ABSTRACT
BACKGROUND
Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population.
OBJECTIVES
To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions.
DESIGN/METHODS
This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer’s disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n = 7,422). Based on self-reported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines).
RESULTS
Overall, 30.9 % (CI 28.0–34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0–7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking.
CONCLUSIONS
Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.
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Notes
Total greater than 100 % as a result of rounding.
REFERENCES
Institute of Medicine. Retooling for an aging America: Building the healthcare workforce. In. Washington, DC: The National Academies Press; 2008.
Berenson RA, Horvath J. Confronting the barriers to chronic care management in Medicare. Health Aff (Millwood). 2003;Suppl Web Exclusives:W3-37–53.
Thorpe KE, Howard DH. The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity. Health Aff (Millwood). 2006;25:w378–88.
Vogeli C, Shields AE, Lee TA, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22(Suppl 3):391–5.
Schneider KM, O'Donnell BE, Dean D. Prevalence of multiple chronic conditions in the United States' Medicare population. Health Qual Life Outcomes. 2009;7:82.
Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162:2269–76.
Stuart BC. How disease burden influences medication patterns for Medicare beneficiaries: implications for policy. Issue Brief (Commonw Fund). 2008;30:1–12.
Bajcar JM, Wang L, Moineddin R, Nie JX, Tracy CS, Upshur RE. From pharmaco-therapy to pharmaco-prevention: trends in prescribing to older adults in Ontario, Canada, 1997–2006. BMC Fam Pract. 2010;11:75.
Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother. 2007;5:64–74.
Pringle KE, Ahern FM, Heller DA, Gold CH, Brown TV. Potential for alcohol and prescription drug interactions in older people. J Am Geriatr Soc. 2005;53:1930–6.
Simonson W, Feinberg JL. Medication-related problems in the elderly: defining the issues and identifying solutions. Drugs Aging. 2005;22:559–69.
Merrick EL, Horgan CM, Hodgkin D, et al. Unhealthy drinking patterns in older adults: prevalence and associated characteristics. J Am Geriatr Soc. 2006;56:214–23.
Blazer DG, Wu LT. The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health. Am J Psychiatry. 2009;166:1162–9.
Klatsky AL. Drink to your health? Sci Am. 2003;288:74–81.
Klatsky AL. Alcohol, wine, and vascular diseases: an abundance of paradoxes. Am J Physiol Heart Circ Physiol. 2008;294:H582–3.
Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Ann Intern Med. 2004;140:211–9.
Mukamal KJ, Rimm EB. Alcohol consumption: risks and benefits. Curr Atheroscler Rep. 2008;10:536–43.
Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671.
Grundstrom AC, Guse CE, Layde PM. Risk factors for falls and fall-related injuries in adults 85 years of age and older. Arch Gerontol Geriatr. 2011;54:421–8.
Immonen S, Valvanne J, Pitkala KH. Prevalence of at-risk drinking among older adults and associated sociodemographic and health-related factors. J Nutr Health Aging. 2011;15:789–94.
Mukamal KJ, Mittleman MA, Longstreth WT Jr, Newman AB, Fried LP, Siscovick DS. Self-reported alcohol consumption and falls in older adults: cross-sectional and longitudinal analyses of the cardiovascular health study. J Am Geriatr Soc. 2004;52:1174–9.
Sorock GS, Chen LH, Gonzalgo SR, Baker SP. Alcohol-drinking history and fatal injury in older adults. Alcohol. 2006;40:193–9.
NIAAA. Harmful Interactions: Mixing Alcohol with Medications. In: NIH; 2007.
Fink A, Morton SC, Beck JC, et al. The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients. J Am Geriatr Soc. 2002;50:1717–22.
Medicare Current Beneficiary Survey (MCBS) (Accessed 2-17-2013 at http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/index.html.)
Medicare Current Beneficiary Survey (MCBS). 2005. (Accessed 2-17-2013 at http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Questionnaires-Items/CMS1253244.html.)
Buccaneer. Chronic Condition Warehouse: User Manual In. Version 1.6 ed; 2010.
Hcup CCS. Healthcare Cost and Utilization Project (HCUP). In. Rockville, MD: Agency for Healthcare Research and Quality; 2011.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61:1234–40.
Wallace M, Shelkey M. Katz Index of Independence in Activities of Daily Living (ADL). Urol Nurs. 2007;27:93–4.
StataCorp. Stata Statistical Software: Release 10. In. College Station, TX: StataCorp LP; 2007.
Basile JN, Bloch MJ. Identifying and managing factors that interfere with or worsen blood pressure control. Postgrad Med. 2010;122:35–48.
Judd SE, McClure LA, Howard VJ, Lackland DT, Halanych JH, Kabagambe EK. Heavy drinking is associated with poor blood pressure control in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Int J Environ Res Public Health. 2011;8:1601–12.
Klatsky AL, Gunderson E. Alcohol and hypertension: a review. J Am Soc Hypertens. 2008;2:307–17.
Klatsky AL. Alcohol, cardiovascular diseases and diabetes mellitus. Pharmacol Res. 2007;55:237–47.
