Longitudinal prevalence of potentially serious alcohol-medication interactions in community-dwelling older adults: a prospective cohort study



This study aims to estimate (i) the prevalence of potentially serious alcohol-medication interactions in a nationally representative sample of older adults using the Potentially Serious Alcohol-Medication Interactions in Older adults (POSAMINO) criteria, and (ii) whether POSAMINO prevalence changes over time.


A prospective cohort study of adults aged ≥ 65 years, using data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA). All 38 POSAMINO criteria were applied at each wave using respondents’ information on regular medications and alcohol consumption. Multilevel logistic regression and negative binomial models were used to investigate whether the prevalence of POSAMINO varied over time.


The overall prevalence of POSAMINO was 18% at baseline, with 8% at risk of one potentially serious alcohol-medication interaction, and 10% at risk of two or more. The most common POSAMINO involved cardiovascular (CVS) agents (15% baseline; 11% wave 2; 14% wave 3), followed by central nervous system (CNS) agents (4% baseline; 4% wave 2; 5% wave 3). Prevalence of any POSAMINO (AOR 0.94, 95% CI 0.81, 1.08) or number of POSAMINO criteria (AIRR 0.97, 95% CI 0.91, 1.04) did not change over time. Any POSAMINO and number of POSAMINO were associated with younger age, male sex and number of medications and chronic conditions.


Potentially serious alcohol-medication interactions occurred in 18% of older adults in this study. Alcohol screening and brief interventions should be considered for high-risk groups at the point of prescribing, particularly among younger older adults, men and as patients receive more medications or develop additional illnesses.

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  1. 1.

    Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM et al (2016) Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study. Lancet 390(10100):1345–1422

    Article  Google Scholar 

  2. 2.

    Britton A, Ben-Shlomo Y, Benzeval M, Kuh D, Bell S (2015) Life course trajectories of alcohol consumption in the United Kingdom using longitudinal data from nine cohort studies. BMC Med 13:47

  3. 3.

    Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, Huang B, Jung J, Zhang H, Fan A, Hasin DS (2017) Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001-2002 to 2012-2013: results from the National Epidemiologic Survey on alcohol and related conditions. JAMA Psychiatry 74(9):911–923

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Meng Y, Holmes J, Hill-McManus D, Brennan A, Meier PS (2014) Trend analysis and modelling of gender-specific age, period and birth cohort effects on alcohol abstention and consumption level for drinkers in Great Britain using the General Lifestyle Survey 1984–2009. Addiction 109:206–215

    Article  PubMed  Google Scholar 

  5. 5.

    Wadd S, Papadopoulos C (2014) Drinking behaviour and alcohol-related harm amongst older adults: analysis of existing UK datasets. BMC Res Notes 7:741

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Moore AA, Whiteman EJ, Ward KT (2007) Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother 5:64–74

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Hovstadius B, Hovstadius K, Astrand B, Petersson G (2010) Increasing polypharmacy - an individual-based study of the Swedish population 2005-2008. BMC Clin Pharmacol 10:16

  8. 8.

    Moriarty F, Hardy C, Bennett K, Smith SM, Fahey T (2015) Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open 5:e008656

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Holton AE, Gallagher P, Fahey T, Cousins G (2017) Concurrent use of alcohol interactive medications and alcohol in older adults: a systematic review of prevalence and associated adverse outcomes. BMC Geriatr 17(1):148

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Holton AE, Gallagher PJ, Ryan C, Fahey T, Cousins G (2017) Consensus validation of the POSAMINO (POtentially Serious Alcohol–Medication INteractions in Older adults) criteria. BMJ Open 7(11):e017453

  11. 11.

    Cronin H, O’Regan C, Finucane C, Kearney P, Kenny RA (2013) Health and aging: development of The Irish Longitudinal Study on Ageing health assessment. J Am Geriatr Soc 61(Suppl 2):S269–S278

    Article  PubMed  Google Scholar 

  12. 12.

    Kearney PM, Cronin H, O’Regan C, Kamiya Y, Savva GM, Whelan B, Kenny R (2011) Cohort profile: The Irish Longitudinal Study on Ageing. Int J Epidemiol 40(4):877–884

    Article  PubMed  Google Scholar 

  13. 13.

    Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(7624):806–808

    Article  Google Scholar 

  14. 14.

    Methodology WCCfDS. ATC structure and principles. Available from: https://www.whocc.no/atc_ddd_index/

  15. 15.

    Holton A, Boland F, Gallagher P, Fahey T, Kenny R, Cousins G (2018) Life course transitions and changes in alcohol consumption among older Irish adults: results from The Irish Longitudinal Study on Ageing (TILDA). J Aging Health 898264318783080

  16. 16.

