Populations for Epidemiologic Studies of theElderly (EPESE) studies of persons aged 65+ varied by site. InEast Boston, 70.5% of the sample drank alcohol in the past yearand 54.7% had used alcohol in the past month. Similar findingswere reported from New Haven; 65.8% had used alcohol in thepast year and 51.9% in the past month. The proportions werelower in Iowa and North Carolina. In the Iowa sample, 46.3%had used alcohol in the past year, while 31.2% had done so in thepast month. In the North Carolina EPESE, 33.4% had usedalcohol in the past year and 24.6% in the past month. Men weremore likely to report use of alcohol in the past month than werewomen 25,26 .Samples from clinical populations have found similar proportionsof high use. In one of the first studies done in the UK,Bridgewater et al. interviewed 101 patients aged 60+ from ageneral practice and found that 92% of the men and 77% of thewomen used alcohol 27 . Iliffe et al. studied 241 patients fromgeneral practice aged 75+ and found that 51% of the men and22% of the women reporting using alcohol in the past 3 months 28 .Using data from the Liverpool Longitudinal Study of ContinuingHealth in the Community, Saunders et al. 29 reported, among 1070men and women aged 65+ randomly selected from patientrosters, that 10.5% admitted to drinking more or less every day(17.7% men and 6.1% women). At the 3 year follow-up, one-fifthof the subjects were regular drinkers, drinking on at least oneoccasion per week 29 . Among a sample of 132 general hospitalpatients aged 65+ in Leiden, The Netherlands, the prevalence ofalcoholism was 9% (13% among men and 7% among women) 30 .Callahan and Tierney 31 found the prevalence of alcoholism to be10.6% among 3954 primary care patients aged 60+. Patients withalcoholism were more likely to be younger, have fewer years ofeducation, and be male, Black, smokers and malnourished 31 .Inasample of 539 medical admissions aged 65+ in the UK, theprevalence of alcohol abuse was 7.8%. An additional 29.7% ofthe sample who were neither abstainers nor occasional drinkersnor alcohol abusers drank regularly; 42.9% of the men and 15.9%of the women 19 .In summary, research studies conducted in both communityand clinical samples over the last several decades have consistentlyshown that alcohol use among older adults is not uncommon, andthat over half of community-dwelling older males may consumealcohol on a regular basis. While the prevalence of use may belower than that seen in younger populations, it is still not clearwhether this is a cohort or an age effect.PREVALENCE OF HEAVY DRINKINGEstimates of the prevalence of heavy use are also quite high in theelderly. Cahalan and Cisin reported from their community samplethat 20% of the males and 2% of the females aged 60+ wereclassified as heavy drinkers 13 . Meyers et al. 24 found in their sampleof Boston residents 60 or older that 1% were self-reportedproblem drinkers. All problem drinkers had long-term drinkingproblems and were less likely to be satisfied with their socialrelationships. While the proportion of problem drinkers waslower in those aged 75+ compared to those aged 60–75, theproportion of drinkers who report problems was similar for bothgroups 24 . Mirand and Welte studied a sample of communitydwellingadults aged 60+ in Erie County, New York, and foundthe prevalence of heavy drinking was 6% 32 . In their sample of 270healthy male and female volunteers aged 65+, Goodwin et al.found that 17% drank more than 30 g alcohol/day on average 22 .In the EPESE, the percentage of persons who drank two or more