Johnson KH, Bazargan M, Bing EG. Alcohol consumption and compliance among inner-city minority patients with type 2 diabetes mellitus. Arch Fam Med. 2000;9:964–70.
Ahmed AT, Karter AJ, Liu J. Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours. Diabet Med. 2006;23:795–802.
Ahmed AT, Karter AJ, Warton EM, Doan JU, Weisner CM. The relationship between alcohol consumption and glycemic control among patients with diabetes: the Kaiser Permanente Northern California Diabetes Registry. J Gen Intern Med. 2008;23:275–82.
Sullivan LE, Fiellin DA, O'Connor PG. The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med. 2005;118:330–41.
Nowacki P, Porebska A, Bajer-Czajkowska A, Zywica A, Koziarska D, Podbielski J. An approach of patients with ischemic stroke to primary and secondary stroke prevention in Poland. Ann Acad Med Stetin. 2007;53:14–9.
Tabak C, Smit HA, Rasanen L, et al. Alcohol consumption in relation to 20-year COPD mortality and pulmonary function in middle-aged men from three European countries. Epidemiology. 2001;12:239–45.
McKee SA, Krishnan-Sarin S, Shi J, Mase T, O'Malley SS. Modeling the effect of alcohol on smoking lapse behavior. Psychopharmacology (Berl). 2006;189:201–10.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD. 2011.
Collins MA, Neafsey EJ, Mukamal KJ, et al. Alcohol in moderation, cardioprotection, and neuroprotection: epidemiological considerations and mechanistic studies. Alcohol Clin Exp Res. 2009;33:206–19.
Peters R, Peters J, Warner J, Beckett N, Bulpitt C. Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age Ageing. 2008;37:505–12.
Greenberg JD, Tiwari A, Rajan M, Miller D, Natarajan S, Pogach L. Determinants of sustained uncontrolled blood pressure in a national cohort of persons with diabetes. Am J Hypertens. 2006;19:161–9.
Rosenman MB, Simon TA, Teal E, McGuire P, Nisi D, Jackson JD. Perceived or actual barriers to warfarin use in atrial fibrillation based on electronic medical records. Am J Ther. 2012;19:330–7.
Goldberg RJ, Burchfiel CM, Reed DM, Wergowske G, Chiu D. A prospective study of the health effects of alcohol consumption in middle-aged and elderly men. The Honolulu Heart Program. Circulation. 1994;89:651–9.
Klatsky AL, Chartier D, Udaltsova N, et al. Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease. Am J Cardiol. 2005;96:346–51.
Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse 2004. (Accessed 2-17-2013 at http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm.)
CMS. Decision Memo for Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (CAG-00427 N) In: CMS; 2011.
Coffield AB, Maciosek MV, McGinnis JM, et al. Priorities among recommended clinical preventive services. Am J Prev Med. 2001;21:1–9.
Menninger JA. Assessment and treatment of alcoholism and substance-related disorders in the elderly. Bull Menninger Clin. 2002;66:166–83.
Saitz R, Horton NJ, Cheng DM, Samet JH. Alcohol counseling reflects higher quality of primary care. J Gen Intern Med. 2008;23:1482–6.
Spandorfer JM, Israel Y, Turner BJ. Primary care physicians' views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract. 1999;48:899–902.
Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34:143–52.
Peel NM, Bartlett HP, McClure RJ. Healthy aging as an intervention to minimize injury from falls among older people. Ann N Y Acad Sci. 2007;1114:162–9.
Stevenson JS. Alcohol use, misuse, abuse, and dependence in later adulthood. Annu Rev Nurs Res. 2005;23:245–80.
Ball AE, Russell EM, Seymour DG, Primrose WR, Garratt AM. Problems in using health survey questionnaires in older patients with physical disabilities. Can proxies be used to complete the SF-36? Gerontology. 2001;47:334–40.
Bann CM, Berkman N, Kuo TM. Insurance knowledge and decision-making practices among Medicare beneficiaries and their caregivers. Med Care. 2004;42:1091–9.
Brown RS, Dale SB. The research design and methodological issues for the Cash and Counseling Evaluation. Health Serv Res. 2007;42:414–45.
Elliott MN, Beckett MK, Chong K, Hambarsoomians K, Hays RD. How do proxy responses and proxy-assisted responses differ from what Medicare beneficiaries might have reported about their health care? Health Serv Res. 2008;43:833–48.
Acknowledgements
Funding
This study was funded by the National Institute on Alcohol Abuse and Alcoholism grant 5R21AA015746.
Contributors
All listed authors made substantive contributions to the design, conduct, or reporting of this study.
There are no other individuals who made substantial contributions but do not meet criteria for authorship. The authors thank Michele Hutcheon for manuscript preparation.
Prior Presentations
Addiction Health Services Research Conference 10/18/12 NY.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Ryan, M., Merrick, E.L., Hodgkin, D. et al. Drinking Patterns of Older Adults with Chronic Medical Conditions. J GEN INTERN MED 28, 1326–1332 (2013). https://doi.org/10.1007/s11606-013-2409-1
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DOI: https://doi.org/10.1007/s11606-013-2409-1