Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence
SIR—We were interested in reading the report by Lang et al. [1]. The findings, which accord with other work on the protective effect of moderate alcohol use, are encouraging. However, it is important that the context should not be lost and that this does not distract from the serious impact of alcohol use (and other substances) on older people.First, as the authors admit, subjects who formed the basis of this study were those living in households only, i.e. older people in hospitals, residential and nursing homes were excluded. The group under study is, therefore, a particular subsection of the ageing population—those who can live independently.
Second, there is no mention of the age range, for example, many studies on older people separate the 50 to 64-year-old age group from those over 65 years.
Third, the use of 14 g of alcohol as the equivalent of one drink is confusing since, in the UK, one unit (or drink) is equivalent to 8 g of alcohol. Thus, one drink under the terms of this study is roughly equivalent to two units of alcohol.
Fourth, UK Department of Health guidelines are not those recommended by the Royal Colleges of Psychiatrists and General Practitioners [2], which creates additional obfuscation. Furthermore, a lower threshold may apply to older people [3–5].
Fifth, a cut-off point of 2 on the CAGE questionnaire was used, though 1 might be more appropriate for older people [6]. Indeed, CAGE may not be the optimal tool [7].
Substantial numbers of the over-65s drink daily: 20% of men aged 65 and over and 5% of women exceeded the Department of Health benchmark (no more than four units for men and three units for women) on at least 1 day during the previous week [8].
Mortality from alcohol consumption in older people is increasing. The alcohol-related death rates in all age groups for men increased between 1991 and 2005. The biggest increase was in men aged 35–54 years, which more than doubled from 13.4 to 29.9 deaths per 100,000. However, the highest alcohol-related death rates in each year were for men aged 55–74 years. In 2005, the rate in this age group was 43.4 per 100,000. Similarly, the death rate for women aged 35–54 years nearly doubled between 1991 and 2005, from 7.2 to 14.2 per 100,000, a larger increase than the rate for women in any other age group. The highest rates in each year were again found in the 55–74 age group. In 2005 there were 19.2 alcohol-related deaths per 100,000 population for women in this age group [9].
It is well documented that increasing levels of alcohol use are directly related to morbidity, as well as to mortality [8–10]. The United Kingdom has no designated alcohol services for older people; the addictive properties of alcohol and access to specialised care for alcohol problems are not mentioned in the National Service Framework for Older People, and there is virtually no UK-based intervention research in this age range. It is important to standardise measurement techniques (with regard to assessment tools, alcohol units and age range) so that comparisons can be made between studies, and so that the public health messages are not made even more confusing by inconsistencies and contradictions.
Most importantly, we should not be complacent and ignore the risks of alcohol consumption in the ageing population by concentrating on those who apparently have few problems. To deny effective treatment interventions to those older people in our communities who have serious psychological and physical problems as a result of alcohol use is tantamount to neglecting an already marginalised and vulnerable population. This is the key to dignity for older people.
1 Professor of Addiction Psychiatry, Keele University Medical School
2 Professor of Geriatric Medicine, Keele University Medical School President, British Geriatrics Society
* To whom correspondence should be addressed E-mail: p.crome{at}keele.ac.uk
References
- Lang I, Wallace RB, Huppert FA, et al. Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence. Age Ageing (2007) 36:256–61.
[Abstract/Free Full Text] - Ball D, Williamson R, Witton J. In celebration of sensible drinking. Drugs Educ Prev Pol (2007) 14:97–102.[CrossRef]
- Crome I, Bloor R. Older substance misusers still deserve better services–An update (Part 1). Rev Clin Gerontol (2005) 15:125–33.[CrossRef]
- Crome I, Bloor R. Older substance misusers still deserve better diagnosis–An update (Part 2). Rev Clin Gerontol (2005) 15:255–62.[CrossRef]
- Crome I, Bloor R. Older substance misusers still deserve better treatment interventions–An update (Part 3). Rev Clin Gerontol (2006) 16:45–57.[CrossRef]
- Conigliaro J, Kraemer K, McNeil M. Screening and identification of older adults with alcohol problems in primary care. J Geriatr Psychology Neurol (2000) 13:106–14.
- Philpot M, Pearson N, Petratou V, et al. Screening for problem drinking in older people referred to a mental health service: A comparison of CAGE and AUDIT. Aging Ment Health (2003) 7:171–5.[CrossRef][Web of Science][Medline]
- Office for National Statistics. Drinking: Drinking among Girls Continues to Rise. At http://www.statistics.gov.uk/cci/nugget.asp?id=1328 (Accessed June 2007).
- Office for National Statistics. Alcohol-Related Deaths: Rates Rise Since 1990s. At http://www.statistics.gov.uk/cci/nugget.asp?id=1091 (Accessed June 2007).
- Babor T, Caetano R, Casswell S, et al. Alcohol: No Ordinary Commodity (2003) Oxford: Oxford University Press.
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