Alcohol for the older person—friend or foe?
It is well accepted that alcohol abuse, in any age, is harmful. In aged people who survive alcohol abuse, resultant progressive neurodegeneration may be expected [1]. However, the cardiological benefits of alcohol consumption in ‘light to moderate’ amounts have given a more positive view of alcohol use [2,3]. That this can reduce the cerebral vascular burden as well as peripheral vascular pathology and perhaps be associated with less atrophy of the hippocampus and amygdala in apolipoprotein E APOE 4 carriers [4] has possible public health implications not only for cardio-vascular health but also for vascular brain health.The vexed question that has arisen is the necessary definition of ‘how much is too much?’ The corollary questions—at what level of consumption, with what pattern of drinking, and what kind of alcohol beverages are associated with benefits or harm—remain confused with no international consensus. The review in this issue [5] points out that there is no ‘close agreement’ to what is ‘optimal’, ‘light to moderate’ consumption, or what alcohol type contributes more benefits to aged people.
In any study of alcohol effects in aged people, there are always certain methodological confounders that present obstacles to vigorous research design. Concomitant existence of obesity, diabetes, history of heavy smoking and other life-style patterns, and vascular diseases together conspire to make research results more difficult to interpret. Aged persons of ‘moderate’ lifestyle and habits may be those whose alcohol consumption reflects, and is a proxy for, a ‘healthy’ life long trajectory than those who may not have follow such lifestyles.
Future research questioning the benefits or harmful effects of alcohol on older persons must abide by a stringent and vigorous methodology. Non-medical print and electronic media are in constant search of populist-sensational stories. They will often take published medical research at face value at best, or at worst misinterpret the data to promote less than accurate but fashionable messages to the public. Our responsibility in public health is to ensure that our research output would not only be vigorous, but would also provide well-defined and evidence-based measures of alcohol consumption with respect to harm or benefit. The review published in this issue may give us a basis for working towards an international consensus in measures of alcohol consumption and shared research methodologies to improve cardio-vascular, cerebro-vascular and cognitive health of the aged persons, and possible preventative interventions.
None
Academic Unit for Psychiatry of Old Age, The University of Melbourne, Normanby Unit, St Vincent's Aged Psychiatry Service, 283 Cotham Road, KEW. VIC. 3101, Australia
Email: e.chiu{at}unimelb.edu.au
References
- Zuccala G, Onder G, Pedone G, et al. Dose-related impact of alcohol consumption on cognitive function in advanced age: results of a multicenter survey. Alcohol Clin Exp Res (2001) 25:1743–1748.[CrossRef][Web of Science][Medline]
- Rimm E, Williams P, Fosher K, et al. Moderate alcohol intake and lower risk of coronary heart disease: meta analysis of effects on lipids and haemostatic factors. Br Med J (1999) 310:1523–1528.
- Agarwal D. Cardioprotective effects of light to moderate consumption of alcohol: a review of putative mechanisms. Alcohol Alchol (2002) 37:409–415.
- Heijer T, Vermeer S, Dijk E, et al. Alcohol intake in relation to magnetic resonance imaging findings in older persons without dementia. Am J Clin Nutr (2004) 80:992–997.
[Abstract/Free Full Text] - Peters R, Peters J, Warner J, et al. Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age Ageing (2008) 37:505–12.
[Abstract/Free Full Text]
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