    Hope (2009) A Standard Drink in Ireland: What strength? : Health Service Executive- Alcohol Implementation Group

  17. 17.

    Forster LE, Pollow R, Stoller EP (1993) Alcohol use and potential risk for alcohol-related adverse drug reactions among community-based elderly. J Community Health 18:225–239

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Immonen S, Pitkälä K (2012) The prevalence of potential alcohol-drug interactions in older adults. Eur Geriatr Med 3:S134

    Article  Google Scholar 

  19. 19.

    Adams WL (1995) Potential for adverse drug-alcohol interactions among retirement community residents. J Am Geriatr Soc 43:1021–1025

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Aira M, Hartikainen S, Sulkava R (2005) Community prevalence of alcohol use and concomitant use of medication - a source of possible risk in the elderly aged 75 and older? Int J Geriatr Psychiatry 20:680–685

    Article  PubMed  Google Scholar 

  21. 21.

    Breslow RA, Dong C, White A (2015) Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res 39:371–379

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Swift W, Stollznow N, Pirotta M (2007) The use of alcohol and medicines among Australian adults. Aust N Z J Public Health 31:529–532

    Article  PubMed  Google Scholar 

  23. 23.

    Wong H, Heuberger R, Logomarsino J, Hewlings S (2016) Associations between alcohol use, polypharmacy and falls in older adults. Nurs Older People 28(1):30–36

  24. 24.

    Stockley’s Drug Interactions [online] [Internet]. Pharmaceutical Press. Available from: https://www.medicinescomplete.com/mc/stockley/current/

  25. 25.

    Zanjani F, Hoogland AI, Downer BG (2013) Alcohol and prescription drug safety in older adults. Drug Healthc Patient Saf 5:13–27

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. 26.

    O’Connell H, Chin AV, Cunningham C, Lawlor B (2003) Alcohol use disorders in elderly people--redefining an age old problem in old age. BMJ 327(7416):664–667

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Curtis JR, Geller G, Stokes EJ, Levine DM, Moore RD (1989) Characteristics, diagnosis, and treatment of alcoholism in elderly patients. J Am Geriatr Soc 37(4):310–316

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Kelly S, Olanrewaju O, Cowan A, Brayne C, Lafortune L (2018) Interventions to prevent and reduce excessive alcohol consumption in older people: a systematic review and meta-analysis. Age Ageing 47(2):175–184

    Article  PubMed  Google Scholar 

  29. 29.

    Duru OK, Xu H, Tseng C-H, Mirkin M, Ang A, Tallen L, Moore AA, Ettner SL (2010) Correlates of alcohol-related discussions between older adults and their physicians. J Am Geriatr Soc 58(12):2369–2374

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Kuerbis A, Sacco P, Blazer DG, Moore AA (2014) Substance abuse among older adults. Clin Geriatr Med 30(3):629–654

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    NIAAA. Older Adults. Available from: https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/older-adults

  32. 32.

    Knott CS, Scholes S, Shelton NJ (2013) Could more than three million older people in England be at risk of alcohol-related harm? A cross-sectional analysis of proposed age-specific drinking limits. Age Ageing 42:598–603

    Article  PubMed  Google Scholar 

  33. 33.

    Richardson K, Kenny RA, Peklar J, Bennett K (2013) Agreement between patient interview data on prescription medication use and pharmacy records in those aged older than 50 years varied by therapeutic group and reporting of indicated health conditions. J Clin Epidemiol 66(11):1308–1316

    Article  PubMed  Google Scholar 

  34. 34.

    Nielsen MW, Søndergaard B, Kjøller M, Hansen EH (2008) Agreement between self-reported data on medicine use and prescription records vary according to method of analysis and therapeutic group. J Clin Epidemiol 61(9):919–924

    Article  PubMed  Google Scholar 

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This work was financially supported by the Royal College of Surgeons in Ireland under the Clement Archer PhD Scholarship.

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Correspondence to Gráinne Cousins.

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Ethical approval for TILDA was approved by the Faculty of Health Sciences Research Ethics Committee at Trinity College Dublin and all participants gave informed written consent.

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Holton, A., Boland, F., Gallagher, P. et al. Longitudinal prevalence of potentially serious alcohol-medication interactions in community-dwelling older adults: a prospective cohort study. Eur J Clin Pharmacol 75, 569–575 (2019). https://doi.org/10.1007/s00228-018-02608-7

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  • Alcohol-medication interaction
  • Older adults
  • Alcohol
  • Geriatric medicine