Are recommended alcohol consumption limits for older people too low?

Transcription

1 Are recommended alcohol consumption limits for older people too low? Dr Iain Lang, Epidemiology & Public Health Group, Peninsula Medical School, Exeter, UK. Prof Robert B. Wallace, College of Public Health, University of Iowa, USA Prof Jack Guralnik, Epidemiology and Demography Section, National Institute on Aging, USA Prof David Melzer, Epidemiology & Public Health Group, Peninsula Medical School, Exeter, UK

2 Background: Current US recommendations are for lower drinking limits for people over 65 than for younger adults. Alcohol Concern has suggested that drinking limits for over- 65s in the UK should be reduced in line with this. These recommendations are based on physiological changes, not evidence. We assess the need for reduced alcohol consumption in older people by examining disability and mortality outcomes in two longitudinal studies of older people, one from England and one from the US.

3 The US NIAAA recommends that older people, of either gender, should drink no more than 1 drink (1.5 units) of alcohol per day. We examine the association between drinking and subsequent disability and mortality, categorising alcohol consumption as 0, >0 to 1, >1 to 2, and >2 drinks per day. We are specifically interested in the effects of consumption in the disputed range of >1 to 2 drinks per day, higher than US guidelines for older people but within the guidelines for younger adult men.

4 Methods Baseline data were from those over 70 in the US Assets and Health Dynamics Amongst the Oldest Old (AHEAD) Study in 1995 and the Health Surveys for England (HSE) of 1998 and These were followed up in the Health and Retirement Study (HRS) in 2002 and the English Longitudinal Study of Ageing (ELSA) in individuals were followed up in the US study and 1674 in the English study. Outcome measures were (self-reported) difficulties with 1 or more Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), difficulty walking medium distances or climbing a flight of stairs, and low measured gaitspeed (ELSA only). Logistic regression modeling was used to estimate the risk of being disabled at follow-up in relation to level of alcohol consumption at baseline. Control variables: age; gender; BMI (categorized as low or normal, BMI under 25; overweight, BMI 25 to 30; obese, BMI 30 or above); education (full-time years: <10, 10-13; >13); smoking (never, ex-, current); baseline co-morbidity (0, 1, and 2 or more of having a heart condition (heart attack, coronary heart disease, angina, congestive heart failure, other heart problem), stroke, HBP, angina, diabetes, arthritis, dementia); income quintile; wealth quintile; exercise; depression.

5 Table 1. Number of study subjects (%) by age and drinking level, by gender AHEAD 1995 HSE 1998/1999 Men n=2338 (%) Women n=3698 (%) Men n=700 (%) Women n=974 (%) Age at (28.6) 881 (23.8) 324 (46.3) 400 (41.1) baseline (34.9) 1244 (33.6) 232 (33.1) 344 (35.3) (36.4) 1573 (42.5) 144 (20.6) 230 (23.6) Mean age Alcohol consumption (drinks/ day) Non-drinkers (63.9) 2949 (79.8) 78 (11.1) 206 (21.1) >0 to (25.1) 636 (17.2) 420 (60.0) 665 (68.3) >1 to ( 7.4) 74 ( 2.0) 109 (15.6) 79 ( 8.1) >2 79 ( 3.4) 33 ( 0.9) 91 (13.0) 21 ( 2.2) Missing 7 ( 0.3) 6 ( 0.2) 2 ( 0.3) 3 ( 0.3) Never drank (37.2) 109 (52.9) Quit for health (14.1) 29 (14.1) reasons Quit for other (43.6) 62 (30.1) reasons Missing 4 ( 5.1) 6 ( 2.9)

6 Figure 1: US data, 7-year follow-up of disability outcomes ADL problems IADL problems Mobility problems Reference line: OR= >0 to 1 >1 to 2 Drinking level >2

7 Figure 2: US data, 7-year follow-up of disability and mortality outcomes ADL problems or mortality IADL problems or mortality Mobility problems or mortality Reference line: OR= >0 to 1 >1 to 2 Drinking level >2

8 Figure 3: US data, 9-year follow-up of disability and mortality outcomes with outcomes from the first 7 years excluded ADL problems or mortality IADL problems or mortality Mobility problems or mortality Reference line: OR= >0 to 1 >1 to 2 Drinking level >2

9 Figure 4: English data, 3- or 4-year follow-up of disability outcomes ADLs IADLs Mobility Low gaitspeed Reference line: OR= >0 to 1 >1 to 2 Drinking level >2

10 Results Our results indicate that the established J-shaped risk curves exist not only for mortality but also for a variety of markers of disability and functioning in old age. Outcomes were robust following sensitivity analyses (including exclusion of early outcomes, use of repeated measures of alcohol intake, consideration of binge drinking, and exclusion of ex-drinkers). There was no association between loss to follow-up and baseline exposure. Further study is needed to corroborate the findings presented here; basing public health advice on sound evidence remains a fundamental goal. Moderate consumption of alcohol carries both risks and benefits, and health recommendations should reflect the net effects for older people

11 Conclusions: For older people who drink moderately (no more than 2 drinks/ 3 units per day) there is no increase in the risk of disability or mortality. We find poorer outcomes, in relation to disability and mortality, for older people who are teetotal or who drink more than 2 drinks/ 3 units per day. We conclude that current recommendations, that older people should reduce their alcohol consumption, are unjustified. Further empirical evidence is needed to support recommendations for lower drinking levels in older people.

12