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What level of alcohol consumption is hazardous for older people? Functioning and mortality in US and English national cohorts
A recent study estimated disability plus mortality risks in older people according to level of alcohol intake based on data from two population-based cohort studies: The Health and Retirement Study (US) and the English Longitudinal Study of Aging. Data were available on 13,333 individuals aged 65 and older followed for 4 to 5 years. Assessed were difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality.

Results showed that 10.8% of US men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older (no more than 1 drink of 14g per day ). Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 for ADL problems, 0.7 for IADL problems, and 0.8 for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women.

The authors conclude that functioning and mortality outcomes are not poor in older people with alcohol intakes above NIAAA recommended levels for the old but within recommendations for younger adults. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.

R Curtis Ellison comments: This is an important paper as the authors evaluated data from two very large epidemiologic studies to determine if data support the current NIAAA guideline in the US that elderly people should limit their alcohol intake to no more than one drink/day. (For younger adults, the recommendations are no more than 2 drinks/day for men and 1 drink/day for women.)

The main results are shown in the following two figures, the first on functional status from pooled data and the second including disability plus mortality in the US cohort. In the first (Figure 2 from the paper), based on the combined subjects from the two studies, it is apparent that the indices of disability are lower in consumers of > 0 to 1 drinks/day than in non-drinkers. Subjects in the next category (up to 2 drinks per day), however, did not show increased impairment, but had estimates of disability that tended to be the same or slightly lower than those of lighter drinkers.In Figure 3, below, the combination of disability or mortality in the US study shows, similarly, that there is no increase in either among subjects consuming up to 2 drinks/day.

Source: Lang I, et al. What level of alcohol consumption is hazardous for older people? Functioning and mortality in US and English national cohorts. J Am Geriatr Soc. 2007;55(1):49–57.

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