Mohammed T. Abou-Saleh

EPIDEMIOLOGY OF ALCOHOL PROBLEMS 611history of heavy drinking 56 . Mellstrom et al. examined a cohort of468 70-year-old Swedish men in 1971–1972, and reinterviewedthem 5 years post-baseline (1976–1977) (n=342) when they were75 years old. In addition, they interviewed a control group of 70-year-old men in 1976–1977. Registration at the TemperanceBoard (recidivists) was used to measure previous alcohol abuse orlarge-scale consumption. Morbidity from diabetes and chronicbronchitis was higher in the recidivists, as was the overall 5 yearmortality rate. Impaired functioning and a high consumption ofinstitutional care were also more frequent among the recidivists 57 .Other researchers have also found impairments in functioningin those elderly with a history of alcohol use. Colsher and Wallacefound that men with a history of heavy drinking had more illness,poorer self-perceived health, more physician visits, more depressivesymptoms, lower levels of life satisfaction and smaller socialnetworks compared to non-heavy drinkers and non-drinkers. Theauthors concluded that a history of heavy drinking was predictiveof impairments in physical, psychological and social health andfunctioning among elderly men 56 .Some studies have found a protective effect of moderate alcoholuse in the elderly. Scherr et al., using the EPESE data from threesites, found that low to moderate alcohol consumption wasassociated with lowered 5 year total mortality as well ascardiovascular mortality in two of the sites, East Boston andNew Haven. In Iowa, there were no differences in mortality byalcohol consumption. There was no association with cancermortality found at any of the three sites. Patients with a baselinehistory of heart attack, stroke or cancer were excluded from theiranalyses 58 . LaCroix et al. found, by following three of the EPESEcohorts of elderly aged 65+ for 4 years, that risk of losingmobility, defined as the ability to climb up and down stairs andwalk a half a mile, was associated with not consuming alcohol,compared with small to moderate amounts of alcohol consumption59 . Galanis et al. recently conducted a longitudinal study ofdrinking and cognitive performance in elderly Japanese-Americanmen and found lower scores on cognitive functioning tests in nondrinkersand heavy drinkers (more than 60 ounces of alcohol/month). Compared with non-drinkers, the risk of a lower score(more errors) on a cognitive functioning test was lowered by 22–40% among men who consumed 1–60 ounces of alcohol/month 60 .Finally, in a sample of 216 inpatients treated for alcoholism, thetreatment outcome was favorable (i.e. the patient was eitherabstinent since treatment or abstinent with three or fewer minorslips) for 28% of the cohort of 60 patients, showing that theelderly alcoholic can be successfully treated 53 .SUMMARYIn summary, alcohol use, including drinking in excess, amongolder adults is prevalent, particularly among males. Because ofinteractions with chronic disease and use of prescribed medications,the use of alcohol among elderly individuals is an importanthealth concern. Based on current use, the prevalence of alcoholuse in future generations may be even higher. Screening andquestioning for alcohol problems should be routine, since effectivetreatments are available. 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